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

More documents

Recommendations

Info

2 Specialties RheumatologyTable 5 Maintaining and improving the quality of careActionService developmentsthat improve careLeadership role andthe introduction ofservice developmentsEducation andtrainingMentoring andappraisal of medicaland other professionalstaffClinical governanceResearch – clinicalstudies and basicscienceLocal, regional andnational workCommentsRheumatology services operate a patient-centred model of care delivered in a multidisciplinarysetting.Service developments may be simple but with associated cost savings (eg introduction of nurse-ledclinics, telephone follow-up clinics or electronic advice to GPs) or may require significant planning andcapital investment (eg introduction of dedicated day units or building of a new multidisciplinary‘one-stop-shop’ outpatient facility).Rheumatologists must be proactive and show leadership in service developments for their specialty.They must engage and negotiate both within their employing trust and outside with commissionersto secure high-quality services for their patients.Agreeing standards of care with other providers and commissioners on a regional basis may preventvariation and fluctuation in service funding and provision. An example of this is the model of10 standards in inflammatory arthritis being developed by the rheumatologists within the EastAnglian Strategic Health Authority.Guidance to help rheumatologists develop and strengthen their services is available from the BSR. 63Undergraduate and postgraduate training are essential parts of the work of most rheumatologists.The time commitment for this will vary but must be included in the agreed job plan.The rheumatologist has an important role in the training and CPD of allied professionals and GPs sothat future multidisciplinary and integrated care of patients with musculoskeletal disorders is of thehighest standard.Rheumatologists would be expected to enrol in the RCP’s CPD programme. They should have timeallocation and funding for 10 days of study leave a year.The BSR holds various meetings, including a 4-day annual general meeting with educational andoriginal research sessions. The society has its own journal, Rheumatology.Currently appraisal of rheumatologists follows individual trust requirements. Enhanced appraisal willsoon be linked to revalidation.Rheumatologists will mentor, appraise and assess colleagues, trainees and other professionals in theMDT.Clinical governance is based on best practice and national guidance.Local, regional and national audit must underpin the governance process. The BSR has a programmeof national audits. The first of these looked at access to specialist services for patients withrheumatoid arthritis and compliance with guidelines in osteoarthritis.Rheumatology has a strong academic and research base. Many trainees in the specialty spend sometime in pure research, which often leads to the award of higher degrees.Consultant rheumatologists should be encouraged to continue and develop their research interests.The Comprehensive Local Research Networks under the auspices of the National Institute for HealthResearch (NIHR) can help facilitate this and there are many opportunities for multicentre clinicalresearch.The BSR biologics registry (BSRBR) monitors the long-term safety of biologic drugs given forrheumatoid arthritis. 64British rheumatology research is well regarded internationally. Recent examples where basic sciencehas supported clinical research leading to important advances in clinical care are the introduction ofanti-TNF agents and an anti-CD20 monoclonal antibody for the treatment of severe rheumatoidarthritis.Rheumatologists are well represented at all levels of clinical management and professional activity.Local work may include clinical leadership or other roles such as undergraduate dean or Caldicottguardian.Regional and national work might be for the royal colleges, DH, NICE, specialist societies or deaneries.The BSR has a regional structure across the UK. The society has a close working relationship with theRCP, with representation on the Joint Specialty Committee and the president sitting on the RCP’scouncil.The BSR has very active clinical affairs and external relations departments, which respond regularly toNICE appraisals and consultation papers from the DH.C○ Royal College of Physicians 2013 241
Consultant physicians working with patientsTable 6 Patient allocation to non-consultant staffHealthcareprofessionalNewpatients or Review patientsFY1/FY2 2 4 (consider assupernumerary,although theyshould see patients)GP clinicalassistant3–4 or 7–10StR 2–4 or 6–10 depending onexperienceStaff grade 5 or 10Associatespecialist6–7 or 12–15 (same asconsultant)Nurse practitioner 6–8 65future, with support for GPwSIs and extended-scopepractitioners.Day-case workThe number of patients managed in day-case unitsrather than being admitted is increasing. Consultantsoften provide support for: assessment and supervision of biologic andcytotoxic drug therapy therapeutic procedures such as joint injections,which are increasingly undertaken with ultrasoundguidance.Inpatient workImproved management of patients has resulted in asignificant reduction in rheumatology inpatientadmissions, and only a minority of units have dedicatedinpatient beds. Patients who require admission areusually admitted by acute medical teams, but thesepatients often have complex disease withlife-threatening complications and require prolongedlengths of stay. Consultant rheumatologists need towork closely with the medical teams to provideongoing care.Specialist on callA significant reduction in the number ofrheumatologists being asked to provide on-call coverhas been seen, with a potential impact on quality of careand training of juniors. If on-call support is notprovided by the hospital trust, adequate provision forward rounds should be built into consultants’ job plans.7 Opportunities for integrated careMultisystem inflammatory diseases with associated risksof serious morbidity and mortality are at the core ofrheumatology and require early, active, multispecialtymanagement and acute care, often in the hospitalsetting. However, integrated care with the communityoffers real opportunities for many patients and could beconsidered under two categories: improvement in careof long-term inflammatory conditions and optimisationof non-inflammatory conditions via directed-carepathways. Proposed changes in service design may meanthat some services are run by GP consortia, whileothers may be run under close integration withsecondary care.Inflammatory conditions, eg rheumatoid arthritis,require rapid access to the MDT, investigations anddiagnosis. Conditions generally require long-termmanagement, including specialist therapies andconsideration of comorbidity and risk. Initialrheumatology input is intensive, but most patients withstable disease could be managed via shared care withgeneral practice and infrequent, usually annual,rheumatology review. 16 Improving shared care couldreduce follow-up rates, improve capacity forrapid-access services for new and flaring patients, andperhaps offer opportunities to optimiseunder-resourced areas, eg podiatry and psychology.Good examples of community-based services exist forback pain, osteoarthritis and other soft-tissueconditions. Initial management occurs in generalpractice, with escalation to a musculoskeletal clinicalassessment/triage service staffed by extended-scopepractitioners or GPwSIs and linked to rheumatology ororthopaedic services in secondary care. The challengefor these services is to ensure that they provide quality,safety and good governance and that they dovetail withsecondary care to avoid duplication. Other specialisedservices may also benefit from a coordinated approach,such as DXA for osteoporosis as part of a fractureliaison and metabolic bone disease service to improvepatient care and reduce long-term healthcare and socialcare usage, eg by prevention of hip fractures.With the engagement of existing rheumatology services,high-quality, productive, integrated care could be242 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:
Page 191 and 192:
Page 193 and 194:
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 207 and 208: Consultant physicians working with
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 247: 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 ...

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

Delete template?

Save as template?