Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
AVPs are involved across primary, secondary and
tertiary care. Most are employed by acute trusts but
some in England by primary care trusts (PCTs). Some
consultants work in a ‘hub and spoke’ network,
delivering services to neighbouring trusts on a practical
or consultative basis.
Some consultants cover the whole spectrum of service
provision in AVM, but others may specialise in
paediatrics or adults. Subspecialty areas include
cochlear implantation, auditory processing disorders,
developmental disorders of speech and language, cleft
palate, adults with learning disability, and paediatric
vestibular service. Delivery is predominantly through an
MDT, which is commonly led by an AVP, audiologist,
paediatrician or otologist.
Practice is primarily outpatient based with inpatient
consultation for patients admitted in other specialties;
rarely, patients are admitted for intensive diagnostic or
rehabilitative work. Adults and children are seen in
separate clinics in all practices.
Secondary audiovestibular services provide a
multidisciplinary approach in dedicated facilities and
manage the vast majority of audiovestibular problems
effectively. Approximately 20% of adult patients and
67% of child patients will see more than two health
professionals at any one visit, with the aim of
Health services for
elderly people
Learning disability
services
Neurology
Audiovestibular medicine
General medicine GP
Adults Paediatrics
Fig 1 Sources of referral to audiovestibular medicine from primary, secondary and tertiary levels.
ENT = ear, nose and throat specialists; GP = general practitioners.
36
ENT
formulating both an accurate diagnosis and a plan for
rehabilitation or treatment. Appointments often include
detailed testing by audiologists and assessments by
other professionals.
Tertiary services for both adults and children are
hospital based and include sophisticated
neuro-otological test facilities, cochlear implant
programmes, bone-anchored hearing aid programmes
and specialised advice and assessment in services such
as cleft palate or falls clinics. Integrated
multidisciplinary care is a key feature of these services.
Sources of referral
Figure 1 shows the sources of referral to AVM from the
primary, secondary and tertiary levels.
Locality-based and/or regional services
Some AVPs work in district general hospitals (DGHs)
and others in specialist centres where the majority of
work is tertiary. There is a disproportionate
concentration of services in London and the South East,
with a few consultants in the north of England, two in
Scotland, one in Wales and large gaps in most other
parts of the country. Different AVPs provide a regional,
supra-regional or national service.
The implementation of the Newborn Hearing Screening
Programme (NHSP) had a significant effect on
Child health and
development
Speech and language
therapy
Newborn hearing
screening programme
Acute paediatrics
Neonatology
C○ Royal College of Physicians 2011