Download 2 acute assessment unit and medical ambulatory care unit

HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
CONSULTANT PHYSICIAN
DEPARTMENT OF ACUTE MEDICINE
JOB DESCRIPTION
SALARY SCALE £75,249 - £101,451
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INTRODUCTION
1.1
The Hull and East Yorkshire Hospitals NHS Trust has an annual budget of circa £481
million, employs approximately 7,000 staff and serves an extended population of 1.2
million.
1.2
Hull York Medical School
The first students of the joint Undergraduate Medical School of the Universities of Hull
and York (HYMS) graduated in 2008. Students follow a five year curriculum which
makes strong use of problem based learning techniques. For the first two years the
students are split into two equal sized cohorts, one of which is based at The University
of Hull and one at The University of York. The two cohorts follow the same curriculum
and some teaching is delivered synchronously to both. At the end of the second year
students undertake their clinical attachments across the wider NHS patch which
incorporates North Yorkshire, East Yorkshire and South Humber. In the three ‘clinical’
years approximately 50% of the teaching is hospital based and 50% community based.
Professor Tony Kendrick is the Dean of the School.
1.3
Chairs in Reproductive Medicine, Surgery, Psychiatry, Primary Care Medicine,
Radiology, Respiratory Medicine, Endocrinology, Vascular Surgery, Head and Neck
Surgery, Oncology and Cardiology have been appointed.
ACUTE ASSESSMENT UNIT AND MEDICAL AMBULATORY CARE UNIT
2.1
Duties
2.1.1 This is a new post and is based at Hull Royal Infirmary. It coincides with a
comprehensive reconfiguration of services for unscheduled medical admissions
for the population of Hull and East Yorkshire with an emphasis on reducing
inappropriate admissions to hospital and earlier supported hospital discharge.
2.1.2
This appointment will enable the Trust to expand its services to unscheduled
medical admissions by providing more clinical leadership to the Unit. The Trust
has recently implemented a new model of working in the AAU, ensuring
continuous consultant presence on the AAU for 12 hours daily on weekdays.
2.1.3
The successful candidate will join five AAU consultant physicians and a group
of 12 other physicians who work in sessions on the unit and share responsibility
for providing an effective medical service for unscheduled medical admissions.
2.1.4
The successful candidate must hold or be within 6 months of being eligible for
specialist registration in Acute Medicine or in General Internal Medicine with the
General Medical Council.
2.1.5
The appointee will be based at Hull Royal Infirmary with office provision and
secretarial support. He or she will have medical in-patient beds located on the
Acute Assessment Unit and also within the new short-stay bed base at Hull
Royal Infirmary, as well as access to outpatient facilities.
2.1.6 There is an Medical Ambulatory Care (MAC) unit co-located within the AAU. This
area provides rapid assessment of patients who are expected to be discharged
same day and also ambulatory care for patients with certain conditions such as
DVT and PE. The number of patients seen in the MAC varies each day but
averages around 10-15. The MAC is staffed by an acute medical registrar/
junior doctor supported by a consultant acute physician, a dedicated senior
nurse and a clinical support worker.
2.2
DEPARTMENT OF ACUTE MEDICINE
2.2.1
Hull Royal Infirmary has a busy Acute Assessment Unit (AAU) taking
admissions from both General Practitioners and the Emergency Department.
The philosophy of the unit is Rapid Evaluation, Stabilisation and Transfer.
2.2.2 The Acute Assessment Unit (AAU) has been operational since December 2000,
and receives between 65 and 100 admissions a day (average 76).
2.3
Staffing
2.3.1 AAU has continual consultant presence from 0830 to 1700hrs provided by the
acute physicians. In the evening continual consultant presence from 17002200hrs is provided by Consultants from Acute Medicine, Renal Medicine,
Endocrinology, Rheumatology, Chest Medicine and Gastroenterology. When on
AAU the consultant’s responsibility is to provide real time assessment and
management of patients admitted to AAU. All Consultant Physicians carry out
post-take ward rounds on the AAU when participating in the General Medicine
on call rota.
2.3.2
Additional Medical Staff
30 Specialist Registrars (training for acute medicine or for dual accreditation,
drawn from the medical specialties) Rota 3:30
3 Specialist Trainee ST3-6 in Acute Medicine based on the unit
15 Trainees drawn from FT2/CT1/CT2
2 FY1 Trainees during any shift
2.3.3 Specialty in-reach to the AAU is provided by Respiratory Medicine,
Gastroenterology, Elderly Medicine, Cardiology and Neurology. Respiratory Medicine,
Gastroenterology and Elderly Medicine see patients de novo after overnight admission.
2.4
Emergency Department
2.4.1 The Emergency Department is being extensively rebuilt as part of the £7m
modernisation programme, linked with Major Trauma Centre accreditation.
There is rapid access to diagnostics including imaging. This compliments the
existing state-of-the-art facilities within the hospital.
The AAU is adjacent to the Emergency Department. There are strong links
between the two departments which function within the Division of Emergency
Medicine. Clinical Pathways are shared and there is an established rotation
among trainees.
2.5
The unit is well supported by all the Medical specialities, including Cardiology and
Neurology which do not participate on the medical intake. The unit has taken the lead
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in delivering unscheduled care for medical admissions, providing ambulatory care,OP
Management of DVT and PE, teaching and training.
2.6
The AAU is supported by a Modern Matron, Nurse Practitioners, Teacher Practitioner,
specialist nurses in Diabetes, Stroke, Critical Care Outreach and Respiratory Medicine.
The Intermediate Care team and Bed Bureau are based on the AAU.
2.7
The AAU works as part of the Medicine Health Group and has a strong governance
framework. The management team include:
Dr A T Webb:
Dr M Aye:
Dr E Middleton:
2.8
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Medical Director, Medicine Health Group
Clinical Director, Emergency Medicine
Clinical Lead, Acute Medicine
A designated ward for Acute Surgical Admissions is operational at Hull Royal Infirmary.
WORK PROGRAMME
3.1
Clinical Duties
3.1.1 The successful applicant will join the existing cohort of sessional consultants to
provide continuous senior review and management of patients on the units.
3.1.2 Morning ward rounds are shared between the General Physician on call
overnight and the morning sessional acute physician.
3.1.3 The successful applicant will also share duties on the Medical Short Stay Ward
(Ward 1, Hull Royal Infirmary), complementing the existing staff of 4 acute physicians
and 4 rheumatologists.
3.1.4 The successful applicant will have the opportunity to develop an area of special
interest outside of acute medicine. This may be either an outpatients clinic, attached to
the appropriate medical speciality, or a special skill such as endoscopy or
echocardiography. The choice of special skill will be decided by the applicant
depending on their own interest and prior experience.
3.2
Clinical Governance/Audit/Research/CPD
3.2.1 There are established multi-disciplinary departmental governance meetings,
where issues arising from incidents, complaints and risks within the speciality
are reviewed regularly.
3.2.2
There is a twice monthly Mortality and Morbidity meeting.
3.2.3
There is a weekly senior acute physicians educational meeting where cases are
discussed, guidelines reviewed and relevant journal articles are discussed.
3.2.4
The Department encourages all CMTs and Specialist Registrars to undertake
an audit project in some aspect of Acute Medicine during their attachment.
There are opportunities for research within our department or with other medical
specialities.
3.3
Teaching
3.3.1 Medical students from Hull University (3rd and final years) have had regular
clinical attachments within the department for a number of years. Teaching
responsibilities in the department will increase with each intake to HYMS. All
physicians have a rolling commitment to the Grand Round/ CPD programme,
SHO teaching and MRCP Part 2 preparation.
3.4
PROGRAMMED ACTIVITIES
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The post attracts 10 programmed activities (PAs); 7.5 PAs are for direct clinical care
(DCC), 1 DCC is earmarked for clinical administrative work. There are 2 supporting
programmed activities (SPA) built into the job plan as the minimum requirement to
support revalidation. Further SPA time may be given to accommodate work-based
assessments, trainee supervision, research etc depending on request from the
successful applicant.
3.4.1 Indicative job plan
Activity
Details
Calculated DCC
AAU/Ambulatory Care
4-5 PAs per week
worked.
4 to 5*
Specialty interest
1-2 Clinic/special skill
1 to 2*
Medical Short Stay Ward
1:8 weekdays and
weekends – morning
ward rounds every day
Mon – Sun
1.0
Clinical Admin
1.0
Supporting Programmed
Activity
2
TOTAL
10
* Note: Total of 6 PAs combined for AAU/ambulatory care and speciality interest.
Ratio of 5:1 or 4:2 depending on interests of the candidate.
3.4.2
Example weekly timetable – AAU / MAC duty
Mon
AM
Tue
AAU
Wed
Thu
SPA
Sun
09001300
PM
Clinical
Admin
Evening
MACS
Special
interest
2+0
(2)
CME
(13001500)
AAU
15002200
17002030
2+0
(2)
Sat
MACS
0830 1630
PAs
worked
DCC+SPA
Fri
1+1
(2)
2+0
(2)
1+0.5
(1.5)
(total)
DCC PAs
worked
OOH
On AAU late shifts (1700-2200), 1.5PA, weekend AAU cover (12001800), 2 PA and weekend MSSW cover, 1PA
Note: although this rota shows 2 evening sessions (AAU and MACs session) this is to
demonstrate potential shift patterns only. It is extremely rare to do more than one evening
a week.
AAU: Acute Assessment Unit
MACS: Medical Ambulatory Care Service
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3.4.3 Example weekly timetable – ward 1 week
Mon
Tue
Wed
Thu
Fri
Sat
Sun
AM
Ward 1
(MSSW)
Ward 1
(MSSW)
Ward 1
(MSSW)
Ward 1
(MSSW)
Ward 1
(MSSW)
Ward 1
(MSSW)
Ward 1
(MSSW)
PM
ADMIN
PAs
worked
DCC+SPA
2+0
(2)
1 +0
(1)
1 +0
(1)
SPA
1+0
(1)
1+1
(2)
CME
(13001500)
1+0
(1)
1+0.5
(1.5)
(total)
AAU: Acute Assessment Unit
MACS: Medical Ambulatory Care Service
3.5
Any extra Programmed Activities will be agreed at the job planning process with the
Clinical Manager. Any such agreement will be made in writing and the additional
Programmed Activities will be incorporated into the Job Plan schedule.
3.6
Out of hours duties: The post holder will participate in the sessional time table (1:13
at present) to cover the AAU from 1700-2200 as well as weekend sessional cover on
AAU and scheduled ward rounds on the Acute Medicine Short Stay Ward. These
attract Direct Clinical Care programmed activities (PAs) as predictable on-call duties.
The post holder is not required to participate in the traditional (non-sessional) on-call
duties, which are currently shared between 22 General Physicians, nor would there be
a requirement to return to the unit after shifts.
3.7
Appropriate office accommodation, secretarial support and IT facilities will be provided.
3.8
Participation in audit/appraisal and CME is mandatory under clinical governance/GMC
guidance.
3.9
The timetable is flexible and can be modified to reflect the special interests and
expertise of the appointee.
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3.10
Duties other than those clinical duties specified will be in accordance with the Job Plan
agreed between the appointee, the present Consultants and the Chief Executive. The
Job Plan allows time for administration, teaching and medical audit.
3.11
All Consultants may be required to work on any of the Trust’s sites.
3.12
Annual and study leave allowance is as per national terms and conditions. Currently,
cover is arranged amongst consultants sharing sessional duties on the AAU (1:13 at
present). This is recognised in the job planning process in terms of annualised hours.
ALLIED SERVICES
4.1
General Surgery
4.1
Ten General Surgeons provide a service to Hull Royal Infirmary and Castle Hill
Hospital. All emergencies go to one acute admitting surgical ward at Hull Royal
Infirmary.
4.2
Orthopaedic Services
4.2.1 Consultant orthopaedic surgeons provide a service across the county. Trauma
services are concentrated on the Hull Royal Infirmary site and elective surgery
at Castle Hill Hospital.
4.2.2
4.3
Intermediate Care
4.3.1 There are two successful intermediate care schemes operating in the county
allied to the two local authorities, Hull City Council and the East Riding of
Yorkshire Council. A member of the intermediate care team is currently based
in the Acute Assessment Unit (AAU) to facilitate early discharge. From
November 2003, a Rapid Response team (nursing and therapy) with close links
to social services has been based in AAU and the Emergency Department.
Emergency Care Practitioners (paramedics with extended role) operate across
the city and have been successful in reducing the number of inappropriate
transfers to A&E.
4.3.2
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Orthogeriatric liaison is led by 3 DME consultants. Following the closure of
Kingston General Hospital in December 2000 and the re-organisation of acute
medical services in the Trust, fractured neck of femur patients are managed on
the trauma wards rather than transferred to a DME ward. Intermediate Care,
Outreach and the Hospital Acute Home Therapy service (HAHTS) are used
extensively. There are regular multi-disciplinary ward rounds to improve medical
care, facilitate discharge planning and co-ordinate the transfer of patients to the
DME.
There are Chronic Disease Management Teams operating in both the east and
west of the city. There is an East Riding Board for the Management of Long
Term Conditions.
THE HOSPITALS
5.1
The Trust comprises of two main hospital sites and operates Outpatient Clinics from
various peripheral sites.
5.2
Hull Royal Infirmary (695 beds)
This hospital is the major acute hospital in East Yorkshire and serves a population in
excess of 600,000. It has the only Accident and Emergency department and the
following specialities:Clinical Haematology
Dermatology
Diabetes/Endocrinology
General Medicine
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General Surgery & Vascular Surgery
Gastroenterology
Medicine for the Elderly
Neurology
Neurosurgery
Neurophysiology
Obstetrics and Gynaecology
Ophthalmology
Oral Surgery & Orthodontics
Orthopaedics
Paediatric Medicine
Paediatric Surgery
Renal Medicine
Rheumatology
Respiratory
5.3
Acute Admissions Unit - The Acute Admissions Unit is situated adjacent to the
Emergency Department. The Unit has encouraged greater integration of the General
Medical teams with the Department of Medicine for the Elderly, at junior and senior
level to cope better with the growing pressures on emergency admissions. Close
working relationships are established between the Admissions Unit and the Emergency
Department.
5.4
A ten bedded Intensive Care Unit is in close proximity to the 9 main Operating room
complex. This hospital has a separate Neurosurgical Intensive Care Unit and a
Cardiac Monitoring Unit. There is a 10-bedded Higher Dependency Unit adjacent to
the ICU.
5.5
Women’s and Children’s Hospital - This development opened in March, 2003 and
provides maternity wards and clinics, an antenatal day unit, a delivery suite, a neonatal
unit with special and intensive care, theatres, an early pregnancy assessment unit, 22
gynaecology beds, a gynaecology day surgery unit, gynaecology day care and
outpatients' department, a sub-fertility unit, an ultrasound department, and a children's
outpatient department.
5.6
Eye Hospital – A eye hospital was completed in October 2002, and provides three
operating theatres, a pre-assessment suite, a twelve-bed inpatient ward, administrative
space and a seminar room.
5.7
Phase two has provided sufficient space to allow a plan for expansion of Consultant
numbers and also for paediatric and adult outpatient clinics, along with supporting
facilities such as orthoptics
5.8
Castle Hill Hospital (645 beds)
The hospital is one of the two major hospitals on North Humberside. Clinical Services
currently on site include:
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Cardiology
Cardio-Thoracic Surgery
ENT and Head and Neck Surgery
Gastroenterology
General Medicine
General Surgery, colorectal and breast
Genito Urinary Medicine
Infectious Diseases
Medicine for the Elderly
North Humberside Breast Screening Service
Orthopaedics
Plastic Surgery
Queen’s Centre for Oncology and Haematology
Rehabilitation
Rheumatology
Thoracic Medicine
Urology Service
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5.9
As part of the ongoing ICU/HDU development, a new building will help provide an
additional 7 beds to the existing 9 bedded Intensive Care Unit.
5.10
The Academic Medical Unit led by Professor Alyn Morice and the Academic Surgical
Unit are based at this hospital.
5.11
Westwood Hospital, Beverley
Outpatients and minor injuries only.
EAST RIDING MEDICAL EDUCATION CENTRE
7.1
The East Riding Medical Education Centre (known as ERMEC) is located on the Hull
Royal Infirmary site. The Centre contains a 200 seat auditorium equipped with full
video and dual projection facilities and three large seminar rooms. There is an
extensive Resource Centre with a sister facility at Castle Hill Hospital. The Resource
Centres have holdings of over 10,000 texts and receive 72 journals on weekly or
monthly receipt, together with some Video and DVD items. Access is available to the
numerous online resources from the Resource Centres’ PCs. The Resource Centres
have 24/7 access via a swipe card system. The centre incorporates the largest
Postgraduate medical educational facility in the Yorkshire Region and supplies catering
and support services, in addition to its central teaching and academic roles.
7.2
The associated department at Castle Hill Hospital includes a 70 seat lecture theatre
with modern audio-visual equipment.
7.3
A £12m Clinical Skills Facility was completed in 2010.
7.4
Dr Makani Purva is the Director of Postgraduate Education for East Yorkshire and is
responsible for the education of medical staff and the running of the East Riding
Medical Education Centre and Dr Tun Aung is the Deputy Director. The Centre has a
comprehensive Postgraduate tuition programme in which the successful candidate will
be encouraged to take part.
7.5
There is a commitment within the Trust for Consultant staff to participate in continuing
professional development.
APPRAISAL/CONTINUOUS PROFESSIONAL DEVELOPMENT
8.1
The Trust is committed to supporting the requirements for continuing education and
professional development is laid down by the Royal Colleges. A personal development
review will be undertaken by the Professional Lead annually and objectives agreed.
Appraisal is carried out according to GMC guidance in preparation for revalidation.
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OTHER MEDICAL INFORMATION
9.1
Local professional bodies include the Joint Hospitals Medical Staff Committee whose
membership comprises of all consultant staff and top-grade scientists; the Hull Medical
Society and a branch of the British Medical Association. The Medical Advisory Group
(MAG) and the Division of Medicine are professional advisory groups advising the
Executive and management teams on behalf of medical staff.
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RESEARCH AND DEVELOPMENT
10.1 There is a Research and Development Facilitator who promotes and facilitates NHS
research in the area.
10.2
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The Service has an admirable record of research publications and international
presentations.
RELATIONSHIPS BETWEEN CONSULTANTS, CHIEF EXECUTIVES AND
TRUSTS
11.1 The management of hospitals and other health care facilities is the responsibility of
Trust Boards discharged through their Chief Executives, who have authority to decide
policy commensurate with their responsibility. Consultants have a primary role to
provide clinical services to patients referred to them.
11.2
The Consultants have a responsibility to the Chief Executive and a commensurate
authority in respect of the reasonable and effective use of such resources and staff as
they use and influence. The successful candidate will be expected to operate within
the agreed speciality budget and workload target. There is in addition a collective
responsibility falling on all Consultants to consult with their colleagues and, hence, to
co-ordinate their individual commitments in order to ensure that the particular clinical
services with which they are involved operate effectively.
11.3
Each consultant has a specific responsibility to the appropriate Service Management
for the use of the resources. The Acute Medicine Department is managed within the
Division of Emergency Medicine.
ADDITIONAL INFORMATION
12.1 Hull is one of the country's main ports and serves as a gateway to the rest of the
European Community.
12.2
There are an increasing number of direct inter-city trains to London and regular
services to other major centres. The M62 motorway provides fast communications
within Yorkshire and links up directly with the A1 and M1 North/South motor routes.
Humberside Airport provides a reliable service to several European cities. There is
easy access to nearby pleasant countryside, dales, moors and first class coastal
resorts. The City of York, with its Minster and many other attractions, including the
Jorvik Centre, can easily be visited in a day.
12.3
East Yorkshire has forty miles of spectacular coastline from Spurn Point in the south to
Filey Brigg in the north. Spurn Point has the only full-time lifeboat crew in the country
and is a bird watchers' paradise. Nearby is Hornsea Mere, a huge freshwater lake and
RSPB reserve. Hornsea also has a famous local pottery and an award winning
Museum of Village Life.
12.4
Both the City of Hull and the nearby market town of Beverley are ancient Boroughs of
considerable interest. Hull was very much rebuilt after heavy bombing in World War II
and is, therefore, a modern as well as an historic City. There is an attractive Yacht
Marina and an international ice rink and there is a good choice of theatre and concert
programmes, at both the New Theatre and Spring Street Theatre within the city centre.
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12.5
Beverley has a beautiful medieval Minster, fine Georgian and other period houses and
cobbled market square. The restored Dominican Friary, dating from the 14th Century
and nearby racecourse are notable attractions.
12.6
The Humber Bridge links the North and South Banks of the Humber, which have a
combined population of some 900,000 people.
12.7
There are good education facilities, both private and state, for school age children and,
in addition to the University of Hull; there is a second university, the Lincolnshire and
Humberside University, based in the area.
12.8
Several new projects have been completed and are underway in the City, to ensure
that Hull is recognised as one of the UK's Top 10 cities by 2010. These include the
Deep, (a Marine Science and Visitor Centre), a £43 million Stadium and the
redevelopment of the Ferensway shopping area where the St Stephen’s Shopping Mall
has recently opened.
12.9
Housing locally is generally cheaper than in most other parts of the country. There are
many villages with good housing/facilities surrounding Hull and within the required
travelling time.
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RESIDENCE
13.1 The post holder must live within 30 minutes travelling time of base hospital.
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CONDITIONS OF SERVICE
14.1 Any Consultant who is unable, for personal reasons, to work full time will still be eligible
to be considered for the post. If such a person is appointed, modification of the job
description will be discussed on a personal basis following consultation with colleagues
and the Chief Executive.
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14.2
Appointment under the Department of Health Flexible Careers Scheme will be in
accordance with the provisions of that scheme and the associated guidelines for Trusts
(08/05/02).
14.3
It is a legal requirement for all doctors to be on the Specialist Register before they can
take up a Consultant appointment.
TRUST SAFETY POLICIES AND PROCEDURES
15.1
You are responsible for your own health and safety and must co-operate with
management to achieve safer work processes and work places, particularly where it
can impact on others.
15.2
You are to ensure suitable and sufficient equipment is provided and the adherence to
Trust safety policies, to sustain the health and safety of staff, patients and visitors, to
areas within your remit.
15.3
You are required to review all risk assessments periodically and particularly when
staffing and/or equipment changes, monitoring the effectiveness of any control
measures implemented.
15.4
You are to ensure suitable and sufficient equipment is provided to sustain the health
and safety of staff, patients and visitors to areas within your remit.
15.5
In addition to the Trust’s overall responsibilities under the Health Act Code of Practice
for the Prevention of HCAI 2006 for your safety, you have a personal responsibility to
ensure that your work adheres to this Code in the delivery of safe patient care within
the organisation.
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EQUAL OPPORTUNITIES
16.1 The Trust is an equal opportunities employer with family friendly working practices
available.
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ACHIEVING A BALANCE
17.1 The Strategic Health Authority is committed to this nationally agreed initiative and will,
in accordance with "Plan for Action" be reviewing and adjusting the numbers and
disposition of hospital doctors. This will involve an increase in Consultant staff and a
reduction in some of the training grade staff. The numbers and grades of junior staff
currently supporting this post are, therefore, not guaranteed and may be changed as
the plan develops.
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VISITING ARRANGEMENTS AND EXPENSES
18.1 Arrangements to visit and meet the Chief Executive to be made through Jodie Savage,
Human Resources Department (01482) 674007. Shortlisted candidates who visit Hull
for this purpose, or at the specific request of the Management, will be granted travel
and appropriate subsistence expenses on that occasion. In the case of candidates
travelling from abroad, travelling expenses are normally paid only from the point of
entry into the United Kingdom.
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PRESENTATION
19.1 Shortlisted candidates for Consultant appointments are required to deliver a 10 minute
presentation on a given topic as part of the selection process.
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CHIEF EXECUTIVE
20.1 The Chief Executive is Mr John Saxby (01482) 675783.
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CONSULTANT CONTACT
22.1 Dr M Aye (01482 675369)
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PROPOSED DATE OF INTERVIEW
23.1 To be confirmed
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CLOSING DATE FOR APPLICATION
24.1 To be confirmed
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