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

More documents

Recommendations

Info

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
Consultant physicians working with patientsmust also participate in appraisal and CPD, and systemsfor mentoring new consultants are encouraged. Renalphysicians also play an important part in undergraduateeducation.Research – clinical studies, teachingand basic scienceRenal medicine has a strong track record in teachingand research. Many specialty registrars (StRs) undertakea period of formal research training, and many NHSconsultants supervise research alongside academiccolleagues. Academic renal physicians often train inlaboratory science and work closely with basic scientists,but renal physicians are increasingly involved in a widerange of research, including epidemiology, clinicalresearch and healthcare service research, as well aslaboratory studies.Regional and national workParticipation of renal physicians in regional andnational work is important to ensure that patients haveequitable access to a high-quality service across the UKand that opportunities for teaching and research arewidely available. These roles, which are usually for afixed term, can be onerous, and it is essential thatarrangements for cover of local duties are agreed withcolleagues and managers.Collectively, these roles in service development andprovision, audit, education and training, mentoring,appraisal and professional development ensure thatrequirements for clinical governance are met. Overallresponsibility for clinical governance usually rests withthe clinical director.Specialty and national guidelinesSpecialist society guidelines Renal Association clinical practice guidelines 12 Good practice guidelines for renaldialysis/transplantation units: prevention and controlof blood-borne virus infection 14 Standards for solid organ transplantation in theUnited Kingdom. 15National Institute for Health and Care Excellenceguidelines Renal failure – home versus hospital haemodialysis.Technology appraisal (TA) 48 16 Central venous catheters – ultrasound locating devices.TA49 17 Renal transplantation – immuno-suppressiveregimens (adults). TA85 18 Type 2 diabetes: the management of type 2 diabetes(update). Clinical guideline (CG) 66 19 Renal transplantation – immunosuppressive regimensfor children and adolescents. TA099 20 Laparoscopic insertion of peritoneal dialysis catheters.Interventional procedures guidance (IPG) 208 21 Cinacalcet for the treatment of secondaryhyperparathyroidism in patients with end-stagerenal disease on maintenance dialysis therapy.TA117 22 Chronic kidney disease: early identification andmanagement of chronic kidney disease in adults inprimary and secondary care. CG73 4 Type 2 diabetes: the management of type 2 diabetes.CG87 (partial update of CG66) 23 Peritoneal dialysis: peritoneal dialysis in the treatmentof stage 5 chronic kidney disease. CG125 24 Chronic kidney disease. Quality Standard (QS) 5 25 Anaemia management in people with chronic kidneydisease. CG114 26 Percutaneous transluminal radiofrequencysympathetic denervation of the renal artery forresistant hypertension. IPG418 27 Hyperphosphataemia in chronic kidney disease:management of hyperphosphataemia in patients withstage 4 or 5 chronic kidney disease. CG157 28 Acute kidney injury: prevention, detection andmanagement of acute kidney injury up to the point ofrenal replacement therapy. CG [In press] 29Department of Health guidance Renal specific management of medicines 30 Reducing MRSA and other healthcare-associatedinfections in renal medicine. 31Quality tools and frameworksThe performance of renal units against these guidelinesis audited for patients on RRT through the annualreports of the Renal Association’s UK Renal Registry(www.renalreg.org), for which data are returned fromall renal units in the UK. There is some evidence ofsustained improvements in the quality of service in anumber of areas for which the registry publishescomparative data – eg the management of renalanaemia and the control of hyperphosphataemia.However, substantial unexplained variation remains,and the role of the registry is anticipated to expand intocontinuous quality improvement.218 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:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
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 170 and 171:
Page 172 and 173:
Page 174 and 175: 2 Specialties Metabolic medicineMet
Page 176 and 177: 2 Specialties Metabolic medicineof
Page 178: 2 Specialties Metabolic medicinemet
Page 181 and 182: Consultant physicians working with
Page 196 and 197: 2 Specialties Palliative medicinePa
Page 198 and 199: 2 Specialties Palliative medicine-
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 226 and 227: 2 Specialties Renal medicineAcademi
Page 228 and 229: 2 Specialties Renal medicineTable 1
Page 230: 2 Specialties Renal medicinekidney
Page 270 and 271: 3 Supporting the delivery of high-q
Page 272 and 273: 3 Supporting the delivery of high-q
Page 274 and 275:
3 Supporting the delivery of high-q
Page 276 and 277:
Page 278 and 279:
Page 280:
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?