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

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2 Specialties RheumatologyTable 7 Regional variations in number <strong>of</strong>rheumatologists per population (updated 2013)RegiondescriptionNo. <strong>of</strong>consultantsPopulationPopulation/consultantEast Midlands 29 4,279,707 147,576East <strong>of</strong>England39 5,491,293 140,802North east 23 2,54,5073 110,655South central 38 3,992,301 105,061South-eastcoast33 4,187,941 126,907South west 53 5,038,200 950,60WestMidlandsYorkshire andHumber57 5,334,006 935,8047 5,038,849 107,210North west 48 6,827,170 142,233London 106 7,428,590 70,081Scotland 39 5,222,100 133,900NorthernIreland17 1,799,392 105,847Wales 28 3,006,400 107,371delivered safely and effectively in various settings(eg hospital, polyclinic and CATS) tailored to the localpopulation. Involvement <strong>of</strong> local rheumatologists mustbe considered early in service development to ensureefficient access to investigations, imaging andthe MDT.8 Workforce requirements for the specialtyData from a recent national survey <strong>of</strong> rheumatologistsin the UK indicates the following (Table 7): 66 Rheumatology continues to be an expandingdiscipline; between 2007 and 2009:– The number <strong>of</strong> consultants in England, Wales,Northern Ireland and Scotland increased from584 to 641 – an increase <strong>of</strong> 9.7%.– Whole-time equivalents (WTEs) increased by13% from 470 to 531. 73% <strong>of</strong> rheumatologists work purely inrheumatology. 14% <strong>of</strong> rheumatologists undertake acute medicine. Currently, one rheumatologist is in place per114,831 population in the UK, <strong>with</strong> wide regionalvariations. Recently, some retirement posts have not been filleddue to funding shortfalls; this expansion <strong>of</strong> thediscipline may plateau or even decreasedepending on the effects <strong>of</strong> current changes inthe NHS.<strong>Consultant</strong> programmed activities (PAs) for aservice for a population <strong>of</strong> 250,000Different patterns <strong>of</strong> <strong>working</strong> across the UK, together<strong>with</strong> different referral patterns from GPs, lead toconsiderable variation in patient numbers inrheumatology units. The consultant requirement,measured as the number <strong>of</strong> PAs needed to provide aservice, depends on the volume <strong>of</strong> inpatient andoutpatient work. Estimates have been made based onepidemiological, needs-based assessments <strong>of</strong> thenumber <strong>of</strong> incident and prevalent cases <strong>of</strong>musculoskeletal conditions likely to present to primarycare, and the estimated proportion <strong>of</strong> these cases thatwould benefit from assessment, treatment andfollow-up in secondary care; the data are supplementedby a large audit performed across 17 units in theMidlands. 3,16,67–69 One WTE consultant is required per 86,000population (2.9 WTE per 250,000). To achieve this would require a total <strong>of</strong> 648consultants, but there is currently a shortfall <strong>of</strong>117 rheumatology consultants. The data assume that a consultant provides4.5 clinics a week for 42 weeks per year, giving a total<strong>of</strong> 189 clinics per year. These data will obviously change depending onregional variations in patient demographics andmodels <strong>of</strong> care. Non-inflammatory conditions such as back pain,osteoarthritis, osteoporosis and regional conditionshave greater unit variations and depend on localpractice and specialist interests. Local commissioning must take into considerationincident cases <strong>of</strong> inflammatory arthritis andprovision for follow-up in accordance <strong>with</strong> NICEguidance.9 <strong>Consultant</strong> work programme/specimenjob planTables 8–10 show specimen job plans for differentscenarios.C○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013 243

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