CWM TAF UNIVERSITY HEALTH BOARD JOB DESCRIPTION

POST: Consultant Physician in Care of the Elderly with special interest in Intermediate Care

SALARY:

DIRECTORATE: Medicine and A&E

BASE: Royal Glamorgan Hospital The post holder will also be required to provide services at other hospital sites.

1. Introduction The post is a replacement post, due to retirement of one of our long standing Consultants in Care of the Elderly. The successful applicant will join a team of three Care of the Elderly Consultants. Acute/General Medicine sessions will be included as a part of General Medical on-call with other Care Of The Elderly Doctor Team or Sessions can be arranged as an Acute Physician on a fixed day.

The post will be subject to the terms and conditions of service governing the appointment of Medical and Dental Staff in Wales, and to the Health Board's terms and conditions as appropriate. The candidate to be appointed will be required to be fully registered with the General Medical Council, to hold, or to be within 6 months of gaining, a Certificate of Completion of Training in General Internal Medicine, and to be on the Specialist Register.

The post holder will be joining a dynamic, forward looking and innovative Care of the Elderly team. The post holder will be based at Royal Glamorgan hospital in Llantrisant, where the Health Board has acute hospital beds covering all medical and surgical specialities. The Women and Child Health department is at present located in Royal Glamorgan Hospital, although there is a possibility that this might change in the future.

The post holder will be expected to help further develop the services provided by the Health Board in both General Medicine and Care of the Elderly, especially in the community. Wide experience in General Medicine and a CCST in General Internal Medicine and Care of the Elderly are essential. A sub-speciality interest in either Community Geriatrics/Intermediate care is sought as the successful candidate will be expected to develop the sub-speciality interest further.

Key to the development of services will be to develop clinical relationships with the colleagues in the Directorate and Local Health Board as well as strengthening working relationships with Primary Care colleagues in order to develop services locally.

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The successful candidate will work as part of a multi-disciplinary team to provide senior experienced clinical leadership in Royal Glamorgan Hospital and to support the development of the integrated care model for older people with complex needs.

The post holder will have involvement in Community Hospital with responsibility for patients admitted under his/her care in Ysbyty Cwm Rhondda. The post holder will also provide senior medical advice and support to our teams of community/specialist nurses, to GPs and support to Associate Specialists/Doctors. Where appropriate, there will be opportunity to undertake domiciliary visits for patients with severe complex disease, following patients after discharge from hospital. There will be expectation of providing clinical leadership to @home services – which provides intermediate care in Cwm Taf University Health Board.

DETAILS OF ACUTE MEDICINE MODEL

Its expected the post holder to undertake the following responsibilities:-

 Undertake Acute management of Elderly patients admitted into Royal Glamorgan Hospital.  Provide clinical leadership to medical team. Each Care of Elderly team consists of Nurse Practitioner, Specialist Registrar in Care of Elderly, Core Medical Trainee/ Foundation trainee.  To be involved in rehabilitation and discharge planning for frail elderly patients.  Interface models with current patient flow work in Royal Glamorgan Hospital (admission avoidance front door, A&E pathways, Frailty Pathway, enhanced discharge planning etc).  Lead on delivery of high quality care in our community bed facilities to serve increasing and more enhanced “step up” models of care as well as rehabilitation.  Specialist community MDT working (virtual ward models for planning care of complex patients) in partnership with Social Care, Mental Health, Primary Care, Specialist Community Nursing, Therapy, End of Life and emergency services.  Multi-disciplinary rapid assessment one stop community clinics (rapid access clinics) – as a part of @home projects and developing on the work already done.  Enhanced community geriatrics with involvement in enhanced support models for care homes, domiciliary input etc.

General Information

The Royal Glamorgan Hospital is situated 3 miles north of junction 34 of the M4. There are many areas of outstanding beauty nearby. To the north is the Brecon Beacons National Park, and to the south is the rolling countryside of Vale of Glamorgan and the South Wales Heritage Coast. Cardiff, the capital city of Wales, is a cosmopolitan city of many contrasts. A castle with 1900 years of history stands along side a modern shopping complex, and one of the world's great civic centres. St David's Hall is one of Britain's major concert halls, and

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the new Millennium Centre - a purpose built lyric theatre - provides the opportunity to find entertainment in music, drama, opera and dance in the city. There are many art galleries and a number of cinemas.

There are many sporting facilities within easy reach of the Hospital. The nearest sports centre is at Llantrisant, 1 mile to the south, and golfers will be attracted to the numerous golf courses in the area, the most famous being the Royal Porthcawl Golf Club, and the Vale of Glamorgan Sports Complex with Golf Club. Cardiff is the home of Welsh rugby, and the Millennium Stadium is situated in the heart of the city. Cardiff is also the home of an international ice-rink, the Welsh National Athletic Stadium and Sophia Gardens, the H.Q of the Welsh Institute for Sport and Glamorgan Cricket Club. The nearby Heritage Coast offers many opportunities for sailing and other water sports.

There is an excellent choice of housing within easy travelling times of the hospitals. Attractive new housing developments are taking place near the Royal Glamorgan Hospital, or a little further a field are the country villages of the Vale of Glamorgan and the northern and western suburbs of Cardiff. Access to the British Rail Intercity 125 network is available at both Cardiff and Bridgend, and there is an International Airport, the Cardiff (Wales) Airport at Rhoose, 12 miles to the south.

The Health Board Profile: Cwm Taf Health Board was established on 1 October 2009 and is responsible for the provision of health care services to over 325,000 people principally covering the Merthyr Tydfil and Rhondda Cynon Taff Local Authority areas. The hospital section of Cwm Taf Health Board has an operating income of over £300 million, and in total employs over 7,600 staff across two District General Hospital sites - the Royal Glamorgan and Prince Charles Hospitals - and seven smaller community hospitals.

General Description of the Base Hospital The Royal Glamorgan Hospital is the base hospital for the southern half of Cwm Taf Health Board. It is a new District General Hospital, commissioned November 1999, serving a population of approximately 185,000 in the Pontypridd and Rhondda areas. In this region there is a high incidence of respiratory disorders particularly COPD and lung cancer. This was the major coal-mining region of Wales and retains a legacy of respiratory disability.

With the commissioning of the new Mental Health Unit, the Hospital has 649 beds, including ICU, HDU and all major specialities are represented.

There is an active Postgraduate Medical Department and during the academic year a full programme of departmental meetings, symposia and evening lectures take place. The Hospital has won praise for its innovatory induction processes, and the Medical Directorate for its teaching achievements. Both have been cited as examples of best practice by the Postgraduate Dean and are being emulated throughout the region. The library is well stocked and is staffed by a team of Librarians. The teaching facilities, audio visual

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equipment and electronic resources are all state of the art. There is a fully equipped Medical Illustration Department.

All Consultants within the Medical Directorate are recognised as Honorary Clinical Teachers by the University Of Wales College Of Medicine, and the hospital is one of the three major District General Hospitals involved in undergraduate medical education, with medical students regularly attached to the hospital for clinical teaching.

Ysbyty Cwm Rhondda Hospital Ysbyty Cwm Rhondda Hospital is situated some 8 miles to the north-west of the Royal Glamorgan Hospital and has 108 beds in the Department of Medicine. The hospital is supported by 4 Middle Grade Doctors (Associate Specialists and Trust Grade) and a team of Nurse Practitioners and Physician’s Assistants. All patients are under the care of the consultant physicians with an interest in care of the elderly. This purpose designed hospital provides intermediate care beds, the stroke neurological service, a dedicated out-patient suite and supporting diagnostic services, with a Primary Care Resource Centre.

Ysbyty George Thomas This hospital is based in Treorchy and has three wards for Psychiatry for the Elderly. Ysbyty George Thomas also has out-patient therapy facilities and is the base for some Community services.

Prince Charles Hospital The District General Hospital for the northern half of Cwm Taf Health Board is Prince Charles Hospital which is 24 miles away from the Royal Glamorgan Hospital. The post holder will be expected to do clinics at this site in line with strategic job planning of the Gastroenterology Department, attend occasional meetings there and work with colleagues across the Health Board to deliver and develop services. There are video conference facilities which provide links between Prince Charles Hospital and the Royal Glamorgan Hospital and are increasing being used for joint meetings across both sites.

Names of Consultant Members of Staff: General Physicians with special interests Dr R Biswas, Care of the Elderly & Rehabilitation Dr S Aslan, Care of the Elderly & Rehabilitation (Replacement Post) Dr R I Dewar, Care of the Elderly & Rehabilitation Dr Manish Chebbi, Care of the Elderly & Rehabilitation Dr James Bolt , Care of the Elderly & Rehabilitation Dr RTM Edwards (P/T), Care of the Elderly & Rehabilitation Dr Dr R Alcolado, Gastroenterology and Hepatology Dr N Hawkes, Gastroenterology and Hepatology Dr Bee Lee, Gastroenterology and Hepatology Dr M Patel, Gastroenterology and Hepatology Dr R Mitra, Cardiology Dr G Ellis, Cardiology Dr R Bleasdale, Cardiology

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Dr C Williams, Cardiology Dr J Huish Cardiology Dr P Evans, Diabetes & Endocrinology Dr A Kahlan, Diabetes & Endocrinology Dr H Lane, Diabetes & Endocrinology Dr P Owen, Diabetes & Endocrinology Dr S Eccles, Respiratory Medicine Dr P Neill, Respiratory Medicine Dr A Benjamin, Respiratory Medicine Dr J Martin, Rheumatology Dr R Goodfellow, Rheumatology Dr C Rhys-Dillon, Rheumatology Dr L Ala, Acute Medicine Dr Eugeine Tabiewo , Acute Medicine Dr N Rathbone, Acute Medicine Dr K Speed, Acute Medicine Dr Nerys Conway Acute Medicine Dr Anna Lewis Acute Medicine Dr C Hodcroft, Acute Medicine Dr C Thomas, Dermatology Dr L El Dars Dermatology Dr J Martin Dermatology

Visiting Consultants Dr N Robertson, Neurology Dr Pickersgill, Neurology Dr B Thomas, Neurophysiology

Other Staff in the Department Mr N Cooper, Directorate Manager, Medicine & A&E Mrs Alison Lagier, Locality Manager for Rhondda Taff Ely Mrs Lesley Lewis, Head of Nursing for Rhondda Taff Locality Manager Mrs A Cassidy, Head of Nursing Medicine and Mrs C John, Senior Nurse Medicine and A&E

Secretarial Support and Accommodation Office accommodation will be provided, and the post holder will be provided with medical secretarial support from the pooled COTE secretarial team.

Middle Grade Support Royal Glamorgan Hospital is recognised centre of training for Specialist Trainees in Care of the Elderly. Usually there are two trainees allocated to the department, and is shared between the two COTE teams. There is also a Specialist Doctor in COTE Department , who covers specialist trainees during their absence. There are two experienced Nurse Practitioner who provides valuable support to both COTE Teams.

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WORK OF THE DEPARTMENT

Integrated Medicine

The Directorate of Medicine/A&E is fully integrated (and manages acute and community hospital beds and district nursing) dealing with approximately 11,500 admissions to the Royal Glamorgan Hospital each year as medical emergencies. The Medical Directorate has access to a total of 454 beds, divided equally between the base hospital and in the satellite hospitals.

The Departments of General Medicine and Geriatric Medicine combined in 1994 to provide a fully integrated service with all acutely ill medical patients being admitted to the Royal Glamorgan Hospital. Initially the patients are admitted to either the Medical Clinical Decision Unit (6 trolleys) or the Cardiac Monitoring Unit (7 beds). Ward 6 acts as an Acute Medical Unit is supervised by an Acute Care Physician based on the Unit during the working day.

Patients who require rehabilitation either as the primary need or after initial acute care, will normally be transferred to Ward 3 in Royal Glamorgan Hospital or Ysbyty Cwm Rhondda, under the care of one of the four Consultants with an interest in Care of the Elderly. In both of these hospitals Staff Grade Physicians will look after the patients on a day to day basis and provide on call cover.

Care of the Elderly (COTE)

The COTE Department in Royal Glamorgan Hospital has four Consultants at present. The current post is a replacement post following retirement of one of the Consultant. All the Consultants have sub-speciality interests. The sub-speciality interests of the Consultants are Dr James Bolt (Movement Disorder Service) ,Dr Salih Aslan (Gastroenterology & Mental Health), Dr Raja Biswas (Orthogeriatrics & Intermediate Care), Dr Manish Chebbi (Acute Geriatrics & Intermediate Care). The COTE Consultants are split into 2 teams:– COTE 1 consists of Dr James Bolt and Dr Manish Chebbi.

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COTE 2 consists of the Dr Raja Biswas & Dr Salih Aslan

Each of the Consultants work for four months “on site” where they look after the acute admissions as well as patients in Community Hospitals. During four months “off site” work they look after only community wards. There is also a very innovative intermediate care service which is being developed and the appointed Consultant will be expected in developing the service. All the Consultants work very closely together and cross cover and support each other as required.

The post holder will have the freedom to develop any further sub-speciality interest e.g. Incontinence, Cognitive Impairment etc, although it is preferable if the post holder would develop Intermediate/Community Service. However, any sub-speciality interest which fits in with the Health Board Development Plan will be accommodated. Any interested candidate is encouraged to discuss this further.

The following sub-specialities are already a part of the COTE Department in the healthboard:-

Stroke Medicine – Dr Dewar / Dr James White are the lead clinicians in Stroke Medicine. Both Acute Stroke Management including TIA Clinics, Thrombolysis and rehabilitation is undertaken. There is dedicated Acute Stroke Unit in Prince Charles Hospital and a specialist Stroke Rehabilitation Unit in Ysbyty Cwm Rhondda Hospital. The Stroke Physician is also a part of Acute Stroke On-call in South Wales responsible for Out-of-Hours Thrombolysis.

Ortho-geriatrics – Acute Orthogeriatrics is being developed in Royal Glamorgan Hospital. Dr Raja Biswas works closely with the Orthopaedic Surgeons to review patients following trauma. Acute Ortho-geriatric input at present is being offered by Dr Biswas with support from Associate Specialist. There is a 28 bedded unit in Royal Glamorgan Hospital looking after patients with falls, and rehabilitation following operation for trauma.

Intermediate Care – An innovative @home project has been undertaken by the Health Board to offer comprehensive multi-disciplinary input to patients who require holistic care. Dr Raja Biswas is the lead clinician in the project and the project is supported by members of the COTE team including Consultants and Associate Specialists.

Movement Disorder – Dr James Bolt is the lead clinician in Movement Disorder. He is supported by Dr Martin Edwards, who is at present working part time.The Unit has a Specialist Nurse for Parkinsons Disease. Patients are reviewed in the Day Unit in Dewi Sant Hospital which also has facility to undertake rehabilitation programme. Input is also provided by Specialist Nurse in patients’ home.

Acute Geriatrics – Dr Manish Chebbi has taken a lead in developing this service based on Frailty model. It is expected his work will link up with intermediate care. The Directorate of Medicine operates an allocation system for acute medical admissions with Acute Physicians and On-call Physicians sharing the post take ward rounds. Care of the Elderly is therefore allocated patients on the Medical Assessment Unit for transfer to the COTE sub

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specialty ward.

The COTE department undertakes weekly multidisciplinary meetings with presentation by all members of the multi-disciplinary team. Apart from that there is weekly X-Ray meeting, medical presentations and opportunity to participate in Grand Rounds.

MAIN DUTIES AND RESPONSIBILITIES OF THE POST

Clinical The post holder will provide, with clinical colleagues (as appropriate), a service in the speciality to the hospitals within the Health Board, with responsibility for the prevention, diagnosis and treatment of illness.

The post holder will have continuing responsibility for the care of patients under his/her care, allowing for proper delegation to, and training of staff. The post holder, in liaison with Consultant colleagues will have responsibility for the proper functioning of the Department in line with the Operational Policy and Strategic Plan (as amended from time to time) of the Health Board.

The post holder will be named in the contracts of junior staff as the person expected to act as educational supervisor for junior medical staff assigned to them, thus overseeing their training and being the initial source of advice for doctors regarding their careers.

The post holder will be required to participate in the Health Board’s risk management process and in Clinical Audit and other clinical governance activities within the Department, the Directorate and the Health Board. The post holder will be positively encouraged to participate in research and development in line with Health Board, Commissioner and NHS priorities.

The post holder will be expected to formulate a Personal Development Plan in conjunction with the Clinical Director to identify training and development needs.

The post holder will be expected to make a significant contribution to the Directorate business planning process through active participation in the clinical directorate structure.

The post holder will participate in the unselected medical emergency on-call rota at Royal Glamorgan Hospital, which currently only involves weekend cover in a 1:20 rota. The

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successful candidate will be required to cover Consultant colleagues on-call period for annual leave and study leave.

Travelling as necessary between hospitals/clinics will be required to undertake such duties.

Teaching The post holder will be responsible for carrying out teaching, examination and accreditation duties as required and for contributing and participating in postgraduate and continuing medical education activity, locally and nationally.

All Consultants teach and train at postgraduate education and occasionally at undergraduate level. There is a very active Postgraduate Training Department, which organises medical education. Strong links have been established with the University of Wales College of Medicine in the teaching of undergraduate students.

The Health Board has excellent Postgraduate facilities at Royal Glamorgan Hospital, containing lecture theatre and library. The library offers full facilities, including CD-Rom with intranet access to Cymru Web and Medline. Junior Medical staff have weekly departmental teaching meetings.

The successful candidate will participate in the departmental weekly teaching/audit sessions.

Management The post holder will be required to co-operate with local management in the efficient running of services and will be expected to share with consultant colleagues in the medical contribution to management. In addition, it should be noted that a clinical directorate structure is in operation, which requires close co-operation and liaison with colleagues as appropriate.

There is a requirement to work within the financial and other constraints decided upon by the Health Board. Additional expenses of any kind must not be committed without the approval of the appropriate manager/budget holder.

Subject to the Terms and Conditions of Service, the post holder will be expected to observe policies and procedures of the Health Board, drawn up in consultation with the professions where they involve clinical matters.

The post holder will be expected to comply with local and national employment and personnel policies and procedures in the management of employees of the Health Board.

The post holder will be required to ensure that arrangements are in place for the organisation of medical staff and that they are allocated duties in accordance with the work of the department.

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JOB PLAN

Review of this Job Description in relation to Job Plans. This post will have regular job planning and a proposed job plan for 10 sessions is enclosed. However, the final job plan will be made following appointment of successful candidate.

SAMPLE JOB PLAN

DAY DESCRIPTION DIRECT AND IN- DIRECT CARE (sessions) SPA Ward Round /MDM 1 0 MONDAY am pm 1 0 Acute Medicine Acute Medicine 1 TUESDAY am pm 1

Community Work 1 0 WEDNESDAY am pm Community Work 1 0 Ward Round /MDM 1 0 THURSDAY am pm Acute 1 Outpatient clinic 1 FRIDAY am pm Acute 1 ON-CALL 0.75 SPA Own time 2 TOTAL 10

MAIN TERMS AND CONDITIONS OF THE POST

The terms and conditions of service including pay which apply to the post are determined by the Health Board who at present take into account the national agreements reached by the General and Hospital Medical and Dental Staff (England and Wales) Whitley Councils and any changes to those conditions which the Secretary of State for Wales may authorise from time to time. Copies of the General and Hospital Medical and Dental Staff (England and Wales) Whitley Council agreements are available for you to inspect in the Personnel Directorate.

The post is superannuable unless the appointee opts out of the scheme or is ineligible to join. Remuneration will be subject to deduction of superannuation contributions in accordance with the Department of Health and Social Security regulations.

The post holder will be professionally accountable to the Director of Medical Services,

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managerially accountable to the Clinical Director, Medicine.

This post will be included in the Job Plan Review exercise currently being undertaken by the Health Board in line with the agreed implementation procedure for the amended Consultant Contract in Wales. The salary applicable is on the consultant pay scale and will be specified in the contract.

The Consultant appointed will be required to live within a 10 miles distance by road of their base hospital unless specific approval for a greater distance is given by the Health Board.

Reimbursement of removal and associated expenses will be subject to the criteria laid down in the General Whitley Council Conditions of Service, together with the Health Board policy.

The Consultant will be required to maintain his/her private residence in contact with the public telephone service. Assistance can be given with the cost of installation and rental charges.

GENERAL INFORMATION

Applicants who are related to any member of staff in a senior officer position at Cwm Taf Health Board should clearly indicate in their application the name of the officer to whom related and indicate the nature of the relationship. A candidate deliberately concealing such a relationship would be disqualified.

Candidates are asked to note that canvassing of any member of the Advisory Appointments Committee or the Employing Authority will disqualify them. This should not however, deter any candidates from approaching any person for further information about the post.

Any offer of appointment will be subject to the receipt of three satisfactory references.

The nature of the work of this post is exempt from the provisions of section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemption Order 1975). Applicants are therefore not entitled to withhold information about connections under the act and in the event of employment, any failure to disclose such connections could result in dismissal or disciplinary action by the Health Board. Any information given will be completely confidential and will be considered only in relation to any application for positions to which the order applies.

Travelling expenses will be reimbursed for only one pre-interview visit and only then to those candidates selected for interview or at the specific request of management, who will be granted travel and appropriate subsistence expenses on that occasion too.

DETAILS FOR VISITING

Candidates who may wish to visit the Department are invited to contact:

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Dr Raja Biswas, Asst Clinical Director Community (01443) 443583 Dr Anthony Gibson, Clinical Director Acute (01443) 443443 Mr Neil Cooper, Directorate Manager (01685) 728702

Clinical Governance The Health Board is committed to delivering the best quality service it can to all of our patients and has established appropriate structures and working arrangements upon which to develop clinical governance throughout the organisation. Clinical governance provides a framework for NHS organisations like ours, and the individuals working within it, to continuously monitor and improve the quality of care it provides. The Health Board firmly believes that each member of staff has a role to play by;  ensuring a patient centred approach in all that they do;  being personally accountable for what they do;  following procedure and standards as appropriate to their role; being an effective team player;  participating in continuing professional development/training opportunities  participating in Health Board clinical governance quality improvement  activities including clinical incident reporting, clinical audit, risk management and changes in practice as appropriate  voicing their concerns if they are not happy with standards or practices within their workplace;  encouraging and sharing good practice and being open to new ideas.

It is therefore the Health Board’s policy to recruit staff who are capable of providing, supporting or managing high quality health care and to ensure that staff remain capable of doing so by establishing standards and by training and other support. Staff should be capable in all respects of fulfilling their contracts of employment. However, at no time should anyone work beyond their level of competence. All staff have a responsibility to inform those to whom they are responsible if they believe they are not competent to perform a duty.

Equality The Health Board will take all practicable steps to ensure that staff are recruited, managed, developed, promoted and rewarded on merit and that equal opportunities are given to all staff with no discrimination of any kind. All staff are responsible for their own professional and personal behaviour. There is a requirement of all staff to conduct themselves in a manner, which does not cause offence to another person. The Health Board is committed to providing a safe, healthy and fair working environment and will take all practicable steps to avoid and eliminate harassment of any kind of its employees at work.

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FACTORS REQUIRED ESSENTIAL DESIRABLE ASSESSED BY 1. Knowledge, personal skills Involvement in teaching, Publications. Involvement Application Form and abilities audit and research with Deanery/ RCP Interview

References

2. Education/ Qualifications At time of interview, the Sub-specialty which Application Form and training candidate must be: complements Care of the Interview On the Specialist Elderly Medicine Register; Production of Evidence Or, be within 6 months of Higher degree and/or (certificates etc) the anticipated Fellowship experience CCT/CESR date if progress has been satisfactory and it is the recommended CCT/CESR date is reached or have a primary medical qualification and recognised specialist qualification from an EEA country or Switzerland which will allow direct entry onto the Specialist Register 3. Experience At least 5 years in Acute Experience in COTE Application Form Medicine, since MRCP Complementary sub- specialty training Interview Confident diagnostician Experience as consultant / locum consultant References

4 Personality requirements to Able to work in a Demonstrate drive, include attitudes and personal multidisciplinary team achievement and Interview disposition and delegate effectively innovation. References

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