Rheumatology in a DGH -

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1 Rheumatology in a DGH - the viewpoint of a new consultant Parthajit Das Consultant rheumatologist Kettering general hospital

2 Overview Introduce myself Pre-Consultant phase.. Diving In the role.. One year on

3 Who am I? M.B.B.S, Kolkata, India MD, Internal Medicine, Pune, India MRCP UK, MRCP (Rheumatology) MSc Sports and exercise medicine CCT-August 2015 Consultant rheumatologist Kettering 01/08/2015

4

5 Consultant interview -February 2015 Development of sustainable Rheumatology services in a DGH in the current climate

6 THE VISION

7 The Local Story (Rheumatology)

8 Department of rheumatology -KGH Center of excellence Exemplary service model for rheumatoid arthritis care - NICE commissioning guidelines. International Osteoporosis Society certified center. 8

9 Excellent services provided Early Arthritis Clinic Treat to target Best practice tariff Specialty clinics - CTD, Vasculitis - Ankylosing spondylitis - Osteoporosis Combined clinics - Interstitial lung disease - Orthopedics -Renal Outpatient electronic disease activity outcomes Well equipped Day Case unit

10 Active academic programme Research - National audits and projects - Research nurse led projects Highly reputed teaching center - good feedback from medical students, junior doctors - British Rheumatology Society Core course - MRCP PACES center Exchange training programme - MSc Sports medicine - Physiotherapy

11 Patient and public involvement Group classes PALS Patients and public involvement National RA Society (NRAS) - National AS society (NASS)

12 Community services Virtual clinics - Telemedicine - WEBEX clinics Emergency helpline specialty nurse led. Online educational tools

13 Monitoring-(Quality of service) Outcomes - Key performance Indicators (KPI) -Breaches -New to Follow up ratio - Avoid unnecessary admissions Positive experience of healthcare -PLICS system -enhancing the quality and cost-effectiveness - Patient and staff feedback Safe healthcare - Morbidity and mortality meetings - DAWN system

14 August -2015

15 The transition : common emotions Positives Excitement Finally a chance to settle down Sense of identity with patients Clinical autonomy New challenges Negatives Fear / Anxiety Poor preparation for senior role Stressful Difficulty saying No

16 Working in KGH Strengths Trust - Foundation trust - National patient survey (8.5/10) -Reached 84% of CQUIN targets - ( Annual survey ) Rheumatology department - Enthusiastic staff members -Huge potential for growth - DAWN system Challenges 2 new consultants Run by locum consultants Clinical pathways Specialty /Combined clinic/referrals MSK radiologists Community services Research projects Rheumatology patient survey

17 Job Planning An agreement with clinical managers Know what is and what is NOT expected of you The job plan comprises: - Typical balance of duties Direct Programmed Activities (PA) Supporting PA - Additional NHS duties - Other external duties On calls commitments

18 Medical workload components Programmed Activity Direct Clinical Care (DCC) under section 3(1) or section 5(1)(b) of the National Health Service Act Supporting Professional Activities (SPA) Additional NHS responsibilities Other external duties Description Ward rounds, Out patient clinics, Admin directly related to patients etc. public health duties, operating sessions, MDT meetings, CPD, teaching, audit, management, research, governance etc. Governance or service lead, Audit lead, clinical tutor, post graduate dean etc. Professional body work (GMC,NHS England), CQC inspectors, Advisor for external apt committee

19

20 New resposibilities Management - writing business plans - strategic thinking and policy making - supervise juniors - dealing with colleagues Clinical care

21 Clinical care The role of a doctor is to amuse patients, while nature takes its course - Francais Xavier

22 Clinical care To set up a service Identify needs - Local needs - CCGs, national Service provision -Identify best practice, -Guidelines Work force Legislation Clinical governance Financial analysis Patient feedback -local regulations, -policies Immediate Targets Early Arthritis Clinic Treat to target - Best practice tariff Specialty clinics - CTD, Vasculitis - Ankylosing spondylitis - Osteoporosis Combined clinics - Interstitial lung disease Well equipped Day Case unit

23

24 Working with colleagues Know your colleagues Hospital/Region Get to know your local GPs Your team - secretary/ nurses/ co-ordinators Yourself

25 Private Practice Regular, scheduled, private work should be shown in the Job Plan

26 Personal development Focus on your interest (Clinical/ Non-clinical/Research) - local/ national/ inter-national Teaching skills Offer to do talks to GPs and patient groups Ask for help; locally / further a field Get a mentor - Doesn t need to be a rheumatologist

27 Networking Linked Regional Hospitals - Leicester - Northampton -National Referral centers/ Specialized commissioning Primary Care Services and Resource Centers Patient or public involvement 27

28 Appraisal Structured annual process Review performance against GMC s definitions of good practice To set out personal goals / plan for these to be met Link to revalidation - Encompasses 5 years of appraisal evidence

29 Collecting your data CPD year runs April to April Collect data and upload sources using NHS toolkit Good clinical care Working with colleagues Management Activity Maintaining good medical practice Teaching and training Research Relationships with patients Probity Health

30 Clinical excellence awards Can be awarded after 1 year in post Need to demonstrate personal development - successful appraisal process - participated in service development - clinical governance - teaching and/or research

31 What does sustainability mean? to the best possible standard in line with national policy and professional standards meeting legal requirements within available financial and human resources Involvement of all stakeholders - Government, Population - Economic, cultural sectors, 31

32 We are determined Better access to quality specialty service Comprehensive care - Closure to home - primary and secondary care Better emergency and planned care 32

33 One year on

34 Excellent services provided Early Arthritis Clinic Specialty clinics - CTD, Vasculitis - Ankylosing spondylitis - Osteoporosis Combined clinics - Interstitial lung disease - Orthopedics -Renal Outpatient electronic disease activity outcomes Well equipped Day Case unit

35 Active academic programme Research -National audits and projects - National early arthritis audit - research nurse led projects Highly reputed teaching center -good feedback from medical students, junior doctors - British Rheumatology Society Core course - MRCP PACES center Exchange training programme - MSc Sports medicine - Physiotherapy

36 Patient and public involvement Group classes PALS Patients and public involvement National RA Society (NRAS) - National AS society (NASS)

37 Community services Virtual clinics - Telemedicine - WEBEX clinics Emergency helpline specialty nurse led. Online educational tools

38 Miles to go..

39 Where I am Lead for Osteoporosis service Northamptonshire Clinical audit lead Rheumatology- KGH Educational lead medical students KGH Educational supervisor

40 Finally If you unsure what you are doing Enjoy it!

41 Thank you

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