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

More documents

Recommendations

Info

2 Specialties Audiovestibular medicineAcademy of Audiology (BAA), the Department ofHealth (DH), the Royal College of Physicians (RCP)and NDCS encouragement by BAAP through appointment of asecond AVP where possible in areas where there is asingle-handed AVP education and training ensuring publication ofcross-discipline information, conferences, teachingand learning opportunities, both locally andinternationally, especially through the InternationalAssociation of Physicians in Audiology (IAPA),which publishes Hearing Balance andCommunication research in conjunction with healthcareprofessionals, basic scientists and patients into thepathophysiology and management ofaudiovestibular disorders.Specialty and national guidelinesTable 3 gives details of AVM guidelines and audits.6 Clinical work of consultantsOutside academic units, all AVPs work exclusively intheir specialty, almost entirely with outpatients. In unitswhere there are no trainees, work is direct rather thansupervisory but is always as part of an MDT.Inpatient workAVPs do not have dedicated inpatient beds, but in anaverage DGH approximately four inpatients per weekare likely to be referred from other specialties fordiagnostic consultation.Outpatient workA consultant AVP working alone in an adult outpatientclinic may see 4–6 new patients or 8–12 follow-uppatients per programmed activity (PA). In a paediatricoutpatient clinic, a maximum of six new or follow-uppatients may be seen. The number will depend on theconsultant’s experience, the complexity of the problemsand the availability of support staff. In some highlyspecialist services fewer patients may be seen.When supervising trainees, the numbers of patients inclinics should be adjusted to allow for teaching anddiscussion of cases.Specialist activities beyond thelocal servicesSome clinical work can be undertaken by telephoneconsultation and email.Specialist investigative and therapeuticproceduresWhenever possible, audiovestibular investigationsshould be carried out at the same attendance as theclinic appointment; this might be combined withassessment and advice from other professionals withinthe MDT. However, this makes the timing of clinicsunpredictable as some patients will inevitably takelonger to assess than others, especially the very youngor the very old.Most investigative and therapeutic procedures arecarried out by other professionals but the coordinationand interpretation is often by AVPs.Specialist on callThere is no on-call requirement for AVM nor doconsultants and trainees participate in the on-call rotafor acute general internal medicine. They may, however,be closely involved in the management of two acutepresentations: sudden hearing loss and acute intractablevertigo. Both conditions require urgent admission,investigation and management in collaboration withotology and/or neurology.Other specialist activityMany AVPs undertake clinical work and teaching inmore than one site, including outreach clinics in DGHs,community clinics, primary-care groups, schools for thedeaf or learning disabled, and domiciliary visits toprivate homes or residential accommodations.An AVP’s work encompasses duties in clinicalgovernance, professional self-regulation, CPD, andeducation and training of others. For many consultantsat various times in their careers it may include research,serving in management, and providing specialist adviceat local, regional and national levels. In a small specialty,work for the RCP, government, specialist societies,patient groups, deaneries and other national bodies is agreater burden than in larger specialties where themajority of consultants may not be involved if they arenot so inclined.Clinically related administrationThe specialist nature of the work, lack of generalknowledge about audiovestibular disorders, tertiary,interdisciplinary and multiagency working, and thepersonal approach to management inherent in the field,result in the generation of a considerablecommunication burden for AVPs and A&C staff.Preparation of complex reports may take half as long asC○ Royal College of Physicians 2013 41
Consultant physicians working with patientsthetimetoseethepatient.Therearenumbersofrequests for clinical information from patient agencies,patients, other professionals and specialists, and forinformation and documentation to supportentitlements such as the disability living allowance,statements of special educational needs, rehousing andimmigration. Adequate administrative infrastructurefor secretarial support, appointments and medicalrecords is essential.7 Opportunities for integrated careAudiovestibular physicians can provide integrated carewith the following services: falls clinics adult and paediatric neurology services adult and paediatric otology services community-commissioned audiological andvestibular services genetics dual visual and hearing loss clinics educational audiology social work for deaf people speech and language therapy.8 Workforce requirements for the specialtyA population of 250,000 generates approximately 1,000new AVM referrals per year and 1,000 follow-upappointments. The follow-up rate is kept low, despitethe specialty being largely concerned with chronicdisease, because non-medical members of the MDTundertake much of the rehabilitation work.Current workforce numbersThere are currently 49 consultant AVPs in England, onein Wales and one in Scotland; giving a total of 51. Mostof these work full time. There are also 12 consultantcommunity paediatricians in audiology, 19 StRs(specialty registrars) – 7 flexible. There are nonon-consultant career grade doctors or GPwSIs.Providing an audiovestibular medicine serviceto a population of 250,000The specialist society 13 recommends that onewhole-time equivalent (WTE) adult and one WTEpaediatric AVP would be needed to provide this service.This assumes that there are sufficient numbers ofprofessionals in the MDT.National consultant workforce requirementsAn initial increase of 104% across the UK is thought tobe an appropriate target over the next few years, with anaim of achieving one WTE per 300,000 population. 1The aim must be to provide the best service for patientsusing an appropriate balance of AVPs, communitypaediatricians and audiologists working closely withtheir ENT colleagues.Calculating the numbers for academic staff is morechallenging: the MSc and diploma courses are largelydependent on the teaching of honorary staff, despiteattracting a large number of overseas, as well as local,students. The success of integrated scientific andclinical research supports the demand for an increase inthis faculty.9 Consultant work programme/specimenjob planTables 4 and 5 give examples of job plans for consultantsplaced in either paediatric or adult work. For those whocover both areas, a hybrid plan would be neededaccording to the service demands of the department.Please note that, because this is a complex rehabilitativefield, the paperwork can be heavy and needs to beadequately catered for in any job plan; the ratio ofadministration:face-to-face patient contact can be0.5:1 to 1:1.10 Key points for commissioners1 Audiovestibular physicians (AVPs) are well placedto advise on planning and commissioning specialistservices because of their training andmultidisciplinary work. Their professionalstandards and national collaborations wouldensure that significant national variation of hearingand balance service provision is minimised, whilemaintaining a focus on local needs.2 Commissioning of audiovestibular medicine(AVM)servicesonaregionalbasiswouldensurethat the specialist skills of the limited number ofAVPs are used most effectively. This would enabledevelopment of robust regional networks forhearing and balance services which would belocated within tertiary centres.3 A nationwide, integrated AVM service shouldinclude cooperative work with colleagues withcomplementary competences and with GPs,42 C○ Royal College of Physicians 2013
Page 1 and 2: Consultant physiciansworking with p
Page 3 and 4: The Royal College of PhysiciansThe
Page 5 and 6: AcknowledgementsWe would like to th
Page 7: AbbreviationsA&EAACsAMUsARCPCCGsCCS
Page 12 and 13: 1 Physicians in the NHS todaycan be
Page 15 and 16: Consultant physicians working with
Page 22 and 23: 2 The work of the specialties2 The
Page 24 and 25: 2 Specialties Acute internal medici
Page 32: 2 Specialties Acute internal medici
Page 47: Consultant physicians working with
Page 54 and 55: 2 Specialties Cardiovascular medici
Page 66 and 67: 2 Specialties Clinical geneticsClin
Page 68 and 69: 2 Specialties Clinical geneticsPati
Page 70 and 71: 2 Specialties Clinical genetics6 Cl
Page 72: 2 Specialties Clinical geneticswork
Page 80 and 81: 2 Specialties Clinical pharmacology
Page 88 and 89: 2 Specialties DermatologyDermatolog
Page 90 and 91: 2 Specialties Dermatology run monit
Page 92 and 93: 2 Specialties DermatologyDermatolog
Page 94 and 95: 2 Specialties DermatologyTable 1 Ex
Page 96: 2 Specialties Dermatology4 Parkin D
Page 99 and 100:
Consultant physicians working with
Page 101 and 102:
Page 103 and 104:
Page 106 and 107:
2 Specialties Gastroenterology and
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 134 and 135:
2 Specialties HaematologyHaematolog
Page 136 and 137:
2 Specialties HaematologyTable 2 A
Page 138 and 139:
2 Specialties Haematologythey have
Page 140 and 141:
2 Specialties HaematologyTable 4 Sp
Page 142:
2 Specialties Haematology11 Departm
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 160 and 161:
2 Specialties Medical oncologyMedic
Page 162 and 163:
2 Specialties Medical oncologyaroun
Page 164 and 165:
2 Specialties Medical oncologyset b
Page 166 and 167:
2 Specialties Medical oncologyTable
Page 168 and 169:
2 Specialties Medical ophthalmology
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
2 Specialties Metabolic medicineMet
Page 176 and 177:
2 Specialties Metabolic medicineof
Page 178:
2 Specialties Metabolic medicinemet
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 196 and 197:
2 Specialties Palliative medicinePa
Page 198 and 199:
2 Specialties Palliative medicine-
Page 200 and 201:
2 Specialties Palliative medicineA
Page 202 and 203:
2 Specialties Palliative medicineTa
Page 204:
2 Specialties Palliative medicine24
Page 207 and 208:
Page 209 and 210:
Page 212 and 213:
2 Specialties Rehabilitation medici
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
2 Specialties Renal medicineRenal m
Page 222 and 223:
2 Specialties Renal medicineLocal a
Page 224 and 225:
2 Specialties Renal medicineInvolve
Page 226 and 227:
2 Specialties Renal medicineAcademi
Page 228 and 229:
2 Specialties Renal medicineTable 1
Page 230:
2 Specialties Renal medicinekidney
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 270 and 271:
3 Supporting the delivery of high-q
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
Page 280:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?