The report contains an overall analysis of numbers going into medical specialist training and identifies which medical specialties are at risk of over-supply as well as identifying the geographical balance. This report is the first of a number of reports looking at the shape and size of the overall workforce needed for the NHS of the future.As one of the first pieces of work carried out by the CfWI in its current form, and within a constricted time span, the underpinning research is necessarily limited, but the report makes recommendations and identifies emerging messages. NHS Employers has welcomed the final recommendations on medical training numbers for 2011 outlined in the CfWIs report published today. Bill McMillan, head of medical pay and workforce at NHS Employers, said: “We support the CfWIs programme of work to increase understanding of the shape of the future medical workforce and the numbers going into training. “It is critical that the correct number of doctors are trained in the specialities and geographical areas where they are most needed to avoid the risk of either a shortage or significant over-supply, both of which can be expensive, demoralising for doctors and affect patient care. “NHS organisations have a central role to play in medical training in the UK and are ultimately answerable to the public and patients for ensuring they have the right people in place with the correct skills, knowledge and commitment. Planning for the next generation of qualified doctors is central to this and todays report will help inform their decisions.” NHS Employers believes it is also important that employers are able to influence the number and geographical location of trainees to make sure that the balance between training and service is appropriate as doctors progress through their training programmes. Shifts in the numbers of trainees at each level of training can have a profound impact on service delivery and the costs of that service. This impact may well extend beyond the medical workforce and encompass reconfigurations of service and different ways of delivering services. NHS Employers believes that NHS organisations are best placed to influence these aspects of the discussions and planning. Together with demand and supply issues there is also a question of cost.
Specialist nurses as good as doctors in managing rheumatoid arthritis patients
The results of the multi-centre trial at the University of Leeds, funded by Arthritis Research UK, showed that there may be some clinical benefit to people with rheumatoid arthritis, whose condition is managed in clinics run by rheumatology clinical nurse specialists, especially with respect to their disease activity, pain control, physical function and general satisfaction with their care. Rheumatoid arthritis is a chronic inflammatory disease , which if untreated may lead to severe disability or death. However, the management of the disease has changed significantly over the past ten years due to better understanding of the disease process, an emphasis on early diagnosis, intensive treatment and the use of more efficacious drug therapies . The nation-wide trial was led by Dr Mwidimi Ndosi, of the University’s Institute of Rheumatic and Musculoskeletal Medicine, and former University academic Dr Jackie Hill. It compared the outcomes of 180 people with rheumatoid arthritis in 10 out-patient clinics around the UK, half run by clinical nurse specialists, and the other by rheumatologists. In both groups the nurse or doctor took a patient history, carried out a physical examination, discussed pain control, change of drugs or dose (including steroid injections ) and offered patient education and psychosocial support. The nurse-led clinics’ appointment times were on average longer than the consultants’ (20 vs 15 minutes). The results of the study, published in the Annals of the Rheumatic Diseases, found that although the nurses made fewer changes to a patient’s medication and ordered fewer x-rays and steroid injections, their patients saw greater improvement in disease activity than those under rheumatologists’ care. Nurses also provided patient education and psychosocial support more frequently than rheumatologists, and their patients also had fewer unplanned hospital admissions or visits to accident and emergency units. “The results of this study show that clinics run by rheumatology clinical nurse specialists can manage many people with rheumatoid arthritis without any reduction in the quality of care and treatment,” said Dr Ndosi. In addition to better improvements in the disease activity, nurse-led clinics had overall lower healthcare costs, representing a cost-effective service. The economic evaluation took into account healthcare resource use, including consultation costs, investigations, hospital admissions and treatments including over-the-counter medications. Interestingly, throughout the 12-month follow-up period, the proportion of patients receiving expensive biologic drug treatment remained more or less constant in the nurse-led clinics, while that of rheumatologist-led clinics doubled. “The development of the role of clinical nurse specialist in rheumatology has resulted in great improvements in rheumatology service, providing a high quality, accessible and person-centred care to people with rheumatoid arthritis ,” said Dr Hill. “The results of this research are encouraging, demonstrating that this model of care is effective, safe, and associated with more patient satisfaction. At a time when deficiencies have come to light in some areas of the NHS, it’s good to know that in rheumatology there are high levels of satisfaction with the care we provide.” Professor Alan Silman, medical director of Arthritis Research UK commented: “Rheumatoid arthritis is, despite modern treatment, a chronic condition requiring long-term expert professional care to help patients manage their symptoms and control disease.