Consultant Physician with an interest in Stroke Medicine

JOB DESCRIPTION

March 2021

1 JOB DESCRIPTION

These are two substantive posts and are a full time 10 PA for two whole-time Consultant Stroke Physician based at Lincoln County Hospital. The purpose of the posts are to ensure the highest quality of care is provided to the population from prevention to hyper-acute treatment and all aspects of rehabilitation. The appointees will join a busy, enthusiastic and hardworking team. Within the team there will be opportunities for developing sub-specialisations and every support will be given to research interests.

The post holders will provide leadership for the management of acute stroke admissions, TIA clinics and medical support to the stroke rehabilitation service. The post holders will work closely with colleagues in the Stroke, Acute Medicine and the Emergency Departments.

We wish to appoint candidates who have had training and experience in Stroke Medicine and intend to commit the majority of their professional time to this specialty. In line with Directorate policy, they will be expected to contribute to the on-call rota for Stroke.

LINCOLNSHIRE Lincolnshire is a scenically and geographically varied county. It includes the Lincoln escarpment, the North which are designated as an area of outstanding natural beauty, and extensive beaches on the coastal strip.

Lincolnshire scores highly when it comes to education from nursery through to and has a growing university culture. In your free time there are many places of interest to visit in Lincolnshire with motor racing at Cadwell Park, lakes for sailing, some of the best coarse fishing in the country and horse racing at Market Rasen. There are a number of historic architectural gems including Lincoln Cathedral, Lincoln Castle, Castle, Belton House, Belvoir Castle, and the Boston stump.

Lincolnshire offers an attractive choice of pretty rural villages or for those who prefer urban living there is a choice of the City of Lincoln which dates back to Roman times, or the traditional market towns of , Boston and Louth. The property market offers potential buyers high quality modern and traditional housing at attractive prices. is only an hour away via mainline train services from Grantham.

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THE TRUST OPERATING MODEL (TOM) On 1st April 2019, the trust implemented the new Trust Operating Model, which includes a new organisational structure and ways of working for everyone. The TOM is an exciting opportunity to make sure we are fit for purpose and that employees get what they require out of the organisation they work for, as well as making sure we get the best that you have to offer. We have gone from 16 Clinical Directorates to streamlining the services into 4 divisions.

THE TRUST The United Lincolnshire Hospitals NHS Trust is a large acute NHS Trust which is responsible for a comprehensive range of health services to a local population of 730,000. It has a total bed complement of 1267 and delivers health care at 3 principal sites: Lincoln County Hospital, Pilgrim Hospital at Boston and Grantham & District Hospital. Many local general practitioners are known personally to the consultant staff and are met at postgraduate meetings and elsewhere.

3 Lincoln County Hospital is situated close to the centre of Lincoln. It is a large and modern complex, catering for most of the major specialties and has 547 acute beds. There is a large, well-staffed Emergency Department and Intensive Care Unit. There is an Ophthalmic Unit, Surgical Day Unit and a purpose-built Clinical Oncology Department. The Trust runs a countywide Primary PCI programme from the Lincolnshire Heart Centre, a Level 1 Heart Attack Centre. Renal beds and inpatient dialysis facilities are co-located on Burton Ward and there are plans to develop this area to accommodate all Lincolnshire acute and inpatient dialysis.

Grantham & District Hospital is a small district general hospital with 144 acute beds, of which 91 are acute medical beds. It has close links with Lincoln, Boston and Newark hospitals as well as teaching centres in Nottingham and Leicester. Primarily it serves the people of Grantham, and Newark with a total catchment population of around 120,000.

Grantham provides Integrated Medicine, Elective General Surgery, Orthopaedics, Anaesthetics and a daytime Emergency Department Service. There is an ambulatory Paediatric service and Midwife Managed Maternity Unit. There is a fully equipped X- Ray Department with a modern CT scanner and MRI scanner (with two sessions per week of cardiac MRI), as well as a Pathology Department providing all pathological services on site. There is a Medical Physics Department, which does all cardio- respiratory work as well as gamma camera work including myocardial perfusion imaging and radionuclide ventriculography.

Pilgrim Hospital is a modern 566 bedded District General Hospital pleasantly situated in Boston with good transport links. A full range of clinical specialties and laboratory facilities of the highest standard are provided. It has close links with community hospitals in and Spalding and is the main hospital centre for South Lincolnshire. The hospital includes an Emergency Department and beds for General Medicine, Elderly Care, General Surgery, Orthopaedic Surgery, Vascular Surgery, ENT, Ophthalmology, Paediatrics, Psychiatry, Oral Maxillofacial Surgery, Obstetrics and Gynaecology and Intensive Care with 12 beds, an Endoscopy Unit and a new MRI scanner.

4 LINCOLN - DEPARTMENT OF STROKE MEDICINE

The Department of Stroke Medicine is a Pan Trust Department. Dr Abdul Elmarimi is the Clinical Lead and full time Stroke Consultant working across both sites. He is supported also by Dr Kresimir Jergovic, Stroke Consultant, Dr Skarlett Markova (NHS locum) and Dr Carmen Constantin (NHS locum). The Lincoln Site is supported by a tier of Stroke Advanced Clinical Practitioners, who provide 24/7 in-reach service including thrombolysis and TIA assessments.

The Boston Site Service is covered by this pan-trust team with a Stroke Unit taking acute patients repatriated from the Lincoln Hyper-Acute Unit. The consultant team are supported at Boston by Dr Gheorghitescu, a Specialty Doctor in Stroke Medicine.

There is a separate 1:6 Stroke On-Call rota on the Lincoln Site and the Stroke Physicians do not have any commitment to the acute medicine on call rota.

24/7 thrombolysis is provided on the Lincoln Site backed by a full hyper-acute Stroke Unit. The trust has temporarily consolidated down to a single Hyper-Acute Unit as part of its’ response to COVID. There are excellent established links with the regional centre at QMC (Nottingham) for mechanical thrombectomy and neurosurgery. The Trust has had over 1200 admissions due to stroke in the last year.

The Lincoln Stroke Unit comprises 28 beds taking patients directly from the ED. They are well staffed with highly skilled nurses and supported by dedicated teams of allied health care professionals including Physiotherapists, Dieticians and SALTs. Dedicated discharge coordinators support the teams, and ensure seamless transfer of care.

There is rapid access to clinic slots for TIA patients 7 days per week and 2 clinics per day most week days. From current levels of activity, Lincoln is likely to see circa 450 new TIA outpatients’ referrals per year.

CT, MRI, carotid ultrasound and medical physics are all available onsite and provide an excellent rapid service. The Vascular Service has been established at Pilgrim Hospital Boston. There is outstanding support by the Cardiology Department in

5 providing contrast/trans oesophageal echocardiograms, and Implantable Loop Recorders when needed.

CARDIOVASCULAR CLINICAL BUSINESS UNIT STAFFING

The Department of Stroke Medicine is contained in the Cardiovascular Business Unit which comprises of circa 40 wte Consultant Physicians with specialist interests. Inpatient care is provided in modern specialty based wards. There is a dedicated Medical Emergency Assessment Unit (MEAU/IAC) where emergency medical admissions from primary care and A&E are treated and a separate Surgical Emergency Assessment Unit (SEAU) at Lincoln. The Medicine Division has an active postgraduate education programme with weekly physicians meetings and Monthly Grand Rounds. The department is committed to mentoring new Consultant Colleagues.

Cardiology Dr V Venugopal Consultant Interventional Cardiologist (Lead Clinician) Dr R Andrews Consultant Cardiologist (Lincoln) Dr W Arthur Consultant Cardiologist (Lincoln) Dr D Morgan Consultant Cardiologist – Device Specialist (Lincoln) Dr M Eisenberger Consultant Cardiologist Device Specialist (Boston & Lincoln) Dr S Kelly Consultant Interventional Cardiologist (Lincoln) Dr D O’Brien Consultant Interventional Cardiologist (Honorary Contract) Dr P Jokhi Consultant Interventional Cardiologist (Lincoln) Dr J Fernandez Consultant Interventional Cardiologist (Lincoln) Dr K Lee Consultant Interventional Cardiologist (Lincoln/Grantham) Dr A Adnan Consultant Interventional Cardiologist Dr J Skopal Consultant Cardiologist (Boston) Dr S Dhar NHS Locum Consultant Cardiologist (Boston) Dr A Ravi Locum Consultant Cardiologist (Boston) Dr D Taleyratne Consultant Interventional Cardiologist (Boston/Lincoln) Dr M Syed Agency Locum Consultant Cardiologist (Lincoln/Grantham) Dr A Houghton Consultant Cardiologist (Grantham Part-Time)

Stroke Medicine Department Dr A Elmarimi Consultant Stroke Physician (Lead Clinician) Dr K Jergovic Consultant Stroke (Neurologist)

6 Dr S Markova NHS Locum Consultant Stroke (Neurologist) Dr C Constantin NHS Locum Consultant Stroke Physician Dr O Owojori Locum Consultant Stroke Physician

Dr I Wahishi NHS Locum Consultant Stroke Physician (Part-time) Dr Pennoose Locum Consultant Stroke Physician

Nephrology Dr M Williams Consultant Nephrologist (Lead Clinician) Dr J Little Consultant Nephrologist Dr K Mahdi Consultant Nephrologist Dr R Hardy Consultant Nephrologist Dr S Mohmad Consultant Nephrologist Vacant New postholder joins April 2021

Diabetes & Endocrinology Dr B Srinivasen Consultant in Diabetes & Endocrinology (Lead Clinician) Dr C Ravikumar Consultant in Diabetes & Endocrinology (Lincoln) Dr A Singh Consultant in Diabetes & Endocrinology (Lincoln) Dr A De Silva Consultant in Diabetes & Endocrinology (Lincoln) Dr A Tarik Consultant in Diabetes & Endocrinology (Lincoln) Dr D Eapen Consultant in Diabetes & Endocrinology (Boston) Dr N Htwe Consultant in Diabetes & Endocrinology (Boston) Dr Y Abdelgader Locum Consultant in Diabetes & Endocrinology (Boston) Dr C Fernandez NHS Locum Consultant

The CBU’s are supported by tiers of Staff Grade Practitioners, Specialist Registrars, CMT level doctors who are part of the North Trent rotation, VTS, FY2s and FY1s who rotate with posts in the Nottingham and Leicester schemes. The CBU maintains an excellent nursing workforce, many of whom have extended their skills to enable them to complement the work of the medical teams. There are also Nurse Consultants in Cardiology and Frailty. Cardiology has 16 experienced Acute Cardiac Practitioners (ACP’s) and the Stroke Service has 5.8wte Advance Care Practitioners.

7 DUTIES AND RESPONSIBILITIES OF THE POST

The post holder will be required to: . Provide in-patient and out-patient care for patients with stroke, TIA and suspected cerebrovascular disease . Contribute to the provision of acute stroke specialist service delivering thrombolysis and other specialist treatments. Acute stroke for the Trust are currently under review in line with the Midlands and East strategic health authority Stroke review. We have functional telemedicine equipment which is used with various aspects of stroke care. Work with the rest of the clinical and managerial team to support and deliver quality improvements on the Stroke Unit and in the community . Take an active part in undergraduate and postgraduate teaching and training . Participate in clinical and other service activities with the object of ensuring a high standard of patient care . Meet Royal College of Physicians standards and British Association of Stroke Physician in continuing medical education, with at least 25 hours of external education in Stroke plus general medicine input . Participate in local mandatory training, yearly appraisal and revalidation . Contribute to the management of the clinical service and service development . Contribute to the development of clinical quality and effectiveness in other clinical areas where these overlap with developments in Stroke

The job will include liaising with and teaching nursing staff, health care assistants, therapists and other members of the multidisciplinary team. It will also include teaching medical students rotating through the ward, teaching and appraising FY and ST trainees and SpRs on rotation at the Hospital.

All staff are required to advocate, champion and demonstrate the below values and behaviours

Patient I am fully committed to providing the very highest centred standards of care to our patients Safety I do everything I can to keep my patients and my colleagues safe

8 I keep my environment clean and tidy I recognise when something is going wrong and I have the courage to do something about it Compassion I show a genuine concern for my patients and my colleagues I communicate well with others, listening and showing an interest in what they have to say I am positive, approachable and friendly

Respect I treat my patients and my colleagues with dignity and respect I work openly and honestly as part of an effective team I keep my promises and do what I say I will, when I said I will, or I will provide an explanation if I can’t Excellence I will always go the extra mile and improve things for my patients and my colleagues I am competent to carry out my role and committed to my personal and professional development I will share good ideas and best practice and encourage my team members to do so too

THE FUTURE It is expected that the post-holder will participate in future service developments. The current service configuration is part of the Lincolnshire STP Acute Services Review. There is an active plan for the future of Stroke Care in Lincolnshire and the stroke clinicians will continue to play an active role in this process.

PROPOSED JOB PLAN This is a 10 PA job plan with 1.5 PA’s attributed to SPA. It is a provisional job plan and indicative. It may change, in consultation with the Clinical Lead, in the future according to service needs. An 11th PA may be available by mutual consent.

Below is an indicative timetable. The timings given are average times for the activities indicated. Given the variable nature of clinical work, it is accepted that some activities may both over and under run. If, however, activity regularly over or under runs, then it may be appropriate to review this job plan and/or the support provided.

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The initial job plans for this post is planned to be: Post 1

AM PM

Admin/ Family & carers’ meetings (0.5 Stroke Ward Round (1 DCC) MON DCC)

CPD/Audit/Teaching (0.5 SPA)

TUES Stroke Ward Round (1 DCC) Multidisciplinary team meeting (1 DCC)

CPD/Audit/Teaching. (0.5 SPA) WED Acute Stroke Ward Round (1 DCC) Stroke research/clinical trials (0.5 SPA) HASU (1 DCC) HASU (1 DCC) THURS Acute stroke A&E/Ward referrals Acute stroke A&E/Ward referrals

Stroke Ward Round (1 DCC) TIA/ Stroke Clinic (1 DCC) 4:5 FRI HASU 1:6 HASU 1:6

Post 2

AM PM

HASU (1DCC) HASU (1DCC) MON Acute stroke A&E/Ward referrals Acute stroke A&E/Ward referrals

Multidisciplinary team meeting (1 DCC) TUES Stroke ward round/ Radiology (1DCC) meeting (1DCC) CPD/Audit/Teaching. (0.5 SPA) WED Stroke ward round (1DCC) Stroke research/clinical trials (0.5 SPA) Admin/ Family & carers’ meetings THURS Stroke ward round (1DCC) (0.5DCC) CPD/Audit/Teaching (0.5 SPA)

Stroke Ward Round (1 DCC) TIA/ Stroke Clinic (1DCC) (5:6) FRI HASU (1:6) HASU (1:6)

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Job Plan Total:

DCC 8.5 (DCC)

SPA 1.5 (SPA)

On Call 1.5 worked PA’s (DCC) in addition to 10PA Job Plan

ON CALL RESPONSIBILITIES The current rota is one in six for thrombolysis and Stroke Emergency cover (1:6 weekends). There is excellent support from the HASU nurses, and easy access to specialist imaging, as well as other specialties. There is access to tele-radiology if required. There is currently an additional 1.5 PA allowance for on call work. Compensatory Rest will be available as per trust policy if disturbed in the night

RESIDENCE

The person appointed will be required to maintain his/her private residence in contact with the public telephone service and reside within reasonable access bearing in mind the duties of the post.

SERVICE OBJECTIVES  To ensure that high standards are met in the provision of care to inpatient and outpatient Stroke/TIA services.  To make all reasonable effort to support the Trust in ensuring that the waiting list objectives as outlined in the NHS plan are met. .  To participate in the clinical governance function.

PERSONAL OBJECTIVES  To maintain skills and knowledge in the fields of Stroke Medicine in line with the outcome of the annual appraisal process. The Trust supports the requirements for continuing professional development as laid down by the Royal College of Physicians and is committed to providing time and financial support for these activities.

 To have an annual appraisal and provide evidence for revalidation in line with the GMC guidelines. The Trust has the required arrangements in place, as

11 laid down by the Royal College of Physicians, to ensure that all doctors have an annual appraisal with a trained appraiser and supports doctors going through the revalidation process.

To work within the Business Unit and Stroke Medicine department to deliver national and local targets including the agreed ‘new to follow up ratio’ for Stroke/TIA clinics. Clinics are booked in line with RCP guidelines (i.e 30mins for a new patient; 15 minutes for a follow up patient).

 To embrace the NHS modernisation agenda.

STUDY LEAVE Study leave necessary to maintain overall competence will be undertaken during the year. It is the responsibility of the post holder to arrange this in conjunction with the Clinical Lead. The Trust will fund this training within the accepted study leave allowance.

OFFICE ACCOMMODATION Office accommodation will be available with a Personal Secretary and a personal computer with Internet access.

HEALTH AND SAFETY The United Lincolnshire Hospitals NHS Trust recognises its duties under the Health and Safety at Work Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare at work of all its employees. In addition the business of the Trust shall be conducted so as to ensure those patients, their relatives, contractors, voluntary workers, visitors and members of the public having access to the Trust premises and facilities are not exposed to risk to their health and safety.

All Medical and Dental staff under contract to the United Lincolnshire Hospitals NHS Trust will be expected to comply with the Trust Health and Safety Policies.

TEACHING AND EDUCATION The post holder will be expected to be actively involved in education, both as a participant and a teacher. The latter will include GPs, nurses, other health care professionals and junior medical staff.

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POSTGRADUATE MEDICAL EDUCATION There are excellent facilities within the PGMC. The library is run by a professional librarian. It is well staffed and offers modern IT facilities, including several points of Internet access. There is 24-hour desktop access to reference material held on CD- ROMS within the library. The PGMC has a lecture theatre and many smaller rooms with a full range of modern presentational equipment.

There is an active undergraduate and postgraduate teaching programme. The main features are:  CT teaching Wednesday afternoon.  FY1 teaching Thursday lunchtime  FY2 teaching Thursday lunchtime  Physicians Meeting Monday lunchtime  Department meeting Tuesday lunchtime  Bi Monthly medical audit meeting

At Lincoln there is a well-developed mentoring and appraisal system for junior staff within the department and the postholder would be expected to take on mentoring duties. There are arrangements in place for new consultants to receive mentoring as required.

In addition many firms have medical students from the University of Nottingham Medical School attached for eight-week blocks throughout their final three years.

APPRAISAL AND CONTINUING PROFESSIONAL DEVELOPMENT (CPD) There is a commitment to regular appraisal, revalidation and CPD. Annual performance appraisal will be held between the post holder and the Service Director/ Clinical Director in accordance with National Guidance on Consultant Appraisal.

CLINICAL AUDIT An active audit Programme exists within the Trust and within the Department of Medicine. The post holder is expected to carry out audit and participate in the programme. Audit is supported by a Clinical Effectiveness Unit. The post holder is expected to take part in the evaluation of SSNAP data as well.

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RESEARCH There are opportunities for clinical research. The Trust has developed good links with the Institute of Health Studies at Lincoln University and there is ample scope for research and further study. There are strong links with the stroke research network, Lincoln being well ahead on its portfolio recruitment each year. The stroke research network pays for 1.5 WTE staff for stroke research.

MAIN CONDITIONS OF EMPLOYMENT The terms and conditions of employment will be determined by the United Lincolnshire Hospitals NHS Trust terms and conditions of employment. These are generally in line with the relevant provisions of the Terms and Conditions of Service of Hospital Medical and Dental Staff ( and Wales) and General Whitley Council Terms and Conditions of Service, as amended from time to time. Copies of these can be seen in the Personnel Department.

In determining salary for the post, the Trust will pay no less favourable rates than those paid to NHS Consultant Medical and Dental Staff. If, in the future, the Trust establishes alternative negotiating arrangements you will be notified of those arrangements, and thereafter any agreements thus reached will form part of your Contract of Employment.

The post holder shall have medical clearance arranged by the Trust before taking up employment.

INFORMATION Potential applicants are invited to contact the following key staff for further information:

Dr Abdul Elmarimi Consultant Stroke Physician Lincoln County Hospital Lincoln LN2 5QY Tel 01522 573260

14 UNITED LINCOLNSHIRE HOSPITALS NHS TRUST PERSON SPECIFICATION POST: Consultant Physician with an Interest in Stroke Medicine

REQUIREMENTS ESSENTIAL DESIRABLE Qualifications &  Current valid GMC Certification registration  Advanced Life Support  MRCP or equivalent certificate

 Certificate of  Higher research completion of specialist qualification training (CCT) or equivalent in General Internal Medicine and Geriatric medicine, Neurology or Stroke medicine (or entry expected within six months of interview date)

Clinical experience  Clinical experience in stroke medicine,  Experience of including acute, TIA, telemedicine rehabilitation and  Ability to take full and prevention independent responsibility for the  Ability to take full and management of acute independent medical emergencies responsibility for clinical care of patients  Expertise in stroke thrombolysis Management  Evidence of  Management understanding of the training or role of clinical qualification management  Evidence of  Ability to organise and leadership in the prioritise workload development of effectively clinical services  Ability to plan strategically and to  Evidence of exercise sound developing a high judgment when faced quality, high with conflicting performance pressures service  Ability to motivate and develop the multi- disciplinary team,

15 balancing departmental and personal objectives Clinical effectiveness  Evidence of contribution to effective clinical audit and clinical risk management Teaching and Training  Experience of  Teaching qualification undergraduate teaching and post graduate training for doctors and other disciplines Research  Understanding of the  Evidence of original principles and research applications of clinical research Personal attributes  Enthusiasm and the ability to work under pressure  An enquiring and critical approach to work  Caring attitude to patients  Ability to communicate effectively with colleagues, patients, relatives, GP’s, nurses, other staff and agencies Information technology  Basic keyboard skills/knowledge of Microsoft packages

Completed by: Dr A Elmarimi, Mrs Rebecca Johnson Date: March 2021 On behalf of the United Lincolnshire Hospitals NHS Trust

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