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2 Specialties Cardiovascular medicineBox 1 Quality tools, service frameworks and progress reports (www.improvement.nhs.uk/heart)NHS Improving Quality (NHS IQ) – now hosted by NHS England (previously National Commissioning Board)Event presentationsHeart improvement national cardiac conference (March 2010): ten years of the coronary heart disease (CHD)NSF. Presentation by Professor Roger Boyle CBE, former national director for heart disease and stroke,Department of Health.Documents for sharingNational Imaging Board. Cardiac imaging: a report from the National Imaging Board. Department of Health,March 2010.NHS National End of Life Care Programme. End of life care in heart failure: a framework for implementation.NHS, June 2010.Strategic Commissioning Development Unit (SCDU). Commissioning pack for cardiac rehabilitation.Department of Health, October 2010.National Institute for Health and Care Excellence. Chronic heart failure. Quality Standards QS9. NICE, June2011.Latest publications in priority areas Quality, innovation and value in cardiac rehabilitation: commissioning for improvement. NHS Improvement,May 2012. National Heart Failure Audit 2011/12. November 2012. GRASP-AF report, published in Heart online. February 2013.British Congenital Cardiac Association (congenital)audits, and NACR (rehabilitation) and others will alsobe hosted in due course.The development of DH’s Quality Accounts in 2010 andthe use of Commission for Quality and Innovation(CQUINN) and other measures in the new outcomesframework in England will still hopefully facilitatefurther audit development to maintain standards of ahigh-quality service and sustain progress. Leadershiproles within NHS Improvement Heart team andcardiovascular networks have been used to drive serviceimprovement and share best practice. The peer reviewprocess of the BCS has contributed to what is now theCare Quality Commission.Education and trainingEducation and training are essential at all levels, frompatients and carers to undergraduates, foundationdoctors and specialist trainees in medicine. Mostcardiologists are involved in teaching students of clinicalmedicine and all grades of junior doctor, particularlythose in higher specialist training in cardiology in theirone of 17 deaneries. Designated trainers will havespecial responsibility for the supervision of registrarsand an increasing workload to provide evidence of theirtrainees’ competence through workplace-basedassessments. Cardiology-supported implementation ofthe Tooke review ensures a formal selection process atentry to specialist training, and has pioneered a nationalapplication process and developed a knowledge-basedassessment (KBA) for use in formative training.Cardiology encourages all trainees to undertake aperiod of research, and the BHF has expanded fundingfor such opportunities to encourage academic training.Formal training programmes are organised by higherspecialty training committees and the BCS organises anannual review course at the RCP with the Mayo Clinic.The BCS has elected vice-presidents for education andresearch, and for training, the latter being theincumbent chair of the specialist advisory committee(SAC) for cardiology. The vice-president for trainingholds delegated responsibility through the Physicians’Training Board from the General Medical Council forsetting standards for higher specialist training in thespecialty, and the deaneries organise annual reviews ofcompetence which are externally verified throughassessment in the penultimate year. The cardiologycurriculum has recently been updated to include newC○ Royal College of Physicians 2013 53
Consultant physicians working with patientsareas of practice such as cardiac computed tomographyand more generic areas such as medical leadership.Paediatric cardiology has its own Certificate ofCompletion of Training (CCT) and SAC with a recentlyupdated curriculum. Possible subspecialties includefetal cardiology. Care of adult congenital heart disease(ACHD) is open to trainees in paediatric or adultcardiology in 1–2 years of ACHD, depending on theultimate level of service.Mentoring and appraisal of medical and otherprofessional staffAnnual appraisal, assessment of contribution toimproving quality and working towards revalidation isan increasing responsibility for consultant cardiologists.Mentoring of junior consultant colleagues, as well asjunior doctors, is also increasing. Mentoring forprofessionals allied to medicine also helps to develop ahighly skilled, clinically competent group of healthcareworkers who will contribute to the delivery ofhigh-quality cardiovascular care.Continuing professional developmentContinuing professional development (CPD) forcardiologists is regulated by the Federation ofthe Royal Colleges of Physicians of the UK, and isprovided by the BCS, which is now accredited by theEuropean Board for Accreditation in Cardiology(EBAC), through its annual scientific meeting, theEducationinheartseries and European Society ofCardiology textbook.Clinical governanceCardiology has been at the forefront of development ofclinical governance at both national and local levels (seeabove, and Specialty and national audit below).Research – clinical studies and basic scienceThe British Society for Cardiovascular Research (BSCR)is an affiliated group of the BCS that recognises theimportance of basic science. It recently held its annualscientific conference jointly with BCS. Nationally,clinical and basic science research is supported by theBHF through project grants, chairs, and senior,intermediate and junior fellows. The medicaldirector of the BHF is a member of the council of theBCS. Consultant cardiologists are encouraged toconduct high-quality research individually and incollaboration with their whole-time academiccolleagues. There should be encouraged activeengagement with the new academic health sciencenetworks.Local management duties and regional andnational workA consultant may be the clinical director or hold someother leadership or management role within the healthservice, NHS trust, network or clinical senate.Alternatively, she or he may be elected to the deanery’shigher specialist training committee.The BCS is run on a day-to-day basis by the presidentelect,secretary, assistant secretary, treasurer and chair ofthe Programme Committee. Affiliated groups addressthe subspecialty areas of echocardiography, nuclearcardiology, heart failure, intervention, pacing andelectrophysiology, congenital heart disease andrehabilitation, and they represent professional groups ofcardiac nurses, cardiac physiologists and primary care.Council representatives also represent colleagues fromthe DGHs, female cardiologists and patients. The BCSalso has a system of regional representatives andnetwork advisers. The Joint Specialty Committeeprovides an essential link between the RCP and BCS.In England, the NHS Improvement Heart team, thenational director and clinical leads/advisers haveprovided the impetus for change within the specialtyover the last decade. Wales, Scotland and NorthernIreland have also developed programmes for improvingservices.Specialty and national guidelinesCardiology practice has responsibility for theobservation of multiple clinical guidelines,interventional procedure guidelines, technologyappraisals and other advice issued by NICE. Table 2includes additions to previous summaries from 2008edition of Consultant physicians working with patients. 9As a constituent member, the BCS endorses andsupports guidelines published by the European Societyof Cardiology.Specialty and national auditNICOR now hosts MINAP, BCIS, SCTS and BritishCongenital Cardiac Association (see above). Althougheach audit looks at a specific aspect of heart disease,they can be linked together to follow a patient’streatment and outcomes throughout their lifetime. Thisdoes not depend on where the patient receivedtreatment, who provided their care or what treatmentthey received. NACR works with the NHS Information54 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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