In this fourth article from the British Cardiovascular Society (BCS), Dr Simon Ray, BCS
Vice-President for Clinical Standards, summarises the major issues of the moment.
The BCS Clinical Standards Division has a broad ranging remit that includes revalidation, workforce issues, guidelines and practice development. Several of these areas are particularly hot topics at the moment.
There are no accurate figures for the consultant workforce in Cardiology. Estimates from the Centre for Workforce Intelligence (CfWI) derived from the National Health Service (NHS) Electronic Staff Records in March 2010 suggest there are 855 cardiologists in England, amounting to 825 whole-time equivalents. Returns from the 2009 Royal College of Physicians (RCP) Consultant Census indicate that we remain a male-dominated specialty with longer hours, and fewer academics and less than full-time appointments than most others. The RCP estimates that there were only 725 consultant cardiologists (647 whole-time equivalents) in England. Not only is this significantly different from the CfWI estimate, but it also suggests a slight reduction in consultant numbers over the last year which does not fit with the experience of cardiologists around the country. Realistically, the large discrepancy in available data makes rational workforce planning impossible, and so the BCS are conducting a survey of UK cardiac networks in an attempt to obtain more accurate figures on the number of cardiologists in post. I urge all of you to assist in collecting these data so that decisions on the future number of training posts can be made upon more accurate assumptions.
Revalidation falls under the remit of the Clinical Standards Committee. The BCS proposals on revalidation of cardiologists were developed by David Hackett in 2008 and are available on the website (http://www.bcs.com/pages/page_box_contents.asp?navcatID=34&PageID=523). The implementation of revalidation has been delayed until 2012, but all indications are that it will still go ahead. The BCS has responded to the consultation document produced by the General Medical Council (GMC), to the Parliamentary Health Select Committee, which is reviewing the GMC’s proposals, and to the Academy of Royal Colleges proposals for a revalidation framework. We are also represented on a number of committees reviewing revalidation. Our overriding principle has been that supporting information for revalidation should, so far as is possible, be derived from routinely collected clinical outcome data to minimise the burden of additional local data collection. The national cardiac audits provide one means by which this might be achieved, and we are working with the British Cardiovascular Intervention Society (BCIS) on a new risk model for percutaneous coronary intervention (PCI) from the BCIS audit dataset, with Heart Rhythm UK (HRUK) on the development of quality standards for pacing and electrophysiology, and with the British Society for Heart Failure (BSH) on standards for heart failure services. We have strongly resisted suggestions to make additional individual audits, for instance the quality of case note entry, a compulsory part of revalidation.
Acute cardiac care future
As the UK develops services to provide 24/7 cover for primary PCI at Heart Attack Centres, the future of Coronary Care Units (CCUs) in other acute hospitals is potentially now under threat. It has been clear for some time that the traditional role of CCUs has been changing, partly due to a reduction in the incidence of ST-elevation myocardial infarction (STEMI), with a corresponding increase in other acute coronary syndromes (ACS), and also due to an increase in presentation of other cardiac conditions, such as atrial fibrillation and heart failure. Services must be well organised and efficient to deal with these patients effectively. This now presents a significant challenge for Acute NHS Trusts.
The BCS believes that:
1. All hospitals accepting acute medical intake should have access to a CCU with appropriate staffing, medical and nursing expertise.
2. The role of the traditional CCU should be widened to cover the greater variety of presenting conditions now managed there – acute cardiac care rather than coronary care.
3. There is evidence that when patients presenting with acute cardiac conditions have early access to specialist opinion and are transferred to cardiology care, outcomes improve.
BCS have organised a Working Group to make recommendations for the delivery of acute cardiac care. Initial responses from cardiac networks suggest that there is considerable interest in this topic.
The Guidelines and Practice Committee deal with requests for comments on proposals from the National Institute for Health and Clinical Excellence (NICE) and other bodies, usually in tandem with the relevant affiliated groups. It also deals with requests for ratification of guidelines from the European Society of Cardiology (ESC) and review of pathways produced by Map of Medicine.
The BCS Imaging Council brings together representatives of the main cardiac imaging disciplines of echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography (CT), nuclear cardiology and invasive angiography. The Council has overseen the development of training documents to complement the Cardiology Curriculum and coordinates the imaging track at the BCS Annual Conference. It has also overseen the development of quality improvement programmes in the imaging disciplines, designed to provide standards against which departments can benchmark themselves.