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

Consultant physicians working with patientsIn tertiary centres, the multidisciplinary forum, whichincludes cardiac surgeons and cardiac interventionalists(for both adults and children), is a vital quality standardfor assessing the appropriate treatments for all patients,including children. The interface between radiologyand cardiology in terms of expertise in imagingand its place within the MDT in the future is an areafor development. The way it evolves will largely dependon local interest and expertise. There is improvingcooperation among the BCS-affiliated groups forimaging modalities. The increasing focus on vascularmedicine is facilitating closer working relationshipsbetween specialists in vascular surgery, nephrologyand diabetes, particularly with respect to preoperativeassessment, and these will also extend from the CVDOutcomes Strategy 2013. The treatment of patientswith infective endocarditis involves cooperationof specialists in microbiology and cardiac surgery withthose in cardiology. There are increasing numbers ofjoint GUCH clinics, which allow specialists to visit localcentres.Working with GPs and GPs with a special interest(GPwSIs)Some GPs are especially interested in cardiovascularmedicine, and GPwSIs have been developed with inputfrom the RCP, the BCS and NHS Improvement foraccreditation. Clinical assistants and hospitalpractitioners should receive this further training toallow them to contribute to services that they typicallyprovide in outpatient or non-invasive investigativecardiology settings. They have a useful role in localmanagement boards and networks for vascular andchronic diseases, and they may become leads, forexample, in developing community cardiac clinics forhypertension and palpitations. The Primary CareCardiovascular Society is an important affiliated groupof the BCS.Other specialty activity beyond local servicesSpecialised commissioning activity often relates to agroup of networks for which standards must be agreedto allow development, and the BCS can contribute thestrength of its affiliated groups and committees.Regional and national reviews of services have beeninfluenced, for example, by the workforce requirementsidentified by the BCS (see section 8). Closercooperation with other organisations is a formalstrategy, as exemplified by the Cardio & VascularCoalition through the production of Destination 2020and Access to cardiac care in the UK. 5,6 Hopefully thiswill be noted in new commissioning structures (seesection 10). A specific resource pack on commissioningof cardiac services has been produced by the BCS. 75 Delivering a high-quality serviceCharacteristics of a high-quality serviceA national cardiac conference was held in March 2010(see Box 1) to celebrate the achievements over 10 yearsfollowing the publication of NSF for coronary heartdisease in England, which enumerated 12 standards ofcare. These were further elaborated on over that 10-yearperiod by Chapter eight: arrhythmias and sudden cardiacdeath, 8 a GUCH guide, and multiple guidelines fromNICE (see Table 2).Success has been seen with rapid-access chest painclinics for angina and the prompt referral of patientswith acute coronary syndrome to cardiologists forangiography, percutaneous coronary intervention orcoronary artery bypass grafting. There has also been amajor reduction in waiting times for investigations andtreatment.However, there is still room for improvement in manyareas, such as cardiac rehabilitation. There is also anincreasing demand for heart failure services andarrhythmia detection, particularly atrial fibrillation foranticoagulation to prevent stroke (a priority of the DH’sQuality, Innovation, Productivity and Prevention(QIPP) programme). Care for congenital heart diseasein both children and adults should be organisedaround regional networks led by congenital cardiaccentres. Access to adequate pacing services andimplantation of complex devices could be improved.Particularly challenging issues involve the developmentand maintenance of high-quality informationtechnology and transfer services, as well as developingcardiology imaging services as recommended inBox 1.Maintaining and improving the qualityof careThe recurrent cycles of national audits for heart disease,which have been increasingly comprehensive, have ledto improvements both in practice (eg with the movefrom hospital thrombolysis to pre-hospitalthrombolysis or PPCI) and of the audit tools thatcomplement the MINAP. The National Institute forClinical Outcomes Research (NICOR) now hostsMINAP, the British Cardiovascular InterventionsSociety (intervention), the SCTS (surgery) and the52 C○ Royal College of Physicians 2013