Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
duty to work to strengthen the system of healthcare on
which our collective human dignity depends.
The RCP has developed the thinking in Doctors in
society to further discuss the role of physicians as we
look forward over the next thirty years. Future
physicians 3 looks at the changing relationships between
physicians and their patients. Society is changing. The
population in the UK is ageing. Citizens want to be
more involved in decisions about their care and make
greater demands for more personalised care. Scientific
and technological advances are moving rapidly, but
healthcare has to be supported by the economic wealth
of the country, with a need for more co-management of
health by patients and self reliance if the costs are not
going to overwhelm the national budget. This scenario
was well described by Wanless in his report. 4 Social
trends of increasing obesity and excess alcohol
consumption, along with rising chronic disease in the
population, are proving challenging, and health
inequalities between different sections of the population
and in different localities need to be tackled. 5 The
Marmot report calls on the medical profession to lead
on all these issues, with leadership based on the
values of professionalism, working in partnership with
others. 5
Quality improvement
The quality spiral shows how the RCP sets standards
and encourages physicians to measure against those
standards, to undertake improvement by implementing
change and then to go on improving.
There is a programme of work at the RCP developed to
encourage and support physicians to evaluate and
improve their clinical practice and hence improve
patient care. Physicians are able to draw on resources
from the RCP at all stages of the ‘quality spiral’ (Fig 1).
The RCP has recently published its quality strategy to
direct the quality improvement work of the RCP. 6 It
describes quality in seven domains:
1 safety
2 patient experience
3 effectiveness
4 equity
5 efficiency
6 timeliness
7 sustainability.
2
Fig 1 The RCP quality spiral.
The quality improvement work of the RCP is organised
to support improvements in all these domains which
underpins the professional practice of doctors. The RCP
supports fellows and members and the organisations
and teams in which they work to improve the quality of
clinical care they deliver to patients by: medical training
and examinations; education and training programmes;
developing clinical guidelines; conducting national
comparative audits; quality improvement projects,
facilitating data and informatics improvements;
undertaking invited service reviews; and supporting
members preparing for appraisal and revalidation.
The production of clinical guidelines and best practice
by the RCP is supplemented by the work of specialist
societies who work on additional detailed guidance for
their own specialty. Practice can be audited against
those standards both locally and by participating in
national clinical audits, many of which are led by the
RCP. The results of the national clinical audits are
published so that individual units can learn about their
own performance and undertake programmes to
improve care. Specific details of the RCP programmes
are outlined in Chapter 3 and on the RCP website.
Health policy
In the 21st century, the context of clinical practice has
changed radically. While the four countries that make
up the UK have always had different administrative
structures for health policy, the differences in healthcare
are increasingly stark since devolution in the late 1990s.
C○ Royal College of Physicians 2011