Memorandum by the Royal College of Physicians
The Royal College of Physicians (RCP) plays
a leading role in the delivery of high quality patient care by
setting standards of medical practice and promoting clinical excellence.
We provide physicians in the United Kingdom and overseas with
education, training and support throughout their careers. As an
independent body representing over 20,000 Fellows and Members
worldwide, we advise and work with government, the public, patients
and other professions to improve health and healthcare.
1. In 2003 the Department of Health was
advised by the Royal College of Physicians (supported by patients,
their allergy organisations and other relevant professional organisations)
in the enclosed report "Allergy: the unmet need"—that:
— The UK is exposed to an epidemic
of allergic illness; one third of the population is directly affected;
the growth in severe allergy, allergy which expresses itself in
novel forms and multiple allergy are especially concerning.
— The NHS is not responding to the
increased need for services (at any level of care); and people
with unmet needs are being diverted into inappropriate care pathways.
— Whereas a comprehensive service development
plan is ultimately required, the first and essential step is to
get properly qualified clinical staff into the front line of service
provision. This requires a strategic investment in training—initially
and primarily in the training of specialist allergy doctors who
can take leadership roles in the development of the specialty.
2. In 2004 these findings and advice were
endorsed by the House of Commons Health Committee.
3. The DH responses (DH Command paper January
2005, and subsequent Review, July 2006) were initially disappointing
as they did not recognise the scale of need.
4. The DH has now conceded the need for
improvement, and that there is enough known to move forward; but
have allocated responsibility to PCTs and SHAs. However, it is
far from clear if these bodies have access to experts in allergy.
5. The College, at a round table chaired
by the then President, Dame Carol Black, reached a consensus on
referral pathways and models of care with potential providers
of allergy care (specialists in allergy, physicians in other specialties,
and other colleges especially paediatrics, RCPCH, and primary
care, RCGP).
6. Underpinning this concensus was the training
of more specialists in allergy, who could provide specialist care
and support developments and improved education in primary care,
and, working in partnership, across the NHS. An absolute requirement
is the creation of more new training posts in allergy (beyond
the current eight available nationally).
7. Research and developments in clinical
care are essential to improve patient care for allergy sufferers
in the UK. Research needs to have a particularly clinical
focus. However, without a more robust specialist clinical service,
with well studied patients and more doctors who specialise in
allergy this will not happen. At present there are few allergy
specialists (26.5 whole time equivalents in adult and paediatric
allergy in the UK) and many of these are supported by academic
funding, so these posts may not continue beyond the tenure of
the current post holders.
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