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

More documents

Recommendations

Info

2 Specialties Respiratory medicineTable 2 Consultant work programme/specimen job planActivityDirect clinical careWorkloadProgrammed activities(PAs)Outpatient clinics 3Ward rounds20–25 patients maximum (half that number ifinvolving complex or high-care patients, such asITU step-down cases)2MDT meetings (eg lung cancer) 0.5Routine bronchoscopy, transbronchial lung biopsyand pleural proceduresBronchoscopy (6 per session) 1Specialist investigative/therapeutic procedures Lung or pleural biopsies (3 per session) 0–1Clinical lead activityWorkload examples are given in the text.Depending on the activity, some of this workmay fall under supporting professional activities(see below)0–1Clinically related administration 1–2Specialist on-call and/or general medicalon-call/post-take ward roundsTotal number of direct clinical care PAsSupporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal dutiesMost respiratory physicians also undertakeacute and general medicineEducation and training, appraisal, departmentalmanagement and service development, auditand clinical governance, CPD and revalidation,researchFor example, medical director, clinical director,lead consultant in specialty, clinical tutorFor example, work for deaneries, royal colleges,specialist societies, Department of Health orother government bodies0.5–1.57.5 on average2.5 on averageLocal agreement withtrustLocal agreement withtrustCPD = continuing professional development; DH = Department of Health; ITU = intensive treatment unit; MDT = multidisciplinary team meeting.10 Key points for commissionersCommissioning is considered to be the process ofassessing the health needs of a population, and thenplanning, securing and monitoring the best possiblerange and quality of health services and healthimprovement services given the resources available. 111 High-quality respiratory commissioning enablesthedeliveryoftherightcareattherighttimeandin the right location for each individual patientwith respiratory illness by a competent workforcethat intervenes with knowledge and understandingof the patient’s place on a local pathway ofcare.2 High-quality respiratory commissioning isinformed by accurate local information on theburden of respiratory disease and the impact onexisting services across the whole system ofrespiratory care.3 It is necessary to have a common understanding ofexisting local respiratory pathways and services andtheir interdependence, as well as accurateinformation on local respiratory outcomes,including distinguishing variation fromunwarranted variation.4 High-quality respiratory commissioning supportsthe development and implementation of‘currencies’ that encourage right care, eg carebundle tariffs and personalised care tariffs.C○ Royal College of Physicians 2013 233
Consultant physicians working with patients5 Patients and carers should provide input into thedesign of local services.6 A culture must be developed that attributes valueto knowledge, expertise and sharing of learning.7 Current and future workforce planning andtraining must be a component of commissionedservices.8 High-quality respiratory commissioning deliversevidence-based, best-value care.9 Support to stop smoking, with counselling andpharmacotherapy as a treatment for smokers withrespiratory problems, is essential across primary,secondary and intermediate care.10 Disease-specific examples of what high-qualityrespiratory commissioning might deliver(depending on local needs assessment) include:• earlier diagnosis of lung cancer and COPD• high-quality asthma care in the community,which reduces avoidable hospital admissions.Further informationThe national strategy for COPD in England 6 provides aframework for commissioners and COPDcommissioning guidance, and packs will be availablefrom NICE and the DH.A national clinical director (respiratory) was appointedto NHS England in April 2013. Respiratory medicine isrepresented on a number of Clinical Reference Groupsfor commissioning specialised services(www.england.nhs.uk/ourwork/d-com/spec-serv).References1 BritishThoracicSociety.Burden of lung disease, 2nd edn.A statistics report from the British Thoracic Society 2006.London: BTS, 2006. www.brit-thoracic.org.uk/Portals/0/Library/BTS%20Publications/burdeon of lungdisease2007.pdf2 Department of Health. Estimated England level grossexpenditure by programme budget. www.rightcare.nhs.uk/downloads/dh englandlevel 2008-09.pdf3 Royal College of Physicians. Report of the national chronicobstructive pulmonary disease audit 2008: clinical audit ofCOPD exacerbations admitted to acute NHS units acrossthe UK. London: RCP, 2008. www.rcplondon.ac.uk/sites/default/files/report-of-the-national-copd-audit-2008-clinical-audit-of-copd-exacerbations-admitted-toacute-nhs-units-across-the-uk.pdf4 Abstracts of the winter meeting of the British ThoracicSociety, London,1–3 December 2010. Thorax 2010;65(suppl IV): A1–196.5 BritishThoracicSociety.Quality standards for clinicallysignificant bronchiectasis. London: BTS, 2012.www.brit-thoracic.org.uk/Guidelines/Bronchiectasis-Guideline-non-CF.aspx6 DepartmentofHealth.Anoutcomesstrategyforchronicobstructive pulmonary disease (COPD) and asthma inEngland. London: DH, 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH 1279747 National Institute for Health and Care Excellence.Continuous positive airway pressure for the treatment ofobstructive sleep apnoea/hypopnoea syndrome.Technology appraisal TA139. London: NICE, 2008.www.nice.org.uk/guidance/index.jsp?action=download&o=400858 National Institute for Health and Care Excellence.Management of chronic obstructive pulmonary disease inadults in primary and secondary care (partial update).http://guidance.nice.org.uk/CG1019 Cystic Fibrosis Trust. Standards for the clinical care ofchildren and adults with cystic fibrosis in the UK 2001.London: Cystic Fibrosis Trust, 2001. www.cftrust.org.uk/aboutcf/publications/consensusdoc/C 3000Standards of Care.pdf10 Federation of Royal Colleges of Physicians of the UnitedKingdom. Census of consultant physicians and medicalregistrars in the UK, 2011: data and commentary. London:RCP, 2013.11 Smith J, Curry N, Mays N, Dixon J. Where next forcommissioning in the English NHS? London: NuffieldTrust/The King’s Fund, 2010. www.nuffieldtrust.org/sites/files/nuffield/publication/where next forcommissioning in the english nhs 230310.pdf234 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:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190: 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 224 and 225: 2 Specialties Renal medicineInvolve
Page 226 and 227: 2 Specialties Renal medicineAcademi
Page 228 and 229: 2 Specialties Renal medicineTable 1
Page 230: 2 Specialties Renal medicinekidney
Page 239: Consultant physicians working with
Page 270 and 271: 3 Supporting the delivery of high-q
Page 280: 3 Supporting the delivery of high-q
show all

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

Create successful ePaper yourself

Delete template?

Save as template?