The Chairman of the Academy of Medical Royal Colleges invited views for a study being undertaken by the Academy into the evidence for benefits to patients of secondary medical healthcare in the NHS being delivered primarily by consultants.
This study is being led by Professor Terrence Stephenson, the Vice-Chairman of the Academy and President of the Royal College of Paediatrics and Child Health. The Academy plans to produce a report of its findings based on published literature across the world and evidence submitted from interested parties.
COMMENTS ON ACADEMY OF MEDICAL ROYAL COLLEGES
THE BENEFITS OF CONSULTANT DELIVERED HEALTHCARE - CALL FOR EVIDENCE
The Royal College of Physicians of Edinburgh (RCPE) is pleased to respond to the Academy of Medical Royal Colleges on its call for evidence on The Benefits of Consultant Delivered Healthcare.
The RCPE supports strongly the benefits of consultant delivered care as demonstrated by experiential evidence, but is unable to offer further published evidence beyond that already available to the Academy in the 2008 report “Medical Workforce Report to identify the added value doctors bring to the healthcare team”; in particular, the evidence available in annex C on acute medicine to which the College contributed previously.
However, we have consulted with a range of our Fellows and offer the following observations/opinions from front line consultants.
What are your views on the benefits of consultant delivered care?
Experienced doctors:
- make rapid, appropriate decisions;
- make the best use of resources, particularly investigations (imaging, endoscopy etc), minimising investigations for patients and contributing to budget saving;
- expedite timely discharge of patients;
- facilitate clear communication to patients and relatives;
- reduce mis-information and complaints.
Do you have any particular evidence or examples of the benefits of consultant delivered care?
- training in endoscopy by flexible working by consultant and trainees - rapid training to competent level in 7 months, average is 2 years;
- Anecdotal: higher discharge rates on ward with higher consultant input;
- UGI bleeding rota - though no reduction in mortality.
What changes are required to have medical care primarily delivered by consultants?
- use skills for tasks consultants can best do, rather than burdening them with tasks that can be achieved equally well by others;
- reduce routine administrative tasks;
- increase time for patient ward rounds from a standard 2 per week to 3;
- improve continuity at ward level to make those ward rounds more efficient and productive;
- move to 7 day working with flexible job planning;
- team-based allocation of patients.
What difficulties do you see with medical care being delivered primarily by consultants?
- loss of other activities, both within the specialty and also outside the hospital (eg contribution to quality initiatives, training and service development).
- “Burn out” unless step down arrangements are available later in careers.