Consultant physicians working with patients 5th edition - FSEM

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Consultant physicians working with patients � Immunotherapy clinic: approximately 20–30 patients are seen per clinic, depending on staffing. � Day-case challenge/complex investigation sessions: these include skin-prick tests, intradermal and/or challenge tests over hours. Typically two patients are seen per doctor depending on casemix and staffing. � Special allergy clinics: these deal with venom allergy, difficult asthma, etc. Investigative and therapeutic procedures These procedures include skin-prick testing, intradermal and challenge testing, occupational allergy testing, immunotherapy, anti-IgE therapy, and drug desensitisation. Specialist on call Allergists are on call for advice in emergencies, other specialties and following day-case procedures. Clinically related administration � Job plan: for a consultant allergist in a specialist centre, a job plan should allow two hours per clinic for work relating to outpatients and time for other clinical work. This includes: providing telephone and written advice to GPs; requesting clinical information before/after appointment to expedite investigation; and supporting management of patients in the community. � Reporting: clinical letters/reports are time consuming and may include treatment plans, drug alerts, information for patients to carry, etc. Where patients are seen once, a full report, often of multiple disorders, is required. Accuracy is paramount because of severity and risk. 7 Opportunities for integrated care Patients may have a single consultation for diagnosis and management, and care can then be continued by their GP. Services by specialist allergy nurses from major centres are in development to provide diagnostic skin test services to local GP practices. 8 Workforce requirements for the specialty There are 26 whole-time equivalent (WTE) consultant allergists in England and none in Wales. The RCP and the House of Commons Health Committee have 32 recommended an increase in allergy trainee and consultant posts. 3,4 The current situation fails to deliver adequate standards of care or to comply with clinical governance and is inadequate for the increasing number of patients with severe, multisystem or non-organ-based allergic disease. Improvement is required across the board – in primary, secondary and tertiary care – to achieve more equal access to appropriate allergy services throughout the country and to gear the training of doctors and nurses to achieve these ends. A substantial expansion in the number of trained full-time allergists providing a dedicated allergy service is needed. For an effective national system of allergy patient care, allergy clinics provided by other consultants need to be networked with specialist allergy centres. Both now and in the immediate future, demand will outstrip service supply by a large measure. Immediate proposals The key step is the creation of a network of regional specialist allergy centres. 3,4 These services in adult and paediatric allergy would provide comprehensive expertise including dealing with more complex diseases and training, research and leadership within the nascent national allergy service. They would support and enable other providers in secondary care and improve geographical distribution of allergy services. A core of experts is essential to set standards and support primary care, where the bulk of allergy care will be delivered. Immediate needs include the following: 1 To create/develop regional allergy centres: an additional 20 adult and 20 paediatric consultants are required for England and Wales. 3,4 2 To increase the number of allergy specialty registrar posts: the DH Workforce Review Team and the House of Commons Health Committee recommended an increase of 20 (centrally funded) national training places in allergy (and 20 for paediatric allergy). Discussion is ongoing with the Centre for Workforce Intelligence. Long-term aim: a mature specialist allergy service (secondary and tertiary) Thelong-termaimistoextendtheservicetoprovide allergist-led services in most major teaching hospitals and a part-time service provided by other consultants. C○ Royal College of Physicians 2011
Calculation of national consultant workforce requirements Assumptions of population/patient need BSACI estimates that at least 3 million people in the UK or 50,000 per million need to see a consultant allergist (5% of the UK population) or 5,000 people per million in any year (if workload is spread over 10 years). 2,5,7 Consultant manpower required � The number of patients requiring referral to a specialist allergist in any year is estimated to be 5,000 per million population. � One consultant will see approximately 670 new, 335 review and 600 day cases per year. � About 416 consultants would be needed for a population of 52 million (England and Wales). � Around 390 additional allergy consultants are required, 50% of which would be in paediatric allergy. The requirement for allergists could be reduced by ∼10–15%, as specialists such as immunologists and dermatologists would contribute to allergy care. Therefore, at a minimum, 160 adult allergists are required. Trainee manpower The current number of trainees is 11. In terms of medical specialty training numbers, 20 additional trainees are required (as well as 20 in paediatric allergy) for immediate development. Table 2 Consultant work programme/specimen job plan Activity Workload Sessions Direct patient care Outpatients 4 new + 2 follow-up patients Day cases 2 1 Immunotherapy 12 1 3–4 Ward referrals 2 0.5 Work related to clinics and clinical advice Work to maintain and improve the quality of healthcare Education and training, appraisal, management, service development, audit and clinical governance, CPD, revalidation, research 2–2.5 2 2 Specialties Allergy 9 Consultant work programme/specimen job plan (tertiary centre) Table 2 shows an outline of the work of an NHS consultant allergist in an allergy centre. The job plan of an academic allergist will differ. This should not be seen as prescriptive. 10 Key points for commissioners 1 Allergy is a major health problem and needs the attention of commissioners. 2 About one in three patients has allergy. Allergy has become more severe and complex; a patient often has several illnesses due to allergy, and multiple allergies. 3 This is a new problem facing the NHS, but allergy is not often addressed. This results in significant costs that could be avoided by good-quality allergy care. 4 The majority of GPs have limited knowledge of or training in allergy (not available in most medical schools). 5 Allergy diagnosis and management leads to avoidance of the triggers and prevention or control of disease (eg anaphylaxis, angioedema, asthma, eczema, rhinitis) and cost savings. It also reduces referrals to a series of other specialists, where treatment is symptomatic and allergy not considered, giving further savings. 6 Allergy is a recognised specialty with specific expertise. Allergy diagnosis is usually not addressed by other specialties. Specialist allergists deal with multiple allergy-driven disorders, often in a single consultation, with ongoing care by the GP. 7 Care pathways, NICE guidance and BSACI guidelines are available. 8 Surveys show that few primary care trusts are aware of, or commission for, allergy. Allergy is not identified in GP commissioning guidance. 9 Commissioning of allergy services from specialists in allergy is essential for patient care. It complies with the Quality, Innovation, Productivity and Prevention (QIPP) programme, will prevent or control further illness, reduce the burden on GPs and hospital services, and be cost saving. References 1 Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in the UK. Thorax 2007;62(1):91–6. C○ Royal College of Physicians 2011 33
Page 1 and 2: Consultant physicians working with
Page 3 and 4: Contents Acknowledgements iv Forewo
Page 5 and 6: Foreword Consultant physicians work
Page 7 and 8: 1 Physicians in the NHS today The u
Page 9 and 10: The parliaments and assemblies in S
Page 11 and 12: arrangements do not lower the quali
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Page 15 and 16: Physicians have a duty to keep good
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Page 19: Confidential Enquiries into Materna
Page 33 and 34: Allergy 1 Description of the specia
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Page 43 and 44: paediatric AVM with increased clini
Page 45 and 46: 2 Specialties Audiovestibular medic
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Consultant physicians working with
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Gastroenterology and hepatology 1 D
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� provide consultant input into c
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The BSG have published documents on
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2 Specialties Gastroenterology and
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10 Key points for commissioners 1 G
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Genitourinary medicine 1 Descriptio
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staff. Many clinics have websites p
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and scientific research into STIs a
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� 20 minutes per appointment for
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Geriatric medicine 1 Description of
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Promoting health and self care Spec
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Work to maintain and improve the qu
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6 Geriatricians are essential in th
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Immunology 1 Description of the spe
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Considering the propensity of antib
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ange of duties including clinical l
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4 Patients with C1-inhibitor defici
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Intensive care medicine 1 Descripti
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Neurology 1 Description of the spec
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patients with LTNCs. Clinical nurse
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How a consultant works in this spec
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Rehabilitation medicine 1 Descripti
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� The minimum size of a viable in
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� Specialist investigative and th
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4 Rehabilitation medicine requires
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Renal medicine 1 Description of the
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they can be involved in decisions a
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community. Specialised wards are al
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(CAPD) and automated peritoneal dia
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2 Royal College of Physicians. Chro
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Sport and exercise medicine 1 Descr
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3 The Royal College of Physicians:
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careers. It is focused increasingly
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Clinical management guidelines To p
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numerous academic papers published
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have a dedicated RCP regional offic
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