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

Consultant physicians working with patients Pulmonary vascular disease: thisisorganisedonasupra-regional basis, and all seven centres (six inEngland and one in Scotland) have been approvedby the National Specialist Commissioning AdvisoryGroup (NSCAG) or National Services Division(NSD) in Scotland. All centres have at least twoconsultants trained in pulmonary vascular diseasewhowillbeabletocommitupto50%oftheirtimeto the specialty. Occupational lung diseases: consultants who work insuch units will receive many tertiary referrals andwill require at least 3–5 PAs per week for thiscomplex work.7 Opportunities for integratedrespiratory careAlthough respiratory medicine provides a mainlyhospital-based service, job patterns involvingcommunity work are increasingly being developed, andconsultants in integrated respiratory care, who havesessions both within a hospital and in the widercommunity, have been appointed in some areas.Examples of community work include: development of care pathways to facilitate care closerto home clinical leadership for integrated respiratory careservices to ensure excellent multidisciplinary clinicalcare across the whole pathway leading local respiratory networks education of primary and intermediate carehealthcare professionals medical input into pulmonary rehabilitation,respiratory nursing services and hospital-at-homeand outreach services clinics in a non-hospital-based setting clinical responsibility for high-quality lung functionand oxygen assessment services assessing and managing patients with complexbreathlessness in the community promotion of better end-of-life care for those withsevere lung disease.8 Workforce requirements forthe specialtyTo provide a high-quality, patient-centred, specialistrespiratory service, as described above, a DGH thatserves a population of 250,000 people requires 7 WTEadult respiratory physicians, equating to 1,428 WTEs inEngland. This assumes that they also undertake on-callwork, are adequately supported by a team of otherrespiratory professionals, have adequate facilities andresources, and work under a direct clinical contract of7.5PAs.Manyunitsfallwellshortofthisnumber.Withdemands for a consultant-led and -delivered service,pressures from the European Working Time Directive,an ageing population and the changing workingpatterns of consultants (with more opting to work lessthan full time), it is estimated that 1.4 consultants willbe required to replace every one current WTE in futureyears.In November 2012, 976 consultants were working inrespiratory medicine in England and, despite financialpressures, the numbers of respiratory consultants hascontinued to increase. In the last quarter of 2012 therewere 641 respiratory trainees in England, roughly half ofwhom are female; 104 of these trainees were out ofprogramme (OOP) at that time. Training programmedirectors and others continue to actively support OOPactivity, but it is increasingly difficult to fill gaps thatthen remain in training programmes with LAT (locumappointment – training) doctors (only 12% ofrespiratory LAT posts were filled in 2012). In contrast tosome other specialties, with the feminisation of theworkforce, there has been little increase in thenumbers of trainees or consultants working less thanfull time.Respiratory physicians who responded to the RCP’scensus in September 2011 were contracted for anaverage of 10.8 PAs, but worked an average of 12 PAs perweek, the vast majority of which were clinical. 10 Withchanges in working patterns and the move toconsultant-delivered service, it seems that consultantexpansion needs to continue for several years to come,albeit at a slower rate than we have seen in recentyears.9 Consultant work programme/specimenjob planThe 10-PA job plan shown in Table 2 assumes that thecorrect number of WTE consultants is employed in thedepartment. As respiratory services are delivered byteams, individualised job plans – in terms of bothcontent and number of PAs worked – can easily beadapted from the 10-PA job plan on a proportionalbasis to accommodate flexible working.232 C○ Royal College of Physicians 2013