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

More documents

Recommendations

Info

2 Specialties Cardiovascular medicine7 Opportunities for integrated careCardiac networks are a reflection of the major progressthat has been made in integrating cardiac care over thelast decade. 1 Once care pathways are clearly defined,further opportunities for integrated care may berecognised and made cost-effective under the QIPPprogramme: one-stop clinics for more firstconsultations, initial investigations and counselling;joint GUCH/adult and paediatric/cardiology localclinics with a significant educational focus; in-reachcommunity heart failure teams to help support heartfailure patients admitted to hospital; or progressivepatient involvement in MDT meetings about care.There is a need for vigilance around the new strategicclinical networks (SCNs) to ensure no dilution ofimpact as the model is extended to other specialties.8 Workforce requirements for the specialtyCurrent workforce numbersThe NHS electronic staff records identified 855consultant cardiologists (whole-time equivalent (WTE):825) in May 2010. There were 580 trainees according toa recent BCS survey, with 980 consultants in England,and 1,200 across UK. Around 12% of consultants and21% of trainees are women, and their recruitment isencouraged to the specialty. There are currently only90 paediatric cardiologists.Number of consultants needed to provide aspecialist service for a population of 250,000The BCS has estimated 10 that the UK requires acontinuing increase in numbers of consultantcardiologists (including at least three paediatricconsultants) per million of the population to providecomprehensive cardiac services. For a population of250,000, no less than a 1:6 on-call ratio should be aimedfor, with more subspecialist consultant cardiologistsrequired for secondary, tertiary and community cardiaccare. Because of PPCI, more interventionalists are nowrequired. Similarly, the new chest pain guidelines willresult in the need for more imagers. The currentpriorities of cardiac rehabilitation and heart failureshould also be recognised in programmed activities(PAs) allocation in job plans for consultants.National workforce requirementsOnly 25% of consultant cardiologists now undertakeacute medicine. The estimated number of consultantcardiologists required does not include those withTable 3 Typical weekly job plan for a consultantcardiologistActivityDirect clinical careProgrammedactivities(PAs)Inpatients (CCU, ward rounds, referrals) 1.5–2.0Outpatients (plus additional outreach forpaediatric cardiologists)Laboratory work (or other specialised clinicalwork)Meetings of the MDT (PCI, cardiac surgery,imaging, arrhythmia)2.0 (+ 2.0)2.0–3.00.5Clinical administration 1.0On call 0.5Total 7.5–9.5Supporting clinical careClinical management, audit, clinicalgovernance, service improvement anddevelopment, teaching, CPD, research,advisory appointments committees, work forexternal organisations for the greater goodof the NHS2.5CCU = cardiac care unit; CPD = continuing professional development;MDT = multidisciplinary team; PCI = percutaneous coronaryintervention.responsibilities for acute medicine or academicmedicine, nor does it take account of the more recentpriorities as described above.9 Consultant work programme/specimenjob planTable 3 outlines the typical work programme ofconsultants undertaking cardiovascular medicine.10 Key points for commissioners1 The principle of working together, enshrinedin the RCP/BCS response to the NHS White PaperEquity and excellence: liberating the NHS, 11has been upheld by all health professionalopinions. The implementation of the Health andSocial Care Bill 2012 demands vigilance undergovernance.2 An essential building block includes liaison at localvascular/chronic disease management board levelC○ Royal College of Physicians 2013 57
Consultant physicians working with patientsbetween the local cardiology service and primarycare clinical commissioning groups. The new CVDOutcomes Strategy 2013 will emphasise anintegrated model of all cardiovascular care withprevention and rehabilitation.3 There should be agreed care pathways for cardiacconditions across the local health economy and thelarger cardiovascular, paediatric and GUCHnetworks. For instance, future commissioningrequirements are likely to mandate screening by apaediatrician with an interest in cardiology prior toreferral to a cardiologist in congenital heart disease.4 Commissioners (NCB and CCGs) should committo reviewing, through the specialty’s clinicalreference group and local senates/networks,achievements in national cardiac audits, both thosewithin NICOR, and those without (eg NACR),together with local mortality trends, in settingpriorities.5 Cardiovascular networks are recognised tohave provided a key (and improving) relationshipwith commissioning. A very successful exampleis the network-based roll-out of PPCI andsubsequent cardiac rehabilitation pathwayreview. 1,126 Service level agreements should define expectedoutcomes to meet national cardiac auditoutcomes and standards (see point 4 above andBox 1).7 Priority investment in development, delivery andintegration of heart failure, cardiac rehabilitation,palliative care and arrhythmia services should bebalanced with a reduction and decommissioning ofothers, without destabilising any aspect of care,whether acute or long term, or causingdisadvantage to patients.8 There should be a sustainable mechanism for inputof the specialty standards of the RCP and BCS,including those of affiliated groups, with patientsthrough CCP UK, via the Joint SpecialtyCommittee/Specialty clinical reference group in thecommissioning process.9 It is hoped that the NHS Commissioning Board inEngland and planning mechanisms for devolvednations will utilise cardiology’s innovativeapproaches to development and acknowledgerelevant informative reports 5,6,7,13 in specialisedand local commissioning.10 A new Strategic Commissioning Development Unit(SCDU) Department of Health model ofcommissioning guide, pioneered for Cardiacrehabilitation (October 2010, see Box 1),provides a model for future commissioning ofservices. 13References1 NHS Improvement-Heart. Growth of primary PCI forthe treatment of heart attack patients in England2008–2011: theroleofNHSImprovementandthecardiacnetworks. www.improvement.nhs.uk/heart2 NHS Specialised Services. Review of children’s congenitalcardiac services in England, July 2012. Judicial review,February 2013.www.specialisedservices.nhs.uk/safeandsustainable3 Department of Health. National service framework forcoronary heart disease. London: DH, 2000.4 Fifth report on the provision of services for patients withheart disease. Heart 2002;88(Suppl III):iii1–59.www.heart.bmj.com [Accessed 25 April 2013]5 Cardio & Vascular Coalition. Destination 2020. A plan forcardiac and vascular health. The voluntary sector vision forchange. London: British Heart Foundation, 2009.www.cardiovascularcoalition.org.uk6 Oxford Healthcare Associates. Access to cardiac care in theUK. A report on invasive procedures in cardiac conditions.Recent trends, variations in access and future need.BritishCardiovascular Society and British Heart Foundation,2009.7 Ray S for British Cardiovascular Society. Commissioningof cardiac services – a resource pack from the BCS.London:BCS, 2011.8 Department of Health. National service framework forcoronary heart disease – chapter eight: arrhythmias andsudden cardiac death. London: DH, 2005.9 Royal College of Physicians. Consultant physiciansworking with patients: the duties, responsibilities andpractice of physicians in medicine, 4th edn. London: RCP,2008.10 Hackett, D. Cardiac workforce requirements in the UK.London: British Cardiovascular Society, 2005.www.bcs.com11 Department of Health. Equity and excellence: liberatingthe NHS. London: Stationery Office, 2010.12 Shahid M, Varghese A, Moqsith A et al.Surveyofcardiacrehabilitation across the English cardiac networks2007–2009. Br J Cardiol 2011;18:33. www.bjcardio.co.uk13 NHS Improvement-Heart rehabilitation team. Quality,innovation and value in cardiac rehabilitation:commissioning for improvement. www.improvement.nhs.uk/ePublications/cardiacrehab/files/html5/index.html58 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 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 106 and 107: 2 Specialties Gastroenterology and
Page 114 and 115:
2 Specialties Gastroenterology and
Page 116:
2 Specialties Gastroenterology and
Page 119 and 120:
Consultant physicians working with
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 ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?