Cardiac workforce requirements in the UK - David Hackett Chairman, BCS Cardiac Workforce Committee
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Cardiac workforce requirements in the UK
David Hackett
Chairman, BCS Cardiac Workforce Committee
June 2005Page 2 of 45
Published by: British Cardiac Society
9 Fitzroy Square
London
W1T 5HW
Tel: +44 (0) 20 7383 3887
Email: enquiries@bcs.com
Website: www.bcs.com
A company limited by guarantee registered in England number 3005604
Registered charity number 1093321Page 3 of 45
Contents:
Page
1 Headline recommendations 5
1.1 Summary: consultant cardiologists required in the UK 5
1.2 Summary: non-consultant cardiology workforce required 6
2 Introduction 7
3 Background to our methods 7
4 Cardiac services for populations: networks versus institutions 9
5 Independent provision of cardiac services 10
6 Women in cardiology 10
7 Academic and research requirements: academic workload 10
contributions to NHS
8 Assumptions: consultant workforce in cardiology 10
9 Assumptions: non-consultant workforce in cardiology 11
10 Clinicians in training 11
11 Workforce needs 11
12 Conclusions 12
Appendix 1: Methodology 13
1 Availability of clinical staff 13
2 Consultant contracts: comparisons with and differences between UK 14
countries
3 Assumptions 14
4 Notes on methodology: detailed workforce requirements 15
Appendix 2: detailed workforce requirements 16
Cardiac workforce requirements: National service framework for CHD 16
1 Secondary prevention of CHD 16
1.1 Specialist clinics for hypertension and lipids 16
2 Investigating and treating angina 16
3 Acute chest pain and thrombolysis service: non consultant 17
staffing
4.1 Diagnostic cardiac catheterisation and angiography: current 17
requirements
4.2 Diagnostic cardiac catheterisation and angiography: future 18
requirements
5 Revascularisation: percutaneous cardiac intervention (PCI) 19
6 Miscellaneous cardiac invasive interventional procedures 21
7 Diagnosis and management of heart failure 21
8 Cardiac rehabilitation (phases I-III) 22
9 Cardiac pacing and electrophysiology devices 23
9.1 Implantable loop recorders 25
10 Pacemaker technical follow-up 25Page 4 of 45
10.1 Implantable cardiac defibrillator (ICD) follow-up 26
10.2 Biventricular pacemaker follow-up 27
10..3 Patients with ICD implants: post-implant and follow-up support 28
requirements:
11 Invasive arrhythmia electrophysiological (EP) studies and 28
ablation
Other cardiac workforce requirements 29
12 Rare cardiac conditions 29
Workforce requirements: general cardiology 29
13 General outpatient cardiology 29
14 General inpatient cardiology 31
14.1 Future inpatient care 32
14.2 Nurses required for inpatient cardiology care 33
14.3 Workforce rotas for inpatients requiring cardiac care 33
15 Paediatric cardiology 34
16 Adults with congenital heart disease 34
17 Academic cardiologists 35
Non-invasive cardiac imaging 36
18 Echocardiography 36
19 Nuclear cardiology 37
Notes for sections 18 and 19: Adjustment of workforce requirements 37
for dynamic imaging in coronary disease
20 Cardiovascular imaging 38
21 Other non-invasive cardiac investigations 38
21.1 Electrocardiograms 38
21.2 Other exercise testing 38
21.3 Ambulatory monitoring 38
21.4 Autonomic investigations 38
22 Assessment of doctors in training in cardiology 39
23 Management requirements in cardiology 39
Summary: subspecialty consultants required 39
Summary: consultant cardiologists required 40
Summary: non-consultant cardiology workforce required 41
Glossary 42
References 45Page 5 of 45
Headline recommendations: cardiac workforce requirementsa
Total consultant cardiologists 52.7 – 84.2 per million population
Total non-consultant cardiology workforce 168 – 211 per million population +?b
1.1. Summary: consultant cardiologists required in the UKa
Cardiology subspecialties Total programmed PAs per Full time
General inpatient and outpatient activities (PAs) per week pmpc equivalent (FTE)
requirements included pro rata million population consultants pmp
With number of procedures or cases; (pmp) per year (working 7.5 PAs
pmp = per million population
per week)
Diagnostic catheters (4412–6750 pmp) 1166 – 2434 28 – 59 3.8 – 7.9
Intervention (2200-3000 pmp) 1462 – 2703 36 – 66 4.8 – 8.8
Heart failure 1807 – 2667 44 – 65 5.9 – 8.7
Rehabilitation (5089 cases pmp) 682 – 931 17 – 23 2.2 – 3.0
Devices (900 new permanent 1808 – 2469 44 – 60 5.9 – 8.0
pacemakers + 700 new implantable cardiac
devices + 107 car resonant pmp)
Electrophysiological study (EPS) + 555 – 1515 14 – 37 1.8 – 4.9
ablation (350–700 pmp)
Miscellaneous (specialised 2º previous 369 – 773 9 – 19 1.2 – 2.5
and rare miscellaneous conditions)
Paediatric cardiologists 1120 – 1224 27 – 30 3.6 – 4.0
Adults with congenital heart 733 – 804 18 – 20 2.4 – 2.6
disease
Less academic -442 -11 -1.4
Imaging: Echocardiography (42800- 4448 – 7669 109 – 187 14.5 – 24.9
47700 pmp)
Imaging: nuclear (6000 stress pmp) 1141 – 1557 28 – 38 3.7 – 5.1
Other imaging 684 – 934 17 – 23 2.2 – 3.0
Trainee assessment 34 1 0.1
Clinical management 624 15 2.0
Total for consultants 16190 – 25896 395 - 632 52.7 – 84.2
These estimated requirements imply that the average individual consultant cardiologist will be
undertaking 1.5-2 programmed activities (Pas) of inpatient cardiac care, 1-2 PAs of general
outpatient cardiac care, and 3-5 PAs of specialised outpatient or laboratory cardiac care, each
week; without any PAs for on-call responsibilities or emergency or unpredictable out-of-hours
work allocated within the 7.5 PAs of direct clinical care.
a
Ranges provided are the minimum and ideal future requirements
b
No data or estimations are available
c
Assumes consultants available 41 weeks per yearPage 6 of 45
1.2. Summary: non-consultant cardiology workforce requiredd
Non-consultant cardiology workforce Sessions pmp per FTE clinicians per
Non-consultant cardiologists, General yeare million population
practitioners with a specialist interest in cardiology
(GPwSIs), nurses, cardiac physiologists (CPs),
required
(working 9 clinical
radiographers
sessions per week)
Secondary prevention of CHD 2372 6.0
Rapid access chest pain clinics 3495 17.6
(RACPC)
Acute chest pain and thrombolysis ? 28 – 47
Post myocardial infarction (MI) follow-up 92 0.2
Diagnosing heart failure 662 1.7
Monitoring heart failure 4590 11.6
Total specialist cardiac clinicians 11211 + ? 65.1 – 84.1
(mainly nurses?)
Inpatient nursing care (coronary care 344 – 571
units (CCU) + wards)
Cardiac catheterisation and 3531 – 5401 8.9 – 13.6
angiography
Angiography pre-assessment 338 – 518 0.9 – 1.3
Percutaneous coronary intervention 4224 – 5760 11 – 15
(PCI)
PCI pre-assessment 169 - 230 0.4 – 0.6
Post PCI follow-up 337 – 460 0.9 – 1.2
Other intervention 177 – 265 0.5 – 0.7
Devices - implantation 1357 (x2) 6.9
Devices – follow-up 4800 (x2) 24
Other electrophysiological intervention 420 – 840 2.1 – 4.2
Total invasive cardiac clinicians 15353 – 19631 50.4 – 61.0
(physiologists, nurses,
radiographers)
Echocardiography: CP/sonographers 10969 – 15880 28 – 40
Other non-invasive cardiac ? ?
investigations
Total non-invasive cardiac clinical 10969 – 15880 + ? 27 – 39 + ?
physiologists
Total cardiac rehabilitation clinical 7803 20
staff
Total (excluding CCU + wards) 45336 – 54525 168 – 211 plus ?
(Non-consultant cardiology workforce)
d
Ranges provided are the minimum and ideal future requirements
e
Assumes non-medical staff available 44 weeks per year @ 3.75 hours per session; and that non-consultant medical
staff undertake 9 sessions of direct clinical work each week.Page 7 of 45
2. Introduction
The British Cardiac Society established the Cardiac Workforce Committee in 2004.
This Committee superseded the previous BCS Cardiac Workforce Working Group that
produced recommendations in 2003 and 2004 for cardiac workforce requirements in
the UK.
Patients are increasingly and rightly demanding specialist cardiological care. Patients
with acute cardiac conditions have better care and outcomes when managed by
cardiologists. Cardiologists should be available to advise and manage patients with
acute cardiology conditions. Hospitals receiving acute cardiology patients should have
a cardiologist on-call rota. Fundamentally, the workforce requirements must enable
the appropriate, effective, efficient and prompt delivery of specialised care. It should
allow patients and their carers to have adequate time with professional clinicians to
discuss their condition and treatments.
3. Background to our methods
In this document we have estimated the cardiac workforce requirements based on
general cardiology needs as well as for each cardiac subspecialty. We also estimate
the non-medical cardiac workforce requirements. We do this from the “bottom up” for
the UK, based on population or cardiac network needs. We have considered
evidence invited and received from each Affiliated Group of the British Cardiac
Society.f We have also considered published statistical data from the British Heart
Foundation, data of NHS outpatient and inpatient activity from the statistical section of
the Department of Health (England) website, and data from other sources.
It is difficult to forecast the recommended workforce requirements of the future when
there are so many rapid cardiac advances currently being introduced. More cardiac
advances are expected and are likely to be introduced into clinical practice within the
time frame of our estimated workforce requirements. We expect clinical advances
that are as yet clinically unknown to be introduced into cardiac practice within the time
frame addressed in this document. However, the workforce consequences of these
developments cannot be quantified within our estimated workforce requirements.
We have considered the following ranges of workforce requirements:
• Firstly, the current workforce required for the provision of cardiac services.
• Secondly, future cardiac workforce requirements, with a range provided from
the minimum to the ideal.
We have provided our recommendations for the workforce required to provide cardiac
services in the future as a range, from the minimum to ideal. It would be unwise to
rely on the bare minimum numbers recommended for workforce requirements. For
example, if the need for percutaneous cardiac intervention (PCI) is actually more than
2,200 procedures per million population and is nearer 3,000 per million population,
then we could be ‘caught short’ by the number of interventionists. We recognise that
neither the minimum nor ideal workforce in cardiology can be instantly achieved.
However, our assessments indicate the future numbers of the cardiac workforce
required. We should be planning and training for this now.
Whilst many advances and changes in cardiac care can be predicted to some extent,
their impact on the required workforce and skill mix are more difficult to foresee with
f
The Affiliated Groups of the British Cardiac Society are: British Association for Cardiac Rehabilitation (BACR),
British Association for Nursing in Cardiac Care (BANCC), British Atherosclerosis Society (BAS), British
Cardiovascular Intervention Society (BCIS), British Congenital Cardiac Association (BCCA), British Junior
Cardiologists’ Society (BJCA), British Nuclear Cardiology Society (BNCS), Heart Rhythm UK (HRUK), British
Society of Echocardiography (BSE), British Society for Heart Failure (BSH), British Society for Cardiovascular
Research (BSCR), Heartcare Partnership (UK) (HCP (UK)), Primary Care Cardiovascular Group (PCCG), Society
for Cardiological Science and Technology (SCST).Page 8 of 45 accuracy. We acknowledge that clinical work is being, and will be, undertaken differently from the past. For example, we have assumed that non-consultant cardiologists will see most of the patients attending Rapid Access Chest Pain Clinics, routine follow-up clinics after myocardial infarction, routine follow-up clinics after percutaneous coronary intervention, Rapid Access Heart Failure Clinics, and heart failure follow-up clinics. Patients will frequently be seen by non-medically qualified staff, such as cardiac specialist nurses. We expect more ‘one-stop’ clinics, for example for people with heart murmurs attending clinics in echocardiography laboratories. We do not, and cannot, precisely specify the skill mix and workforce disciplines required for each cardiac subspecialty area. We are not aware of any systematic information (from the NHS Modernisation Agency, for example) about possible new ways of working which has allowed the redeployment of clinicians. For example, clinical work that has previously and conventionally been undertaken by consultant cardiologists or junior cardiologists, that is now undertaken by other clinicians such as nurses or clinical physiologists. So we cannot accurately and systematically calculate by how much the future cardiac medical workforce requirements might be reduced through new ways of working. There are many other issues that we expect will affect cardiac workforce requirements in the future. These include modernisation and new ways of working. In future, we expect more flexible working hours, an optional extended retirement age, changing job plans at different stages of careers and reduced working hours as a consequence of the European Working Time Directive. We also expect multi-skilling, changing roles such as nurse practitioners, increasing patients’ expectations, more specific clinical governance and revalidation issues requiring more people to do the same work as undertaken in the past, a reduction in service contribution by academics and trainees, and less service delivery by trainers because of more specific training requirements. We expect more part-time clinicians working in cardiology in the future, especially amongst women. It is notable that 83% (20 out of 24) of female specialist registrars in cardiology are considering part-time work on completion of their training (see section 6 below)1. If substantially more consultant cardiologists choose to work part-time in the future, there will be implications for substantial increases in the numbers of trainees required. We expect the net result of all these changes will be the need for more clinicians. We will need a more specialised medical and non-medical workforce compared to the present ways and means of delivering cardiac services. Extra staff to provide new ways of working should result in improvement in the consistency and quality of care that patients receive. These new ways of working may reduce the demands on cardiologists and their time. However, in some cases, supervision of the new ways of working may increase the demands on cardiologists, who will be responsible for running these services. Non-medical staff will not be able to become competent in and undertake all of the current duties of medical staff. Furthermore, all of the above new ways of working will not diminish the estimated requirements for cardiologists undertaking the assessment and clinical care of patients. This applies especially emergency and acute cases, and performing invasive procedures, as outlined in this document. If these changes in medical working practices are to be successfully delivered, there remains widespread concern within the cardiac community in regard to the availability of the additional non-medical professional clinical staff who will be required.
Page 9 of 45
4. Cardiac services for populations: networks versus institutions
The cardiac workforce requirements have been estimated for network populations,
based on the needs of each million of the population. Of course, the population is not
necessarily simply divided into ‘one million’ pockets for the purposes of workforce
calculations.
In this way, cardiac networks can estimate their workforce and subspecialty
requirements, rather than base their needs on individual institutions, or on the
competency need for single institutions or individual clinicians. For example, in some
areas, large secondary care hospitals may provide all secondary and some tertiary
care cardiac services. On the other hand, in other regions, small secondary care
hospitals may provide little specialist secondary or tertiary care cardiology. These
services might be provided by tertiary care hospitals for the local cardiac network.
Cardiac workforce requirements for secondary care cardiac services can be
calculated based on a referral population basis. Cardiac workforce requirements for
tertiary care cardiac services should be calculated in the same way. It can be more
difficult to estimate, however, as the size of the tertiary referral population may be less
certain. Furthermore, most tertiary care cardiac units also provide secondary care
cardiac services for their local, smaller population.
Our workforce recommendations are based on an average population need. They
should be adjusted for the local burden of cardiac disease, and for geographical
factors such as sparse population density. Where the local incidence or prevalence of
cardiac illness is high, for example in Scotland and in Northern Ireland, then the
cardiac workforce requirements should be adjusted accordingly. However, where the
local incidence or prevalence of cardiac illness is lower than average, for example in
prosperous parts of England, it is highly debatable whether the cardiac workforce
requirements should be adjusted down accordingly.
Demographic trends will, in fact, result in the need for an increased cardiac workforce
in the future. The reduction in mortality of coronary heart disease leads to an increase
(not a decrease) in the prevalence of cardiac morbidity and the numbers of patients
with cardiac problems. An increased ageing of the population and the improved
management of patients with cardiovascular diseases results in a higher prevalence
of cardiac disease. The prevalence of disease will grow faster than the rate of
population growth.
The British Cardiac Society has published a report on regional differences in the
provision of cardiac services in the UK.2 This report points out that there are large
discrepancies and disparities in the commissioning, investment, workforce, facilities,
waiting times, capacity and volume of procedures, and availability of new
technologies, in different parts of the UK. These differences are unfair and
unacceptable.
The National Service Framework (NSF) for Coronary Heart Disease (CHD) in England
published in 20003 has resulted in a marked investment in cardiac services and
improvement in cardiac health of the population. Further investment and
improvements will be expected with the publication Chapter 8 of the NSF for CHD:
Arrhythmias and Sudden Cardiac Death.4 These initiatives are expected to result in
further increases in demands on cardiac services, and from patients and people. In
turn, these increased demands will result in the need for greater workforce numbers
and a more specialised cardiac workforce.
These factors will result in an increase in the prevalence of patients with chronic
coronary heart disease, heart failure, and arrhythmias, particularly atrial fibrillation,
etc. People are visiting, and are expected to increasingly visit, their physicians more
frequently. Therefore, we see no reason to consider a reduction in our
recommendations of the need for the cardiac workforce in the future with a reductionPage 10 of 45
in age-specific cardiac mortality as observed in the UK, or with improved cardiac
services.
5. Independent provision of cardiac services
The cardiac workforce requirements recommended in this document are for the
provision of all cardiac services for populations or cardiac networks. Where there is
substantial independent provision, for example from the private sector, then the
National Health Service workforce requirements could be reduced accordingly. No
systematic data is available on the volume of provision of cardiac services to each
cardiac network by the independent sector, however. There is no public data that
could be used to adjust the NHS cardiac workforce requirements relative to the
independent provision of cardiac services for the local cardiac network. We do not
expect the required cardiac workforce numbers to be affected in any major or
important way by the independent provision of cardiac services.
6. Women in cardiology:
The British Cardiac Society has recently published a report from a working group on
Women in UK Cardiology. This report points out that in 2002 and 2003, women
represented 60.5% of entrants to medical school, but only 16.8% of specialist registrar
trainees in cardiology, and only 7.5% of consultant cardiologists. Recommendations
in this report include the encouragement of recruitment of women, the facilitation of
flexible training, the establishment of more part-time consultant posts, and the
opening up of cardiac subspecialties to more women, with mentoring support
available at all levels. The implications for the cardiac workforce requirements will be
the need to increase the number of trainees and training posts by more than the
number of expected full-time equivalent consultant cardiology posts required.
7. Academic and research requirements: academic workload contributions to NHS
The RCP Consultant Census survey of academic physicians in September 2002
indicated that each academic cardiologist worked an average of 9.2 notional half-days
(NHDs) for the NHS in excess of their contract. There needs to be a formal
recognition that academic cardiologists cannot continue to shoulder this level of
individual clinical workload in the future. The increased numbers of under-graduate
medical students, and post-graduate students and trainees, will result in a need for an
increase in the number of academic cardiologists with relatively less NHS
commitments (see section 16 in the appendix).
The British Cardiac Society strongly supports cardiovascular research, whether
undertaken by those with primary academic appointments or by staff with full-time
NHS appointments. The NHS has formally specified the importance of research (and
development). Substantial teaching or research cannot be shoehorned into one of the
average of 2.5 programmed activities of supporting professional activity as part of a
job plan. The time required for and devoted to teaching and research must be
recognised in individual job plans; and sessions or programmed activities of direct
clinical care replaced by research activities will require more staff to deliver clinical
care.
8. Assumptions: consultant workforce in cardiology
Our estimates of cardiac workforce requirements for consultant cardiologists are
based on the new consultant contract (2003) in England.5 Our assumptions are that:
• A programmed activity (PA) for consultant medical staff is 4.0 hours.
• Each full-time equivalent consultant undertakes 7.5 programmed activities
(PAs) of direct clinical care each week. However, each individual consultant
and job plan may differ in the number of programmed activities of directPage 11 of 45
clinical care undertaken. Individual job planning and contracts will determine
the individual number of consultants required.
• Where consultant availability and working times vary compared with the
consultant contract (2003) in England, the estimates for the consultant
cardiology workforce required will need to be adjusted accordingly, for
example in other UK countries.
The recommendations for proposed sub-specialty workforce requirements should not
be seen as being too rigid. Many consultant cardiologists could have interests in
general and secondary care cardiology as well as in a subspecialty. Other consultant
cardiologists might have interests and skills that span more than one subspecialty.
Our recommendations will, however, allow cardiac networks to estimate their needs
for subspecialty workforce requirements.
The estimated cardiac workforce needs are provided here on the basis of overall
numbers of programmed activities or sessions required. This will allow a cardiac
network to plan the overall workforce needs for its communities, taking the specific
individual interests of the consultant cardiologists into account. We have not included
the needs of acute (general) medicine for those consultants with combined
appointments in cardiology and acute (general) medicine in these estimates of cardiac
workforce requirements.
9. Assumptions: non-consultant workforce in cardiology
Our assumptions are that:
• A clinical session for non-medical clinical staff is 3.75 hours (based on the
terms and conditions of Agenda for Change).6
• Each full-time equivalent clinician undertakes an average of 9 sessional
activities of direct clinical care each week. However, each individual clinician
may differ in the number of sessions of direct clinical care undertaken.
• Where clinical staff availability and working times vary compared with the
terms and conditions of Agenda for Change, the estimates for the non-
consultant cardiac workforce required will need to be adjusted accordingly.
10. Clinicians in training
We strongly believe that the contribution of clinical trainees to delivering routine
service workload should not be considered or included in substantive workforce
planning. With more formal training programs and competency-based assessments,
more of the trainer’s time will be required to train the trainees in the future. In fact, the
needs of trainers in training the trainees is likely to require additional (training) time
over and above the estimated requirements for delivering the service workload by
trained, substantive clinicians.
Training places for doctors should probably be numerically targeted for the needs of
subspecialty training. In addition to the needs for general and secondary care
cardiology, it will be necessary to consider national or regional quotas of numbers of
doctors in training in intervention, devices and arrhythmias, heart failure, cardiac
imaging, paediatric cardiology, and in adults with congenital heart disease (ACHD),
etc.
11. Workforce needs
The number of specialist clinicians required for the cardiac workforce are specified as
full time equivalents (FTE). With the new 2003 consultant contract (in England), some
consultant cardiologists may work more than 7.5 programmed activities (PAs) of direct
clinical care. This will result in an overall reduction in the total consultant numbers
required for the cardiac workforce. On the other hand, we expect more part-time
clinicians in the future, especially more part-time consultant cardiologists, particularlyPage 12 of 45
amongst women. This will result in an overall increase in the total numbers required
for the cardiac workforce. However, the FTE workforce requirements would remain
the same. These trends will obviously have quite different implications for the
numbers of trainees required.
There were 710 (equivalent to 663 FTE - Department of Health data 2004)7 or 630
(Royal College of Physicians of London data 2003)8 consultant cardiologists in
England, representing 12.4 – 14.5 per million population. If all current cardiology
specialist registrar trainees with a national training number in England were appointed
to consultant cardiology posts, we understand that by 2010, there would be
approximately 900 consultant cardiologists in England, or 18 per million population.
We fear that this level of provision will be very inadequate for the consultant cardiac
workforce requirements of the UK.
12. Conclusions
Cardiac workforce requirements in the UKg
Total consultant cardiologists 52.7 – 84.2 per million population
Total non-consultant cardiology workforce 168 – 211 per million population +?
g
Ranges provided are the minimum and ideal future requirementsPage 13 of 45
Appendix 1: Methodology
1. Availability of clinical staff:
NHS staff Medical staff England (new Non-medical clinical
consultant contract 2003) staff
(Agenda for
Change)6
Annual leave 30 – 32 days 27 – 33 days
Public holidays 8 days 8 days
Internal clinical governance leave ? ?
Study leave 10 days (30 days for SpRs) ?
External professional leave ? ?
Sickness absence leave rate 1.4%h (England) 4.7% (England: see
below)
Estimated subtotal leave 48 – 60 days 36 – 52 days
Total annual leave (5-day working 10 – 12 weeks 7 – 10 weeks
week)
Total working year 40 – 42 weeks 42 – 45 weeks
Average working year 41 weeks 44 weeks
Working hours per week 40 hours 37.5 hours
(excluding breaks)
Working hours per session 4.0 hours per Programmed 3.75 hours per
Activity (PA) session
Work time spent in direct clinical care 7.5 PAs (75% of total) 9 sessions?
(assumption 90% of
total?)
Annual work time of a FTE clinician ~60% ~75%
spent in direct clinical care
We do not know how much time is spent, on average, by clinical staff on activities that require
internal or external professional leave in the UK. Many NHS Trusts have clinical governance
half-days every month which all clinical staff attend. This will reduce clinical availability of
individuals by perhaps 8 sessions or programmed activities of direct clinical care over a year.
It is uncertain how much time is spent, on average, by cardiologists on external professional
activities. The Department of Health has specifically supported activities involving the need
for external professional leave for the greater good to the NHS.
After allowing for leave, and time spent outside direct clinical care, it can be seen that each
full-time equivalent consultant cardiologist is available for work involving direct clinical care for
about 60% of their annual time. Therefore for consultant cardiologists to provide a full-time,
40 hours per week, 52 weeks per year, service that covers their leave, and covers their work
activities that are not direct clinical care, requires 1.7 full time equivalent consultants. It is not
known whether sickness absence rates for consultant medical staff in the NHS are different in
the various countries in the UK.
Similarly after allowing for leave, and time spent outside direct clinical care, it can be seen that
each full-time equivalent non-medical clinical staff is available for work involving direct clinical
care for about 75% of their annual time. Therefore for non-medical clinical staff to provide a
full-time, 37.5 hours per week, 52 weeks per year, service that covers their leave, and covers
their work activities that are not direct clinical care, requires 1.3 full time equivalent non-
medical clinical staff.
Reported sickness absence leave rates for all staff working in the NHS in different countries of
the UK:
• England 4.7%i
h
http://www.nhspartners.org.uk/subscribers/Inter_org_summary.pdf
i
http://www.dh.gov.uk/assetRoot/04/08/71/28/04087128.xlsPage 14 of 45
• Wales 6.0%j
• Scotland 4.9%k
• Northern Ireland 4.9%l
The reported sickness absence rates for all staff working in the NHS in Scotland and in Northern
Ireland are similar to those in England, but are greater in Wales. Therefore, the requirements for
the non-consultant cardiac workforce in Wales should be increased by about 1.3% more than the
estimates provided in this document for England.
2. Consultant contracts: comparisons with and differences between UK countries:
Country Englandm Walesn Scotlando N Irelandp
Annual leave 30 – 32 days 30 days 30 days 30 – 34 days
Public holidays 8 days 8 days 10 days 10 days
Study leave 10 days 10 days 10 days 10 days
Total leave# 48 – 50 days 48 days 50 days 50 – 54 days
Usual working hours 40h per week 37.5h per week 40h per week 40h per week
Sessional or PA hours 4h per PA 3.75h average 4h per PA 4h per PA
Direct clinical care 7.5 PAs/week 7 sessions/week 7.5 PAs/week 7.5 PAs/week
#
includes internal clinical governance leave, external professional leave and sickness absence leave
Leave entitlements are broadly similar between the various countries in the UK (although slightly
greater in Northern Ireland for consultants with more than 7 years of completed service). But the
terms and conditions of service for consultants in Wales results, on average, in 12.5% fewer hours
(26.25 hours compared with 30 hours in England) of direct clinical care each week. Therefore, the
requirements for the consultant cardiac workforce in Wales should be increased by about 12.5%
more than the estimates provided in this document.
3. Assumptions:
Cardiac activities which are generally consultant-based:
• Diagnostic cardiac catheterisation and angiography
• Percutaneous Coronary Intervention (PCI), carotid intervention, ASD/PFO closure
• Device implantation and replacement
• Invasive cardiac electrophysiology studies and ablations
• Trans-oesophageal and stress echocardiography
• Reporting cardiac resynchronisation, magnetic resonance and nuclear studies
• Management of rare conditions: cardio-myopathies, pulmonary hypertension, Marfans
syndrome, muscular dystrophies, etc
• Paediatric cardiology, adults with congenital heart disease (ACHD)
• Formal clinical management (eg clinical director, service director, lead clinician)
Cardiac activities which are generally not consultant based, but with consultant
supervision:
• Device follow-up
• Trans-thoracic echocardiography
• Reporting non-invasive cardiology investigations, echocardiography
j
http://www.agw.wales.gov.uk/publications/2004/agw2004_1es.pdf
k
http://www.isdscotland.org/isd/files/040525_web.pdf
l
http://www.dhsspsni.gov.uk/hss/governance/documents/HPSS_RMGen_Induction.pdf
m
http://www.dh.gov.uk/assetRoot/04/07/04/06/04070406.pdf
http://www.dh.gov.uk/assetRoot/04/06/99/50/04069950.pdf
n
http://www.wales.nhs.uk/sites3/documents/433/Nat_Consultant_Contract.pdf
http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=433&id=23209&pid=3907
o
http://www.show.scot.nhs.uk/sehd/paymodernisation/ConsultantContract.htm
p
http://www.dhsspsni.gov.uk/publications/2004/Consultant_TCS_%20FinalVersion.pdf;
http://www.dhsspsni.gov.uk/publications/2004/NewConsultantContract.pdfPage 15 of 45
Cardiac activities which are generally not consultant based, but with consultant lead and
direction:
• Secondary prevention
• Rapid access chest pain clinics
• Acute chest pain and thrombolysis
• Pre-assessment for angiography and percutaneous coronary intervention
• Post myocardial infarction follow-up
• Post percutaneous coronary intervention follow-up
• Rapid access heart failure clinics
• Monitoring and follow-up of heart failure
• Cardiac rehabilitation
4. Notes on methodology: detailed workforce requirements
Note1:
The tables are numbered for each section. For each table:
A refers to consultant cardiologist requirements
B refers to non-consultant requirements for clinicians, both medical and non-medical.
Note 2:
There are several areas where data are not available for cardiac workload and thus not
available for cardiac workforce estimations. Where no data or estimations are available, a “?”
has been entered rather than leave it blank. We would prefer to acknowledge our uncertainty
rather than ignore the requirements. Thus, where estimated workforce requirements have
been listed as “?” or as “data +?”. It implies that the actual numbers are not easily estimated,
and will be greater than those listed in this document.
Note 3:
PMP or pmp = per million population.
DCC = Direct clinical care
PA = Programmed ActivityPage 16 of 45
Appendix 2: detailed workforce requirements
Cardiac workforce requirements: National Service Framework for CHD
1. Secondary prevention of CHD
UK statistics from British Heart Incidence UK Prevalence UK
Foundation (UK population 58.789m)
Myocardial infarction UK 275000 = 4678 pmp 1.2 million = 20412 pmp
Angina UK 335000 = 5698 pmp 2.0 million = 34020 pmp
All CHD UK 2.65 million = 45076 pmp
Coronary heart disease statistics; 2003 edition:
http://www.heartstats.org/uploads/documents%5C2003stats.pdf
1B. Secondary prevention of CHD Requirement pmp
(non-consultant based)
New cases: Incidence of MI @4678 pmp @15 miniutes each (1170 hours)
New MIs for 2º prevention: 50% discharged alive and survive 585 hours
>30d
New cases: incidence of angina @5698 pmp @ 15 minutes (1425 hours)
each
New angina for 2º prevention: 80% 1140 hours
Follow-up cases: prevalence of CHD @45076 pmp @ 10 (7513 hours)
minutes each
Follow-up Coronary Heart Disease for 2º prevention: 80% 6010 hours
Secondary prevention time 7735 hours
Allow 15% extra capacity to allow for peaks and troughs 1160 hours
Total secondary prevention time 8895 hours
Sessions @3.75h each 2372 sessions
If each clinician available 44 weeks per year 54 sessions per week
If each clinician works 9 sessions per week 6.0 FTE clinicians pmp
1.1. Specialist clinics for hypertension and lipids
There is a requirement for specialist regional hypertension clinics, run by consultants, for people
with “resistant or difficult” hypertension. There are perhaps 30-40 such clinics in the UK.
There is a requirement for specialist regional hyperlipidaemia clinics, run by consultants, for
people with “resistant or difficult” hyperlipidaemia. There are perhaps 30-40 such clinics in the UK.
We have assumed 2 PAs per week for each of these clinics.
1A. Specialist prevention clinics Requirement pmp
(Consultant based)
30-40 hypertension clinics with 2 PAs per week 3120 – 4160 PAs UK
30-40 hyperlipidaemia clinics with 2 PAs per week 3120 – 4160 PAs UK
Total specialist prevention clinics 6240 – 8320 PAs
Per million population 106 – 142 PAs pmp
If each consultant available 41 weeks per year 2.6 – 3.5 PAs per week
pmp
If each consultant works 7.5 PAs per week in direct clinical 0.3 – 0.5 consultants pmp
care
2. Investigating and treating stable angina
2B. Rapid access chest pain clinics Requirement pmp
Incidence of angina @335,000 UK 5698 pmp
Referrals for chest pain = 2x incidence 11396 pmp
Clinic time required @1h each referral (including Exercise 11396 hoursPage 17 of 45
ECG testing)
Allow 15% extra capacity to allow for peaks and troughs and 13105 hours
for inefficiency*
Sessions @3.75h each 3495 sessions pmp
If each clinician available 44 weeks per year 79 sessions per week pmp
FTE staff required (Two of nurse, physiologist, GPwSI, or non- 17.6 FTE
consultant cardiologist) each clinician working 9 sessions per
week
* It is not possible to do a partial number of cases in each session (eg 3.5 cases in 3.5 hours); only whole numbers of
cases can be seen and investigated.
3. Acute chest pain and thrombolysis service: non-consultant staffing
We expect in the future that some ambulance and paramedical services will diagnose ST-segment
elevation myocardial infarction, and may administer thrombolytic treatment before hospital
admission. We expect that chest pain specialist nurses will initially assess and diagnose patients
to confirm or exclude chest pain with cardiac causes, and initiate treatment. To provide a
24h/7d/52w service with prospective cover would require a bare minimum of 6 FTE cardiac
specialist nurses in each acute admitting hospital; we understand that Southampton General
Hospital, for example, requires 10 FTE specialist nurses for these responsibilities.
3B. Chest pain specialist nurses PMP
Acute hospital units UK: 274 x 6 -10 specialist nurses each 28 – 47 FTE staff
3B. Post MI follow-up
Myocardial infarction @ 275000 UK 4678
MI: 50% discharged alive and survive >30d 2339
Post MI clinic time @ 0.5h each 1170
Allow 15% extra capacity to allow for peaks and troughs and for 1346 hours
inefficiency
Sessions @ 3.75h each 92 sessions pmp
If each clinician available 44 weeks per year 2.1 sessions per week pmp
FTE staff required each clinician working 9 sessions per week 0.2 FTE
4. Diagnostic cardiac catheterisation and angiography
4.1. Current requirements
The requirements for diagnostic cardiac catheterisation and angiography laboratories was
estimated in 2002 based on the predicted numbers of revascularisation procedures suggested in
the National Service Framework published in 2000.9 It is now clear that the required population
numbers recommended for diagnostic cardiac angiography and percutaneous coronary
intervention are much too conservative. The ratio of diagnostic cardiac catheterisation to all
cardiac interventions (both PCI and cardiac surgery), used to estimate the population requirement
for diagnostic cardiac angiography, was estimated in 2002 at 2.2 to 1. This is also now too
conservative a ratio.
The numbers of percutaneous coronary intervention (PCI) procedures are increasing
exponentially: the mean rate of growth in total PCI numbers in the UK has been 15% per year
since 1991. Planning for a current volume of 1500 PCI procedures pmp is now appropriate. Best
estimates for current planning for future PCI requirements in the UK should be within a range of
2200-3000 procedures pmp (for detailed data see PCI section 5 below). And a ratio of 2.5:1 for
diagnostic cardiac catheterisation procedures to all interventions (PCI and cardiac surgery) is
more appropriate for future planning. It is assumed that perhaps one-third of PCI cases will be a
direct follow-on from diagnostic angiography.
Previously estimates were that the average time required for diagnostic cardiac catheterisation
and angiography was a weighted average of 37.5 minutes (from patient entry to until exit from the
cardiac catheterisation laboratory). St Mary’s Hospital, London, reviewed accurate records for the
overall duration of diagnostic cardiac catherisation and angiography procedures in the cardiacPage 18 of 45
catheterisation laboratory databases. The average duration in 2002-03 was 36.8 minutes (34.5
minutes for elective cases, 39.2 minutes for acute cases). We use an average duration of 37.5
minutes for each diagnostic cardiac angiography case for calculating future workforce
requirements.
4A. Diagnostic cardiac catheterisation and Procedure Procedure time pmp
angios: consultants required now need pmp
Cardiac interventions: total PCI 2200-3000
Cardiac interventions: Angiography before PCI (⅔) 1465-2000
Cardiac interventions: cardiac surgery 700
Total cardiac interventions 2165-2700
Diagnostic cardiac catheterisation and angiography = 5412 – 3383 – 4219 hours pmp
2.5x interventions @ 37.5 minutes 6750 pmp
Allow for 20% inefficiency* and for peaks and troughs 4060 – 5063 hours pmp
Programmed Activites @ 4h each 1015 – 1266 PAs pmp
If each consultant available 41 weeks per year 24.8 – 30.9 PAs per week
pmp
If each consultant works 7.5 PAs/week in direct 3.3 – 4.1 FTE consultants
clinical care pmp
4B. Diagnostic cardiac catheterisation and
angios: physiological staff required now
Non-medical staff: nurses (2), physiologists (1), 16204 – 20252 hours
radiographers (1)
Sessions @3.75h each 4321 – 5401 sessions
pmp
If each clinician available 44 weeks per year 98 – 123 sessions per
week pmp
If each clinician works 9 sessions per week 10.9 – 13.7 FTE pmp
* It is not possible to do a partial number of cases in each programmed activity (eg 6.4 cases in 4 hours); only whole
numbers of cases can have procedures performed.
4.2. Future requirements
Future trends:
• Current developments in multi- (ie 64 or 128) slice, simultaneous, fast acquisition, cardiac
computed tomography (CT) imaging with sufficient resolution might replace diagnostic
(epicardial) coronary angiography within the next few years. As a result, there may be
fewer isolated diagnostic coronary angiography cases required in the medium and long-
term future. Until this technology becomes available, it is very difficult to quantify how
many current patients undergoing diagnostic coronary angiography might have similar
useful diagnostic information provided by future cardiac CT imaging.
• It is expected that in future there will be proportionately more diagnostic coronary
angiography cases proceeding directly to percutaneous intervention (PCI) at the same
time; and therefore fewer sole diagnostic coronary angiography cases.
It is very difficult to quantify with confidence or precision how many fewer sole diagnostic coronary
angiograms might be required in the medium and longer-term future. The following estimates must
be treated with considerable caution. On the assumption that either:
• two thirds rather than one-third of PCI is combined angiography and directly proceeding to
intervention at the same time = 733 – 1000 pmp fewer sole diagnostic angiography cases;
or alternatively,
• if most patients with acute myocardial infarction or acute coronary syndromes have urgent
in-hospital angiography and consideration of directly proceeding to PCI: with a total of
4678 pmp myocardial infarctions, say 50% (= 2339 pmp) initially survive and are admitted
to hospital, and say 75% of these might actually have urgent angiography and
consideration of PCI, perhaps twice as many as currently undertaken acute diagnostic
followed on by intervention cases as at present (= one-half of 1750 = 875 fewer pmp)
fewer diagnostic angiography cases; a very similar estimation to that above.Page 19 of 45
• Because of the considerable uncertainty of the future need for sole diagnostic coronary
angiographic laboratories, we have assumed that the future requirement might range from
the possible future reduction indicated above to the current predicted need.
4A. Diagnostic cardiac catheterisation and Procedure Procedure time pmp
angios: consultants required in future need pmp
Diagnostic cardiac catheterisation and angiography = 4412 – 2758 – 4219 hours
2.5 x interventions @ 37.5 minutes 6750 pmp pmp
Allow for 20% inefficiency* and for peaks and troughs 3310 – 5063 hours
pmp
Programmed activities @ 4hours each 828 – 1266 PAs pmp
If each consultant available 41 weeks per year 20.2 – 30.9 PAs per
week pmp
If each consultant works 7.5 PAs/week in direct 2.7 – 4.1 FTE
clinical care consultants pmp
4B. Diagnostic cardiac catheterisation and
angios: physiological staff required in future
Non-medical staff: nurses (2), physiologists (1), 13240 – 20252 hours
radiographers (1)
Sessions @3.75h each 3531 – 5401 sessions
pmp
If each clinician available 44 weeks per year 80 – 123 sessions per
week pmp
If each clinician works 9 sessions per week 8.8 – 13.7 FTE pmp
4B. Pre-angiography assessment
Clinic time required @15 mins each 4412 –6750 1103 – 1688 hours
pmp pmp
Allow for 15% inefficiency* and for peaks and troughs 1268 – 1941 hours
pmp
Sessions @3.75h each 338 – 518 sessions
pmp
If each clinician available 44 weeks per year 7.7 – 11.8 sessions
per week pmp
If each clinician works 9 sessions per week 0.9 – 1.3 FTE pmp
* It is not possible to see or do a partial number of cases in each programmed activity (eg 6.4 cases in 4 hours); only
whole numbers of cases can have procedures performed.
5. Revascularisation: Percutaneous Cardiac Intervention (PCI)
In 2003, there were 53,261 PCI procedures performed in the UK, a rate of 894 per million
population (pmp). The mean rate of growth in total PCI numbers has been 15% per year since
1991. The estimated ratio of PCI to isolated CABG surgery in the UK is now 2.1:1, and is
increasing. The proposed NSF rates for myocardial revascularisation of at least 750 PCI and 750
CABG procedures pmp are no longer enough for PCI, nor an appropriate ratio. Planning for a
current volume of 1500 PCI procedures pmp is now appropriate.
This would be an increase to 88,200 procedures (= 1500 PCI pmp) in the UK. In 2001, France and
Switzerland undertook 1500 PCI pmp, and Germany 2300 PCI pmp; it is expected that these
numbers will increase in the next few years, perhaps substantially with the introduction of drug-
eluting stents. Best estimates for current planning for future PCI requirements in the UK should be
within a range of 2200-3000 procedures pmp.10
Accurate records for the overall duration of percutaneous cardiac intervention procedures have
been reviewed in the cardiac catheterisation laboratory databases at St Mary’s Hospital in London.
The average time (from patient entry to until exit from the cardiac catheterisation laboratory) in
2002 and 2003 was 85.9 minutes (80.3 minutes for elective cases, and 89.7 minutes for acute
cases, including diagnostic angiography immediately beforehand). In the future, it is expected thatPage 20 of 45
there will be a relatively greater proportion of acute cases, and more complex cases, for
intervention. An average duration of 90 mins for each case in the future for planning PCI needs is
used here for calculating workforce requirements.
5A. Percutaneous coronary intervention: consultants Procedure Procedure time pmp
now need pmp
Percutaneous coronary intervention @ 90 minutes 1500 pmp 2250 hours pmp
Allow for 20% inefficiency* and for peaks and troughs 2700 hours pmp
Programmed Activites @ 4hours each 675 PAs pmp
If each consultant available 41 weeks per year 16.5 PAs per week pmp
If each consultant works 7.5 PAs/week in direct clinical 2.2 FTE consultants pmp
care
5B. PCI: other clinical staff now
Non-medical staff: nurses (2), physiologists (1), 10800 hours
radiographers (1)
Sessions @ 3.75h each 2880 sessions pmp
If each clinician available 44 weeks per year 65 sessions per week pmp
If each clinician works 9 sessions per week 7.3 FTE clinicians
* It is not possible to do a partial number of cases in each programmed activity (eg 2.7 cases in 4 hours); only whole
numbers of cases can have procedures performed.
In order to provide a 24hour/7day interventional service, including primary percutaneous coronary
intervention in acute myocardial infarction, interventions would need to be provided in a network
facility where there would be a rota of a minimum of at least 6 interventionists, preferably 10
interventionists in each unit, to provider adequate cover for leave: see cardiac workforce
document 2003.10
5A. Percutaneous coronary intervention: Procedure Procedure time pmp
consultants in future need pmp
Percutaneous coronary intervention @ 90 2200 - 3300 - 4500 hours pmp
minutes 3000 pmp
Allow for 20% inefficiency* and for peaks and 3960 - 5400 hours pmp
troughs
Programmed Activites @ 4hours each 990 - 1350 PAs pmp
If each consultant available 41 weeks per year 24 – 33 PAs per week pmp
If each consultant works 7.5 PAs/week in direct 3.2 – 4.4 FTE consultants
clinical care pmp
5B. PCI: other clinical staff in future
Non-medical staff: nurses (2), physiologists (1), 15840 – 21600 hours
radiographers (1)
Sessions @ 3.75 hours each 4224 – 5760 sessions pmp
If each clinician available 44 weeks per year 96 – 131 sessions per week
pmp
If each clinician works 9 sessions per week 11 – 15 FTE clinicians pmp
5B. PCI pre-assessment
Clinic time required @15 minutes each 2200 – 550 – 750 hours
3000 pmp
Allow for 15% inefficiency* and for peaks and 633 – 863 hours pmp
troughs
Sessions @3.75 hours each 169 – 230 sessions pmp
If each clinician available 44 weeks per year 3.8 – 5.2 sessions per week
pmp
If each clinician works 9 sessions per week 0.4 – 0.6 FTE clinicians
pmpPage 21 of 45
5B. Post PCI follow-up
Post PCI clinic time follow-up @0.5 hours each 2200 – 1100 – 1500 hours pmp
3000 pmp
Allow for 15% inefficiency* and for peaks and 1265 - 1725 hours pmp
troughs
Sessions @3.75 hours each 337 – 460 sessions pmp
If each clinician available 44 weeks per year 7.7 – 10.5 sessions per
week pmp
If each clinician works 9 sessions per week 0.9 – 1.2 FTE clinicians
pmp
* It is not possible to do a partial number of cases in each programmed activity (eg 2.7 cases in 4 hours); only whole
numbers of cases can have procedures performed.
6. Miscellaneous cardiac invasive interventional procedures:
Examples of these include percutaneous closure of PFO/ASD, percutaneous carotid intervention,
percutaneous mitral valvuloplasties, and percutaneous septal ablation in hypertrophic
cardiomyopathy. We have excluded adults with congenital heart disease procedures.
Assume that each interventional cardiac centre requires an average of 1.0 PA each week for all of
these miscellaneous interventional procedures; currently there are 56 NHS interventional cardiac
centres in the UK; with expansion of PCI, there may be perhaps 66 interventional cardiac centres
in the UK with a population of 58.8 million.
6A. Miscellaneous cardiac invasive Procedure need Procedure time pmp
interventional procedures: consultants pmp
UK: 56 – 66 tertiary cardiac centres @ 1 PA 56 – 66 PAs per 48 – 56 PAs pmp per
per week each week year
If each consultant available 41 weeks per 1.2 - 1.4 PAs per week
year pmp
If each consultant works 7.5 PAs per week in 0.2 FTE consultants pmp
direct clinical care
6B. Miscellaneous cardiac invasive
interventional procedures: other clinical
staff
Non-medical staff: nurses (2), physiologists 12.8 – 19.2 hours per
(1), radiographers (1) week pmp
Sessions @ 3.75 hours each per week 3.4 – 5.1 sessions per
week pmp
Sessions per year 177 – 265 sessions per
annum pmp
If each clinician available 44 weeks per year 4.0 – 6.0 sessions per
week
If each clinician works 9 sessions per week 0.5 – 0.7 FTE clinicians
pmp
7. Diagnosis and management of heart failure
The British Society of Heart Failure recommends that patients presenting with suspected heart
failure should be seen by a consultant cardiologist specialising in heart failure. Furthermore, a
consultant specialising in heart failure should lead in the monitoring and follow-up of patients with
heart failure; each patient should be reviewed on average annually by a consultant cardiologist
with a special interest in heart failure.
UK statistics from British Heart Foundation11 Incidence UK Prevalence UK
(UK population 58.789m)
Heart failure 63500 = 1080 pmp 880000 =
14969 pmpPage 22 of 45
7B. Rapid access heart failure clinics (diagnostic) Requirement pmp
Incidence of heart failure @ 63500 UK 1080 pmp
Referrals with symptoms = 2x incidence 2160 pmp
Clinic time required @ 1hour each referral (incl echo) 2160 hours
Allow 15% extra capacity to allow for peaks and troughs and for 2484 hours
inefficiency
Sessions @3.75 hour each 662 sessions pmp
If each clinician available 44 weeks per year 15 sessions per week
pmp
FTE staff required (One of nurse, physiologist, GPwSI, or non- 1.7 FTE clinicians pmp
consultant cardiologist) each clinician working 9 sessions per
week
7A. Consultants with special interest in diagnosing heart Requirement pmp
failure
Clinic time required @ 20-30 minutes each patient 719 - 1080 hours
Allow 15% extra capacity to allow for peaks and troughs and for 827 - 1242 hours
inefficiency
PAs @ 4.0hour each 207 – 311 PAs pmp
If each consultant available 41 weeks per year 5 – 8 PAs per week pmp
If each consultant works 7.5 PAs/week in direct clinical care 0.7 – 1.1 FTE consultants
7B. Monitoring of heart failure Requirement pmp
Prevalence of heart failure @ 880000 14969 pmp
Clinic time required 6 monthly* @ 15 minutes each 7484 hours
Echo time required annually @ 30 minutes each 7485 hours
Allow 15% extra capacity to allow for peaks and troughs and for 17214 hours
inefficiency
Sessions @ 3.75 hours each 4590 sessions pmp
If each clinician available 44 weeks per 104 sessions per week
pmp
FTE staff required (nurse, physiologist, GPwSI, or non-consultant 11.6 FTE clinicians pmp
cardiologist) each clinician working 9 sessions per week
7A. Consultants with special interest in monitoring heart Requirement pmp
failure
Clinic time required annually @15 minutes each 3742 hours
Allow 15% extra capacity to allow for peaks and troughs and for 4303 hours
inefficiency
PAs @ 4hours each 1076 PAs pmp
If each consultant available 41 weeks per year 26 PAs per week pmp
If each consultant works 7.5 PAs/week in direct clinical care 3.5 FTE consultants
* ”At least 6 monthly”: http://www.nice.org.uk/pdf/CG5NICEguideline.pdf
7A. Total Consultants specialising in heart failure Requirement pmp
Diagnosing heart failure 0.7 – 1.1 FTE consultants pmp
Monitoring heart failure 3.5 FTE consultants pmp
Total consultants specialising in heart failure 4.2 – 4.6 FTE consultants pmp
8. Cardiac rehabilitation (phases I-III)
In each cardiac network, cardiac rehabilitation should be provided locally. The British Association
for Cardiac Rehabilitation (BACR) website specifies that at least two staff should supervise each
exercise session; that the ratio of staff to patients in these classes should be 1 toYou can also read
