Partha Kar: The consultant of the future

Type “define an NHS consultant” into Google and you’ll get more than 5 million results—none of which actually crystallises what the role involves. It’s a term that’s ever more shrouded in ambiguity as the NHS morphs and changes while moving into the unknown future.

So what exactly should the role encompass, and in what direction are we heading? Should consultants simply run their specialist clinics at the time of their choosing and then walk away? Should they lead and develop a service? Or should they do more? When patients are asked for their views, most, if not all, have asked to be ‘treated as a person, not a number’.

So, how about five roles that we would like to see a consultant of the future hold?

Specialist: Perhaps we need to accept that there are some areas where specialists are better than anyone else. It wouldn’t be good for patient care to ask someone else to do a specialist’s job, (and besides, taxpayers’ money has been spent to learn those particular skills). A case in point—setting up insulin pumps for antenatal diabetes requires specialist training and should remain the responsibility of specialists to ensure that a high quality of care is maintained.

Educator: We should also accept that in the present economy we cannot afford a system in which every patient sees a consultant. A specialist needs to hold a role as an educator, with general practice acting as the first port of call. Be it with trainees or qualified physicians, a specialist can contribute significantly to improving the health care of a patient by using virtual methods, case discussions or even reviewing patients with the local practice nurse or GP. Build relations, help to educate and inspire the next generation to follow your example – these have to be the primary goals for a consultant.

Leader: Consultants should be concerned with the leadership of the whole system, not just their own services. If we genuinely believe that we need to ‘do something’ to improve public health, perhaps consultants should become the focal point for leading changes in schools and colleges; become active public health campaigners; promote sports in schools, encourage early diagnosis, and educate the public? In spite of everything that is said in the media, the public still respects the opinion of a doctor, so why not be at the forefront with the media, hospital communications, and local councils?

Accountable officer This leads on to the question – is there a willingness among specialists to be accountable for the outcome of services? If data suggests that something isn’t right, perhaps it’s better to accept it and try to make the necessary improvements rather than challenging the data or treating it as a conspiracy.

Patient representative: Finally, what can a consultant do for a patient? Can we take down the barriers and be there when needed? Are we bold enough to look past the traditional ways of holding clinics, and instead offer patients slots when they want them, or even communicate with them by email, video links or phone? Indeed, why can’t we listen to what patients want in their services and then try to lead the changes needed? Why can’t we try and get past the age-old view of “I know best.” There are too many examples of the ‘aloof’ consultant, who has little time to speak directly to patients. The days of ‘us’ seeing patients on our own terms is – quite rightly – dying a slow death. We need to ensure that we can rise to the challenge and use existing forums to suit patients – especially as a disease progresses where engagement should be the key mantra.

In the words of Lao Tzu, “If you do not change direction, you may end up where you are heading.” As specialists, we continue to mull over where we are heading. Maybe it’s time for us to make sure we lead the change in direction – and perhaps the first step is to redefine what we do.

Partha Kar is a consultant endocrinologist. This blog was first published on the King’s Fund website.