Consultant physicians working with patients 5th edition - FSEM

More documents

Recommendations

Info

Consultant physicians working with patients 3 A nationwide integrated AVM service should include cooperative work with colleagues with complementary competences and with GPs through formally embedded pathways. This service should be designed utilising the clinical network expertise from other services with a proven track record (eg cancer services). 4 AVPs should work with their local GPs to promote ‘self care’ of AV problems and address inequalities within disadvantaged and minority groups. 5 AVPs should hold clinical governance positions within GP consortia and/or the NHS commissioning board (and similar posts in Wales and Northern Ireland) to contribute knowledge and expertise. 6 AVM should be easily locatable in the Choose and Book service, with a named consultant to facilitate patient choice. This would optimise referral patterns and quality of care. 7 In order to facilitate the patient’s voice, systems within the Local Health Watch should include education, relevant support groups (eg NDCS, RNID), local sensory support and social services. 8 National audit against published clinical standards should be undertaken systematically. 9 Robust arrangements to ensure quality and consistency of care should be in place through appropriate national registers, with a single currency of outcome measures, regardless of who is providing AVM services. 10 The wider health and economic benefit to the patient’s quality of life is owing to the holistic approach of AVM. In order to maintain and improve standards of care, AVPs should be appointed in those large areas of the country where AVMislackingandAVPsshouldbereplacedon retirement. Relevant publications � Department of Health. Equity and excellence: liberating the NHS. London: DH, 2010. 16 � Royal College of Physicians. The RCP response to Liberating the NHS: commissioning for patients. 17 � Royal College of Physicians. Hearing and balance disorders: achieving excellence in diagnosis and management. Report of a working party. London: RCP, 2007. 1 References 1 Royal College of Physicians. Hearing and balance disorders: achieving excellence in diagnosis and 44 management. Report of a working party. London: RCP, 2007. 2 Yardley L, Owen N, Nazareth I, Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 1988;48(429):1131–5. 3 Royal National Institute for the Deaf. www.rnid.org.uk/ information resources/aboutdeafness/statistics/ 4 Niemensivu R, Pyykko I, Wiener-Vacher SR, Kentala E. Vertigo and balance problems in children – an epidemiologic study in Finland. Int J Pediatr Otorhinolaryngol 2006;70(2):259–65. 5 National Deaf Children’s Society. http://rm3-ndcs. torchboxapps.com/for the media/faqs 1.html#faqblock4 6 Fortnum HM, Summerfield AQ, Marshall DH, Davis AC Bamford JM. Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. BMJ 2001;323(7312):536–40. 7 Department of Health. Health survey for England 1997. London: DH, 1997. 8 HaggardM,HughesE.Screening children’s hearing: a reviewoftheliteratureandtheimplicationsofotitismedia. London: DH, 1997. 9 National Institute for Health and Clinical Excellence. Surgical management of otitis media with effusion in children. Clinical guideline CG60. London: NICE, 2008. 10 MRC Institute of Hearing Research, APD Special Interest Group, 2004. www.ihr.mrc.ac.uk/ 11 Turner-Boutle M. On the evidence. Pre-school hearing, speech, language and vision screening. Health Serv J 1998;108(5602):36–7. 12 Health and Social Care Information Centre. The 18 weeks delivery programme, audiology pathway. www.ic.nhs.uk/webfiles/Events/SUS%20AWARENESS %20EVENTS/HEATHER%20CORLETT.pdf 13 British Association of Audiological Physicians. Auditory, balance and communication disorders. Audiological medicine in the UK: a guide for users, commissioners and providers. Policy document. London: BAAP, 2002. www.baap.org.uk/images/stories/BAAP Policy Doc.pdf 14 Newborn Hearing Screening Programme. Guidelines for the aetiological investigation of infants. http://hearing.screening.nhs.uk/medical#fileid16484 15 University of Manchester. Modernising children’s hearing aid services. www.psych-sci.manchester.ac.uk/mchas/ 16 Department of Health. Equity and excellence: liberating the NHS. London: DH, 2010. 17 Royal College of Physicians. The RCP response to Liberating the NHS: commissioning for patients. www.rcplondon.ac.uk/policy/responding-nhsreform/liberating-nhs C○ Royal College of Physicians 2011
Cardiovascular medicine and paediatric cardiology with adult congenital cardiology 1 Description of the specialty What is the specialty? Cardiovascular medicine involves the management of patients with suspected or confirmed cardiovascular disease and conditions of the heart, circulation and linked organs associated with diabetes, renal disease or cerebrovascular disease. Paediatric cardiology is a specialty that deals with all aspects of care of patients with congenital heart disease, from before birth to adulthood. More and more patients have grown-up congenital heart disease (GUCH) and they are followed in GUCH centres and local centres with joint expertise – an example of improved integration of services (see section 7). Regionally coordinated genetics and pathology services are being developed for investigation of people with a family history of sudden death. There is no room for complacency if we are to prevent further cases of premature cardiac death and improve quality of life for people with chronic heart disease. Who are the patients? Most patients arrive at emergency departments as acute admissions, presenting with shortness of breath, chest pain or some other cardiac symptom such as transient loss of consciousness. They are stratified according to risk so that those with acute coronary or another high-risk syndrome (eg arrhythmia) receive appropriate specialist care on cardiac care units (CCUs), or on continuing care or heart failure wards. In 2010, 73% of patients with ST elevation myocardial infarction (STEMI) were taken to network-designated centres in England for primary percutaneous coronary intervention (PPCI). 1 Follow-up of many different cardiac disorders with increasing subspecialty focus, eg cardiomyopathy and valve disease, is appropriate. Congenital heart disease affects eight out of every 1,000 live births, and this represents a major clinical challenge for detection and management. Main disease patterns The current emphasis is on early primary prevention, diagnosis and secondary prevention in a larger population of people with coronary heart disease who are living for longer. The increase in patients with heart failure is being addressed through specialised support in the community, but palliative care for patients with heart failure and cardiac rehabilitation completing all care pathways are priorities in England until 2015 (see section 5, Box 1). Severe aortic stenosis in frail patients can now be managed by transarterial valve implantation (TAVI). The field of paediatric cardiology has also become increasingly subspecialised, with new developments in prenatal detection and interventional and electrophysiological treatments, and the outlook for these patients has been greatly improved. Treatments for pulmonary hypertension, cardiac transplantation, and implantation of left ventricular assist devices (LVADs) are concentrated within supra-regional centres. The pattern of endocarditis is ever-changing, and extra vigilance is needed since the National Institute for Health and Clinical Excellence (NICE) recommended removing routine prophylaxis for susceptible patients in 2008. 2 Organisation of the service and patterns of referral A typical service The aim is to provide a seamless transition for adult and child patients from primary to secondary and then to tertiary care, as necessary, and back to local rehabilitation within cardiac networks through the use of agreed care pathways. Some advances in service provision pioneered within tertiary care are appropriate for regular use in secondary care, such as implantation procedures and follow-up of patients with implantable cardioverter defibrillators (ICDs). A key part of the agenda for cardiac networks is equity of healthcare C○ Royal College of Physicians 2011 45
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
Page 13 and 14: (10-session programmed activity (PA
Page 15 and 16: Physicians have a duty to keep good
Page 17 and 18: is evolving towards a more open, ho
Page 19: Confidential Enquiries into Materna
Page 33 and 34: Allergy 1 Description of the specia
Page 35 and 36: Drug allergy and anaphylaxis during
Page 37 and 38: Table 1 Guidelines and audits for a
Page 39 and 40: Calculation of national consultant
Page 41 and 42: Audiovestibular medicine 1 Descript
Page 43 and 44: paediatric AVM with increased clini
Page 45 and 46: 2 Specialties Audiovestibular medic
Page 47 and 48: When supervising trainees, the numb
Page 49: clinical research supports the dema
Page 53 and 54: Table 1 Service location and main a
Page 55 and 56: and should seek advice for unfamili
Page 57 and 58: 2 Specialties Cardiovascular medici
Page 59 and 60: Educationinheartseries and European
Page 61 and 62: Number of consultants needed to pro
Page 63 and 64: Clinical genetics 1 Description of
Page 65 and 66: Patient support groups Close links
Page 67 and 68: � diagnosis of genetic disorders
Page 69: ‘direct-to-consumer’ tests) wil
Page 95 and 96: Gastroenterology and hepatology 1 D
Page 97 and 98: � provide consultant input into c
Page 99 and 100: The BSG have published documents on
Page 101 and 102:
2 Specialties Gastroenterology and
Page 103 and 104:
10 Key points for commissioners 1 G
Page 105 and 106:
Genitourinary medicine 1 Descriptio
Page 107 and 108:
staff. Many clinics have websites p
Page 109 and 110:
and scientific research into STIs a
Page 111 and 112:
� 20 minutes per appointment for
Page 113 and 114:
Geriatric medicine 1 Description of
Page 115 and 116:
Promoting health and self care Spec
Page 117 and 118:
Work to maintain and improve the qu
Page 119:
6 Geriatricians are essential in th
Page 122 and 123:
Consultant physicians working with
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 131 and 132:
Immunology 1 Description of the spe
Page 133 and 134:
Considering the propensity of antib
Page 135 and 136:
ange of duties including clinical l
Page 137:
4 Patients with C1-inhibitor defici
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 147 and 148:
Intensive care medicine 1 Descripti
Page 149:
changing rapidly and is likely to i
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 171 and 172:
Neurology 1 Description of the spec
Page 173 and 174:
patients with LTNCs. Clinical nurse
Page 175 and 176:
How a consultant works in this spec
Page 177:
10 Key points for commissioners 1 C
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 199 and 200:
Rehabilitation medicine 1 Descripti
Page 201 and 202:
� The minimum size of a viable in
Page 203 and 204:
� Specialist investigative and th
Page 205 and 206:
4 Rehabilitation medicine requires
Page 207 and 208:
Renal medicine 1 Description of the
Page 209 and 210:
they can be involved in decisions a
Page 211 and 212:
community. Specialised wards are al
Page 213 and 214:
(CAPD) and automated peritoneal dia
Page 215:
2 Royal College of Physicians. Chro
Page 218 and 219:
Page 220 and 221:
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Page 243 and 244:
Sport and exercise medicine 1 Descr
Page 245:
� diagnostic musculoskeletal ultr
Page 248 and 249:
Page 250 and 251:
Page 252 and 253:
Page 255 and 256:
3 The Royal College of Physicians:
Page 257 and 258:
careers. It is focused increasingly
Page 259 and 260:
Clinical management guidelines To p
Page 261 and 262:
numerous academic papers published
Page 263 and 264:
have a dedicated RCP regional offic
Page 265:
prod consum dh/groups/dh digitalass
show all

Consultant physicians working with patients 5th edition - FSEM

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?