High-quality care needs the multi-disciplinary team: an interview with Professor Koottalai Srinivasan

Friday, September 15, 2023


Respiratory Futures talked to Professor Koottalai Srinivasan, Consultant Respiratory Physician and Hospital Dean at Shrewsbury & Telford Hospitals NHS Trust; and Keele University Medical School.

Also a member of the BTS Council and Education and Training Committee, Professor Srinivasan shares his journey in respiratory health, and experience of being part of BTS.

Can you tell us a little about your day-job, and what it was that drew you into working in respiratory health?

I am a full time Consultant Respiratory Physician in a Shrewsbury & Telford, which is a DGH and teaching hospital. My day-job involves looking after general respiratory patients on the ward, outpatients, procedures including bronchoscopy and pleural procedures. I contribute to the GIM on call too. In addition, the role of Hospital Dean for University of Keele Medical School at Shrewsbury & Telford involves teaching, organising and maintaining the quality of education of approximately half the year 4 and 5 students in clinical placements from Keele.

The real reason for being drawn into working in Respiratory health was the inspiration drawn from Dr Jon Goldman and the late Dr David Sinclair, who were my consultant supervisors, during my SHO days in Torbay Hospital in the mid – 90s. They showed me how interesting a speciality respiratory medicine was and the extraordinary range of work involved.

In your opinion, what are the biggest challenges facing the respiratory workforce at the moment?

Respiratory medicine faces the workforce challenges that all specialities are facing in the UK, which is increasing volume of work with shrinking numbers of doctors, specialist nurses, physiologists. Specifically, though respiratory medicine is very much an integral part of the general medicine take in a UK hospital, the reorganisation of training over the last 14 years or so now means that the generalists on call in a hospital are increasingly unable to safely perform procedures like chest drains which used to be done by trainee doctors in general medicine. Other precautions like mandatory thoracic ultrasound before pleural interventions are meaning that only a handful of appropriately trained respiratory physicians can perform these in an on-call situation. This tension between the need to continue with GIM on calls as 30% of the general take is respiratory; and the ever increasing need to provide more specialised services to the whole health service as specialists means a significant increase in workforce is needed. This is a major concern currently in the modern NHS. It has to be dealt with urgently. This medical workforce issue is just part of the need for increased training and production of specialist nurses, physiologists, and other respiratory healthcare workers if we are to continue to provide a high-quality respiratory health care service in the coming decades.Has respiratory medicine changed a lot since you began practicing? What areas would you still like to see further improvement in?

In addition to the issue mentioned above with regards to how certain areas of respiratory medicine has moved from the general medicine portfolio to more specialised respiratory medicine work, there has been a significant increase in highly specialised development of the science and provision of services in a number of areas. In my own area of special interest of Sleep medicine, there has been a huge increase in referrals from primary care to specialist clinics due to increased awareness.

There has also been tremendous advancement in the science in areas such as interstitial lung disease (ILD) with antifibrotic treatments, lung cancer with the advent of biologic treatments and personalised treatment, biologics in severe asthma. All this has been exciting and wonderful for patients, though challenging from organising services and the necessary workforce for hospitals providing them. The important point to make is the associated increase in expertise of our specialist nurses in all these specialities and it has been a real pleasure to work with them as the science and evidence has advanced over the last couple of decades and to see how their dedication improves the quality of care that our patients get from the whole team.

The development of the multidisciplinary team (MDT) in the sub specialities has been another wonderful thing in giving better care to our patients. This includes our physiologists, who are integral to some of the sub-specialities like sleep and NIV and are taking the pressures off the system with well-developed physiologist led pathways.

The area which needs to develop much faster is the integrated ways of working between primary and secondary care. Though there has been progress in this area, including the fact that integrated care is in the new curriculum for specialist training in respiratory medicine (2022), there is a real need for speeding up with support from the government as it would lead to better, slicker, safer care for our respiratory patients in addition to reducing the hospital admissions rate, which in turn would lead to massive cost savings in a stretched NHS.

You recently joined the BTS Council, what has your role involved so far?

It has been a true honour to be a member of the BTS Council over the last 18 months or so. I am truly grateful to have been able to be part of the body that allows discussions about key issues facing respiratory medicine in the UK. During my time, I have seen the development and publication of the workforce document under the stewardship of Dr. Paul Walker, our chair. This has been an extremely important step as we need a vision and strategy to get to where we wish to be in a certain period of time and this document is something for the BTS to be proud of.  A number of other important issues have been discussed at Council and it has been a privilege to be part of those.

As member of Council, I am also a member of the Education and Training Committee. In this role, I have been involved in the organisation of the programme for the BTS Summer meetings. The liaising with specific proposed chairs and speakers and giving form to the sessions has been an interesting and rewarding experience. It has been a learning experience on the Council and hope to do more before the end of term.

Is there anything you would like to say to other colleagues who are considering joining or taking up a role with BTS?

I would like to urge colleagues and others who wish to join or take up roles with BTS to do so without hesitation. I have personally found it extremely rewarding. There is nothing better than being able to contribute to the development of our own beloved speciality and also sub-specialities we may be interested in. A personal passion for me has been education and training; and being involved in the Committee means there can be a contribution in that area with the fulfilment of seeing BTS continuing to be at the forefront of supporting the training of our next generation in respiratory medicine. In addition, the networking has been fantastic and allows us in the community to know each other across the country and share ideas and thoughts at the various meetings.