Consultant physicians working with patients - Royal College of ...

More documents

Recommendations

Info

2 Specialties Palliative medicine– explicit standards for interval between referraland first assessment consultants in palliative medicine providing:– early medical review with sufficient time forthorough review and dedicated administrativesupport– rapid links to other relevant disciplines– 24-hour medical advice for colleagues incommunity and hospital MDTs with core specialists in palliative medicine,nursing, physiotherapy, occupational therapy andsocial work evidence-based clinical management with efficientinformation technology (IT) systems, and access tomedical notes and results of investigations efficient and effective communication andcollaborative working relationships within core andwider teams clinical audit and research programmes to evaluatetreatments and outcomes education and training programmes for continuingprofessional development (CPD) of own staff andothers patient and family involvement in managementplans and discussions about preferred place of careand death support for carers and families through illness intobereavement.In addition, specialist inpatient palliative care unitsshould have: adequate number of dedicated beds adequate medical staffing at all grades, includingout-of-hours cover trained specialist palliative care nurses with highnurse:patient ratio (UK average: 1:1.5) appropriate equipment for care of weak, cachecticand debilitated patients – eg pressure-relievingmattresses, electrically operated beds and chairs,easily operated nurse-call systems and assistedbaths/showers space for private interviews/counselling sessions,prayer, reflection and faith rituals comfortable sitting area for patients and visitors,with self-catering/overnight facilities dedicated space for viewing the deceased person.Clinical facilities should be integrated whereverpossible. The physical proximity of inpatient, outpatientand community teams and day-care facilities promotesgood communication and efficient use of consultantexpertiseandtime.Whereaservicecoversawidegeographical area, outlying beds or day-care units maybe provided in community hospitals with support fromspecialist palliative care.In acute hospitals, there needs to be private space forconversations, comfortable seating for patients andfamilies, self-catering/overnight facilities and near-wardteaching facilities. Drugs should be administered anddispensed promptly to avoid long waits for weakpatients. Adequate arrangements should be in place forrapid communication with the GP and communitynurses when a patient is discharged or dies.A national specialist palliative care peer-reviewedprocess is being tested at present. 9 A quality standardfor end-of-life care was published by the NationalInstitute for Health and Care Excellence (NICE) inNovember 2011, consisting of 16 quality statementswhich collectively describe a high-quality end-of-lifecare service. 10Maintaining and improving the quality of careService developments to deliver improved careHigh-quality services need to be responsive to patients’needs, efficient in use of resources, collaborative inrelationships with other services and continuouslyvigilant in maintaining standards of care through audit,teaching and research. Service developments include: joint clinics/MDTs in oncology and heart failure,respiratory, renal and neurological medicine access to 24-hour health and social care for palliativecare crises leadership and strategic innovation within localtrusts, including education, evaluation and research implementing end-of-life care and advance careplanning tools: integrated care pathways for thedying, Gold Standards Framework and PreferredPriorities for Care, or equivalent workforce planning.Education and trainingWork in this area includes: development of consensus syllabus forundergraduate palliative medicine 11 development of specialty curriculum, certificateexamination and assessment framework with theRoyal College of Physicians (RCP) development of a report on professionaldevelopment in end-of-life care for physicians 12C○ Royal College of Physicians 2013 191
Consultant physicians working with patients regular educational events, sometimes incollaborationwiththeRCPortheRoyalSocietyofMedicine (RSM) leadership of e-learning programme for end-of-lifecare (e-ELCA: www.e-elca.org.uk) 13 guidance on clinical governance, outcome measuresand audit mentoring scheme for new consultants training programmes for specialty trainees andspecialty doctorsResearchThere are relatively few academic departments inpalliative medicine. Research in this group of vulnerablepatients with a high attrition rate is difficult, yet anevidence base in this clinical area is crucial. Research isrequired in the efficacy and cost-effectiveness ofpalliative care interventions, models of care andtranslational research.The APM science committee runs a trainingprogramme in critical appraisal and research methodsfor the specialty. Increasing numbers of specialtyregistrars (StRs) and consultants in palliative medicineare achieving higher research degrees. A network ofAPM research champions support new researchersacross UK and Ireland.Specialty tools and national guidelinesNational guidance involving palliative care has appearedin a number of influential publications. 14–21 Reportsof relevance to the specialty include the NationalConfidential Enquiry into Patient Outcome and Death(NCEPOD), 22 the National Audit Office report 23 andGold Standards Framework After Death Analysis. 24 TheNational End of Life Care Intelligence Network, launchedin 2010, provides a focus for data relating to end-of-lifecare (www.endoflifecare-intelligence. org.uk).6 Clinical work of consultantsConsultants in palliative medicine provide clinicalleadership to specialist palliative care inpatient units,community and hospital palliative care teams, and daycentres. Their role includes: direct clinical care providing advice to primary and secondary carecolleagues attending site-specific cancer MDTs and forlong-term conditions, eg chronic obstructivepulmonary disease (COPD)Table 2 Programmed activities (PAs) contracted andworked (full-time consultants): Royal College ofPhysicians’ census 2011 25ActivityMean PAscontracted perweekAll activities 10.6 12.1Clinical PAs 7.1 7.6Supporting PAs 2.5 3.4Academic PAs 0.5 0.6Other PAs 0.5 0.5Mean PAs workedper weekPAs contracted and worked (less than full-timeconsultants): Royal College of Physicians’ census2011 25ActivityMean PAscontracted perweekAll activities 7.6 8.6Clinical PAs 5.4 6.0Supporting PAs 1.8 2.1Academic PAs 0.1 0.2Other PAs 0.3 0.3Mean PAs workedper weekNote: most consultants in palliative medicine play a greater role in thestrategic development of palliative care services locally than is commonin other specialties. A high percentage of (31%) 26 consultants inpalliative medicine work single-handedly, so they carry moreresponsibility for education, audit and research. running joint/parallel clinics with other specialists service development.Many are single-handed (31%). 26 Although traineenumbers have increased, palliative medicine remainsconsultant delivered and consultant led. Neither StRsnor consultants usually participate in the on-call rotafor acute general medicine.As outlined in Table 2, full-time consultants work anaverage of 48.4 hours (12.1 programmed activities(PAs)) and part-time consultants 34.4 hours (8.6 PAs). 25Consultant posts are often split between local districtgeneral hospitals (DGHs), tertiary hospitals,community services and specialist palliative care units(voluntary/NHS), with implications for cross-siteworking and travel. Considerable time is spent liaisingwith GPs and colleagues in primary and secondary care.192 C○ Royal College of Physicians 2013
Page 1 and 2:
Consultant physiciansworking with p
Page 3 and 4:
The Royal College of PhysiciansThe
Page 5 and 6:
AcknowledgementsWe would like to th
Page 7:
AbbreviationsA&EAACsAMUsARCPCCGsCCS
Page 12 and 13:
1 Physicians in the NHS todaycan be
Page 15 and 16:
Consultant physicians working with
Page 17 and 18:
Page 19 and 20:
Page 22 and 23:
2 The work of the specialties2 The
Page 24 and 25:
2 Specialties Acute internal medici
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32:
Page 35 and 36:
Page 37 and 38:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 54 and 55:
2 Specialties Cardiovascular medici
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
2 Specialties Clinical geneticsClin
Page 68 and 69:
2 Specialties Clinical geneticsPati
Page 70 and 71:
2 Specialties Clinical genetics6 Cl
Page 72:
2 Specialties Clinical geneticswork
Page 75 and 76:
Page 77 and 78:
Page 80 and 81:
2 Specialties Clinical pharmacology
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
2 Specialties DermatologyDermatolog
Page 90 and 91:
2 Specialties Dermatology run monit
Page 92 and 93:
2 Specialties DermatologyDermatolog
Page 94 and 95:
2 Specialties DermatologyTable 1 Ex
Page 96:
2 Specialties Dermatology4 Parkin D
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 106 and 107:
2 Specialties Gastroenterology and
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 134 and 135:
2 Specialties HaematologyHaematolog
Page 136 and 137:
2 Specialties HaematologyTable 2 A
Page 138 and 139:
2 Specialties Haematologythey have
Page 140 and 141:
2 Specialties HaematologyTable 4 Sp
Page 142:
2 Specialties Haematology11 Departm
Page 145 and 146:
Page 147 and 148: Consultant physicians working with
Page 160 and 161: 2 Specialties Medical oncologyMedic
Page 162 and 163: 2 Specialties Medical oncologyaroun
Page 164 and 165: 2 Specialties Medical oncologyset b
Page 166 and 167: 2 Specialties Medical oncologyTable
Page 168 and 169: 2 Specialties Medical ophthalmology
Page 174 and 175: 2 Specialties Metabolic medicineMet
Page 176 and 177: 2 Specialties Metabolic medicineof
Page 178: 2 Specialties Metabolic medicinemet
Page 196 and 197: 2 Specialties Palliative medicinePa
Page 200 and 201: 2 Specialties Palliative medicineA
Page 202 and 203: 2 Specialties Palliative medicineTa
Page 204: 2 Specialties Palliative medicine24
Page 212 and 213: 2 Specialties Rehabilitation medici
Page 220 and 221: 2 Specialties Renal medicineRenal m
Page 222 and 223: 2 Specialties Renal medicineLocal a
Page 224 and 225: 2 Specialties Renal medicineInvolve
Page 226 and 227: 2 Specialties Renal medicineAcademi
Page 228 and 229: 2 Specialties Renal medicineTable 1
Page 230: 2 Specialties Renal medicinekidney
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 270 and 271:
3 Supporting the delivery of high-q
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
Page 280:
show all

Consultant physicians working with patients - Royal College of ...

Create successful ePaper yourself

Delete template?

Save as template?