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4.5 Patient/Carer Experience 4.5.4 Access to Medical, Nursing and Paramedical Expertise The consultant nephrologist is central to the provision of optimal medical care for the patient with ESRF. Relative to Europe, the numbers of whole time equivalent (WTE) nephrologists remains low. The ratio of RRT patients to the consultants available has climbed so high as to undermine the notion of a consultant based service. The proportion of outpatient contacts made by a consultant is often less than 1 in 3. It is important that consultant contact time with out-patients is at recommended levels (See Appendix IV). Consultant expansion is a complex issue which may relate to the future configuration of renal services. This is addressed in Section 5.6.2. The role of the nurse within the multi professional team is pivotal as he/she spends substantially more time than any other professional in direct patient contact. He/she is also in the unique position to provide client education, health promotion and act as the patients' advocate within the renal service. Specialist nursing roles have been developed to increase the effectiveness of pre dialysis education, diabetic care, PD home care and palliative care which translate into an improved quality service. Specialist nurses are essential to provide this service and each patient should have a named nurse in order to ensure continuity. Future development should include promotion of advanced practice and nurse consultant roles. Development of autonomous roles result in improved care and treatment in that nurses with diagnostics and prescribing responsibilities improve patient management and outcomes. The tendency to regard paramedical personnel as luxuries rather than essential components of the multidisciplinary team is to be deplored. Their numbers should be expanded in line with the expansion of the RRT population (see Section 5.6). Drug treatment is key in renal therapy. Pharmacy expertise is proving beneficial in streamlining care, improving compliance and meeting the challenges of clinical governance. Pharmacists now adjust individual patient therapy to minimise adverse events and maximise therapeutic benefit. Renal pharmacists often run medication review clinics and are involved in discharge planning. Given the devastating personal impact of ESRF, there is a great demand for information about benefits, attendance allowances, insurance etc. While Social Workers are often employed by local authorities, many are seconded whole time into the renal service and become renal specialists. In addition, social workers have traditionally been trained in counselling skills which are increasingly in demand. The practical, economic and psychological needs of patients are addressed often via the more 'mundane' tasks that are needed e.g. Benefits work, arranging community services etc. Nutritional care is an important part of the management of renal disease. Dietitians are increasingly involved in the prescription and quality assurance of dialysis in the diagnosis and treatment of malnutrition and in the prevention and management of bone disease. Interventions in diabetes and in risk factors for cardiovascular disease are other important areas which bring patients into contact with the renal dietitian. Link workers with translation skills have been recruited into the multidisciplinary team with great success in certain areas in recent years. These posts can enhance educational activities and may also help to achieve acceptable transplantation rates in ethnic minorities.  |