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

2 Specialties RheumatologyTable 10 Full-time academic clinical rheumatologistActivity Workload Programmed activities (PAs)Direct clinical careAcute trustSpecialist patient clinics plus associatedadministration (administration approximately0.25 sessions per clinic)1.5Ward round and inpatient referrals 1Research academic sessions – universityTotal number of direct clinical care andacademic PAsSupporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal dutiesFull academic sessions (this is an example; theexact work balance will vary considerably fromone individual to the next)Teaching and training, appraisal, audit, clinicalgovernance, CPD, revalidation, some aspects ofacademic work.eg medical director/clinical director/leadconsultant in specialty/clinical tutoreg work for deaneries/royal colleges/specialistsocieties/DH or other government bodies, etc57.5 (average)2.5 (average)Local agreement with trustLocal agreement with trust10 Key points for commissioners1 Commissioning for rheumatic diseases mustensure that patients’ needs are at the centre ofservice planning and support the concept of ‘nodecision about me without me’.2 Consultants, as well as all other key healthcareprofessionals, such as specialist nurses,physiotherapists and occupationaltherapists, should be involved incommissioning of rheumatology services ata local level.3 Many rheumatic diseases are complex,chronic, disabling and life shortening.Successful commissioning must includelong-term planning, with integrated pathwaysbetween primary and secondary care, includingsocial support.4 Commissioning must involve patientrepresentation through organisations such as localARMA networks, National Rheumatoid ArthritisSociety (NRAS) and Arthritis Care.5 The introduction of competition in commissioningof services brings a risk of fragmentation of existinggood-quality clinical networks, which are essentialfor management of rheumatic diseases.6 Commissioning must focus on quality andoutcome measures (including the ability to work)rather than on targets that may not be clinicallyrelevant.7 Quality of services should be assessed by qualitymetrics and by (multicentre or national) auditsagainst national standards produced by bodies suchas NICE, the BSR and the RCP.8 Commissioning must conform to NICE clinicalguidance and technology appraisals but should alsobe flexible enough to recognise that some patientswith severe progressive rheumatic diseases shouldnot be disadvantaged because their condition hasnot been assessed by NICE.9 Commissioning must recognise the clinicalimportance and potential cost benefit of earlyreferral and specialist treatment for rheumaticdiseases, as highlighted by NICE guidance, the18-week commissioning pathway for inflammatoryarthritis and the National Audit Office’s report onservices for rheumatoid arthritis. 510 Crude ratios of new patients to follow-up patientsdo not reflect service quality in rheumatology unitsand must be analysed in the context of the localclinical casemix, staffing and model of serviceprovision.C○ Royal College of Physicians 2013 245