Rheumatology in a DGH - the viewpoint of a new consultant Parthajit Das Consultant rheumatologist Kettering general hospital
Overview Introduce myself Pre-Consultant phase.. Diving In the role.. One year on
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
Consultant interview -February 2015 Development of sustainable Rheumatology services in a DGH in the current climate
THE VISION
The Local Story (Rheumatology) 2020 7
Department of rheumatology -KGH Center of excellence Exemplary service model for rheumatoid arthritis care - NICE commissioning guidelines. International Osteoporosis Society certified center. 8
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
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
Patient and public involvement Group classes PALS Patients and public involvement National RA Society (NRAS) - National AS society (NASS)
Community services Virtual clinics - Telemedicine - WEBEX clinics Emergency helpline specialty nurse led. Online educational tools
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
August -2015
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
Working in KGH Strengths Trust - Foundation trust - National patient survey (8.5/10) -Reached 84% of CQUIN targets - ( Annual survey 2014-2015) 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
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 - 7.5 Direct Programmed Activities (PA) - 2.5 Supporting PA - Additional NHS duties - Other external duties On calls commitments
Medical workload components Programmed Activity Direct Clinical Care (DCC) under section 3(1) or section 5(1)(b) of the National Health Service Act 1977. 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
New resposibilities Management - writing business plans - strategic thinking and policy making - supervise juniors - dealing with colleagues Clinical care
Clinical care The role of a doctor is to amuse patients, while nature takes its course - Francais Xavier
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
Working with colleagues Know your colleagues Hospital/Region Get to know your local GPs Your team - secretary/ nurses/ co-ordinators Yourself
Private Practice Regular, scheduled, private work should be shown in the Job Plan
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
Networking Linked Regional Hospitals - Leicester - Northampton -National Referral centers/ Specialized commissioning Primary Care Services and Resource Centers Patient or public involvement 27
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
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
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
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
We are determined Better access to quality specialty service Comprehensive care - Closure to home - primary and secondary care Better emergency and planned care 32
One year on
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
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
Patient and public involvement Group classes PALS Patients and public involvement National RA Society (NRAS) - National AS society (NASS)
Community services Virtual clinics - Telemedicine - WEBEX clinics Emergency helpline specialty nurse led. Online educational tools
Miles to go..
Where I am Lead for Osteoporosis service Northamptonshire Clinical audit lead Rheumatology- KGH Educational lead medical students KGH Educational supervisor
Finally If you unsure what you are doing Enjoy it!
Thank you