Chairman Mr David White Chief Executive Mr Sam Higginson Consultant in Older People’s Medicine Department of Older People’s Medicine Norfolk and Norwich University Hospitals NHS Foundation Trust January 2020 Introduction .................................................................................................... Page 3 The Department ............................................................................................. Page 4 Consultant staff……………………………………………………………… Page 6 Clinical staff and trainees…………………………………………………… Page 7 Education and Training .................................................................................. Page 8 Duties of the Post ........................................................................................... Page 8 Job Plan ......................................................................................................... Page 9 Provisional Timetable ................................................................................... Page 10 Person Specification .................................................................................... Page 11 About the Trust ............................................................................................. Page 12 General Conditions of Appointment ............................................................. Page 19 Contacts for Further Information .................................................................. Page 21 2 Introduction This is a consultant appointment to the Older People’s Medicine (OPM) department. In the last 2 years, there has been an expansion of the department’s work and involvement with frailty in the Emergency Department creating the UKs first Older Persons Emergency Department (OPED). Successful applicants would join a team of 16 consultant geriatricians. It is anticipated the postholder would engage in core activities of the department, as well has have the opportunity to develop subspecialty interests, in particular in acute frailty work. Applicants will be expected to take part in either the on call rota for Acute Geriatric Medicine or for the Older Persons Emergency Department team, or a mixture of both. There are also opportunities to consider taking part in the Trusts Acute Medicine and physician of the day rota. Job plans are flexible and include core activities such as taking responsibility for the care of inpatients under Older Peoples Medicine (OPM) in the Norfolk and Norwich University hospital. Post holders are also required to see patients of other specialties when they are referred for an opinion. There will be sessional work for assessing frail older patients in the Emergency Department or in the Acute Medical Unit. There is also the opportunity to be involved in partnership working within the local community units. We are currently working with the National Acute Frailty Network to improve the pathway for our older population. This involves changing the way we work as outlined above to much more collaborative working in the ED (Emergency Department) and CDU (Clinical Decisions Unit). Our ambition is to identify the frail older person as soon as they have contact with a member of the Acute Hospital team and to ensure that a Comprehensive Geriatric Assessment (CGA) is initiated in a timely way and that the results of this are communicated accurately to the patient’s GP. This also applies to our on demand out patient service whereby all new referrals are seen within 48 hours of referral and offered a multidisciplinary CGA rather than a traditional out patient assessment. As a team, we currently provide care for all patients over the age of 80 admitted with general medical conditions, with specific older peoples’ medicine wards specializing in short stay, dementia, complex long stay and fractured NOF patients over 70. We are keen to extend our reach further, and are in the process of expanding our in-patient frailty liaison service to offer CGA to frail older adults under the care of other medical teams and other divisions in the trust. A candidate who is unable for personal reasons to undertake the duties of a whole- time post will receive equal consideration. If such a candidate is appointed, the job content will be modified as appropriate in consultation with consultant colleagues and local management. We welcome all applications irrespective of age, disability, gender, sexual orientation, race or religion. Additionally, people with disabilities will be offered an interview providing they meet the minimum criteria for the post. The Trust operates job share and flexible working. 3 The Department This is a dynamic department, with ~8300 admissions per annum and an overall average length of stay of ~12 days. We have 4 (soon to be 5) wards, an outpatient department and strong working relationships with our front door and neighbouring provider Trusts. Frailty identification and intervention has seen a significant redesign of our services in the last 2 years. We now staff our OPED team (Mon-Fri 8am-8pm, and Sunday) as a consultant led service, with ambition to extend this to cover the whole weekend. This has seen a significant decrease in our ED conversion rate for frail elderly. We’ve created an area on our short stay ward to deliver CGA (comprehensive geriatric assessment), and by pulling patients direct from ED to this area (OPAC – Older Persons Ambulatory Care) we have increased our same day discharges, with anticipated knock on effects for the rest of the department. Acutely admitted patients from GPs are selected for OPM while in the AMU (Acute Medical Unit), using a locally developed system of triage which is a hybrid of age- related and needs-related systems. The age cut-offs vary according to the presentation of the patient. Approximately 43% of acute medical emergencies are triaged to OPM by the current criteria. We offer an admission avoidance advice line for local GPs, Mon-Fri 9-5, with the back-up of an outpatients service (OPAS – Older Person’s Assessment Service) that can see any new emergency referral within 48hrs of referral, and receive a multidisciplinary CGA review. At present Movement Disorder Clinics (MDC) are run to a traditional 18wk RTT pathway, with significant work to ensure we meet best practice tariff for these patients. All OPM acute inpatients are accommodated on a single site in the 964 bedded Norfolk and Norwich University Hospital. There are 4 OPM wards of approximately 36 beds, with 2/3 consultants for each ward: Loddon - Short stay discharging 270 patients per month facilitated by daily multidisciplinary meetings and a one-stop Dispensing pharmacy on the ward. Kimberley - Acute O.P.M. with a focus on Isolation for patients with infective illness Elsing – Acute OPM with a focus on dementia. The team work closely with the Dementia Intensive Support Team, a mental health trained OT and the liaison psychiatry team. Brundall - Orthopaedic–medical unit for fast stream management of fracture neck of femur cases. There are usually outliers, although concerted efforts are made to keep these to a minimum. The department runs a ward based consultant allocation system to 4 minimise the number of wards each consultant has to work on and to maintain consistency in the volume of each consultant’s workload. At peak times there can be 10 outliers for each Consultant. Outpatient activity is equally high, with ~5000 attendances per annum within the O.P.M Outpatient Department in the Norfolk and Norwich University Hospital. The Movement disorder clinic has around 300 patients under follow up. Norfolk has community units, primarily offering rehabilitation facilities. These Units require weekly consultant input. These are at the Norwich Community Hospital (40 beds, including a stroke rehabilitation ward), Dereham Hospital (21 beds) and Benjamin Court in Cromer with 16 beds. In addition, consultant services are provided to Community beds in Ogden Court (21 mixed rehab, community palliative care and planning beds) in Wymondham. There are several other community hospitals that are run by local GPs to which OPM consultants may transfer patients. Some community hospitals have day treatment and therapy centers; these are therapy led. Clinicians are actively involved with CCGs in commissioning services for older people to ensure they are equitable throughout Norfolk. All Community Hospitals are managed by Norfolk Community Health and Care Trust. Appointees will be provided with an office, computer, internet access and secretarial support which may be shared. 5 Consultant Staff - There are currently 16 consultants in the department Clinician Sub-specialty Interest Dr Martyn Patel Service Director for OPM Dr A Niruban Acute OPM and Lead for Movement Disorders Dr J Edwards Chair of Geriatrics STC – Eastern Region Dr Indunil Gunawardena Orthogeriatrics, + Movement Disorders Dr. Susan Lee Orthogeriatrics, Falls Lead, Audit Lead Dr Garry Dawson Orthogeriatrics + Surgical Liaison Dr Sarah Bailey OPED and Frailty Team Lead Dr Helen May Chief of Service for OPM and AMU Dr. Kelum Pelpola Acute OPM and Frailty team Dr Rebecca Wiseman Acute OPM + Governance Lead Dr Sarah Clark Acute OPM and Frailty team, Dementia Lead Dr Ruth Rallan Dementia, Community Geriatrics Dr Dilusha Acute OPM and Dementia Care Lamabadasuriya Prof. Lesley Bowker Medical education, ethics Dr Meenal Karkhanis OPED team Dr Muhammad Ibrahim OPED team 6 Other clinical staff Dr Alice Schweigart Associate Specialist, Outpatient lead Dr Nahid Iftekhar Specialty Doctor - Orthogeriatrics Dr. Amanda Dalcassian