CLINICAL ENDOCRINOLOGY: LOOKING TO THE FUTURE
HELEN SIMPSON | Features
Happy birthday to us! 75 years and still going strong.
As clinicians, patients are at the centre of all we do. Around 60–70% of members of the Society for Endocrinology are involved in patient care, so the Society has a key role in underpinning excellence in this area. Clinical members fall into many categories – medical students, specialist registrars and consultants, nurses, clinical academics – each with differing needs.
THE IMPACT OF COVID-19
The COVID-19 pandemic has hit clinical endocrinology hard. Many clinicians were moved into COVID surge duties previously and, as I write, are again. We have all learnt to work differently. Outpatient activity went virtual in March 2020 and we have not seen some of our patients face-to-face for the duration of the pandemic. Many training meetings were cancelled and, when we were able to hold meetings, they moved online. As we face another wave of the pandemic, it is evident that we will have to work differently for some time to come.
The shape of the future is not yet known, and the impact of all of this is impossible to quantify. But what is clear is that we have actually kept everything going, and we deserve a huge ‘well done’.
The Society for Endocrinology has provided strong clinical leadership. The Clinical Committee issued a COVID-19 resource for managing endocrine conditions early in the pandemic, and the Steroid Emergency Card was launched. The Future of Endocrinology working group issued a document, Planning and Recommendations for COVID-19 Second Wave. This provided advice and resources although, with the varying pressures of each successive wave, I do think that we will have to carry on adapting in our individual institutions.
The shape of the future is not yet known, and the impact of all of this is impossible to quantify. But what is clear is that we have actually kept everything going, and we deserve a huge ‘well done’
EXCELLENCE IN CLINICAL CARE
Any advances in the practice of endocrinology can only come to fruition if services are able to offer excellence in clinical care. It may not seem very ‘sexy’, but if our patients cannot get their appointments at the right time, in the best place for them, with the most appropriate healthcare professional, we cannot translate any research into improved patient outcomes. There is very little evidence that a routine clinic appointment is of clinical utility and, with advances in electronic patient records, patient portals and virtual clinics, we have an opportunity to work differently.
Stealing from a colleague at University College London Hospitals, we need to become ‘hospitals without walls’, to reimagine our services. The Future of Endocrinology working group has set out to provide support for us to do this across three domains:
(a) education and training
(b) the primary care interface and
(c) digital care options and models of care (including patient self-care).
A Resource Hub is being developed to be hosted on the Society’s website, so we can share examples of different types of clinical practice and service development. The Clinical Committee and Society staff must ensure that the Resource Hub is a continually evolving, updated and effective tool that can be used and adapted by members throughout the UK. There must be time at the SfE BES conference to make this an iterative process, and provide opportunities to learn from each other. There needs to be an acknowledgement that service development and quality improvement are key to what we do on a daily basis, and should have equal standing to other disciplines. We also need to acknowledge that a ‘one size fits all’ solution does not work. As Don Berwick (Chair of the 2013 review Improving the Safety of Patients in England) says, homogenised medicine is bad medicine.
There is an appetite to continue the wonderful collaborations and networks we have created during the life of the Future of Endocrinology working group and it would be a lost opportunity not to build on these.
PUTTING PATIENTS FIRST
Working with patient support groups is also key. We (clinicians) are very good at deciding on metrics to assess outcomes, or devising research questions, but how about working on what matters to patients, such as PROMS (patient-reported outcome measures) and PREMs (patient-reported experience measures)? For example, do we know that individuals with short stature worry about this – or are other issues, such as fertility, more important to our patients? We will only deliver truly excellent care when we blend patients’ needs with our clinical practice. That means listening to and hearing what patients say.
We will only deliver truly excellent care when we blend patients’ needs with our clinical practice. That means listening to and hearing what patients say.
THE IMPORTANCE OF TRAINING
Another challenge for endocrinology is the dominance of general medicine for clinical trainees. This was an issue pre-pandemic, but COVID-19 has had a devastating impact on training in endocrinology. Many trainees have had their education disrupted by repeated redeployments, service changes, postponement of examinations, personal illness or shielding. Many trainees have experienced significant psychological trauma during the pandemic, and we are all tired/burnt out. IMT3 training means that there will be 4 years of training for those not undertaking a period of research. This is not long enough to train an endocrinologist. The Society for Endocrinology is in a powerful position to lobby and work with partners to highlight the risks of shortened training for the future of endocrinology.
Lastly, the Society is developing a research strategy. Many endocrine disorders are rare, long term conditions and it can be difficult to get funding for pilot data. In addition, single centres are generally underpowered to yield meaningful data. The Society for Endocrinology is ideally placed to build on collaborations and networks for data collection, and we can work nationally rather in our individual silos.
However, if we are serious about healthcare professionals being involved in research, we need to be given time to do this. Those of us who are NHS-funded do research activities in our own time. This is not a sustainable model, especially for those with caring and parenting responsibilities outside work. In this new world, where there are extremely high rates of burnout, there should not be an expectation to perpetually work during our evenings and weekends.
WE ALL HAVE A ROLE TO PLAY
My final refection is that the Society is made up of its members: so, when we think about the future, we are all beholden to make a difference. We should get involved, contribute, network, mentor, support each other during these horrible times, and share knowledge and information. It’s not about us, it’s about our patients. At a micro level, it’s each patient contact – be it virtual/digital or face-to-face. At a macro level, it’s ensuring our clinical services evolve to provide excellent care in the new pandemic world we are facing.
The Society for Endocrinology has a broad base, well structured committees and networks, with space for everyone. The Society brings us together, and it is we who will make a difference for the future.
Conflict of interest: Full-time NHS clinician in a tertiary centre.