The UK Medicine and Healthcare products Regulatory Agency has asked the College to advise Fellows and Members that the European Medicines Agency has completed a review of rimonabant (Acomplia, a treatment for obesity) after concerns about its psychiatric safety. The review has found that the benefits of rimonabant do not outweigh the risks of psychiatric reactions in clinical use. The marketing authorisation for this medicine will be suspended across the European Union.
The Federation of the Royal Colleges of Physicians in the UK has just published its census of consultant physicians in the UK 2007.
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Expansion of the consultant physician workforce during 2006/2007 was 4.8%. Whilst an improvement on the previous year's increase of 1.8%, the two-yearly average expansion (3.5%) remains disappointing.
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Acute medicine had the greatest increase (63%). The Federation of Medical Royal Colleges of the UK's vision of delivering a consultant-led acute medicine service is successfully rolling out across the county. There were also expansions in specialties that support emergency admissions including endocrinology & diabetes, gastroenterology, geriatric medicine and respiratory medicine.
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Competition for consultant posts in many medical specialties appears to be increasing. Only 20% of advisory appointment committees failed to appoint a consultant physician during 2006/2007 (compared with more than 30% in recent years).
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Less than whole-time consultant physicians comprised 12.9% of the workforce. 24% of physicians were keen to reduce their contracted hours, suggesting a lack of availability to reduce work/work flexibly.
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Women consultants increased by 8.7% in 2006/2007. Women are outpacing average workforce expansion and represent 25% of the workforce. 45% of SpR/StRs in the medical specialties are women. The number of women consultants will continue to rise over the next few years due to those women entering medical training. However, women are under-represented in several acute specialties and research is needed to ensure that options for women in medicine are not limited.
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Average contracted time for physicians has fallen from 10.8 programmed activities (PAs) for consultants on all contracts. Whole-time consultant physicians are typically contracted fpr 11.3 PAs. Many physicians work in excess of their contracted hours, providing 0.8 PAs (3.2 hours) above contracted time.
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54% reported working in excess of the 48 hours required by the European Working Time Directive (EWTD). Consultant physicians may be pressured to increase their hours to support patients when the 2009 EWTD applies to junior doctors.
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92% of hospitals admit medical patients to a medical admissions unit. Once admitted there is a trend to triage the medical take to specialty firms. 56% of consultants on duty for emergency medicine undertake twice-daily ward rounds; 12% choose to do rolling or continuous ward rounds.
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Only 22% of consultants are free from other clinical duties to concentrate on acute medicine.
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55% of consultants report that they have inadequate time to support trainees in training, assessment or appraisal.
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Drives towards increasing care in the community and hospital reconfiguration have changed working practices for consultant physicians: 15% reported a change in workplace, 20% reported a change in job-plans and 28% reported a change in workload; equal numbers reported increases in work as decreases.
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Analysis of the populations served by consultant physicians for medical specialties shows variations in provsion by specialty between regions (strategic health authorities) and nations. Almost all fall short of the optimum for delivery of expected standards of care, (recommended by the Federation of Medical Royal Colleges of the UK and specialist societies). It is hard to understand how standards of care can be similar when there is such wide variation.
