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

2 Specialties Clinical pharmacology and therapeuticsAlthough the supervision and management of generalmedical patients is a major direct contribution to theNHS, most consultants in clinical pharmacology andtherapeutics take on other roles that contributeindirectly to achieving local NHS service objectivesand standards. These activities usually focus on themanagement of medicines in primary and secondarycare, eg: leading or playing an important role in the activitiesof drug and therapeutics committees and overseeingthe use of drugs in both hospitals and primary care managing a local drug formulary, which may bejointly agreed with local GPs editing and facilitating the production of localprescribing guidelines for common medicalproblems taking a lead role in reporting adverse drug reactionsand reviewing local medication errors undertaking HTA, which might involve reviewingnew and established drugs for clinical andcost-effectiveness purposes auditing and reviewing patterns of local drug use,with the aim of maximising effective and safe use ofmedicines in the NHS.All of these activities make an important contributionto achieving local objectives in clinical effectiveness,clinical risk management and clinical governance.Clinical pharmacologists are likely to play a major rolein auditing and investigating local drug-relatedincidents.Some consultants provide a drug information service,often with the support of a clinical pharmacist. Thismay include a plasma drug concentration monitoringservice, advising on the management and preventionof medication errors, and an advice service on drugoverdoses and the management of adverse drugreactions. Some consultants have a specialist interest inforensic pharmacology and provide expert advice incoroners’, criminal and civil cases. There should beadequate provision for all of these important publichealth and additional service commitments withinajobplan.6 Clinical work of consultantsHow a consultant works in this specialtyClinical pharmacologists have varied working patterns,but most NHS and academic consultants are accreditedin clinical pharmacology and therapeutics (CPT), withgeneral internal medicine (GIM) as their secondspecialty. However, the skills of clinical pharmacologyand therapeutics are generic and are fully applicable toother medical specialties. A few consultants also practisein specialties such as geriatric medicine, cardiology,paediatrics, oncology, respiratory medicine orrheumatology, and it is likely that the number of suchconsultants will increase as more varied trainingschemes are established.Inpatient workActivities will normally be devoted to supervising themanagement of acute medical patients and the specialistwork of the individual consultant. This work typicallyrequires two ward rounds per week at fixed times. 2 Thenumber of inpatients for which the consultant team isresponsible should ideally not exceed 20 patients. Partof this time will be dedicated to inpatient referrals forpatients with pharmacological or toxicologicalproblems. Consultants expect to work in an adequatelystaffed ward, with the appropriate facilities and ancillaryservices to care for a typical casemix of general medicalpatients. They should have the support of at least onejunior doctor who has completed general professionaltraining.Outpatient workTime will be allocated for seeing new patient referrals,including emergency referrals and follow-up afterdischarge from accident and emergency or a hospitalward. Consultants normally provide this service withthe support of junior staff and must allow time for theirsupervision. It is reasonable to expect that theassessment of a new patient will take approximately 30minutes and follow-up patients approximately15 minutes. Trainees require more time and should notwork in isolation. A typical clinic might include 4–6new patients and 10–15 follow-up patients. Thesesessions should include time for dictating clinic lettersand administrative matters relating to the outpatientservice. Some clinical pharmacologists also providespecialist clinics, eg in cardiovascular risk management,asthma, or epilepsy. Patients are sometimes referredwith specific therapeutic, toxicological or otherdrug-related problems.Specialist investigative or therapeutic proceduresClinical pharmacologists will not normally undertakespecialist procedures other than those that arise fromother specialty activities.C○ Royal College of Physicians 2013 75