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

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2 Specialties Clinical geneticsPatient support groupsClose links exist with many relevant patient groups,and clinical geneticists are well represented amongtheir expert advisers. Close links also exist with theGenetic Alliance (umbrella organisation of laysupport groups).Availability of clinical records/resultsRecords are accessible under the Data Protection Act1998, with care taken not to disclose information heldabout other family membersRole of expert patientThis is fully acknowledged; with mutual consent,patients may be put in touch with others similarlyaffected.Communication with patientsThe aim is to be prompt, clear and sensitive.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team workingThe clinical genetics service links with GCs, who havea background in nursing or science with specialisttraining. The Association of Genetic Nurses andCounsellors (AGNC) is registered with the HealthProfessions Council 10 and there is a very closeintegrated working practice between clinical geneticistsand GCs (see report 11 ). There is also close liaison withlaboratory scientists – biochemical, molecular andcytogeneticists – with routine combined meetings.Working with other specialtiesClinical geneticists are valued members of clinicalnetworks, eg cancer/oncology, fetal medicine andcardiology. Advice is provided on familial/geneticdiseases and genetic testing. There are combined/jointclinics, eg ophthalmic, prenatal (fetal medicine) andcardiac genetics (eg Marfan syndrome). Joint reportsof the Clinical Genetics Society (CGS) with theAssociation of British Neurologists 12 and the RoyalCollege of Obstetricians and Gynaecologists 13 highlightthe importance of joint working practices.Working with GPs and GPs with a specialinterest (GPwSIs)Referral guidelines are available to assist GPs in clinicalmanagement, eg for family history of common cancers.These may be national guidelines, eg National Institutefor Health and Care Excellence (NICE) guideline onfamilial breast cancer, or local guidelines. Some GPwSIswere established with white paper funding 4 andclinical geneticists often teach at GP study days.Other specialty activity beyond local servicesNational forums exist to discuss difficult diagnostic,ethical or management problems. These have regularmeetings and include the following: UK Dysmorphology club – quarterly meetings;similar regional events GenEthics club (informal forum to discuss ethicallydifficult cases) – meets three times a year to discussdifficult ethical cases and issues smaller special interest group meetings, eg paediatricneurogenetics multicentre regional meetings for audit andtraining, eg South West of Britain group (six RGCs)meets three times a year annual national conferences – CGS, AGNC, CancerGenetics Group and British Society of HumanGenetics.5 Delivering a high-quality serviceQuality standards for clinical genetic services includethe following: applying principles of ‘good medical practice’ 14 toclinical genetics and giving time to clinicalgovernance giving attention to detail and accuracy in diagnosis –the key to high-quality genetic counselling adherence to quality standards documents 3,15 the Genetics Commissioning Advisory Group(GenCAG) have produced auditable qualitystandards for commissioning, 16 including promptpostclinic letters and response to urgent referrals,eg prenatal cases service should be part of an RGC, with access tospecialised genetic laboratories and academicuniversity departments of medical genetics (seereference 17 for requisite facilities).Maintaining and improving the quality of careThe following activities help maintain and improve thequality of care: patient satisfaction surveys and local, regional andnational auditsC○ Royal College of Physicians 2013 61
Consultant physicians working with patients clinical review meetings within RGCs andinter-centre case-note peer reviews national steerage from the clinical governancecommittee of the CGS.Service developments that improve patient care establishment of clinical networks for expandingsubspecialty demand, eg cardiac genetics regular development and updating of care pathways implementation of new diagnostic tools, egmicroarray comparative genomic hybridisation(array-CGH), in collaboration with laboratorycolleagues.Education and training Entry to four years of clinical genetics at StR gradeis at specialty training year 3 (ST3) level after coremedical training. Membership of the Royal Collegeof Physicians (MRCP(UK)), or the member of theRoyal College of Paediatrics and Child Health(MRCPCH), must be attained prior to entry. Up to12 months of training spent in pre-agreed research,such as a PhD, or in a locum appointment fortraining (LAT) post may be recognised. Most training programmes involve rotation throughblocks specialising in different areas such asdysmorphology, cancer genetics, neurogenetics,cardiac genetics, prenatal genetics, research andspecial interest. From 2012, trainees will take a specialty certificateexamination or a diploma of the Royal College ofPathologists.Mentoring and appraisal of medical and otherprofessional staffA consultant clinical geneticist will appraise fellowconsultants, junior doctors and genetic counsellors, aswell as undergoing their own annual appraisal.Continuing professional developmentThis is an academic specialty and rapid developments ingenetic science make adequate continuing professionaldevelopment (CPD) essential, for which numerousopportunities exist. Job planning should allow foradequate CPD time. 18Clinical governanceThe following are routinely in place: care pathways and clinical protocols in place formany conditions; regularly audited regular departmental clinical meetings for casediscussion regular combined clinical-laboratory meetings.Research – clinical studies and basic scienceThis is considered essential. Many consultants conducttheir own clinical and laboratory collaborative projects,actively recruit patients for national and internationalstudies, and publish regularly. Genetics has a growingportfolio within a comprehensive local researchnetwork as part of the National Institute for HealthResearch (NIHR). Those seeking an academic careercan train through an ACF post.Local management dutiesA consultant may be the lead clinician or the clinicaldirector or may hold other leadership or managementroles within the service or NHS trust.Regional and national workBecause clinical genetics is a small specialty, a highproportion of consultants will therefore undertakecommittee work at a regional and/or national level.Examples of national committees are: the NationalScreening Committee, Human Genetics Commission,Human Genome Strategy Group, NICE and advisorygroups for national specialist services.Specialty and national guidelinesThe following guidelines are available: see CGS website (www.clingensoc.org) NICE guidelines for familial breast cancer 19 Scottish consortium pathway guidelines for themanagement of common genetic disorders andothers.Specialty and national auditLocal and regional audit projects are regularlyconducted in relation to specific diseases and serviceissues, and national audit projects are beingdeveloped. A regular inter-regional case note audit isundertaken.Quality tools and service frameworksQuality tools for clinical genetics are underdevelopment and genetics is mentioned in a number ofnational service frameworks (NSFs), eg cardiac services.62 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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