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

More documents

Recommendations

Info

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
Consultant physicians working with patientsTable 1 Consultant work programme/specimen job plan for an academic clinical pharmacologist working in auniversity teaching hospital, based on 10 PAsActivity Workload Programmed activities (PAs)Direct clinical careEmergency duties arising from acute receiving(24 hours)Inpatient (ward rounds, referrals, MDTmeetings)10–15 patients 0–110–15 patients 0–1Outpatient clinics 5–10 patients 0–1Administration directly related to patient care(eg referrals, notes, complaints, correspondencewith other practitioners)Public health duties, eg medicinesmanagement: running a drug and therapeuticscommittee, managing a formulary, developingprescribing policies, health technologyassessment, drug information services0.5–10–2Supporting professional activities (SPAs)Work to maintain and improve the quality ofhealthcareOther NHS responsibilitiesExternal dutieseg CPD, postgraduate teaching and training,management of doctors in training, audit, jobplanning, appraisal, revalidation, contributionto service management and planning, clinicalgovernance activitieseg Caldicott guardian, clinical audit lead,clinical governance lead, undergraduate andpostgraduate dean, clinical tutor, regionaleducation adviser, medical managementresponsibilitieseg work for NHS bodies (eg advisorycommittees), work for other external bodies (egMHRA, CHM, NICE, royal colleges, GeneralMedical Council (GMC), Postgraduate MedicalEducation and Training Board (PMETB), BritishMedical Association (BMA), BNF and BNFC),NHS disciplinary procedures, NHS appealsprocedures, advisory appointments committees1.5 on averageLocal agreement with trustLocal agreement with trustAcademic duties Teaching undergraduates 1–2Research 2–4University administration 1Note: PA = programmed activities equivalent to 4 hours each.2 As almost all are trained in GIM, the potentialcombination with acute medicine for newappointments is attractive.3 Consultant clinical pharmacologists’ contribution tothe acute medical take means that specialty traineeswill contribute to the medical registrar rota.4 Management of drug formularies and therefore drugexpenditure is an important contribution to localhealth economies, which clinical pharmacologistsare trained to undertake.5 Clinical pharmacologists are well placed to supportthe infrastructure needs of NHS trusts to manage78 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 17 and 18:
Page 19 and 20:
Page 22 and 23:
2 The work of the specialties2 The
Page 24 and 25:
2 Specialties Acute internal medici
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32:
Page 35 and 36: Consultant physicians working with
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 116: 2 Specialties Gastroenterology and
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?