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Golden Jubilee National Hospital Surgical Specialties Directorate Job Description and Particulars Relating to the Post of Consultant Anaesthetist 1. Job Identification Job Title: Consultant Anaesthetist Responsible to: Operational/Strategic Lead and the Associate Medical Director Accountable to: Chief Executive Department(s): Department of Anaesthesia and Peri-Operative Medicine 2. Introduction The Golden Jubilee Hospital is a state of the art tertiary referral centre on the banks of the River Clyde in close proximity to Glasgow International Airport and within 30 minutes of the centre of Glasgow by road and rail links. Direct overnight sleeper rail service to Euston, London is available via the local station 5 minutes from the hospital. The Golden Jubilee National Hospital is effectively situated a short distance west of Glasgow City and is minutes away from the countryside of the West of Scotland and Loch Lomond. Glasgow and the immediate surroundings have a population of around 580,000. It is Scotland’s largest city and commercial capital. The city has a renowned vibrant cultural life, with municipal art galleries and museums, first class sports and leisure facilities, a wide range of theatres and restaurants, excellent shopping and is only 45 miles from Edinburgh. The hospital was originally built as a private hospital in 1995 and is now fully part of NHS Scotland. Together with the Beardmore Hotel and Conference Centre it forms the National Waiting Times Centre special Health Board. It has 300 beds overall with all wards having single or two bedded rooms with ensuite facilities. The estate is one of a high specification and has the invaluable asset of a hotel and conference centre as an integral unit alongside the hospital. This has provided a very pleasing and attractive working environment for staff and a desirable patient experience. All facilities are managed by the National Waiting Times Centre Board. The main clinical services provided are Heart and Lung Specialties, elective major Orthopaedics, General and Plastic Surgery, as well as Endoscopy and Diagnostic Imaging. Orthopaedic Service The orthopaedic service works across five laminar flow theatres in a modern theatre suite, delivering over 22% of all hip and knee replacements for the NHS in Scotland, and approximately 50% per cent of those by West of Scotland hospitals. The service has just undergone a further expansion, with further expansion planned. One of the great successes within the Orthopaedic program is the ‘CALEDonian’ Technique (Clinical Attitudes Leading to Early Discharge). This is a multi-disciplinary approach to perioperative care aimed at promoting enhanced recovery and facilitating early discharge – the programme has reduced the length of hospital stay following joint replacement to an average of 4 days. There is also a growing activity of Orthopaedic day cases, predominantly foot and ankle surgery and this has followed the appointment of a Specialist Orthopaedic surgeon. Overall, the department has recently increased the rate of day of surgery admissions for joint replacements and this initiative has been supported by the opening of a new Surgical Day Unit (SDU). This has also been facilitated in part by providing Consultant Anaesthetic sessions in the preoperative assessment clinic. Despite the fact that the GJNH has no defined geographical 'catchment area' (by virtue of being a national hospital), day of surgery admissions are possible in some patients by allowing overnight stay prior to surgery in the adjacent Beardmore hotel. General & Plastic Surgery The General group of Anaesthetists provide cover for elective general and plastic surgery lists. These lists are elective in nature and predominantly daycases. This work is shared across two fully equipped theatres and surgical cover is provided by visiting Consultant Surgeons. Acute Pain Service (APS) The hospital has a long established and well resourced Acute Pain Service that is part of the Department of Anaesthesia & Perioperative Medicine. This service is Consultant led and supported by four specialist APS nurses. The service adopts a proactive team approach in delivering an individualised patient-centred service which is primarily aimed at supporting the various enhanced recovery initiatives across the hospital and minimising the effect of pain as a factor limiting the rate of recovery from surgery. The APS team are responsible for developing and delivering education programs across the hospital to the various multidisciplinary teams in relation to pain management. The management of pain within GJNH is highly protocolised in order to provide both efficacy and safety in pain management. The development of policies and protocols is the responsibility of the Consultant APS Lead and the APS Nursing team in partnership with other stakeholders throughout the hospital and changes are made through the APS steering group which meets quarterly. The APS is continuously involved in Audit and Research and maintains a comprehensive database, which is subject to regular review and helps to inspire innovation and directs changes towards improvements to clinical practice in the continuous evolution of the CALEDonian technique and Thoracic enhanced recovery program. The General Anaesthetists also provide a limited, medium to long term Central venous access service (using peripherally inserted central catheters), which is offered hospital wide and supported by the radiology department with access to the fluoroscopy suite. The West of Scotland Heart and Lung Centre The Centre was created in March 2008 at the Golden Jubilee National Hospital, bringing Interventional Cardiology and Cardiothoracic services previously provided by Greater Glasgow and Clyde and Lanarkshire onto our Specialist Tertiary Centre. The interventional cardiology service which includes primary PCI is among the busiest in the UK. The Centre also provides the regional electrophysiology service for the West of Scotland. In addition to these regional specialist services the GJNH is the site for the co-location of three services funded by the National Services Division of National Services Scotland (accountable for commissioning specialist services provided on a national basis on behalf of the Scottish Executive). These include the Scottish Adult Congenital Cardiac Service (SACCS), the Scottish Advanced Heart Failure Service (SAHFS, incl. Transplantation and mechanical assist service) and the Scottish Pulmonary Vascular Unit (SPVU). With this array of specialist cardiopulmonary services for a catchment population of 2.2 million, the GJNH is one of the largest heart and lung centres in Europe. The Heart and Lung Centre also benefits from MRI and CT imaging facilities with capabilities for CT angiography and a brand new 64 slice CT. Thoracic Surgery Thoracic Surgery in the West of Scotland is provided solely at the West of Scotland Heart & Lung Centre at the Golden Jubilee National Hospital. Three full-time Thoracic Surgeons and two mixed practice Cardiothoracic surgeons undertake the full range of thoracic surgical procedures including a small component of oesophageal surgery. The unit is committed to the principle of enhanced recovery and has recently developed programmes of VATS lobectomy and thymectomy. There is one thoracic ward which manages the majority of patients. In addition there is a new surgical day unit for same day admission and day surgical procedures. Two thoracic operating rooms are available, both of them equipped to a high standard with fluoroscopy, laser and video thoracoscopy. Although the High Dependency Units are mixed cardiothoracic, one HDU receives the majority of the thoracic patients. All surgeons deal with referrals in a flexible manner, but lung cancer referrals tend to based on the geographical patterns defined by the MDTs (see below). Cardiothoracic trauma is not uncommon in the West of Scotland and all Cardiothoracic surgeons are expected to provide emergency cover for the management of chest trauma. The APS team provide input into the pain management of postoperative thoracic surgical patients and cases are reviewed on the daily APS 'ward round'. Management Structure The NHS National Waiting Times Centre Board is one of eight Special Health Boards of Scotland. It reports directly to the Scottish Government. The hospital has recently undergone a process of organisational change, restructuring of services into two divisions: Regional/National Medicine and Surgical Specialties, Anaesthesia, ICU and Theatres are part of the Surgical Specialties Division. The following individuals hold positions on the Board: Chair Jeane Freeman Chief Executive Jill Young Medical Director Mike Higgins Nurse Director Shona Chaib Surgical Specialties Division Management Team: Associate Medical Director, Surgical Specialties Dr. Alistair Macfie Head of Operations, Surgical Specialties Mrs Lynn Graham Operations Manager Mrs C MacArthur Head of Nursing Mrs Anne Marie Cavanagh Theatre Manager Mrs Karen Boylan CEO DIRECTOR OF BUSINESS SERVICES HEAD OF OPERATIONS MD AMD OPERATIONS & STRATEGIC LEAD DIRECTOR OF NURSING HEAD OF NURSING GOVERNANCE LEAD CONSULTANT Medical leadership in department structure 3. Work of the Department The Department of Anaesthesia and Perioperative Medicine, has established itself as a major centre of excellence in anaesthesia, intensive care and pain medicine. The current medical staff comprises of 22 resident and 4 visiting consultants, one specialty doctor, two PA (A) s and two research fellows (Glasgow University). The department has an international reputation in pain management and Regional Anaesthesia, attracting visiting anaesthetists from all over the world. Consultant Anaesthetists also provide support for Outpatient pre-admission clinics. There is additional support from two full-time PAA’s (Physician Anaesthetic Assistants), whose role is to support the work of the department in theatre, pre-assessment and audit/research activities as directed. We have an active research programme that attracts a steady stream of clinical research fellows to the department. The main areas of interest are: Pharmacology and PK/PD of intravenous anaesthesia Brain function monitoring and effects of anaesthesia Multi-modal analgesia Regional Anaesthesia and Enhanced Recovery Mechanism of lung injury Coagulation and blood transfusion Measurement of plasma levels of ropivacaine following infiltration anaesthesia in joint arthroplasty The hospital has a modern operating theatre department which consists of 16 operating theatres to facilitate with the following distribution of specialties: Cardiac ( 4 ) Thoracic ( 2 ) Orthopaedic ( 5 ) General, and plastic surgery ( 3 ) There is also a separate day facility providing Ophthalmic and Endoscopy activity. The operating theatres provide a 24-hour on-call service with morning lists commencing at 08.00. There is a special arrangement to accommodate unexpected over-runs There are two intensive care units with a total of 22 physical beds (currently 21 staffed) and there are 16 high dependency beds in two separate units. Apart from post-operative cardiac and thoracic surgical patients, the unit manages patients critically ill with heart failure and patients undergoing heart transplant under the Scottish National Advanced Heart Failure Service and it supports the regional primary angioplasty service. There is a mechanical circulatory support programme and there is a contingency for complex orthopaedic and general surgical patients in critical care. We serve patients undergoing complex adult congenital surgery within the Scottish Adult Congenital Service. We have links with Glasgow and surrounding obstetric services to provide peri-partum care for women with severe congenital heart disease or heart failure. Techniques used in the intensive care include renal replacement therapy, intra-aortic balloon pump counter pulsation, ventricular assist device support, invasive and non-invasive ventilation, pulmonary artery catheterisation, and transoesphageal echocardiography. There is dedicated prospective sessional daytime cover from the team of 10 consultant anaesthetic intensivists and a dedicated out of hours rota. The National Services ward (including the Scottish National Advanced Heart Failure Service) currently occupies an adjacent 8-bedded high dependency area. There is an excellent 24/7laboratory service providing Clinical Chemistry, Haematology, Blood Transfusion (utilising electronic cross-matching) and Microbiology. The pharmacy department provides a medicine management service to an increasing number of clinical areas and there is a comprehensive rehabilitation department including physiotherapy, occupational therapy, speech therapy, chiropody, podiatry, acupuncture and laser treatments. The radiology department is well equipped with a full range of up to date diagnostic imaging equipment including MRI, 64 slice CT, Ultrasound, Fluoroscopy and Bone Densitometry Conference, Research and Education facilities Research, Development and Innovation are very important components of the activity at the Golden Jubilee National Hospital supported by a steering group and dedicated manager. Contract (commercial) research is encouraged and staff use income generated from this source to maintain research support staff such as Clinical Research Fellows and Research Nurses. Academic research is also encouraged and the new appointment will be strongly encouraged to take an active role in this activity. The appointee will also be expected to work with other national and UK collaborative projects that are relevant to position. A number of consultants undertake significant research and academic work. The Board is committed to the development of innovative clinical programmes. The new Beardmore Health Sciences Centre (BHSC) opened in May 2011. The Centre will contain a dedicated Clinical Research Facility for managing patients recruited to clinical trials. There are four consulting rooms; one is set up for echocardiography, one for an exercise tolerance suite and two rooms for general consulting and volunteer studies. The rest of the BHSC is made up of a small prep room, a nurse’s station and a patient waiting area. The facility is adjacent to the main auditorium of the conference centre providing excellent opportunities to develop teaching techniques and learning. Improved audiovisual links to theatre have recently been established. The Beardmore Hotel and the integral conference centre attached to the Golden Jubilee Hospital is a unique arrangement in the UK and will enable important national and ‘focus’ international meetings to share learning in the UK and beyond. Governance and Risk management The Board has a comprehensive programme that covers both clinical and research governance domains and all medical staff are expected to uphold clinical and non-clinical policies and be exemplar role models for all other medical and non-medical staff. Patient safety underpins clinical practice and initiatives following the guidance of the SPSP and subsequent programmes apply to all staff. Medical staff are required to undergo annual appraisal, meeting the requirements that will be required for revalidation purposes. The Medical Director is the Responsible Officer for all medical staff who work principally at the Golden Jubilee National Hospital. Appointment of recognised Medical Appraisers, and staff education The Board is committed to developing a strong educational ethos within the department and the new appointee will be expected to provide education and support to medical and non-medical staff members and develop the key educational skills to be an effective clinical supervisor. Supporting relevant programmes will be a requirement for the new appointment. 4. Duties of the Post /Proposed Job Plan From the 1st July 2009, NHS Scotland has committed to a 9:1 job plan. The successful candidate would be expected to provide the following; 9 direct clinical care PA’s (DCC) The number of DCCs may be reduced on account of agreement 1 SPA, to include preparation for annual appraisal and revalidation, audit, teaching, continuing medical education and in-house training. * EPA’s (Extra Programme Activities, DCC or SPA) may be agreed following agreement in objective setting to undertake other duties (e.g. Education supervisor, management, specific projects for service improvement and patient safety and operating list etc). Indicative Job Plan This job plan is focused on supporting the orthopaedic expansion and the regional thoracic programme for suitably trained candidates. Day Monday 0800-1800 Tuesday 0900 -1300 1300 -1700 Wednesday 0900 -1300 1300 -1700 Thursday 0800-1800 DCC Activity PA’s Orthopaedic Theatre 2.75 AM – General/Plastics PM – Pre-Assessment 1.25 0.5 PM – Pre-Assessment 0.75 Orthopaedic theatre 2.75 Friday Sub Total Day 8.0 Flexible Activities SPA Unpredictable OOH (on call) Subtotal Grand Total PA’s 1 1:8 rota with prospective cover 1 2.0 10 The tabled job plan is an indicative programme that will be revised 3 months after commencement by Directorate Management Team. All attributes are based on flexible cover of the rota when required. Submission and review of job plan Job plans are reviewed on an annual basis by the Medical Director or his deputy. Changes will be discussed and agreed with the post holder in line with service needs and objectives set for the consultant. On-call Arrangements The successful candidate will have access to secretarial support, and a hot desk with access to a personal computer. The appointee will be expected to work flexibly on the basis of the needs of the Anaesthetic service. The Hospital does not have a general emergency receiving unit, but will directly readmit patients with complications that have arisen from treatment at the Golden Jubilee National Hospital. Emergency Cardiology and Cardiothoracic patients are received directly 24/7 apart from those who are admitted to trauma units. There are currently 3 Consultant Anaesthetic on-call rotas: ICU 1:10 CT Theatres/Cath lab 1:8 Non CT & Acute Pain 1:8 This post holder will be expected to participate in the Non CT & Acute Pain on call service. Prospective cover of colleague for annual and study leave is a requirement of the post. There is 24/7 emergency General Surgery provided by consultants with their principle employment for adjacent health boards. They also undertake elective surgery (day or 24 hour stay procedures). 5. Terms & Conditions of Service National terms and conditions of service (Consultants (Scotland) 2004) cover the post. The post is subject to pre employment checks such as Disclosure Scotland, Occupational Health, Visa clearance (where applicable) and satisfactory references. You are required to be registered with the General Medical Council throughout the duration of your employment and to comply with and abide by the relevant code of professional practice, as appropriate. It is also required to familiarise and comply with local clinical policies and protocols. The appointee will be expected to work with local managers and professional colleagues in the efficient running of services. The appointee will be expected to follow the local and national employment and personnel policies and procedures. All medical staff employed by the Centre is expected to comply with the agreed health and safety policies. The successful candidate(s) will normally be required to live within 45 minutes drive of GJNH. The Terms and Conditions of Service state that the “removal expenses shall be reimbursed and grants paid only when the employing authority is satisfied that the removal of the practitioners home is required and the arrangements proposed are reasonable”. Therefore, successful candidates are advised not to enter into contractual arrangements for the removal of their home until such a time as the formal approval of the Centre is confirmed in writing. Annual appraisal and job planning is a requirement for all permanent medical staff. JOB DESCRIPTION AGREEMENT Job Holder’s Signature: Date: Print name: Date: Head of Department Signature: Date: 6. Further information and arrangements to visit Intending applicants are welcome to visit the Department and to discuss the post in detail by arrangement with Mrs. L. Graham, Head of Operations Surgical Specialties, Tel 0141 951 5519 or Prof. S. Schraag, Operational and Strategic Lead, Tel 0141 951 5609 at the Golden Jubilee National Hospital, Clydebank. In the first instance please contact: Dr John F Luck , Operational and Strategic Lead Non Cardiac Specialties Golden Jubilee National Hospital Agamemnon Street Clydebank G81 4DY Tel: 0141 951 5609 Email: [email protected] Dr Alistair Macfie, Operational and Strategic Lead for Cardiothoracic and Critical Care Golden Jubilee National Hospital Agamemnon Street Clydebank G81 4DY Tel: 0141 951 5298 Email: [email protected] Dr. Mike Higgins Medical Director Golden Jubilee National Hospital Agamemnon Street Clydebank G81 4DY PA: Irene Kielty: 0141 951 5600 Email: [email protected] 7. Applications Applications should contain: Comprehensive CV Two reference contacts Covering letter indicating and describing the application Copies of training certificate Copy of GMC certificate Evidence of further qualifications Completed applications to be returned to: Miss Paula Wood Human Resources Assistant Human Resources Department Golden Jubilee National Hospital Beardmore Street Clydebank G81 4HX National Waiting Times Centre NHS Board Recruitment Person Specification - Consultant Anaesthetist Essential Desirable How or where to be judged 1. Qualifications MBChB or Equiv. Higher research degree Application FRCA or Equiv. Evidence of mandatory training e.g. resuscitation, hand hygiene and fire training. Application On GMC specialist register or eligible to be within 6 months Application Application Application/Interview 2. Training / Experience Extensive training in Anaesthesia Recent experience of working within the NHS Uk provider Advanced thoracic anaesthesia training . Specialist training in loco regional anaesthesia Application/Interview Application/Interview Application/Interview Application/Interview European Society of Regional Anaesthesia (ESRA) diploma 3. Skills/Knowledge Effective MDT working Excellent team working skills Experience in ultrasound for regional anaesthesia IT skills including use of clinical systems. Interview Application/Interview Application/Interview 4. Understanding of the objectives of the NWTC Board Clinical Strategy 5. Teaching & Education Interview To provide clinical supervision of postgraduate training doctors Application/Interview Teaching undergraduates and other health professionals Application/Interview Ability to become an educational supervisor Application/Interview “Training the trainers” qualification. Application 6. Clinical Audit & Risk Management Demonstrate recent experience of clinical audit and evidence based practice Application/Interview Application/Interview Key principles of Clinical Governance and Data Protection Application/Interview Understanding of risk management and patient safety initiatives 7. Research and innovation Previous and current active interest in Peer-reviewed publications in research with evidence of recognised journals reflecting publications peri-operative medicine Previous contributions to innovative service developments Application/Interview Interview 8. Understanding of GMC Requirements Knowledge of ‘good medical practice’ Interview Knowledge of appraisal/revalidation process Interview Understanding of the GMC and its new roles Interview 9. Leadership/Management Demonstrate leadership potential Previous management and Clinical Leadership roles Interview Application/Interview Management qualification or leadership training e.g. MBA Application/Interview