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HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST CONSULTANT PHYSICIAN DEPARTMENT OF ACUTE MEDICINE JOB DESCRIPTION SALARY SCALE £75,249 - £101,451 1 2 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 2 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 3 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 3 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 4 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. 5 4 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 5 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 6 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: 7 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 7 8 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. 8 9 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. 10 RESEARCH AND DEVELOPMENT 10.1 There is a Research and Development Facilitator who promotes and facilitates NHS research in the area. 10.2 11 12 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. 9 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. 13 RESIDENCE 13.1 The post holder must live within 30 minutes travelling time of base hospital. 14 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. 15 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. 10 16 EQUAL OPPORTUNITIES 16.1 The Trust is an equal opportunities employer with family friendly working practices available. 17 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. 18 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. 19 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. 20 CHIEF EXECUTIVE 20.1 The Chief Executive is Mr John Saxby (01482) 675783. 21 CONSULTANT CONTACT 22.1 Dr M Aye (01482 675369) 22 PROPOSED DATE OF INTERVIEW 23.1 To be confirmed 23 CLOSING DATE FOR APPLICATION 24.1 To be confirmed 11