Reorientation of services to allow expert cardiological input into the care of all patients with heart disease. At present a great deal of the care of patients with heart disease is delivered by non-cardiologists (for example, general physicians and physicians from other subspecialties who admit patients on take). This is particularly true of acutely ill patients who are in most need of expert management

Involvement of cardiologists in time consuming but important activities, which have been recently introduced, are essential but do not help deal with the enormous volume of cardiac patients:

• audit

• clinical governance

• risk management

Responsibilities for teaching/training and mentoring of medical students, specialist registrars and other health care professions

Revalidation—both personal, and involvement with assessment of others

Peer review of other units as part of the British Cardiac Society scheme

General management issues for NHS trusts

Involvement across the healthcare district in leading the development of networks of care

Introduction of increased requirements for personal continuing professional development (CPD)