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

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2 Specialties Palliative medicineTable 5 Consultant work programmeActivity Work PAsDirect clinical careInpatient unitOutpatient clinicsHome/domiciliary visits2 ward rounds (including teaching round)1 MDTCase conferences1–2 clinic sessionsSupervising StR clinicsAdditional urgent referrals as requiredJoint clinics (some)1–2 home visits per weekSupervising StRs and community clinical nurse specialists2.51–20.5–1Day care Assessments 0.5Acute hospital team 2 ward assessments (including teaching round) 2.5MDT meeting with ward and community 1On call for specialist advice and emergenciesOn-call weekend ward rounds1–2Supporting professional activities (SPAs)Work to maintain and improve quality ofcareOther NHS responsibilitiesExternal dutiesEducation, training, appraisal, management, servicedevelopment, audit, clinical governance, CPD andrevalidation, researcheg medical director, clinical director, lead clinician,clinical tutoreg work for deanery, royal colleges, specialist society,DH, other bodies2.5By local agreementwith trustBy local agreementwith trustthis guidance has been produced will need to beupdated in the coming years, and the commissioningadvice revised to take into account the additionalpressure from ageing and long-term conditions inparticular. Generic guidance for commissioningend-of-lifecareisalsoavailable. 341 Over the next 30 years, the demand for palliativecare services will continue to increase becauseof an ageing population and a predicted 20%increase in mortality rates (patients aged 80 yearsor more).2 Equitable service delivery is needed for long-termconditions, as well as cancer, based on joint healthand social care needs assessments.3 Strategic planning requires collaboration ofstatutory health, social care and voluntary sectorproviders, with involvement of public, patients andusers in all aspects of the commissioning cycle.4 GPs and specialists need to be fully involved inplanning and commissioning palliative careservices and developing care pathways which:a identify key triggers/criteria for the end-of-lifecare phase for cancer and long-term conditionsb promote patient choice and advance careplanningc are based on national guidance and useoutcome measures.5 Integrated multiprofessional health and social careteams are necessary to provide high-qualitycoordinated care to patients and their families.6 Service specifications need to provide the range andtype of services for optimal delivery across hospital,community, care home or hospice and otherlocations, eg prisons and hostels for the homeless.7 Seven-day and 24-hour generic and specialistpalliative care services are critical to enable patientsto remain in the community by meetingC○ Royal College of Physicians 2013 195
Consultant physicians working with patientsout-of-hours palliative care crises and avoidingcarer breakdown.8 Palliative medicine consultants provide clinicalleadership, promote care coordination acrosshospital, hospice and community, reduce symptomburden experienced by patients, facilitate successfulearlier discharges into the community and preventinappropriate admissions. 279 A skilled health and social care workforce will be amajor cost driver for improving end-of-life care inall care settings and is a fundamental part of thework of palliative care physicians andprofessionals.10 Outcome measures should be embedded withincontracts and funding mechanisms for quality caredelivered in all settings. In this patient population,outcomes can be difficult to measure but should bebased on the End of Life Care Quality Markers(2009) 21 and NICE Quality Standards for End ofLife Care. 10References1 National Council for Palliative Care. National survey ofpatient activity data for specialist palliative care services:MDS full report for the year 2010–11. London: NCPC,2012. www.ncpc.org.uk/publication/mds-full-reportyear-2009-2010-0[Accessed 19 Jan 2013].2 National Council for Palliative Care. National survey ofpatient activity data for specialist palliative care services:MDS full report for the year 2006–2007. London: NCPC,2007.3 National Council for Palliative Care. National survey ofpatient activity data for specialist palliative care services:MDS full report for the year 2007–2008. London:NCPC,2008.4 Department of Health. Endoflifecarestrategy:promotinghigh quality care for all adults at the end of life.London:DH, 2008.5 Scottish Government. Living and dying well: a nationalaction plan for palliative and end of life care in Scotland.Edinburgh: Scottish Government, 2008.6 Department of Health, Social Services and Public Safety.Living matters: dying matters. A palliative and end of lifecare strategy for adults in Northern Ireland. Belfast:DHSSPS, 2010.7 All Wales Palliative Care Planning Group. Palliative careplanning group Wales: report to the Minister for Healthand Social Services. Wales: AWPCPG, 2008.http://wales.pallcare.info [Accessed 19 January 2013].8 National End of Life Care Programme. Newsletter, June2010. www.endoﬂifecareforadults.nhs.uk[Accessed 19 January 2013].9 National Cancer Action Team. National Cancer PeerReview Programme: manual for cancer services: specialistpalliative care measures. London: National Cancer ActionTeam, 2012.10 National Institute for Health and Care Excellence.Quality standard for end of life care for adults. London:NICE, 2011. http://guidance.nice.org.uk/QS13 [Accessed19 January 2013].11 Paes P, Wee B. A Delphi study to develop the Associationfor Palliative Medicine consensus syllabus forundergraduate palliative medicine in Great Britain andIreland. Palliat Med 2008;22:360–4.12 Joint working party of Royal College of Physicians ofLondon, the National End of Life Care Programme andthe Association for Palliative Medicine of Great Britainand Ireland. Improving end-of-life care: professionaldevelopment for physicians. London: RCP, 2012.13 Department of Health, Association for PalliativeMedicine of Great Britain and Ireland, National End ofLife Care Programme and e-Learning for Healthcare.E-learning for end of life care for all. London:DH,APM,NEoLCP and e-Learning for Healthcare, 2010.www.e-elca.org.uk [Accessed 19 January 2013].14 Royal College of Physicians. Palliative care services:meeting the needs of patients. London: RCP, 2007.15 National Institute for Health and Care Excellence.Guidance on cancer services: improving supportive andpalliative care for adults with cancer. The manual.London: NICE, 2004.16 Department of Health. The national service frameworkfor renal services. Part two: chronic kidney disease,acute renal failure and end of life care.London:DH,2006.17 Department of Health. National service framework forolder people. London: DH, 2001.18 National Institute for Health and Care Excellence.Dementia: supporting people with dementia andtheir carers in health and social care. London: NICE,2006.19 Department of Health. Coronary heart disease: nationalservice framework for coronary heart disease – modernstandards and service models. London: DH, 2000.20 Department of Health. Endoflifecarestrategy: promotinghigh quality care for all adults at the end of life.London:DH, 2008.21 Department of Health. End of life care strategy: qualitymarkers and measures for end of life care.London:DH,2009.22 National Confidential Enquiry into Patient Outcome andDeath. Caring to the end? A review of the care of patientswho died in hospital within four days of admission.London: NCEPOD 2009.23 National Audit Office. End of life care.London:NAO,2008.196 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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