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3 Supporting the delivery of high-quality carethem in revalidation, and a permanent revalidationoffice has been established.Regional adviser networkThe RCP maintains a network of regional advisers andregional specialty advisers in 19 UK regions. Ten regionshave a dedicated RCP regional office providing a localpoint of contact for our members, supporting the workof the regional advisers and offering valuable supportfor RCP activities within the region.Following a review of the role of regional advisers, theRCP is working with its local representatives to developprofessional networks that have the capacity tocontribute to service quality improvement. There havebeen a series of regional conversations with localphysicians facilitated by the regional advisers. This is anopportunitytoraiseconcernsaswellassharewhathasgone well. The RCP has then fed back those findings tolocal trust chief executives and medical directors. Otherimportant roles for regional advisers may include: developing local educational programmes participating in the local deanery school of medicine reviewing and approving job descriptions considering proposals for fellowship advising on clinical excellence awards approving educational events for CME liaising with college tutors promoting the hosting of MRCP(UK) in the region developing relationships with physicians in the area,to assist with service delivery issues supporting local commissioning/planning processes.Work with specialist societiesSpecialist societies work with their members to promotehigh-quality care in that particular specialty. The RCPworks with the individual societies, using their expertisewhen needed, and meeting with them through jointspecialty committees. Some of the larger societies send arepresentative to the RCP Council.Working party reportsThe RCP provides guidance to physicians and the widerNHS on topics of clinical relevance by publishingreports from working parties, which are set up as taskand finish groups, to review what is known about asubject, including the patient and public’s perspective,and making recommendations for best practice andfuture policy development. These reports are availableon the RCP website.Workforce issuesThe RCP Medical Workforce Unit (MWU) collects andanalyses information on issues related to humanresources and workload. Data are collected in theannual census on consultant physicians, annualspecialty registrar (StR) survey and annual StR census.Data include numbers, demographics, workload andrelevant topical data. The results of the consultant andStR census are available online. The unit also performsperiodic surveys of other physicians, eg specialty andassociate specialists.Data are used to inform discussion with the DH (via theCentre for Workforce Intelligence), the medicalspecialties, other colleges and the media. The MWUworks very closely with the JRCPTB to ensure thatrecommendations about future StR numbers areaccurate and appropriate.TheMWUhasledtheRCP’sapproachtotheEuropeanWorking Time Directive (EWTD), and has beeninvolved in the development of the ‘Hospital at night’system. It has exposed the difficulties and dangers ofcertain rotas and has expressed concern over the balanceof time juniors spend in training, service work or onemergency duties. It is particularly concerned with thecurrent role of and issues facing StRs in medicine.It is involved in a range of other workforce-relatedprojects including: flexible training for physicians;monitoring consultant vacancies; and women inmedicine, particularly as trainee physicians. The MWUruns an in-house questionnaire service, which designs,performs and analyses surveys to support RCP activities.The Professional Affairs Department manages the RCP’sstatutory and non-statutory role in the appointment ofconsultants and other senior hospital doctors in theNHS. It works with NHS trusts and regional advisers inorder to review job descriptions and providenominations of consultants to serve on advisoryappointments committees (AACs). Advice is offered tomedical staffing departments regarding ‘good practice’and statutory and non-statutory procedures. An annualC○ Royal College of Physicians 2013 271
Consultant physicians working with patientsreport is produced and AAC data made available to theMWU.Invited service reviewsAn invited service review can be requestedby hospital management and fellows or members of theRCP when they require independent advice on issuesof concern in relation to the practice of medicine. Thismay be in respect of service delivery, patient safety, teamfunctionality, clinical governance or workload issues.This process supports physicians and trust managementwhen they feel that the practice of good clinicalmedicine is compromised, and forms an importantmethod for protecting patient care and ensuringpatientsafety.Thereportisgiventothecommissioningorganisation, with recommendations for improvementand the RCP will offer further support if invited todo so.International OfficeThe International Office supports members and fellowsworking outside the UK, and promotes RCP expertiseand services. It builds relationships with keyindividuals, organisations and governments, and takesan advocacy role on global health issues identified bythe RCP. With nearly 20% of the RCP’s subscribingmembers and fellows working in over 80 countries andin all continents, international relations are vital. TheRCP aims to extend its role to promote high standardsof healthcare globally by engagement with its overseasfellows and members, strategic partners and individualcountries and regions.The key objectives of the department include:1 the support of medical graduates from outside theUK, who wish to undertake part of their training asphysicians within this country. This involves threeschemes, namely the International SponsorshipScheme, the Clinical Placement Initiative and theInternational Medical Graduate scheme2 overseas partnerships to support postgraduatemedical training. At present these includecommitments in West Africa, with the West AfricanCollege of Physicians, Sudan, Oman, China and SriLanka. Further international collaborations tosupport postgraduate training are in the planning orearly development stages3 international networking with key organisations andagencies, including the World Health Organization,overseas universities and governments, the UKDepartment for International Development, andother UK government departments4 support for the international work of other RCPdepartments, including Education, the NationalClinical Guidelines Centre, and CorporateCommunications and Publishing.ConclusionThe Royal College of Physicians is involved in manyactivities to set standards, measure standards andimprove standards. The ongoing spiral of improvementis a dynamic process. The aim is to ensure that patientsreceive the best care possible and have a goodexperience of care. We have begun work looking at theprocesses of care – eg how ward rounds are conducted,how the professions should better work together andhow to improve communication, particularly betweendoctors and nurses.We recognise that care is delivered within systems, andthat doctors need to work to improve systems of care aswell as individual interactions with patients. This willimprove efficiency, patient experience and patient safety.We are constantly reviewing how doctors perform inwider society and recognise that professionalism is alsoa dynamic concept, which changes as society changes.We will continue to develop resources to help doctorswho are members and fellows of the RCP to constantlyimprove their practice and to deliver high-quality careto patients. Our work also continues to be a resource forproviders of care, commissioners, planners, policymakers, patients and the public.References1 Royal College of Physicians. A strategy for quality: 2011and beyond. www.rcplondon.ac.uk/policy/improvinghealthcare/rcp-strategy-for-quality2 Donabedian A. The quality of care. How can it bemeasured? JAMA 1988;260:1743–8.3 Brook RH, Kosecoff JB. Competition and quality. HealthAffairs 1988;7:150–61.4 Healthcare Quality Improvement Partnership. Newprinciples of best practice in clinical audit.London:HQIP,2011.272 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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