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

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2 Specialties RheumatologyTable 7 Regional variations in number ofrheumatologists per population (updated 2013)RegiondescriptionNo. ofconsultantsPopulationPopulation/consultantEast Midlands 29 4,279,707 147,576East ofEngland39 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 of 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 of rheumatologistsin the UK indicates the following (Table 7): 66 Rheumatology continues to be an expandingdiscipline; between 2007 and 2009:– The number of consultants in England, Wales,Northern Ireland and Scotland increased from584 to 641 – an increase of 9.7%.– Whole-time equivalents (WTEs) increased by13% from 470 to 531. 73% of rheumatologists work purely inrheumatology. 14% of rheumatologists undertake acute medicine. Currently, one rheumatologist is in place per114,831 population in the UK, with wide regionalvariations. Recently, some retirement posts have not been filleddue to funding shortfalls; this expansion of thediscipline may plateau or even decreasedepending on the effects of current changes inthe NHS.Consultant programmed activities (PAs) for aservice for a population of 250,000Different patterns of working across the UK, togetherwith different referral patterns from GPs, lead toconsiderable variation in patient numbers inrheumatology units. The consultant requirement,measured as the number of PAs needed to provide aservice, depends on the volume of inpatient andoutpatient work. Estimates have been made based onepidemiological, needs-based assessments of thenumber of incident and prevalent cases ofmusculoskeletal conditions likely to present to primarycare, and the estimated proportion of 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 of 648consultants, but there is currently a shortfall of117 rheumatology consultants. The data assume that a consultant provides4.5 clinics a week for 42 weeks per year, giving a totalof 189 clinics per year. These data will obviously change depending onregional variations in patient demographics andmodels of 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 of inflammatory arthritis andprovision for follow-up in accordance with NICEguidance.9 Consultant work programme/specimenjob planTables 8–10 show specimen job plans for differentscenarios.C○ Royal College of Physicians 2013 243
Consultant physicians working with patientsTable 8 Full-time rheumatologistActivity Workload Programmed activities (PAs)Direct clinical care4–5 outpatient clinics and associatedadministration (administration approximately0.25 sessions per clinic)Ward work, inpatient referrals, day unit andMDT support5–61Patient-related administration 1Total number of direct clinical care PAs7.5 on averageSupporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal dutiesTeaching, training, appraisal, audit, clinicalgovernance, CPD, revalidation, research,departmental management and servicedevelopmenteg medical director/clinical director/leadconsultant in specialty/clinical tutoreg work for deaneries/royal colleges/specialistsocieties/DH or other government bodies, etc2.5 on averageLocal agreement with trustLocal agreement with trustTable 9 Rheumatologist with GIMActivity Workload Programmed activities (PAs)Direct clinical careOn-call dutiesTotal number of direct clinical care PAsSupporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal duties3–4 outpatient clinics and associatedadministration (administration approximately0.25 sessions per clinic)GIM and specialty ward round, inpatientreferrals, day unit and MDT supportPatient-related administration, relatives andcontactPeri- and post-take ward rounds weekdays andweekends (1:10)Teaching, training, appraisal, audit, clinicalgovernance, CPD, revalidation, research,departmental management and servicedevelopmenteg medical director/clinical director/leadconsultant in specialty/clinical tutoreg work for deaneries/royal colleges/specialistsocieties/DH or other government bodies, etc4–52118.5 on average2.5 on averageLocal agreement with trustLocal agreement with trust244 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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