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

2 Specialties Renal medicineInvolvement of renal physicians in otherspecialty workConsultants whose primary specialty is renal medicinemay work in additional specialties. The most commonadditional specialties declared by renal physicians in theRCP’s census of consultant physicians in 2011 includedgeneral (internal) medicine, acute medicine andtransplantation medicine. Other specialties mentionedwere cardiology, clinical genetics, clinicalneurophysiology, endocrinology, genitourinarymedicine, immunology, intensive care medicine,metabolic medicine, obstetric medicine, paediatriccardiology and rheumatology. 9Working with GPs, GPs with a special interest(GPwSIs) and the primary care teamRenal physicians work closely with primary carecolleagues to ensure that pathways for the managementof CKD are agreed in accordance with guidelines in theUK. 3,4 Appropriate locality-based electronicinformation and decision support have been developed.The role of GPwSIs in renal medicine has not beendeveloped. The primary care of CKD is dominated bymanagement of vascular risk, which is mainstreamwork for all GPs. Complex cases will still need referral toa renal physician, although shared-care protocols forongoing management are often appropriate. Renalphysicians play a major role in providing educationabout CKD for non-specialists, especially those inprimary care, and in providing leadership as carepathways for CKD emerge within healthcommunities.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality service is one in which patients and theirfamilies and carers have timely access to the expertise,advice and support of the full range of renal healthcareprofessionals within the multiprofessional team. Thecharacteristics of such a service are described in theNational service framework for renal services forEngland. 10,11 The service should meet the goalsrecommended by the Renal Association’s clinicalpractice guidelines. 12Specialised facilities required fora high-quality serviceRenal units require specialised facilities for outpatienthaemodialysis – at the hospital base of the renal unit, insatellite units in other hospitals or freestanding in thecommunity. Specialised wards are also required for thecare of inpatients with renal disease, including ahigh-dependency facility and facilities for renaltransplantation. Isolation facilities are required for thecare of patients with highly transmissible diseasesreceiving haemodialysis. The standards for suchfacilities have been laid out. 13Information technologyIn addition, renal units should have the informationtechnology (IT) necessary to perform internal audit andto submit required data to the UK Renal Registry. Mostrenal units are highly computerised, using a range of ITsystems. Although these systems are veryheterogeneous, it is possible to use ‘mapping’ softwareto extract data items to external databases, including theRenal Patient View website mentioned above. In thenear future, this mapping and extraction software couldbe used to ensure that information could be transferredfrom one renal unit to another if a patient movesaround the country.Maintaining and improving the quality of careThis work encompasses duties in clinical governance,professional self-regulation, continuing professionaldevelopment (CPD), and education and training ofothers. For many consultants at various times in theircareers, it may include research, management, and theprovision of specialist advice at local, regional and/ornational levels.Service developments to deliver improved careThe increasing numbers of patients who need treatmentfor kidney disease underline the importance of the renalphysicians’ role in planning with commissioners forexpansion and development of services and inevaluating innovative approaches to service delivery.Leadership is usually provided by the clinical director ornetwork lead. Other consultants may need to sharesubstantial local management duties depending on thesize of the unit.Education and trainingTraining renal physicians to meet the requirements forconsultant expansion is essential, and consultants needsufficient time to supervise and appraise trainees. Allrenal physicians are involved in education and training,and many will act as educational supervisors withintheir hospital and/or will take on specific roles withintheir deanery or for the royal colleges. Renal physiciansC○ Royal College of Physicians 2013 217