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

2 Specialties AllergyTable 1 Guidelines and audits for allergy servicesOrganisation Guidance WeblinkBSACI Standards of Care CommitteeNICEGuidelines for specialists (including rhinitis,urticaria, angioedema, anaphylaxis during generalanaesthesia, drug allergy, egg allergy, venomimmunotherapy); guidelines for primary careDiagnosis of food allergy in children andyoung peopleAnaphylaxis (in development)Venom immunotherapy (in development)www.bsaci.orghttp://guidance.nice.org.uk/CG116Royal College of Paediatrics & ChildHealth (RCPCH)Care pathways for children with allergyIncludes:www.rcpch.ac.uk/allergy/anaphylaxiswww.rcpch.ac.uk/allergy/foodallergyOrganisation Audit WeblinkBSACIEastern Region InquiryVenom immunotherapyAsthma deathsQuality tools and frameworksQuality of care requires clinical expertise. The history isparamount and reliance on tests alone is a source ofmisdiagnosis. Allergy services are sometimes providedby those with little training, so standards vary. Allergyplays an important role in various diseases, eg asthma,but this aspect is often ignored. BSACI guidelines are agood source of developing and supporting standards.Allergy centres should evaluate diagnostic methods andconduct clinical research.6 Clinical work of consultantsHow a consultant works in this specialty An allergist works full time in allergy. This specialtyis outpatient and day-case based, with minimalinpatient component. NHS consultants typically have five clinics a week,comprising general allergy and some specialisedclinics or day-case sessions. Day-case work includes complex investigation,diagnostic challenge tests and desensitisation andanti-IgE therapy. Telephone or written advice is also provided withoutseeing the patient; consultants act as an educationalresource for GPs. Outpatient work is complex and each consultationtakes time. This is because many patients havemultiple allergic disorders, which are usuallydealt with in a single consultation, so a detailedallergy history is critical to accurate diagnosis. Thisrequires team approach and a series of diagnosticand management components, eg allergenavoidance, self-management plans, training to useadrenaline auto-injectors and organisation of schooltraining. Day-case work involves a series of diagnostic steps,over 4–6 hours, with the risk of anaphylaxis. There is a heavy burden in information provisionandcomplexityofletters,egindrugorfoodallergy. A centre might see 5,000–8,000 patients with asignificant component of day cases per annumdepending on staffing; 100% of the work is specialtyand >95% outpatient/day-case based. Theconsultant supervises the work of other members ofthe team.Inpatient workAllergists do not deal with acute medicine. They do,however, provide a consultation service for inpatients,eg with drug allergy.Outpatient work General allergy clinics: new to follow-up patientratios vary with the complexity of referrals andservice provided, eg four new patients plus tworeview patients per doctor. Additional time isrequired for teaching and reviewing patients oftrainees.C○ Royal College of Physicians 2013 31