Consultant physicians working with patients 5th edition - FSEM

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Abbreviations A&E accident and emergency AACs Advisory Appointment Committees AMUs acute medicine units ARCP Annual Review of Competence Progression CCST Certificate of Completion of Specialist Training CCT Certificate of Completion of Training CEEU Clinical Effectiveness and Evaluation Unit CESR Certificates of Eligibility for Specialist Registration CMO chief medical officer CMT Core Medical Training CPD continuing professional development CQC Care Quality Commission DFID Department for International Development DGH district general hospital DH Department of Health DOPS directly observed procedural skills EWTD European Working Time Directive GIM general internal medicine GMC General Medical Council GPwSI general practitioner with a specialist interest GSF Gold Standards Framework HDU high dependency unit HES Hospital Episode Statistics HIU Health Informatics Unit HPA Health Protection Agency HWDU Health and Work Development Unit ICUs intensive care units IOG Improving Outcomes Guidance JRCPTB Joint Royal College of Physicians Training Board KBA Knowledge Based Assessment LAT locum appointment for training MAU medical admissions unit MDT multidisciplinary team MINAP Myocardial Infarction Audit Project mini-CEX mini clinical evaluation exercise MMC Modernising Medical Careers MRC Medical Research Council MTAS Medical Training Application Service NCGC National Clinical Guideline Centre NHDs notional half days NHS National Health Service NICE National Institute for Health and Clinical Excellence NSFs National Service Frameworks NTN national training numbers OoHMT Out-of-Hours Medical Team PAs programmed activities PACES Practical Assessment of Clinical Examination Skills PbR Payment by Results PCN Patient and Carer Network PCT primary care trust PGDs patient group directions PIU Patient Involvement Unit PMETB Postgraduate Medical Education and Training Board PwSIs practitioners with a special interest RITA Record of In-Training Assessment SAC specialist advisory committee SAS staff and associate specialists SHA strategic health authority SPAs supporting professional activities StR specialty registrar WHO World Health Organization WTE whole-time equivalent Note: this edition uses the terminology specialty registrar (StR) to update the term specialist registrar (SpR). vi C○ Royal College of Physicians 2011
1 Physicians in the NHS today The unique skill of the consultant physician is the ability to diagnose and make clinical decisions in difficult, complex and uncertain circumstances. Development of this skill takes comprehensive and thorough learning, time and experience. It is more than a collection of competencies. It reflects, individually and collectively, a culture of striving for excellence that has been built up over centuries. The Royal College of Physicians supports this practice with education, training, continuing professional development (CPD) and quality improvement. It sets standards, measures standards and works with other bodies, to ensure that consultants practise the highest standards of medical care and constantly strive to improve practice. The Royal College of Physicians (RCP) has a vision of doctors educated and trained to the highest standards delivering care to patients that is of the highest quality. The objectives of the RCP include: 1 � championing the values of the medical profession � improving standards in clinical practice � supporting physicians in their practice of medicine through education and training � promoting patient-centred care � engaging the government, the public and the profession and providing leadership on health and healthcare issues. Leading for quality: the foundation for healthcare over the next decade 1 was published by the RCP in March 2010 to set the framework of the policy themes which underpin our vision of a modern health service that is committed to continuous improvement. A leading theme is of better clinical integration and collaboration, whereby doctors in partnership with their patients and in collaboration with other health professionals lead the planning and implementation of services that cross traditional organisational boundaries, particularly those of primary and secondary care, and social care. We are committed to a strong and sustainable medical workforce, so that the right numbers of physicians are trainedtotherightstandard,todeliverthecarethatis needed by our patients. We are also committed to reducing harm, from alcohol, tobacco, obesity, health inequalities and climate change. Consultant physicians have several roles. We are pre-eminently clinicians working with individual patients. We practise in clinical teams both as leaders and as members. We learn, teach and research. As doctors our main responsibility is to our patients. But it is the exercise of additional activities and roles that supports standards of excellence. Doctors in society: medical professionalism in a changing world 2 describes the moral and ethical context of medical practice: Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors. Medicine is a vocation in which a doctor’s knowledge, clinical skills and judgement are put in the service of protecting and restoring human well-being. This purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability. In their day-to-day practice, doctors are committed to: � integrity � compassion � altruism � continuous improvement � excellence � working in partnership with members of the wider healthcare team and with patients. These values, which underpin the science and practice of medicine, form the basis of a moral contract between the medical profession and society. Each party has a C○ Royal College of Physicians 2011 1
Page 1 and 2: Consultant physicians working with
Page 3 and 4: Contents Acknowledgements iv Forewo
Page 5: Foreword Consultant physicians work
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
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 and 50: clinical research supports the dema
Page 51 and 52: Cardiovascular medicine and paediat
Page 53 and 54: Table 1 Service location and main a
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2 Specialties Cardiovascular medici
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Educationinheartseries and European
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Number of consultants needed to pro
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Clinical genetics 1 Description of
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Patient support groups Close links
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� diagnosis of genetic disorders
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‘direct-to-consumer’ tests) wil
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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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changing rapidly and is likely to i
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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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10 Key points for commissioners 1 C
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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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� diagnostic musculoskeletal ultr
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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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