Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
Excellence over and above just fulfilling contractual
obligations to a satisfactory standard can be rewarded
by the Clinical Excellence Awards scheme. 20
Discretionary points can be allocated by local trust
management. Bronze, silver, gold and platinum awards
can be allocated by a national process, to reward
excellence in service delivery, quality improvement,
teaching, research or management. About 30% of all
consultants are in receipt of some sort of award, either
local or national. The proportion of physicians who
receive national awards is proportionally higher than in
other medical disciplines. The scheme is under review
and may be changed after a period of consultation. The
RCP has submitted its view that the scheme does reward
excellence and encourages the delivery of high-quality
care and excellence in teaching, research, management
and clinical care.
The changing role of the consultant
over time
The role of the modern consultant is expected to
develop and change during a professional lifetime.
Consultants usually have three phases to their
professional lives:
1 establishment of clinical practice and vigorous
involvement in it
2 new responsibilities and roles within their own
hospital
3 leadership roles at local, regional and national level,
for some.
As part of this wider development some clinicians take
major roles in clinical service development, quality
improvement, management, research or education.
These roles may be at local, regional or national level.
Although not always of direct and immediate value to
the employing trust, they are important for the wider
service and add greatly to national strategic direction
and support the drive for excellence.
Additional duties that may be undertaken include:
� work on advisory panels for employment of other
consultants
� lead for undergraduate education
� royal college tutor
� clinical tutor
� director of postgraduate medical education
� manager or director of service
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� leadership of quality improvement processes
� clinical audit lead governance lead.
Within the health economy, activities can include:
� sessional commitments to primary care
organisations or regional bodies
� educational leads for undergraduate and
postgraduate education within the deanery
� RCP regional advisers (RAs).
Nationally they may include roles in the following
organisations:
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medical royal colleges
GMC
Care Quality Commission
Departments of Health
National Institute for Health and Clinical Excellence
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(NICE)
British Medical Association (BMA)
National Clinical Assessment Service (NCAS).
Supporting staff and facilities
All consultants require an office base with secretarial
support and a pager or mobile phone. Some also need
computer and internet access at home for results that
may include radiology.
The details will vary according to the specialty.
‘Hot-desking’ and computer-sharing can function well
in some situations; the real question is whether the
arrangements enable high-quality work.
Some specialties work closely with scientists, specialist
nurses and therapists, all of whom contribute to the
extended clinical team and high-quality patient care.
These staff often have additional skills contributing to
management, research teaching and audit.
Doctors work very closely with nursing colleagues on
the hospital wards. It is essential that there is strong
clinical leadership for the overall care of patients, and
that accountabilities are clear. A nurse should be present
on the ward rounds conducted by consultants, to ensure
that all issues are addressed. Future management plans
for patients need to be discussed between doctors and
nurses, as well as other members of the healthcare team
and the patient, with excellent communication, so that
everyone is working towards the same goal.
C○ Royal College of Physicians 2011