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

Consultant physicians working with patientsin the UK is ageing. Citizens want to be more involvedin decisions about their care and make greater demandsfor more personalised care. Scientific and technologicaladvances are moving rapidly, but healthcare has to besupported by the economic wealth of the country, witha need for more co-management of health by patientsand self-reliance if the costs are not going to overwhelmthe national budget. This scenario was well described byWanless in his report. 4 Social trends of increasingobesity and excess alcohol consumption, along withrising chronic disease in the population, are provingchallenging, and health inequalities between differentsections of the population and in different localitiesneed to be tackled. 5 The Marmot report calls on themedical profession to lead on all these issues, withleadership based on the values of professionalism,working in partnership with others. 5In 2013, Robert Francis published his report on the MidStaffordshire NHS Foundation Trust public enquiry.The RCP was an invited participant in the enquiry. Thefindings, of a need for an overall cultural change toreally put patients at the heart of care and to ensure thatthey are always treated with dignity and kindness is achallenge to all parts of the system. The RCP will belooking at all the recommendations and restating ourcommitment to clinical leadership at the bedside,based on professionalism and also wider engagementwith the system to ensure that quality of care is alwaysput first. 6 See the RCP website (www.rcplondon.ac.uk)for the RCP’s response to the Francis Inquiry report.Quality improvementThe quality spiral shows how the RCP sets standardsand encourages physicians to measure against thosestandards, to undertake improvement by implementingchange and then to go on improving.There is a programme of work at the RCP that has beendeveloped to encourage and support physicians toevaluate and improve their clinical practice and henceimprove patient care. Physicians are able to draw onresources from the RCP at all stages of the ‘qualityspiral’ (Fig 1). The RCP has published its qualitystrategy to direct the quality improvement work of theRCP. 7 It describes quality in seven domains:1 safety2 patient experience3 effectiveness4 equityFig 1 The RCP quality spiral.5 efficiency6 timeliness7 sustainability.The quality improvement work of the RCP is organisedto support improvements in all these domains whichunderpins the professional practice of doctors. The RCPsupports fellows and members, and the organisationsand teams in which they work, to improve the qualityof clinical care that they deliver to patients by: medicaltraining and examinations; education and trainingprogrammes; developing clinical guidelines; conductingnational comparative audits; quality improvementprojects, facilitating data and informaticsimprovements; undertaking invited service reviews;and supporting members preparing for appraisal andrevalidation.The production of clinical guidelines and best practiceby the RCP is supplemented by the work of specialistsocieties who work on additional detailed guidance fortheir own specialty. Practice can be audited againstthose standards both locally and by participating innational clinical audits, many of which are led by theRCP. The results of the national clinical audits arepublished so that individual units can learn about theirown performance and undertake programmes toimprove care. Specific details of the RCP programmesare outlined in Chapter 3 and on the RCP website.Health policyIn the 21st century, the context of clinical practice haschanged radically. While the four countries that make2 C○ Royal College of Physicians 2013