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Immunology and Allergy Services in Scotland

VI: EDUCATION, TRAINING AND RESEARCH

Education and Training

91 Recruitment and training of junior medical staff is recognised as crucial to any specialty's continued existence. This is particularly acute in the case of immunology where there is a national shortage of junior medical staff in training. Furthermore, because allergy has only just been designated as a specialty in its own right, it will be four or five years before the NHS will be in a position to fill consultant posts with trained allergists. It is understood that a Task Force has recently been set up by the British Society for Allergy and Clinical Immunology to review the issue of inadequate allergy provision with officials at the Department of Health in London.³¹

92 The number of trainees requires careful consideration and must be co-ordinated with future consultant vacancies which arise either de novo from increased clinical need or as a consequence of retirement.

93 In Scotland, the training of junior medical staff in immunology has been centred primarily in Glasgow. This has proved to be difficult to operate in practice because of the requirement to provide appropriately supported and structured training programmes and the increasing demands that have been made upon the single-handed Consultant Immunologist.

94 Higher medical training in Immunology and in Allergy are both supervised by the SAC in Immunology and Allergy of the Joint Committee on Higher Medical Training comprising representatives of all the UK Royal Colleges of Medicine and the Royal College of Pathologists. A structured programme and curriculum has been established which specifies requirements for entry into, and completion of, such Higher Medical Training with the attainment of a Certificate of Completion of Specialist Training (CCST) in Immunology. (A separate training programme and CCST exists for allergy). This has been compared to the combined clinical and laboratory training programme undertaken for higher medical training and the acquisition of a Certificate of Completion of Specialist Training in Haematology. Clear guidance and instruction on the infrastructure, which is seen as essential to support such a training programme, has also been provided.

95 Under-diagnosis of rare syndromes should be addressed within the training requirements for other specialties. To this end, it is recommended that SAC's and Regional Specialty Advisers should emphasise the importance of clinical immunology training in dermatology, rheumatology, chest medicine, general medicine and gastroenterology.

96 Training must be undertaken, not only at the junior level but also in the Primary Care setting. A comprehensive programme of education and training on immunological and allergic conditions for general practitioners and other primary health care professionals, such as GP practice nurses and pharmacists, should be established as a matter of urgency. Such initiatives should help to ensure that appropriate use is made of consultant time which is a valuable resource.

97 Nurse specialists have a key role to play in providing information and instruction to patients and carers on the administration of injectable adrenalin. Regular reviews of the patients and carers should also be undertaken to ensure that their training is kept up to date.

98 A number of the above aims could be fulfilled by a single co-ordinated body such as the Academy of Royal Colleges.

Research

99 Immunology and allergy are areas ripe for research, particularly in relation to the introduction of new tests which have the potential to simplify the investigation to these conditions.

100 Given the present impossibility of determining the true extent and nature of severe allergic reactions among the Scottish population, the Group considers that the Scottish Executive should lend its encouragement to a nationwide epidemiological study to establish the incidence of severe allergy and anaphylaxis in Scotland.

101 The Chief Scientist Office should look favourably on applications for original research which may lead to the introduction of new tests or offer to provide information on the epidemiology of severe forms of allergy and anaphylaxis in Scotland.

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