Scott’s View, St Boswells, Scottish Borders TD6 0AP

Borders General Hospital, Melrose, Scottish Borders TD6 9BS

Job Description and particulars for the post:

Locum Consultant in Emergency Medicine October 2021 – March 2022 NHS Borders – Job Information Pack

Reference Please quote on all correspondence Grade Locum Consultant in Emergency Medicine Location Hours / PA’s Full time – At least 10 PAs per week (Part-time may be considered) E.P.A. (s) offered by mutual agreement Salary Scale Consultant scale -

Your Thank you for expressing an interest in the above post within NHS Borders. Application Please find all the relevant information attached to begin the application process.

Should you require further information regarding this post you can contact the Medical Staffing team or make informal enquiries with the department using the contact details below.

Contact Telephone 01896 826167 Details Email [email protected]

Application How to apply: Process If you are an existing NHS Scotland employee please log onto https://apply.jobs.scot.nhs.uk/internal/vacancies.aspx

If you are external to NHS Scotland please log onto https://apply.jobs.scot.nhs.uk/vacacies.aspx

Visits and Informal visits can be arranged and informal enquiries regarding this post will Enquiries be welcomed by:- Dr Colm Consultant in 01896 826993 McCarthy Emergency [email protected] Medicine Dr Andrew Consultant in 01896 826997 Baillie Emergency [email protected] Medicine The post is available from October 2021 and a start date will be agreed with Date post is the successful candidate. vacant NHS Borders For further information regarding NHS Borders, please visit our website:- Website www.nhsborders.org.uk

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NHS Borders Why work for us?

Our Values are at the heart of all that we do: ●Care and Compassion ●Quality and Teamwork ●Dignity and Respect ●Openness, honesty and responsibility

Patients are at the centre of everything we do in our daily working lives at NHS Borders ensuring they are safe, cared for efficiently, effectively by suitably experienced and qualified staff driving quality at the heart of patient care. We are a dynamic and forward thinking team with a wealth of clinical and leadership experience. We aim for an open and honest culture and believe in nurturing future stars in NHS.

We apply Values Based Recruitment, and seek to test competence, clinical skills and knowledge in the interview/assessment process but also assess that the values and behaviours of individual candidates align to the Values of the NHS in Scotland

NHS Borders was one of the first NHS Boards in Scotland with an entirely integrated structure for management of health services. Decision-making is firmly embedded within an integrated Clinical Executive, part of a natural evolution towards more integrated care, which has seen health and social services within the Borders develop nationally recognised joint initiatives. The NHS Borders Board covers an area co-terminus with the local authority and has developed close and effective links with Scottish Borders Council, including the creation of a Joint Health and Care Partnership Board moving forward the integration of health and social care.

The 5.1 The Emergency Department Department The Borders General Hospital E.D. has been a Consultant Led service since 2008. A service which was previously run by the orthopedic team has evolved and grown to become an efficient and integrated service to receive, investigate and treat the urgent and emergency needs of the population of Scottish Borders, 24 hours a day, seven days a week. With the growing demands of an ageing population and a growing population we are seeking to expand the consultant base.

5.2 Medical Staffing The Department has two consultants Dr Colm McCarthy, appointed in June 2016 and Dr Andrew Baillie, appointed in September 2018. The Page 3 NHS Borders – Job Information Pack

Core Staffing is in the form of Specialty Doctors (mainly previously GP qualified). Additional staff come from GP trainees who are shared with the orthopaedic and trauma service. We also have four posts filled annually with Clinical Development Fellow appointees (CDF), since the initiation of this type of post, CDFs have proved popular, been quickly filled and all CDFs have progressed onto desired training posts at the end of their attachments.

5.3 Nurse staffing Nurse staffing within the ED comprises registered nurses and nursing assistants led by a senior charge nurse. Plaster technicians staff the Plaster Room in the in-hours period. A departmental clerk undertakes clerical duties Mon to Sun 12.30 – 21.00hrs.

Emergency Nurse Practitioners (ENPs) undertake the assessment, diagnosis, treatment and discharge of patients with minor injury. The ENPs provide a dedicated nurse led service during weekdays Tues – Friday (13:00 to 21:00) and Mondays - Weekends (10:00 to 21:00).

Overnight nurse staffing comprises trained staff rostered from 19:45 to 08:15.

5.4 Attendances The attendance rate is increasing year on year despite some of the traditional ED flow being proactively re routed via the Acute Assessment Unit (AAU).

Increasing trends are likely to continue with the increase in population base (related to establishment of train line to Edinburgh) and the ever increasing ageing of the population (the Scottish Borders has the oldest population in Scotland).

Compared to other health boards we have a slightly higher level admission rate. This level has been dropping year on year and internal review suggests that the low population density around the hospital and the large area the Borders covers the ED have very little issues with inappropriate attendances and has a very small ‘frequent attender’ cohort.

5.5 ED Services Patients may self-present or be referred in by GP, arrive by own transport or brought by ambulance; there is also a helipad at the

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hospital. Referrals from GPs are made direct to specialties. Medical and surgical GP referrals are assessed in their respective assessment receiving units with a default to the ED in times of bed pressures. Orthopaedic GP referrals are assessed by this specialty in the ED.

ED nurses are trained in Manchester Triage and X-ray requesting and have the right to refer patients direct to the appropriate specialty following triage. In the out of hours period the ED Doctor is supported by the Hospital at Night team. Clinical responsibility for acutely unwell patients is managed by the on call medical/surgical/orthopaedic teams as appropriate.

The ED is co-located with the GP out of hours service (Borders Urgent Care Centre - BUCC). There are close ties with the ED and flow between the departments occurs to support each other in periods of severe demand and if clinically appropriate. The BECS service is very proactive in supporting the ED and is currently trialing processes to make transfer of appropriate patients more streamlined.

A team providing Psychiatric Emergency Care Services (PECS) has been established to cover the Borders area. This includes a service to the ED for advice, assessment and management of patients presenting with mental health needs.

The Borders General Hospital has its own hospital-at-night team, including nursing practitioners, to cover inpatient care and emergency admissions overnight.

There are four Minor Injury Units (MIUs) in the Borders, at Hawick, Peebles, Kelso and Duns.

The MIUs are situated in Community Hospitals, and are overseen by the Ward Manager of each hospital. Nurses from the MIU may seek advice regarding patient care from the GP covering the community hospital, or from the ED.

With the advent of Trauma centre care in Scotland; the Borders General Hospital is currently preparing to be designated as a Major Trauma Unit. It will stabilize and transfer appropriate patients to the RIE (nearest Major trauma Centre). An existing consultant is designated as the Major Trauma lead for the BGH. POST INFORMATION

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The Post We are looking to expand the consultant in emergency medicine base to; reflect the increasing demand on the service; the acknowledged importance of having efficient and effective front door leadership; and the need to continue to innovate the service particularly where major trauma and education is concerned.

Depending on subspecialty training there are opportunities locally for a sub specialty interest e.g. in intensive care medicine, paediatrics or acute medicine. We are also exploring the sub specialty opportunities with dual site working and network arrangements with NHS Lothian and possibly other NHS Boards as partners, for example potential sub speciality sessions could include a day at Edinburgh Royal Infirmary.

The appointee will continue to contribute to the ongoing development of the clinical interface with acute medicine, general surgery, orthopaedics, paediatrics, obs/gyn and intensive care.

A full time post of 10 programmed activities with possibility of mutually agreed EPA(s) available but applications are welcome from candidates who may be interested in part time commitments or job share.

Reporting You will report to the Clinical Director, Unscheduled Care (Dr J Manning) who Arrangements will agree your job plan.

Health and You are required to comply with NHS Borders Health and Safety Policies. Safety

Training You will be responsible for the training and supervision of the doctors in the Grade training grades during their rotations through the ED. GPST1s and FY2 Medical Staff Level doctors have fixed rotations in the ED during their orthopaedic rotations. We have CDF appointees and are considering a CESR type rotation for more experienced doctors with an interest in completing the equivalence of higher training.

Medical 2 Consultant (Dr Colm McCarthy and Dr Andrew Baillie) Staffing within 11 Specialty Doctors mostly previously GP qualified (various commitments, Unit most part-time). 4 full time CDFs (from August 2021) Training Grade Medical Staff for Orthopaedics and Trauma (with duties in ED) 4 GPST, 2 FY2, 1 CDF

DUTIES AND RESPONSIBILITIES Main Duties 8.1 Summary of Role in Emergency Department The successful candidate will provide:

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• Responsibility for the delivery of unscheduled care within the department, to meet national targets • Shared administrative and leadership responsibility for the ED • Shared responsibility for care delivered by Emergency Nurse Practitioners (ENPs) in the ED. • Liaison with agencies that interface with the ED e.g. police, SAS, social services, alcohol & drugs partnership, public health • Liaison with primary care services throughout the Borders, also supporting care delivered in minor injury units in community hospitals • Liaison with specialist centres that may receive transfers

8.2 Specific Clinical Responsibilities • Supporting doctors from all acute specialties within the BGH when they deliver care in the ED. (Includes Orthopaedic Surgery, Anaesthetics, General Medicine, General Surgery, Paediatrics, Medicine for the Elderly, Mental Health, Women’s’ Health) • Supervising, training, and developing protocols to support the ENP service. • Liaison with all A.H.P.s involved in EM patient care. • Supporting the senior charge nurse with training and development issues for ED nursing staff. • Facilitate preparation and ongoing governance regarding the BGH’s role as a Major Trauma Unit

8.3 Administrative Responsibilities • Representing the department at organisational meetings within and outside the BGH. • Complaints management. • Support and drive clinical governance systems within the ED

8.4 Teaching • Participation in teaching activities at undergraduate level and postgraduate education within the hospital, including induction training for doctors new to the hospital • Provision of training to prehospital care professionals including ambulance service paramedics and technicians • Provision of training to ED nursing staff in relevant skills, and subjects including X-ray requesting, use of PGDs, interpretation, prescribing, and management of minor injuries. • facilitate the introduction of SIM in current hospital wide and ED

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specific teaching

8.5 Audit • Monitoring the use of the Emergency Department Patient Management System (Trakcare) and supporting further developments. • Auditing ED activity and participating in national audit projects

8.6 Further Responsibilities • Support and leadership role in the delivery of unscheduled care across the organisation, contributing to achievement of hospital- wide four-hour standard. • To at all times comply with the GMC’s guidance on “Good Medical Practice” as amended or substituted from time to time • To ensure that patient confidentiality is maintained at all times • To participate in the Statutory & Mandatory training programme. • To contribute to Scottish Patient Safety Programme and there may be an opportunity to develop QI initiatives. WORK PROGRAMME AND OUTLINE JOB PLAN The specific Job plan will depend on subspecialty sessions and number of programmed activities will be modified for part-time or job share post holders. An outline is presented below.

There is no requirement to work night duty except in unforeseen circumstances. With current attendances in the out of hours it is suggested that one evening shift a week would be factored in job plans. Weekend working may be considered by mutual agreement.

Outline Job Plan Days Timing Type of Work Location Monday AM OFF Based on a 10 P.A. job Back Shift Direct Clinical Care – Emergency Medicine BGH ED plan. All direct clinical care shifts in ED in Tuesday AM Direct Clinical Care – Emergency Medicine BGH ED accordance with agreed PM Direct Clinical Care – Emergency Medicine BGH rota. Wednesday AM Direct Clinical Care – Emergency Medicine BGH ED PM Direct Clinical Care – Emergency Medicine BGH ED Time will be scheduled for Thursday AM Sub Specialty Interest Various sub specialty interest and shared administrative PM Direct Clinical Care – Emergency Medicine or BGH ED ED clinical/patient admin/liaison responsibility of the ED Friday AM Direct Clinical Care – Emergency Medicine / S.P.A. ED BGH ED and liaison with GPs, Protected Training (1 week in 4) specialist centres etc. PM S.P.A. Clinical governance / performance meetings leadership BGH

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Borders General Hospital The Borders General Hospital is the district general hospital serving the Scottish Borders Region. The hospital offers services in General Medicine, Haematology, Palliative Care, Medicine for the Elderly, Stroke Medicine, Paediatrics, General Surgery, Orthopaedic Surgery, Ophthalmology, ENT, Obstetrics and Gynaecology. There is a 6 bedded ITU and an active outreach programme for critically patients.

The Emergency Department provides facilities for the reception, resuscitation, examination and treatment of patients in the Scottish Borders who require emergency admission, or immediate care and discharge. The ED service is well integrated with the Borders Emergency Care Service (BECS), which is the Primary Care out-of-hours service for Borders. The department is led by a consultant emergency physicians (Dr Colm McCarthy & Dr Andrew Baillie).

Within the Department of General Medicine there are specialists in Cardiology, Respiratory Medicine, Diabetes and Endocrinology, Gastroenterology, Neurology and Rheumatology. Visiting consultants provide clinics for Oncology, Dermatology, Renal Medicine and Clinical Genetics.

There is a 6 bedded ITU run by the Anaesthetic Department who also run an acute haemodynamic support service with outreach staff from ITU liasing with ward staff.

There is an up to date laboratory service covering Haematology, Microbiology and Clinical Chemistry with ready access to more specialised investigations in Lothian laboratories and other laboratories in Scotland. The Radiology Department is well equipped for routine radiology, CT scanning, ultrasound, Doppler studies, nuclear medicine and MRI. CT coronary angiography and cardiac MRI are well established in the department.

There is an active post graduate programme under the direction of the Director of Medical Education, Dr Olive Herlihy, with excellent facilities in the Educational Centre on the hospital campus. The BGH has in the past few years invested heavily in simulation training with a Consultant Anaesthetist as Simulation Lead.

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Educational Facilities and Development

There is an excellent staffed library within the Borders General Hospital grounds with good Internet access. The library is staffed Monday – Friday and security swipe card access in out of hours period, 7 days per week. As well as a range of textbooks and journals, there is access the heath e-library and to the online clinical enquiry and response service (CLEAR) from Healthcare Improvement Scotland and NHS Education for Scotland.

Post graduate and continuing medical education is actively encouraged and supported. There are weekly department education meetings, and a hospital wide monthly educational half day.

There is an excellent weekly x-ray meeting with the department of radiology which has a spiral CT scanner and Gamma camera, up to date Doppler echo facilities and a purpose- built CT and MRI suite.

The Borders General Hospital is a teaching unit for undergraduate students in medicine. Appointed consultants act as educational supervisors for individual students attached to different teams.

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NHS Borders Why work for us? Description Our Values are at the heart of all that we do: ●Care and Compassion ●Quality and Teamwork ●Dignity and Respect ●Openness, honesty and responsibility

Patients are at the centre of everything we do in our daily working lives at NHS Borders ensuring they are safe, cared for efficiently, effectively by suitably experienced and qualified staff driving quality at the heart of patient care. We apply Values Based Recruitment, and seek to test competence, clinical skills and knowledge in the interview/assessment process but also assess that the values and behaviours of individual candidates align to the Values of the NHS in Scotland NHS Borders has an entirely integrated structure for management of health services. Decision-making is firmly embedded within an integrated Clinical Executive, part of a natural evolution towards more integrated care, which has seen health and social services within the Borders develop nationally recognised joint initiatives. The NHS Borders Board covers an area co-terminus with the local authority and has developed close and effective links with Scottish Borders Council, including the creation of a Joint Health and Care Partnership Board. Some key statistics:

(a) Size of Area – 1804 square miles (5.9% of the area of Scotland)

(b) Population – 113,000 (2.2% of the Scottish population)

(c) The area has 12 main towns i.e. with over 1,500 population, the largest being Hawick (14,573), Galashiels (14,361) and Peebles (8,065). However, some 30% of the population lives outwith towns of 1,000 population or more (compared to Scottish average of 12%). (d) The proportion of the population over 65 is the highest

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in Scotland

45 – 59 years 20.84% (19.29% Scottish average) 60 – 74 years 15.83% (13.98%) 75+ years 8.86% (7.09%)

(e) There are 4 Community Hospitals providing GP acute, intermediate care, palliative care, rehabilitation and NHS continuing care beds – primarily for frail elderly patients. Hospital No. of beds Peebles (Haylodge Hospital) 23 Duns (The ) 18 23 Hawick Community Hospital: 23

There are also community-based Day Hospitals within Duns Hospital, Kelso, Hawick and Peebles and the purpose built day hospital in Eyemouth each with 15 places.

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The Scottish Borders The Hospital is situated on the outskirts of Melrose in the Scottish Borders. The Borders covers a large and scenically beautiful area of the Southern Uplands of Scotland. Predominately rural, it is historically a unique part of the country and the home of the Border Reivers. Annually each town maintains their Common Ridings. Seven-a-side rugby originated in Melrose, and the Melrose event draws large crowds each year. The Borders has tremendous facilities for sport and leisure. Glentress and Innerleithen mountain bike parks are world renowned for cross country biking. The beautiful Berwickshire coast provides options for sea kayaking, surfing, diving and fishing. In addition there are facilities for fishing, golf, swimming, horse riding, cricket, football, hiking and many other activities. Excellent cultural opportunities in terms of music and art societies, drama, and small theatres. There are excellent restaurants, cinemas and shops. Excellent Fitness Centre in Galashiels and other Borders towns. There is a purpose built nursery in the grounds of the hospital.

The Scottish Borders offers all the benefits of rural life with very easy access to major cities such as Edinburgh (37 miles) Glasgow (75 miles) Newcastle (75 miles). Edinburgh is renowned for its cultural activities in music, including opera and ballet, theatre, cinemas (including a film theatre) and visual arts, and of course every year there is the world famous Edinburgh International Festival and Fringe Festival. Local transport links have improved greatly in the last year or so.

After an absence of almost 50 years, the Borders Railway has now opened, with train services to central Edinburgh running every thirty minutes (journey time 50 minutes approx). Tweedbank Station is a few minutes walk from the Borders General Hospital. On opening the railway Her Majesty Queen Elizabeth said "The Borders railway brings so much promise for sharing and invigorating this most beautiful countryside as a place to work, live and enjoy.” There are rail links to the rest of the country at Berwick Upon Tweed, and Carlisle and there is easy access to Edinburgh Airport (approximately 1 hour 15 minutes) and Newcastle Airport (approximately 1 hour 30 minutes).

By the way MELROSE has taken the title of the best place to live in Scotland in a new national ranking - https://www.thetimes.co.uk/article/melrose-in-the-borders-is-best-place-to- live-in-scotland-says-sunday-times-survey-8hrlq8lqb

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NHS Borders Person Specification Form Locum Consultant in Emergency Medicine

Requirements Essential Desirable A Qualifications Basic Medical Qualification registered with GMC and ATLS, ALS, Basic a license to practice. EPLS MIMMS Postgraduate FCEM (or equivalent certificate) GMC Specialist Registrar for Emergency Medicine.

CCT (or equivalent) in Emergency Medicine

B Experience Completion of training in Emergency Medicine

C Ability Knowledge and experience of Emergency Medicine Knowledge and allied specialties commensurate with completion of specialist training

Clinical Skills Assessment and examination of undifferentiated and Technical patients including resuscitation, investigation, Skills management and interpretation of results. D Motivation Self-motivating and enthusiastic. Able to motivate Teaching experience and initiative. others. E Personality Effective interpersonal skills. Able to establish good relations with colleagues and able to work within a multidisciplinary team. F Audit Experience of clinical audit G Research Research experience. Postgraduate Degree. H Management Willingness and ability to participate in hospital Ability management and to accept ethos of management. Capable of self-reflection. Possession of negotiating skills. Experience of management within the NHS.

Well organised and ability to combine clinical and management roles effectively

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SPECIFICATION OF NHS VALUES Value Description Method Of Assessment NHS Values Care and Compassion Interview and Assessment, MDT discussion, In Expectations tray exercise • Treat people as though they matter • Involve people • Consider people as individuals and acknowledge diversity • Puts the patient first • Shows they care NHS Values Dignity and Respect Interview and Assessment, MDT discussion, In Expectations tray exercise • Team player • Manages own attitudes and behaviour • Addresses concerns with colleague as they arise • Communicates respectfully, openly and professionally • Listens and turns that into action • Sees things form another persons perspective NHS Values Openness, Honesty and Responsibility Interview and Assessment, MDT discussion, In Expectations tray exercise • Takes person responsibility for actions • Sharing of ideas for improvement • Observes processes • Ability to work across boundaries • Commitment to work to best of their ability NHS Values Quality and Teamwork Interview and Assessment, MDT discussion, In Expectations tray exercise • Works as part of a tem to support others and improve service provision • Acknowledges mistakes • Takes responsibility • Inspires the team

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TERMS AND The Terms and Conditions of Service are from the Consultant Grade CONDITIONS Terms and Conditions of Service (New Consultant’s Contract) issued March 2004 by the Scottish Executive Health Department.

As a fixed term locum post the appointment will be made by NHS Borders.

The full-time salary for 10-programmed activities will be on the scale £84,984-£112,925 per annum with scale placing as appropriate to previous consultant level experience and background. The appointment is available full time on a 10PA basis but applicants who wish to work part-time/job share are welcome.

The Job Plan will be agreed in association with the Clinical Director, with input from the General Manager and Associate Medical Director. Changes will be discussed and agreed with yourself in line with service needs and subject to annual review, or more frequently on request by either party.

Possession of FCEM or equivalent certificate is essential. You must also be fully registered with the General Medical Council with a licence to practice.

The person appointed may be expected to take part in the undergraduate and postgraduate teaching programmes.

The person appointed will have a continuing responsibility for the care of patients in his or her charge and will undertake the administrative duties associated with the care of his or her patients and an appropriate share in the running of the clinical department.

The appointment will be superannuable and subject to the regulations of the National Health Service. Superannuation Scheme and the remuneration will be subject to deduction of contributions accordingly, unless the appointee chooses to opt out of the Scheme.

NHS Borders is legally liable for the negligent acts or omissions of the employees in the course of their NHS employment. Medical staff are however advised to ensure that they have defence cover for activities not covered by the Board’s indemnity.

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All entrants to the NHS Borders must be certified medically fit and the appointment is conditional on such certification. Arrangements for medical screening (usually by questionnaire) are undertaken by the Occupational Health Service.

Termination of the appointment will be subject to a 1 month notice period of notice on either.

For locum appointments financial assistance will be provided with temporary accommodation costs in the local area if required. Depending on circumstances support for relocation may be available for successful candidate in accordance with NHS Borders’ Relocation Policy.

NHS Borders operates a No Smoking Policy. It is a condition of your employment that you must not smoke whilst you are on duty. Failure to observe this rule could result in disciplinary action. When selecting new staff, NHS Borders does not discriminate against applicants who smoke but applicants who accept an offer of employment will, in doing so, agree to observe the Board's policy on smoking.

NHS Borders Equal Opportunities Policy affirms that all employees should be offered equal opportunities in employment, irrespective of their age, gender, marital status, race, religion, creed, sexual orientation, colour or disability.

The Ionising Radiation (Protection of Persons Undergoing Medical Examinations) Regulations 1988 will apply to this post.

The holder of this post may be required to undertake on a regular basis or occasional basis exposure prone invasive procedures (EPPs). As this could potentially place patients at risk, candidates must show evidence of immune status to HEPATITIS B, or agree to undergo the necessary procedures.

It should be noted that the offer of appointment is subject to confirmation that the successful candidate is HEPATITIS B immune. This is checked by the Occupational Health Service.

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