Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
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2 Specialties Rehabilitation medicine Special clinics: examples <strong>of</strong> these include:– young adults clinic– prosthetic amputee rehabilitation clinic– specialised wheelchair and/or seating clinic– environmental control assessment clinic– spasticity clinic– incontinence clinic– diagnosis-specific clinics, eg MS clinics. Specialist investigative and therapeutic procedureclinics: these include clinics for botulinum toxin,phenol blockade and gait analysis.Specialist on callA consultant may be on call for in<strong>patients</strong> one in two orone in three nights, but is unlikely to need to come intothe hospital more than once a month.Other specialist activity including activitiesbeyond the local service<strong>Consultant</strong>s in RM <strong>of</strong>ten link <strong>with</strong> appropriatespecialties,aslistedinsection4.Clinically related administrationIn RM, assessments are complex; clinics <strong>of</strong>ten involveletters to numerous services and agencies, whichrequires at least half the duration <strong>of</strong> the clinic inaddition to the clinic itself. At least 1 PA per weekshould be allocated for administration.<strong>Consultant</strong>s in RM participate in negotiating fundingfor complex care packages and liaising <strong>with</strong> primarycare trusts, social services and others. Reports onphysical and mental capacities, employment, benefits,insurance, etc, are also frequently required.Community work<strong>Consultant</strong>s in RM increasingly undertake outreach ornetwork-based activity to support specialist teams inthe community. Activities include: MDT meetings (including interagency liaison) outreach clinics home visits (1 PA for 3 or 4 visits) scheduled visits to specialist nursing homes.wide-ranging needs, the practice <strong>of</strong> RM exemplifiesinteragency communication and cooperation.Vocational rehabilitation entails close relationships <strong>with</strong>other agencies, including employers.8 Workforce requirements: clinical andsupport staffCurrent consultant and trainee numbersThere are 177 whole-time equivalent (WTE) RMconsultants. 1 More than 90% <strong>of</strong> RM consultants areemployed full time. Development <strong>of</strong> new consultantposts is proving difficult due to current pressures tomeet government spending targets.There are about 65 specialty trainee (ST) posts in UK.National training numbers (NTNs) have remainedstatic although in common <strong>with</strong> other medicalspecialties RM is facing under-recruitment to STposts. This has implications for future consultantposts.Estimated requirement for consultantsThe BSRM recommends a minimum <strong>of</strong> 1.5 WTEconsultants per 250,000 <strong>of</strong> the population, including0.9 WTE consultants for inpatient and out<strong>patients</strong>ervices and 0.6 WTE consultants for communityprovision. This requires 195 WTE consultants forEngland (233 for the UK), which is an increase <strong>of</strong>approximately 32% on current numbers. Additionalconsultants are required for <strong>patients</strong> <strong>with</strong> highlycomplex needs. Current numbers are thus little over half<strong>of</strong> what is required. Over a 10-year period, RM hasshown the second highest expansion rate at about 150%(Census 1993 to Census 2003), 31 but the currentshortfall remains urgent. Developing new consultantposts is in line <strong>with</strong> the National service framework forlong-term conditions (Quality Requirements 4, 5 and6). 5 The NSF also stipulates the need for networks <strong>of</strong>services that are close to <strong>patients</strong>’ homes for <strong>patients</strong><strong>with</strong> highly complex disabilities. In some parts <strong>of</strong> theUK (especially metropolitan areas) such networks havedeveloped to reflect a mix <strong>of</strong> ‘complex specialised’,district specialist and local general services.7 Opportunities for integrated care<strong>Consultant</strong>s in RM have exceptionally well-developedlinks <strong>with</strong> community health and social services.Because people <strong>with</strong> complex disabilities haveNon-medical workforceThere is a parallel requirement for non-medical staff, asan RM consultant cannot practise effectively <strong>with</strong>outaccess to appropriate numbers <strong>of</strong> specialist nurses,therapists and clinical psychologists.C○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 209