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

2 Specialties Clinical pharmacology and therapeuticsabove 15% of the total) and there are pressures toprescribe newer, more expensive medicines. There is a requirement to contain costs by adoptingagreed formularies and making rigorous assessmentsof the clinical and cost effectiveness of new drugs. There has been a significant expansion in medicalstudent numbers to around 6,000 annually, whichhas been maintained. Acute general medical admissions are increasingannually. The increasing burden on physicians running aspecialty service (eg gastroenterology andcardiology) is creating difficulties in providing acutemedical cover. Junior doctors’ hours of work have decreased andthis continues to have an impact.Clinical pharmacology is one of the few specialtieswhose numbers are currently decreasing – numbers inEngland and Wales fell by three consultants in the threeyears to 2009. Sufficient consultants are required todeliver academic programmes, including teaching.There is a strong case to be made for having one WTEclinical pharmacologist in every large district generalhospital (DGH) for acute medicine and to address thespecialty needs of trusts and local primary care trusts.Using a previously developed model, the workforcerequirement for consultants in clinical pharmacologyand therapeutics is approximately 440 WTE. Thisnumber of consultants is based on providing: one WTE consultant per DGH serving a populationof 250,000 one WTE consultant per 180 medical students intraining.In the present climate, this expansion is unrealistic andit is felt that expansion of a minimum of 10% perannum over the next decade is realistic. This wouldincrease numbers to almost 150.Following the successful joint initiativeof the NHS Executive and the Association of the BritishPharmaceutical Industry (ABPI), the number of traineesin clinical pharmacology increased during the 1990s, butthis scheme has ended. Recent initiatives by the WellcomeTrust, the Medical Research Council and the NIHRwill increase the numbers of research-trained clinicalpharmacologists, but more NHS posts are required.9 Consultant work programme/specimenjob planReflecting acute medicine commitment oracademic appointment as appropriateTables 1 and 2 summarise the range of activitiesundertaken by consultant physicians in clinicalpharmacology and therapeutics with responsibilities inGIM, the recommended workload and the allocation ofprogrammed activities (PAs) (each PA is considered tobe a period of four hours). The job plan is based on acommitment of 10 PAs per week, although the typicalworking patterns of clinical pharmacologists involveextra PAs. Suggested work programmes have beenprovided for a consultant working in a universityteaching hospital (Table 1) and one in a DGH (Table 2).Academic clinical pharmacologists will normally hold afull-time university contract (the full-time salary beingpaid by the university) and an honorary (unpaid) NHScontract. The honorary contract will normally includenotmorethanfiveNHSPAs,ofwhichnomorethan3.5 PAs will be devoted to direct clinical care activities(as defined in the 2003 consultant contract). The awardof these concurrent contracts recognises thecontribution that academic consultants make, bothdirectly and indirectly (medicines management) to theNHS clinical service. This arrangement also recognisesthat the activities carried out on behalf of the NHS havevalue for teaching and research. The job plan of anacademic clinical pharmacologist will be made byagreement between the consultant, the dean and themedical director of the NHS body (or their nominatedrepresentatives) and will take full account of theprinciples set out in the Follett Report 2001 concerningthe relationship between academic and clinicalworkload. 6 The academic contract will includeresponsibilities for research, undergraduate teachingand administration relating to these and other NHSduties. In some cases it will be the university departmentas a whole that makes a commitment to provide a fixednumber of PAs to the NHS service, allowing for moreflexible participation of the individual academicconsultants in clinical duties.10 Key points for commissioners1 Clinical pharmacology and therapeutics is a diversespecialty, with consultants often undertaking verydifferent clinical activities.C○ Royal College of Physicians 2013 77