JOB DESCRIPTION
LOCUM CONSULTANT in CARDIOTHORACIC ANAESTHESIA & INTENSIVE CARE
Contents
Section Page
1 Summary and Key Responsibilities 2 Papworth Hospital NHS Foundation Trust 3 Cardiothoracic Anaesthesia - Staffing, Facilities and Activity 4 Duties of the Post and Proposed Clinical Timetable 5 Research Activities 6 Terms and Conditions 7 Brief Terms of Appointment 8 General Information 9 Informal Visits 10 Person Specification
SECTION 1
SUMMARY This post provides anaesthetic support for cardiothoracic surgical and Critical Care services at Papworth Hospital. The post holder will contribute to the provision of anaesthetic services for cardiothoracic surgery, transplant surgery, interventional cardiology, critical care and extra-corporeal membrane oxygenation (ECMO). In addition, the post holder will be required to attend pre-assessment clinics and to participate in early evening elective operating sessions as well as Saturday elective operating sessions. The post includes a commitment to the theatre, critical care and ECMO out of hours rotas on a rotational basis. The post- holder will contribute to the training of medical students, foundation, core and specialist trainees and allied health professionals. In addition the post-holder is expected to initiate and participate in clinical audit, quality improvement and academic activities. The post-holder will be employed full time at Papworth Hospital.
KEY RESPONSIBILITIES The day-to-day provision and development of cardiothoracic and transplant anaesthesia, critical care and ECMO at Papworth Hospital.
KEY TASKS Shared responsibility with other colleagues for the cardiothoracic anaesthetic service, Critical Care, ECMO and on-call duties as outlined above. Teaching, training and clinical supervision of trainees. Participation in the research, audit and quality improvement activities of the Department of Anaesthesia and Intensive Care. Maintenance of the highest clinical standards in the management of patients and compliance with clinical governance initiatives. Participation in continuing professional development and appraisal.
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Royal Papworth Hospital Royal Papworth Hospital is the UK’s leading heart and lung hospital, treating more than 100,000 patients each year from across the UK. Since carrying out the UK’s first successful heart transplant in 1979, the hospital has established an international reputation for excellence in research and innovation. Ninety-eight per cent of patients say they would recommend Royal Papworth Hospital to their friends and family.
As well as performing more heart and lung transplants than any other UK centre, Royal Papworth Hospital has the UK’s largest Respiratory Support and Sleep Centre (RSSC). It is the only centre in the UK for a number of specialist services including Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty (BPA). In addition, the hospital is one of only five UK centres for the provision of ECMO services for respiratory failure.
Royal Papworth Hospital is a member of Cambridge University Health Partners (CUHP), a partnership between one of the world's leading universities and three NHS Foundation Trusts. CUHP delivers world-class excellence in healthcare, research, clinical education and improves the health of people across Cambridgeshire and the wider regions.
We have a reputation for being one of the best performing hospitals in the country - a status that we are determined to maintain. Throughout the hospital, there is a pioneering spirit and a willingness to embrace new ideas in all aspects of healthcare, combined with meticulous monitoring and review of clinical outcomes, both in established and novel treatment modalities.
We have been at the core of the COVID-19 response in Mach 2020, and provided immediately support to other critical care units in the region. We successfully increased our ECMO capacity from 3 to over 20 beds within a couple of weeks.
More information can be found on the hospital’s website. (www.royalpapworth.nhs.uk).
Management of staff Royal Papworth Hospital has several clinical divisions.
3 Two consultant clinical directors and one divisional manager lead the division of Surgery, Transplant and Anaesthetics, with clinical business unit leads for individual services.
There are further non-clinical directorates for Research and Development, Human Resources (including Education and Development), Clinical Governance and Risk Management, together with Central Corporate Services.
Location and local facilities The hospital moved in 2019 to a brand new, state-of-the-art hospital on the Cambridge Biomedical Campus. A new Heart and Lung Research Institute is being built next to the hospital. Royal Papworth Hospital is situated in the Cambridge Biomedical Campus, just to the South of the city. There is a direct guided bus linking us to the train station and the city (5 minutes). There is easy access to London by road and rail. Sports and leisure facilities are available on the campus itself. Facilities include:
• Five operating theatres, five catheter laboratories (for non-surgical procedure) and two hybrid theatres
• Six inpatient wards
• 310 beds, including a 46-bed critical care unit and 24 daycare beds
• Mostly en-suite, individual rooms for patients
• A centrally located outpatients unit offering a wide range of diagnostic and treatment facilities
• A link corridor to Addenbrooke’s Hospital and one being built to link to the Research institute
• An atrium on the ground floor with a restaurant, coffee shop and convenience store
• Our building has been designed with infection control in mind, and we are currently optimising all pathways to respond to ensure we are prepared at best in relation to COVID-19.
• We have rapidly deployed digital solutions to support new ways of working.
Further information can be found on the hospital’s website ( (www.royalpapworth.nhs.uk). 4 Education and learning
The hospital has always recognised that education and research are of fundamental importance in enabling continuing innovation in clinical services and the delivery of high- quality patient care. Both education and research are key priorities for the Trust’s Executive team and are supported by appropriate resources and facilities. The co-location with the Heart and Lung Research Institute will draw together the highest concentration of heart and lung researchers from academia, healthcare and industry in Europe. The Institute will be home to over 380 scientists and state-of-the-art laboratories in genomics, population sciences, research into cellular mechanisms of disease and translational science. It will include a special ten bed facility where the first-in-patient studies of new treatments can be conducted.
5 SECTION 3
Department of Anaesthesia and Intensive Care
Consultant medical staff There are more than 25 consultants in anaesthesia and/or intensive care with sessional commitments at Royal Papworth. In addition, several positions are open for locum (short term) appointments; these are mostly used to allow senior trainees to progress to a consultant role before embarking on a firm consultant career.
The Department of Anaesthesia and Intensive Care is part of the division of Surgery, Transplant and Anaesthetics. The Clinical Directors are Mr David Jenkins and Dr Alain Vuylsteke.
The Clinical Business Lead for Anaesthetics and Theatre is Dr Kiran Salaunkey, and the Clinical Business Lead for Intensive Care is Dr Nicola Jones. Both represent their respective units at divisional level.
TRAINEE MEDICAL STAFF There are typically at least 25 trainees working within the department of Anaesthesia and Critical Care. These include foundation, core and specialist trainees from the East of England Deanery as well as fellows from the UK and overseas, interested in gaining specialist experience in cardiothoracic anaesthesia, critical care, echocardiography and ECMO.
Clinical facilities There are six operating theatres (one of which is a hybrid theatre/cath lab) with four adjacent recovery beds, six cardiac catheter laboratories and several pre-admission clinics.
The critical care unit has 46 single rooms, all equipped to care for level 3 patients. These include 8 isolation rooms with negative pressure. The design of the unit allows for 6 cohorting of patients in response to severe infections such as COVID-19. The department was able to accommodate very rapidly over 20 patients on ECMO using the existing facilities. The unit has been fully computerised since 2006, and all multidisciplinary meetings are accessible remotely.
Departmental workload The anaesthetic department has seen a steady increase in the number of operations over the last few years and has grown to accommodate this activity. We are a busy unit and thrive on delivering high-quality care to a large number of patients. The number of scheduled cardiac cases has increased to more than 2,000 per year. Evening and Saturday elective activity is enabled to accommodate this extra demand. It is our ambition to resume this despite the disruption caused by. the COVID-19 pandemic.
Anaesthetic services are provided for heart and lung transplantation, ventricular assist device (VAD) implantation and pulmonary endarterectomy (PEA).
There is a significant thoracic surgical workload. In addition, electrophysiology and device insertions by the cardiologists continue to increase.
The Critical Care department has seen an increase in activity, including to support patients post cardiothoracic surgery as well as those requiring ECMO, or with advanced heart failure, severe acute respiratory failure and following out-of-hospital cardiac arrest and primary percutaneous coronary intervention (PPCI). This unique expertise led the critical care unit to be one of the busiest in the East of England during the COVID-19 pandemic.
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DUTIES OF THE POST AND PROPOSED CLINICAL TIMETABLE
Successful applicants will contribute to the provision of cardiothoracic anaesthetic and critical care services at Royal Papworth Hospital on an alternating rotational basis.
Successful applicants will contribute on a rotational basis to the theatre, critical care and ECMO out-of-hours rota.
The distribution of duties are currently reviewed due to the COVID-19 pandemic, and all times or days are only for illustration.
In addition to providing day-time anaesthetic services in the operating theatres and cardiac catheter laboratories, the department has a commitment to providing as and when required early evening cover (18:00-20:00, Monday - Friday) for elective cardiac cases and Saturday cover (08:00-18:00).
The Critical Care department is staffed by 3 consultants during daytime and provides an on-call system to cover the unit at night (with a predefined proportion of time on site)
The ECMO service is covered by a consultant 24/7 who is available to assess and retrieve patients within the region and elsewhere in the UK. This includes instituting mobile ECMO support whenever appropriate. The service provides advice to referring centres on the management of patients with severe acute respiratory failure.
Consultants report to the Business Unit Leads, are responsible to the Clinical Directors and the Medical Director, and are accountable to the Chief Executive.
Consultants agree a job plan and participate in annual appraisals, together with any monitoring that may be required.
8 In addition, our consultants comply with clinical governance initiatives and maintain their professional development.
All of our consultants must ensure that, before embarking on techniques that are new to them and not part of an ethics committee approved research programme, they have attended appropriate training, that the relevant clinical and management colleagues have been informed and that there is divisional agreement for any new development.
WORKING PATTERN
The department runs several rotas and successful applicants are most likely to join the ECMO consultant rota.
Job plans are annualised, and the overall yearly activity agreed with the Clinical Director. It is then allocated equitably on the rota according to service needs, departmental choices and personal preferences. Rota are published every quarter, and locked several weeks in advance to allow for personal planning.
Example includes: i) cardiothoracic anaesthesia, including some late cases to 20:00; ii) cardiothoracic critical care, typically every second day for a 2 weeks period, including ECMO cover on the day and night of the critical care duty (24h on call for ECMO); iii) support for transplant and acute emergency theatre activity when on call for ECMO (this is backed up in case an ECMO retrieval is required simultaneously);
The day-time clinical sessions to be worked flexibly, Rota are set at least 6 weeks in advance. The Consultant will be expected to support, develop and encourage the research and teaching activities of the department. The Consultant will be expected to take part in clinical audit and governance meetings. The Consultant will be expected to provide cross-cover for the scheduled work of absent colleagues and to provide flexibility for late finishes and early starts in theatre and radiology. The post holder will contribute to the out-of-hours provision of anaesthetic and critical care services. 9 SECTION 5
Section 5 - Research, education and audit
Research
There is an established Research & Development (R&D) directorate with a well- developed infrastructure providing considerable support for research activities throughout the hospital.
The department supports a range of research interests and has a long history of good clinical research output.
Education
There is strong support for continuing professional development (CPD) within the Trust. All consultants are encouraged to undertake CPD in accordance with Royal College guidelines.
The department runs a program of lectures, tutorials and a journal club nearly every morning. These can be accessed remotely. Several courses attracting international attendees are organised by members of the department within Royal Papworth or at outside venues. These include echocardiography courses, ranging from TOE courses for anaesthetists and other medical staff, to FICE accredited intensive care echocardiography or BSE exam preparation courses. These are being reviewed in the context of living with COVID but there is an ambition to embrace new technology to continue being active.
Consultants are asked to support, engage and develop these activities.
Audit and clinical governance
The hospital is a recognised national and international leader in the field of clinical audit and the monitoring of clinical performance. Clinical governance is a key aspect of our daily practice. 10
SECTION 6
TERMS AND CONDITIONS
This appointment is exempt from the provision of Section 4 (2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974, (Exemption Order) 1975. Applicants are not entitled therefore, to withhold information about convictions which for other purpose are ‘spent’ under the provisions of the Act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Trust. Any information will be completely confidential and will be considered only in relation to any application for the position to which the Order relates.
The Trust is committed to providing safe and effective care for patients and one of the principles set out in the GMC’s ‘Duties of a Doctor’ is that a doctor has an ethical responsibility to act quickly to protect patients where they have reason to believe that they or a colleague are unfit to practice. To ensure this, there is an agreed procedure for medical staff the enables them to report, quickly and confidentially concerns about the conduct, performance or health of medical colleagues. All medical staff practicing in the Trust should ensure that they are familiar with the procedure and apply it.
The successful candidate will be required to live within 30 minutes normal travelling time of the hospital, and must be contactable by telephone.
The appointee may be required to undergo a medical examination dependent on the date of last medical examination for a post within the NHS.
The Trust will require the successful candidate to have and maintain full registration with the General Medical Council, and if appropriate, membership of a recognised Medical Defence Organisation. You are strongly recommended to maintain defense body membership in order to ensure that you are covered for any work which does not fall within the NHS indemnity scheme, (e.g., private practice, even if that activity is being
11 undertaken on NHS premises, good Samaritan acts, and for cover if you are involved in GMC disciplinary procedures or criminal proceedings.
Within their own area of responsibility, the post-holder will be responsible for assessing the risks to the health and safety of staff, patients and visitors or to the achievement of the Trust's objectives. The post-holder must ensure that identified risks are reported centrally to the Risk Management Team, so that significant clinical and non-clinical risks are included in the Trust's Risk Register.
The post-holder will participate, as required, in clinical and non-clinical audit projects aimed at improving patient care and the effective and efficient delivery of services.
Where required by safety legislation or mandatory requirements of bodies such as the NHS Litigation Authority, the post-holder will contribute to the preparation and review of written risk assessments, including clinical risk assessments, at appropriate intervals and, where necessary, develop and implement suitable risk treatment plans. The post-holder will be responsible for ensuring attendance of staff at mandatory training sessions appropriate to the posts held and for providing a quarterly breakdown of attendance and reasons for non-attendance.
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BRIEF TERMS OF APPOINTMENT
The post is offered as a one year fired term contract.
The post is subject to the terms and conditions for Consultant (England) 2003 for consultant medical staff, incorporating General Whitley council conditions of service as explicitly stated. Also to any amendments which are from time to time the subject of negotiation by the appropriate negotiation bodies and are approved by the Secretary of State. The post is also subject to the Trusts policies and procedures.
Noted below are the summary salary points of the consultant terms and conditions: 12
i) The post is full-time with 10 programmed activities ii) Basic salary on commencement will normally be at the minimum point of the pay scale on first appointment to the consultant grade. The pay scale commences at £76,001 pa iii) Where applicable the on-call rota is Category A.
SECTION 8
INFORMAL VISITS
Informal visits can be arranged via the Anaesthetic Secretaries, Melanie Yea
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PERSON SPECIFICATION
REQUIREMENTS ESSENTIAL DESIRABLE
Qualifications FRCA or equivalent FFICM or equivalent qualification in anaesthesia qualification in intensive care CCT or equivalent in medicine (ICM) anaesthesia Qualification in another Expected Entry on the GMC specialty (e.g. MRCP) Specialist Register Higher Degree (e.g. MSc, MD, PhD)
Clinical Training Training equivalent to that Training in cardiothoracic ICM required for gaining UK CCT with the management of in Anaesthesia patients with heart failure, Training in ICM heart and lung transplantation Training in cardiothoracic and mechanical heart support anaesthesia devices. CCT in ICM Training in another specialty (e.g. medicine) Overseas experience in cardiac and thoracic anaesthesia and intensive care medicine
Experience Twelve months experience in Formal fellowship in adult adult cardiothoracic cardiothoracic anaesthesia / anaesthesia / ICM ICM Competence in the use of Experience of management of adult transesophageal patients with heart failure, echocardiography heart and lung transplantation Experience in the transfer of and mechanical heart support the critically ill patient devices.
14 Experience in the Certification or Full management of patients accreditation in transthoracic / with ARDS/ALI transoesophageal echocardiography (UK, Europe or USA exam) Experience in the management of patients on ECMO
Personal attributes Ability to work in a team Membership of learned, Good interpersonal skills societies Caring attitude to patients e.g. Association of Commitment to continuing Cardiothoracic Anaesthetists professional development (ACTA) or Intensive Care Society Good interpersonal skills (ICS) Willingness to undertake professional responsibilities at regional/national level Good communication skills
Research Understanding of research Evidence of published or methods and governance presented research in the field of cardiothoracic anaesthesia and ICM
Audit Principles of audit and Evidence of driving change in quality improvement as it anaesthesia and ICM applies to anaesthesia and ICM Evidence of experience in conducting audit of clinical work and quality improvement initiatives.
Teaching Experience of clinical Evidence of formal training in teaching and lecturing to teaching, training assessment
15 colleagues and and appraisal. undergraduates Teaching diploma or qualification (e.g. PGCE, FHEA)
Job description and person specification agreed by:
Medical Director______Dr Roger Hall Date______
Clinical Director______Dr Alain Vuylsteke Date______
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