AGENDA FOR CHANGE
JOB DESCRIPTION
1. JOB IDENTIFICATION
Job Title: Consultant Clinical Scientist (Biochemist)
Reports to: Clinical Director and the Divisional General Manager of the Clinical Support Division
Department : Blood Sciences Department, Raigmore Hospital
Directorate : Clinical Support Division
Job Reference: SSCLSSRaigBiol16
No of Job Holders: 1
Last Update : Reviewed 6th July 2020
2. JOB PURPOSE
The post holder will have a central role in leading the provision and continuing development of a comprehensive clinical and scientific biochemistry service by the Blood Sciences department across the laboratories at Raigmore Hospital, Caithness General Hospital and Belford Hospital.
The post holder will have responsibility for the ongoing development of the biochemistry component of the Area Laboratory Service for Blood Science services, incorporating the laboratories at Raigmore Hospital, Caithness General Hospital and Belford Hospital.
The post holder will provide an analytical, interpretive and clinical advisory service on the diagnosis and treatment of patients, to medical, nursing staff and other clinical staff within the acute and primary care settings. The post holder will instigate and conduct research, clinical audit and be responsible for directing service development.
3. ORGANISATIONAL POSITION
Dotted line indicates professional management not line management responsibility
4. DIMENSIONS AND ROLE OF DEPARTMENT
The Blood Sciences Service in NHS Highland provides laboratory services to primary and secondary care within and beyond the Highlands. These services are currently delivered as a network from three sites; Belford Hospital in Fort William, Caithness General Hospital in Wick and Raigmore Hospital in Inverness. This network is accredited by UKAS in accordance with ISO15189. It is expected that the Blood Sciences Services at the Oban (and potentially Stornoway) sites will be integrated into the existing network in the future subject to future discussions. The Blood Sciences services for the Argyll and Bute CHP are currently predominately provided by the clinical laboratories of the Lorn & Islands District General Hospital, Oban. Management sits with the Blood Sciences laboratory manager and there is currently a service level agreement with Greater Glasgow and Clyde that includes some clinical input into the laboratory. Should the laboratory in Oban be integrated into the network that arrangement would cease. The Area Laboratory Blood Sciences service provides an analytical, interpretative and advisory service in both biochemistry and haematology for the Highlands of Scotland, with the laboratories at Caithness General Hospital and Belford Hospital also providing blood transfusion services to their hospitals. Caithness General Hospital and Belford Hospital laboratories provide core services to the hospitals and also to local GP practices. The Blood Sciences Department at Raigmore performs the more specialised tests for these areas. Approximately 53% of the workload comes from general practitioners. The service is provided 24 hrs/day, 365 days/year. A shift system is in place at Raigmore Hospital with on-call services at Caithness General Hospital and Belford Hospital. The Department provides a wide range of analyses within the department, and also maintains and monitors the performance of near-patient testing equipment in secondary care on all three sites. As well as general medicine and surgery, Raigmore Hospital also has a number of specialised clinical units for which the Blood Sciences department provides services, including Coronary Care Unit, Intensive Care Unit, Special Care Baby Unit and Paediatrics, Oncology, and Renal Dialysis Unit. CGH and BH both have renal dialysis units on site. The Blood Sciences service is provided for patients throughout North Highland (population approximately 320,000). The annual routine biochemistry workload at Raigmore Hospital is approximately 250,000 requests. At CGH and Belford hospitals the workload is 40,000 and 24,500 requests respectively. Staffing based at Raigmore Hospital is one consultant chemical pathologist, one consultant clinical biochemist (this post), one principal clinical biochemist, one blood sciences manager, two team managers, one in each discipline, four senior BMS team leaders, one point of care coordinator, 18.5 WTE specialist BMS, one quality lead (post vacant), two band 6 Annex 21 BMS, 10.03 WTE MLAs, one departmental secretary and two clerical staff. The staffing at CGH is one laboratory manager, one team leader, two specialist BMS, one trainee band 5 BMS and three part-time MLA and phlebotomist. At Belford Hospital the staffing is one laboratory manager, two team leaders and one part-time MLA and phlebotomist.
5. MAIN TASKS, DUTIES AND RESPONSIBILITIES There is no current requirement to provide clinical support to Blood Sciences department, Lorn and Islands Hospital but the post holder would be expected to contribute should this become necessary.
Clinical / Patient Care
Independently discuss, advise and challenge clinicians, including senior medical staff and nursing staff in both primary and secondary care, on the highly complex interpretation of all biochemistry and specialist investigations. This includes the selection, performance and interpretation of clinically relevant tests and advice on differential diagnoses, monitoring, treatment and therapy changes. The post holder will exercise their judgement regarding referral to another clinical speciality and engage in discussion regarding patient management Where necessary liaise with and advise patients (and carers) regarding biochemical tests to be performed on them. Clinically authorise reports, provide written interpretive comments and advice for inclusion within patient records. This will involve participation in the reports authorisation rota during normal working hours Monday to Friday, on average one week in three. There is no current requirement to provide out of hours cover but the post holder would be expected to participate in a rota should this become necessary Determine the best combination of tests for each clinical case, the method of requesting, sample handling and result reporting. Ensure harmonisation of testing profiles, reporting practices, methods of requesting and sample acceptance policies across the Blood Sciences services at Caithness General Hospital and Belford Hospital, and the Blood Sciences Department at Raigmore Hospital. Set the standards for laboratory contact with clinicians and determine how the clinical advisory service is delivered. Ensure that appropriate systems for clinical governance in respect of Blood Sciences services are operational in the laboratories at Caithness General Hospital and Belford Hospital, and the Blood Sciences Department at Raigmore Hospital to ensure a high standard of laboratory service provision for patients. Represent the Blood Sciences Department at clinical and multi-disciplinary team meetings and case conferences as required. Contribute an expert Blood Sciences opinion at clinical meetings or ward rounds as required.
Managerial
The post holder will be appropriately qualified and eligible to apply for the role of Clinical Lead In conjunction with the departmental clinical lead and service managers, to provide key scientific input into the strategic development of the Blood Sciences services at Caithness General Hospital and Belford Hospital, and the Blood Sciences Department at Raigmore Hospital in order to ensure continued provision of a high quality service In conjunction with the departmental clinical lead and service manager, to be responsible for ensuring the quality of service provided by the Blood Sciences services at Caithness General Hospital and Belford Hospital, and the Blood Sciences Department at Raigmore Hospital and for ensuring that nationally accepted standards (UKAS or equivalent organisation) are maintained. Deal with any complaints made regarding the service provided. Represent the laboratory at appropriate meetings. To be responsible for interpreting to NHS Highland the implications to the Clinical Blood Sciences service of local developments and national, clinical and operational strategies for changes to clinical services and the way they are delivered. An example of this would be assessing the impact of the introduction of new guidelines or clinical practices on the Blood Sciences workload, service development and revenue expenditure e.g. the use of calprotectin in the diagnosis and management of inflammatory bowel disease. Within the Departmental Management Team, participate in short, medium and long-term planning, affecting service delivery of Blood Sciences provision to the Highland Region. This includes location of services between laboratories and point of care testing facilities. Promote the appropriate development of point of care testing, particularly with reference to use of point of care testing in primary care and community settings, in line with NHS Highland’s programme of replacement and development of community hospitals Participate in the formulation of departmental policies, operational procedures, training schedules and safety protocols. Make a major contribution to the development of the blood sciences service. This will include buying into the vision of a truly integrated service with cross-trained staff that will be sustainable in the long- term. Working with staff to engage them in the process of reviewing the service and bringing about change.
Scientific
To be responsible for ensuring the quality, to nationally accepted standards (UKAS or equivalent organisation), of the analytical biochemistry service provided within the Blood Sciences services at Caithness General Hospital and Belford Hospital, and the Blood Sciences Department at Raigmore Hospital including participation in appropriate internal, regional, national quality control and assessment schemes. To ensure that policies and procedures are in place to allow the laboratory management team to select, procure, evaluate and implement new technologies as appropriate, including point of care testing across NHS Highland. To provide expert analytical knowledge for the provision and development of the service. To provide specialist analytical supervision and support in areas of particular expertise, for routine and specialist patient investigation. To disseminate knowledge gained during study or research, and to develop projects resulting in presentations and publications at local, regional, national and international meetings and in peer reviewed scientific journals. The post holder will be required to provide professional advice to NHS Highland or other bodies, potentially including acting as an expert witness to the Court Service.
Research and Development
The post holder will, as an integral part of the job: Initiate and undertake clinical audits pertinent to clinical biochemistry and act on their outcomes. Input findings to the Clinical Governance team within NHS Highland. Supervise and evaluate the outcomes of clinical audits, investigations and research conducted by others in the department. Initiate, co-ordinate and implement research and development within the department, and in support of NHS Highland research programmes. This includes analytical and clinical evaluation of new investigations and specialist scientific equipment or tests to be introduced into the routine service. Act as clinical research project supervisor to MSc level, of trainee clinical scientist and BMS staff where required. Manage the funding of research projects. Take responsibility for the evaluation and implementation of recent developments in clinical Blood Sciences and ensure the service provides evidence-based good practice. Advise on and contribute to the clinical biochemistry aspects of research projects proposed and conducted by staff from other departments of the trust.
Training and Education
The post holder will: Ensure the development, maintenance and dissemination of the highest professional standards of practice, through active participation in internal and external CPD training and development programmes to postgraduate standards. This will include arranging and participating in departmental/trust seminars and local and national meetings and training events. Organise and supervise the training of Trainee and Registered Clinical Biochemists. Contribute to the departmental responsibility for teaching/training (BMS, junior doctors/medical students, nurses) in Clinical Biochemistry. Participation in formal teaching sessions is required. Ensure the provision of appropriate opportunities for the professional development of BMS and other departmental staff, to meet professional registration requirements.
7a. EQUIPMENT AND MACHINERY The post holder needs to become fully conversant with the equipment used and the assays performed in the laboratory. Current equipment at Raigmore Hospital includes Siemens Advia 2400, 2120i and Centaur analysers, Abbott Architect, a Siemens track with associated sample managers, TOP 500 coagulation analysers, an osmometer, Tosoh G8 analysers for HbA1c and haemoglobinopathies, a spectrophotometer and a Benson viscometer. The laboratory information system is Ultra and iPassport is used for document control. The department is also responsible for point of care equipment that performs biochemistry tests, including blood gas analysers and blood glucose meters. Advise on the clinical need for procurement and use of point of care equipment, such as blood gas analysers and blood glucose meters, and work with others to refine governance structures as required.
7b. SYSTEMS Possess an in depth understanding of the use of laboratory informatics, and other interfaced IT systems e.g. SCI Store, in order to provide a quality service to clinicians. Analyse laboratory data using statistical packages and produce appropriate reports. Implement, maintain and operate quality and document management software. This is an integral part of the quality management system. Use of standard computer word processor, database and spreadsheet packages The post holder will possess particular computer skills for the presentation of the department’s data to end-users and independently deal with problems and improvements in the presentation and manipulation of this data.
8. ASSIGNMENT AND REVIEW OF WORK
Will have freedom to act on their own responsibility at consultant level, working within professional guidelines. Will have senior input into the professional direction of the service provided by the Blood Sciences services at Raigmore, Caithness General Hospital and Belford Hospital, and for ensuring that the standards required by UKAS are maintained. Will develop clinical guidelines for testing strategies and clinical protocols within the department and across NHS Highland. Will initiate and direct research and development on relevant clinical and scientific problems, including analytical and clinical evaluation of new investigations and specialist scientific equipment, or tests to be introduced into routine service. Will initiate clinical audit pertinent to Clinical Biochemistry. Be expected to organise their own time and prioritise work accordingly. The duties and responsibilities of the post will be reviewed as part of the staff appraisal process.
9. DECISIONS AND JUDGEMENTS
In conjunction with the departmental clinical lead be responsible for the professional direction of clinical biochemistry services provided by the laboratories at Raigmore Hospital, Caithness General Hospital and Belford Hospital. Work autonomously to interpret highly complex results and provide a comprehensive advisory service for screening, diagnostic and prognostic tests. This will include advising on further testing strategies, diagnosing disease and modifying care and treatment based on biochemistry results, patient history, drug information, patient signs and symptoms and results of tests from other disciplines that may be conflicting. There will be a number of possible options. Be expected to anticipate problems and take steps to resolve them. Supervise clinical scientist staff. Be responsible for the provision of the biochemistry service on a day-to-day basis when acting as duty biochemist. Judgements will be required in complex situations where patients may be critically ill. Represent the service/directorate, contributing to decisions on organisation-wide managerial and clinical working groups and committees eg managed clinical networks, health board advisory teams
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
Managing change. Responding to the challenge of maintaining and raising the quality of the service in a rapidly changing environment. Responding to developing national and professional standards for laboratory medicine. Ensuring the most effective use of resources to meet increasing workload, which can be influenced by external factors over which the department has no control. This may have effects across all of the laboratory disciplines. Maintaining and developing good relationships with clinical colleagues in order to ensure that the service meets the needs of its users. Being responsible for the professional direction of clinical biochemistry services in laboratories that are distant from each other, and ensuring that wherever possible commonality of practice is in place.
11. COMMUNICATIONS AND RELATIONSHIPS
The post holder will be required to: Explain the clinical significance of highly complex results to a range of staff including medical and nursing staff up to consultant level. Lead changes in laboratory working practices by providing expert advice and supporting and motivating staff. Develop good working relationships with the Clinical Director and the General Manager of the Clinical Support Division and other senior members of the operational units/Board management teams to enable discussion and progress in the wider issues affecting the department. The post holder is required to be an advocate for the service, which may involve interactions of differing professional opinions. Occasionally vigorously challenge managerial or medical opinions, maintaining conviction in own knowledge and opinions. Participate in and establish clinical and professional networks of staff locally and nationally. Present research and development results, clinical audit findings, clinical cases, and new policies and guidelines at local and national meetings. Provide instructional training and ongoing education to laboratory staff, other health professionals and patients. Deal with the provision and receipt of highly complex and sensitive information effectively. Negotiate with outside suppliers and procurement officials on the provision of laboratory equipment and services. Explain to senior non-clinical management colleagues proposals for service development and service redesign. Listen to, and counsel staff on complex inter-personal and performance-related problems within the department. Deal with and resolve enquiries and complaints as required, from clinicians, patients (where there may be barriers to understanding), managers and staff, which may be complex, sensitive and contentious.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical Frequent requirement for sitting in a restricted position while authorising reports at computer workstation (more than 50% of time). Requirement to travel to Caithness General Hospital and Belford Hospital, each on a monthly basis. This can be by car, train or bus. Requirement to stay away from home during visits to Caithness General Hospital and Belford Hospital if required by the needs of the service. Occasional requirement for lifting eg equipment, reagents. Frequent exposure to unpleasant working conditions, blood, urine, body fluids and faecal samples, infectious agents.
Emotional
Deal with and resolve enquiries and complaints as required, from clinicians, patients (where there may be barriers to understanding), managers and staff, which may be complex, sensitive and contentious. Deal with the provision and receipt of highly complex and sensitive information effectively. Required to direct staff to change some aspect of work procedures or priorities, confirming that delegated authority has been consistent with expectations. This will involve confronting staff with issues they do not agree with and may include disciplinary procedures. May need to vigorously challenge medical or managerial opinions. There is occasional exposure to distressing or emotional circumstances whilst taking part in ward rounds, clinics or diagnosing terminal disease. Required to lead on changes within the service and deal with staff concerns and reaction to proposed changes.
Mental
There is frequent requirement for prolonged intense concentration. This post involves a wide variety of activities and there is a need for prolonged concentration to allow deadlines to be met and ensure a high quality of service at all times. Examples of activities include clinical validation of results, which involves review of patient results produced in real time in the laboratory computer system, taking into account previous results and clinical information. During this activity the post holder is subject to regular and frequent interruptions for clinical advice, and information from both service users and colleagues within the department. Intense concentration is required to ensure that valid and accurate results are reported at all times and that clinical opinion takes into account the subtleties of each case. Urgent requests for clinical advice are also made, which require intense concentration to ensure that correct decisions, which will influence patient management, are made. Other activities include management and strategic planning .These are frequently interrupted for immediate clinical or professional advice. These interruptions are unpredictable and may require multi-tasking and re- prioritisation of work pattern. The post holder will be frequently expected to make decisions at short notice which will affect patient management or service provision. May need to vigorously challenge medical or managerial opinions, maintaining conviction in own knowledge and opinions. Prolonged and intense concentration required for interpretation of quality control data, statistical analyses, writing scientific papers, audit reports, writing of departmental policies and procedures.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Qualifications
Upper second or first class Honours degree in relevant science e.g. Biochemistry or Blood Sciences. Completion of the nationally accredited Grade A training programme (3 years). MSc in Clinical Biochemistry or PhD in a relevant field. Fellowship of the Royal College of Pathologists (FRCPath) as required for medical consultant posts, or equivalent professional experience. Demonstration of appropriate continuing profession development
Registration
Clinical Scientist State Registration with the Health and Care Professions Council (HCPC)
Experience
At least 7 years experience as a Clinical Scientist in Biochemistry or Blood Sciences and developed expertise in one or more specialist analytical or clinical areas. To have attained a good record of achievement in research, development and audit activities through presentation at national or international conferences and publication in peer reviewed medical and scientific journals.
14. JOB DESCRIPTION AGREEMENT I agree that the above Job Description is an accurate reflection of my duties and responsibilities at the date of signing.
Job Holder’s Signature: Date:
Manager’s Signature: Date: