CONSULTANT in CRITICAL CARE 10 Programmed Activities

CONSULTANT IN CRITICAL CARE

10 Programmed Activities – Full-time

INFORMATION PACK AND JOB DESCRIPTION

KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST

King’s College Hospital NHS Foundation Trust is one of the UK’s largest and busiest teaching hospitals with over 1.5 million patient contacts a year and more than 13,000 staff based across five main sites in South East London and Kent.

The Trust provides a full range of local hospital services across its different sites, and specialist services from King’s College Hospital (KCH) site in Camberwell and the Princess Royal University Hospital (PRUH) site in Bromley, Orpington Hospital, and some services at Beckenham Beacon and Queen Mary’s Sidcup.

The Trust is recognised internationally for its work in liver disease and transplantation, neurosciences, cardiac, haemato-oncology, fetal medicine, stroke, major trauma, and Emergency Department.

King’s is a key partner in one of London's foremost Academic Health Science Centres, King's Health Partners (KHP). KHP is one of only six Department of Health-designated AHSCs in England. It brings together a world-leading research-led university – King’s College London – and three successful NHS Foundation Trusts: King’s College Hospital, Guy’s and St Thomas’, and South London and Maudsley.

With the acquisition of the PRUH and Orpington Hospitals in October 2013, the Trust increased in size and importance, now caring for patients in the boroughs of Bromley and Bexley in addition to Lambeth, Southwark and Lewisham. Many services, such as Trauma and Neurosurgery, are delivered on a regional basis, whilst people from throughout the UK and beyond come to us for our world renowned specialist services such as Liver and Foetal Medicine. Already one of only 4 major trauma centres in London, King's became the largest provider of stroke services with Hyper Acute Stroke Units based on both acute hospital sites in Kent and London. An elective orthopaedic centre was established in 2013 at Orpington Hospital, and this has already grown to become the second largest orthopaedic centre in London.

King's specialist services include some world renowned departments. The Liver Department has the largest transplant centre in Europe, and is celebrated for its innovative practice, the development of split liver transplants, as an example. In foetal medicine, the Harris Birthright Centre under Professor Kypros Nicolaides has led the world in the development of foetal scanning and surgery. King's has two "A" rated hyper acute stroke centres, and the centre at King's Denmark Hill was rated as the best in the country in a recent Royal College of Physicians national study. The Hospital also provides innovative cardiac, neurosurgery and haemato-oncolgy departments, and the largest Bone Marrow transplant centre in Europe.

King’s College Hospital NHS Foundation Trust has an enviable track record in research and development and service innovation. In partnership with King’s College London, the Trust has recently been awarded a National Research Centre in Patient Safety and Service Quality. It is also a partner in two National Institute for Health Research biomedical research centres. The first is a Comprehensive centre with King’s College London and Guy’s and St Thomas’ NHS Foundation Trust and the second is a Specialist centre with the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry. King’s College Hospital NHS Foundation Trust has also recently strengthened its research and development infrastructure in order to better support clinical researchers across the organisation.

King’s College Hospital NHS Foundation Trust is part of CLAHRC (Collaboration for Leadership in Applied Health Research), a collaborative partnership between universities and surrounding NHS organisations, focused on improving patient outcomes through the conduct and application of applied health research. The work of the CLAHRC South London is funded for five years (from 1st January 2014), by the NIHR (National Institute for Health Research).

The Trust has an annual income of around £1 billion, around half of which is derived from Clinical Commissioning Groups. However, education and research are also important sources of income, currently contributing around 8% of the total. The Trust is embarking on a strategy to achieve greater diversification of its income, with growth anticipated in tertiary referrals, research and commercial services activities. There is also a developing fund raising partnership within King’s Health Partners for the Institute programs in Cardiovascular, Haematology and Neurosciences.

King’s College Hospital NHS Foundation Trust has a very positive culture, built on the core staff and service values of:

• Understanding you • Inspiring confidence in our care • Working together • Always aiming higher • Making a difference in our community

We offer a family friendly working approach for all staff to ensure a good work-life balance. The Trust provides a supportive mentoring and career planning programme. Applications for job sharing are welcome.

King’s Health Partners Academic Health Science Centre (AHSC)

King's is known as an innovative organisation and it is working hard to develop significant partnerships with health and social care partners across London and with industry, designed to improve the provision of integrated care to patients. It is a pivotal founding member of one of the country's Academic Health Sciences Centres (AHSC) known as King's Health Partners (KHP).

King’s Health Partners is a pioneering collaboration between King’s College London, Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. This unique combination brings together one of the world’s leading research-led universities and three of London’s most successful NHS Foundation Trusts.

The driving purpose behind King’s Health Partners is to continually seek and bring about swifter and more effective improvements in health and well-being for patients and people everywhere, by combining the best of basic and translational research, clinical excellence and world-class teaching to deliver ground-breaking advances in physical and mental healthcare.

King’s Health Partners (KHP) is one of only five Academic Health Science Centres in the UK accredited by the Department of Health. This followed a selection process carried out by a panel of internationally renowned clinicians and researchers.

One of only six AHSCs in the UK, it brings together an unrivalled range and depth of clinical and research expertise, spanning both physical and mental health. The AHSC's combined strengths will drive improvements in care for patients, allowing them to benefit from breakthroughs in medical science and receive leading edge treatment at the earliest possible opportunity.

The partnership brings together:  Three of the UK's leading NHS Foundation Trusts;  One of the top 20 universities in the world;

 Services provided across central and outer London locations, including seven mental  health and physical healthcare hospitals and many community sites;  4.2 million patient contacts each year; 36,000 staff; 25,000 students; and a combined  annual turnover of £3.1bn.

Further information on KHP can be found on its website www.kingshealthpartners.org

DEPARTMENT DESCRIPTION

1. INTRODUCTION

The aim of this post is to provide consultant cover to adult critical care services across the Trust at both the DH and PRUH sites. The post holder will be required to join in a seamless manner with the other full time Intensivists within the Trust to provide optimal care in all these areas on a rotational basis.

The post-holder will be expected to provide cover into the various aspects of the critical care services at King’s on a flexible basis; we would expect the 10 PA job plan to average out over the normal rota 15 week rotation. The Critical Care areas are outlined below.

The post holder will be required to undertake periods of resident and non-resident critical care duties. Time is available within both aspects of the role to allocate to teaching, CPD and research depending on an individual’s interests and after discussion with the Clinical Director (CD) and Divisional Manager (DM).

2. SPECIFIC AREAS

Critical Care: Kings is virtually unique in being a major teaching institution located within the capital with all necessary acute services on site, and thus has an unparallelled patient population in terms of clinical diversity and complexity. Currently adult Critical Care is provided in 6 separate geographical Critical Care areas. Liver Critical Care provides 19 beds. Frank Stansil (Medical Critical Care) provides 14 beds, Christine Brown (Surgical Critical Care) provides 18 beds, Jack Steinberg (Neuro Critical Care) provides 18 beds and CCUA & B provide (General ICU) 15 beds each in the first phase of the new Kings Critical Care Centre (KCCC). Although all Units have a dominant speciality there is mixing of patients across the Critical Care areas depending on bed availability. Kings College Hospital also incorporates the PRUH and this has, at present, a 10 bed Critical Care area.

The department is currently undergoing a phase of rapid growth with phase 2 of the KCCC due to open in the next 6-8 months offering a further 31 beds. We are concurrently working on a further rapid expansion over the next 12 to 18 months to provide a total of approximately 170 beds of the same quality across both sites.

In addition to our bed pool we provide an ‘in house’ Extracorporeal Membrane Oxygenation (ECMO) service which has recently been awarded ‘Platinum Excellence’ status. This award has only been given to 16 out of 400 centres worldwide.

Thus, the basic strategy underpinning the delivery of adult critical care services across the Trust is to devolve services to stand-alone Critical Care Units with a mix of Medical, Surgical, and Neurosurgical patients respectively, whilst maintaining central control through a rotating pool of Consultant intensivists. A stand-alone specialist Liver Critical Care Unit is also part of the Critical Care Directorate. With the future redevelopment and expansion of the critical care bed pool we hope to develop critical care areas with specialist interests to promote excellence in clinical care, education and research. There are designated leads for the sub-speciality clinical areas (cardiac, neurosciences, haemato-oncology, medicine / surgery, liver and trauma). The expansion of critical care will facilitate enhanced tertiary level care as well as dedicated specialty areas for specialties such as neurosciences and cardiac.

The critical care units operate as ‘closed’ units with consultant intensivists exercising control over the delivery of ‘step up’ and ‘step down’ care between the areas, and admissions and discharges to and from the units. Close links and communication with the speciality consultants is essential to ensure optimal use of capacity and ensure cohesive management planning. Discharges and 5 admissions are facilitated by a Critical Care Bed Manager, who communicates with the on call consultant staff, nurse in charge, admitting teams and site managers. A starred consultant, one of the on call team, co-ordinates admissions out of hours if there are no beds available within the normally designated areas.

Each Critical Care Unit has its own dedicated establishment of 8-9 junior medical staff, advanced intensive care fellows and trainees, nursing staff, Advanced Critical Care Practitioner’s (ACCPs) and allied healthcare professionals (AHPs), supported by a pool of consultants on a rotational basis. All units provide a mix of both level 2 and 3 beds according to need.

The unit is currently accredited by The Faculty of Intensive Care Medicine (FICM) for training in all stages in Intensive Care Medicine.

Specialist ‘critical care’/high ratio specialty nursing is also delivered across the Trust by other divisions. These areas have close links with both the clinicians and managers in Critical Care and all support each other during surges in activity. Paediatrics have level 2 and 3 beds (12), Renal have 2 level 2 beds and neurosurgery / neurology have level 1 / 2 beds within Kinnear Wilson ward. Cardiac run a 6 bedded Cardiac Recovery Unit and a level 1 / 2 area on V&A ward.

Critical Care at King’s as a whole is due for redevelopment, allowing an opportunity to align our facilities with national guidelines and standards of care. We attach the highest priority to good data collection both for clinical quality control, research and alignment with NHS England payment systems.

Trauma: King’s is one of the four designated Level 1 Trauma Units in London, together delivering an integrated trauma system for London. To ensure both optimal care and efficient processing of the most severely injured patients Health Care for London (the commissioning body) insisted that Level 1 centres should be defined by the presence of a dedicated ‘Resuscitation Team’ headed up by a Trauma consultant resident on-call, and positioned at the operational heart of each Unit. It should be emphasised that the role of the trauma consultant is not necessarily hands on, but should engage, direct, and coordinate all necessary diagnostic and therapeutic specialities in a timely fashion.

In King’s we have attempted to refine this principle even further, seeking to improve the interface between Emergency Care and Critical Care, with both consultant groups contributing to the Trauma Rota. We see this as the first step in establishing a seamless acute care axis within our hospital embracing all levels of acute care (Levels 1 through 3) and widening the remit of critical care beyond the immediate confines of an intensive care unit.

Mobile critical care service & outreach - iMobile: iMobile provides medical emergency response to the wards at both the PRUH and Denmark Hill campus. At Denmark Hill the team is 2 nurses, a Critical Care Registrar and during the day Monday to Sunday a Critical Care consultant who works with the team and the Critical Care bed manager and acts as co-ordinator for admissions to the Critical Care bed pool. At the PRUH iMobile is provided by 2 nurses supported by the Critical Care Registrar and Consultant.

This will service a number of different functions:

1. Rapid response and safe transfer 2. Critical care discharge follow up & support 3. Traditional critical care referral and outreach advisory service 4. Mobile critical care interventions for early intervention & enhanced recovery in both surgical and medical patients

The service will be multi-disciplinary in nature, with both Consultant and nursing leadership, and the team will consist of two specialty registrars and two critical care nurses to deliver the required care across the trust on every shift, working as an extension of the current referrals system. The 6 team will work closely with both the primary admitting teams, the critical care services, and the site and operations teams especially at night.

As well as service delivery, the mobile critical care service will offer opportunities to undertake health services research in complex socio-cultural interventions designed to improve patient centred care in keeping with King’s values.

Additional critical care capacity: The second phase of the new build KCCC is due to open in the next 6-8months. This is an exciting and innovative development to improve patient outcomes and experiences as well as enabling the provision of additional capacity for the increase in the critical care tertiary services work whilst new facilities are constructed.

We also have surge capacity plans should the need arise.

Research: This is a growing focus within the Critical Care Area with Comprehensive Local Research Network (CLRN), own account and commercial studies being undertaken. Particular areas of interest relate to the pathophysiology of Traumatic Brain Injury in conjunction with Professor Tony Strong and Mr. Christos Tolias, (department of neurosurgery). Particular interest relates to the investigation of the phenomenon of ‘Spreading Cortical Depression’ employing such modalities as micro-dialysis and high-resolution MRI. Other work relates to NAVA, point of care coagulation testing in sepsis and traumatic brain injury, end of life care, processes of care and immune function in the critically ill. There is an excellent group of research nurses covering both the Emergency Department, Anaesthesia and Critical Care with regard to recruitment in CLRN studies. The recruitment rate has risen substantially in recent years.

Education: Education is a primary interest of several consultants within the Critical Care team and there is active involvement in both postgraduate and undergraduate training programmes. We are accredited for postgraduate training by FICM and partner with Kings College London to deliver high quality critical care education as part of their medical undergraduate programme. We work with both Anaesthesia and the Post Graduate Medical Education Centre to deliver simulation training.

All trainees are provided with an educational supervisor and 3 Consultants (2WTE) have sessions in their job plan as FICM Faculty Tutors.

Management organization Each CC unit has its own Clinical Lead and Matron. There are also leads for research, audit and M&M, Risk and Governance, infection control and I Mobile service. There is an operational meeting on the Units on a Monday morning and in additionally there are regular lunch time sessions, Tuesday teaching, Wednesday Journal Club and research and Thursday Audit alongside Risk and Governance. Risk Governance meetings are held in CC, CCTD and attendance at Trust wide committees. There are long stay complex patient meetings weekly. There are Tuesday meetings (10am) addressing 1. Educational and trainee issues 2. Policies and Practice 3. Clinical Leads meeting and Consultants meeting 4. Management meeting. We also hold a quarterly Audit day for the all critical care staff. Outputs of all meetings feed into a quarterly Quality Board Meeting facilitating pathways for service improvement and change control.

Consultant development mornings are provided on the 5th week of the month in house and there is also a hospital wide consultant morning held 3 monthly. We also hold development ‘away days’.

Office, Computer and Admin Support All Consultants will be allocated office space with access to a computer and ‘hot desk’ during their managerial/administration time. The department is supported by a dedicated team of administrators.

Intensive Care Consultants at King’s College Hospital (Denmark Hill Site)

 Dr Tom Best (Clinical Director)  Leonie Penna (Chief Medical Officer)  Dr Andre Vercueil  Dr Phil Hopkins  Dr Georg Auzinger  Dr Clemens Pahl  Dr Sharon Cain  Dr Neeraj Singh  Dr Stephanie Strachan  Dr Tom Hurst  Dr Ritesh Maharaj  Dr Shahana Uddin  Dr Charlotte Anderson  Dr Sara Leonard  Dr Christian Michaelis  Dr Simon Calvert  Dr Sam Hutchings  Dr Rob Loveridge  Dr Sam Patel  Dr Victoria Metaxa  Dr Claire Park  Dr Chris Palin  Dr Savvas Vlachos  Dr Tom Williams  Dr Sergio Canestrini  Dr Sancho Rodriguez Villar  Prof William Bernal  Dr Chris Willars  Dr Jenny Townsend  Dr Tasneem Pirani  Dr Mark McPhail  Dr Brian Hogan  Dr Richard Fisher  Dr Iain Carroll  Dr Milena Angelova Chee  Dr Rohit Saha  Dr Adrian Wong  Dr Pervez Khan  Dr Peter Beaumont  Dr Eleanor Bates  Dr Carmen Lopez  Dr Adam Czpran

3. CLINICAL ORGANISATION

The budgetary and managerial structure of the Trust is divided into three divisions. The Department of CC is part of the Network Division. The Clinical Director of Critical Care is Dr Thomas Best and The Deputy Director of Operations is Leanna Rathbone. Critical Care has its own service manager (Katy Childs) and administrative staff.

4. TEACHING AND TRAINING

MEDICAL STUDENT TEACHING

King’s College Hospital NHS Foundation Trust, as a major teaching hospital, works in partnership with King’s College London to provide the highest possible quality of medical education. The mutual interest of the Trust and School in quality medical education is supported by the undergraduate tariff.

All consultants are expected to be committed to teaching and to play their part in the delivery of the undergraduate curriculum. These activities would include the planning and review of teaching, and the assessment of students which could, where properly structured, be undertaken simultaneously with service delivery commitments, including ward rounds and outpatient clinics.

Of necessity, the requirements of the medical curriculum change over time and it is not always possible to identify specific teaching commitments in job plans – when this is the case the general requirement for teaching time should be made clear.

The need for flexibility is acknowledged by the Trust and, for example, within a service department it is possible that the overall teaching commitment to be unevenly allocated between staff to achieve optimal teaching and service quality.

The appointed physician will participate in teaching medical students, post-graduate doctors and other groups at King's College Hospital and King’s College London (KCL) School of Medicine.

POST-GRADUATE TEACHING The Trust has over 400 training posts in virtually all specialties. The postholder will be expected to participate in teaching and training postgraduate doctors, which in addition to direct clinical supervision is likely to include acting as an ‘educational supervisor’ to one or more individuals, providing them with regular appraisal and support. Consultants that undertake educational supervision will be provided with appropriate training in accordance with national requirements and accredited by the Director of Medical Education.

5. RESEARCH AND DEVELOPMENT

Involvement in high quality research is strongly encouraged at King’s, as this supports both the delivery of high quality clinical care, and our role as a partner in a major Academic Health Sciences Centre.

Support for Research An important component of the Trust’s Research and Development (R&D) strategy is to strengthen the support available to Researchers, to make it as easy as possible to participate in, and to lead, clinical research.

Each Division has some local research infrastructure, including a nominated R&D Lead, and an R&D Facilitator linked to the central R&D Office. The Trust’s philosophy is to devolve research funding where possible, allowing most Divisions also employ research co- ordinators and research nurses, who support one or more active researchers within the clinical specialties. This includes devolving the Trust’s allocation of NHS service support funding (CLRN) in proportion to patient recruitment into CLRN adopted studies, for use in supporting CLRN activity. Divisions are encouraged to maintain a balanced portfolio of research activity, including CLRN studies, commercial studies and health services research.

Assistance for PIs is also provided in research design (through the Research Design Service, based at Guys Hospital), the statistics service (statistical support is available on the Denmark Hill Campus 3 days a week supported by KCH R&D) and financial support for costing research proposals and grant applications (R&D finance). GCP (Good Clinical Practice) training is supported by King’s Health Partners. Multi-disciplinary involvement in the research process is strongly encouraged.

Research and Job Planning The undertaking of research within a job plan should be discussed during appraisal and as part of job planning activities. All staff should be aware of the research being undertaken within their Division and in the Trust, and actively support recruitment into relevant open studies, whether or not they have a primary research component to their Job Plan. All individuals undertaking research are expected to have a good working knowledge of Research Governance standards, and are required to undertake GCP (Good Clinical Practice) training.

Governance of Research All R&D projects are registered with the Trust’s R&D office, which manages and co-ordinates the R&D approvals process. This ensures that all projects meet the prevailing standards of research quality, and are in receipt of appropriate ethical approval and local agreements, prior to R&D governance approval being issued.

Each Division is required to convene a local Research meeting, where feasibility is discussed and peer review co-ordinated. This function will ultimately be taken on by Clinical Academic Groups within King’s Health Partners (rather than the Trust’s Divisions), as these become established across KHP.

6. CLINICAL GOVERNANCE

The post holder will be expected to contribute and participate in the Department’s ongoing clinical audit programme, and will carry out all necessary administrative duties associated with the care of their patients. The post holder also has a general duty of care for the health, safety and well-being of work colleagues, visitors and patients within the hospital, in addition to any specific risk management or clinical governance accountabilities associated with this post.

7. MEDICAL STUDENT TEACHING

The appointed physician will normally participate in teaching medical students, postgraduate doctors and other groups at King's College Hospital NHSFT and King’s College London (KCL) School of Medicine.

King’s College Hospital NHS Foundation Trust, as a major teaching Trust, works in partnership with King’s College London to provide the highest possible quality of medical education. The mutual interest of the Trust and School in quality medical education is supported by the SIFT contract.

All consultants are expected to be committed to teaching and to play their part in the delivery of the undergraduate curriculum. These activities would include the planning and review of teaching, and the assessment of students, which could, where properly structured, be undertaken simultaneously with service delivery commitments, including ward rounds and outpatient clinics.

Of necessity, the requirements of the undergraduate medical curriculum changes over time and it is not always possible to identify specific teaching commitments in job plans. Some specific roles will be job planned.

The need for flexibility is acknowledged by the Trust and within a service department, it is possible that the overall teaching commitment can be unevenly allocated between staff to achieve optimal teaching and service quality.

8. POST-GRADUATE TEACHING

The Trust has over 700 training posts and over 400 Trust doctors across all specialties. The postholder will be expected to participate in teaching and training postgraduate doctors, which in addition to direct clinical supervision is likely to include acting as an ‘educational supervisor’ to one or more individuals, providing them with regular appraisal and support. Consultants that undertake educational supervision will be provided with appropriate training in accordance with national requirements and accredited by the Director of Medical Education. Allocation of time for post graduate education is normally job planned as a team.

9. RESEARCH AND INNOVATION

Involvement in high quality research is strongly encouraged at King’s NHSFT, as this supports both the delivery of high quality clinical care, and our role as a partner in a major Academic Health Sciences Centre.

Support for Research An important component of the Trust’s Research and Innovation (R&I) strategy is to strengthen the support available to researchers, to make it as easy as possible to participate in, and to lead, clinical investigator led or commercial portfolio adopted research.

Each Division is aligned with Research Delivery units, including designated R&I Leads. R&I Facilitators link to the central R&I Office. The Trust’s philosophy is to devolve research funding based on weighted recruitment to NIHR CRN portfolio studies e to Research Delivery Units (RDU), allowing engagement of research co-ordinators and research nurses, who support one or more active researchers within the clinical specialties for CRN activity. Departments and RDUs are encouraged to maintain a mixed model balanced portfolio of research activity, including CLRN studies, commercial studies, charity funded studies and health services research.

Assistance for PIs is also provided in research design (Research Design Service, based at Guy’s Hospital), a research support clinic local to KCH, a statistics service (available on the 3

Denmark Hill Campus supported by KCH R&I and financial support for costing research proposals and grant applications (R&I finance). Commercial trials are costed by the KHP Clinical Trials Office (CTO) and this office also provides CRAs to audit all non-commercial CTiMP studies. GCP training is supported by the KHP CTO. Multi-disciplinary involvement in the research process is strongly encouraged.

Research and Job Planning The undertaking of research within a job plan should be discussed during appraisal and as part of job planning activities. All staff should be aware of the research being undertaken within their Division and in the Trust, and actively support recruitment into relevant open portfolio adopted studies, whether or not they have a primary research component to their Job Plan. All individuals undertaking research are expected to have a good working knowledge of research governance standards, and are required to undertake GCP training as appropriate for the research they are involved in.

Governance of Research

All R&I projects are registered with the Trust’s R&D office, which manages and co-ordinates the R&D approvals process. This ensures that all projects meet the prevailing standards of research quality, and are in receipt of appropriate ethical approval and local agreements, prior to R&D governance approval being issued.

Each RDU is required to convene a local research governance meeting chaired by the RDU research lead, where feasibility is discussed and peer review co-ordinated.

10. CLINICAL GOVERNANCE

The postholder will be expected to contribute to and participate in the Department’s ongoing clinical audit programme and quality improvement programmes, and will carry out all necessary administrative duties associated with the care of their patients. The postholder also has a general duty of care for the health, safety and well-being of work colleagues, visitors and patients within the hospital, in addition to any specific risk management or clinical governance accountabilities associated with this post.

11. STUDY AND ANNUAL LEAVE

The postholder will be expected to comply with the Continuing Professional Development (CPD) requirements of the relevant Royal College or Faculty and/or provide appropriate documentation and reflection in their appraisal documentation. Study leave may be requested in accordance with the Trust’s Policy for CPD. Annual leave may be taken in accordance with the Trust’s Guidelines on Leave Arrangements for Medical and Dental Staff. To ensure the smooth running of the service the postholder will ensure that, in conjunction with colleagues, adequate arrangements are made to cover planned absences and the expected approvals would go through e leave planning (SARD, medirota) or another agreed system. Leave must be booked with appropriate time lines to allow effective service continuity.

12. TERMS AND CONDITIONS

The post is covered by the current Terms and Conditions - Consultants (England) 2003, the Terms and Conditions of Service of NHS Medical and Dental Staff (England) 2002 and Trust Policies and Procedures where relevant.

There is a commitment to undertake routine job planned work on Saturdays or Sundays with appropriate job planning and commensurate time without commitment to the Trust.

Appointment is conditional upon a satisfactory medical assessment, which may include an examination.

13. SAFEGUARDING RESPONSIBILITIES

The Trust takes the issues of safeguarding children, adults and addressing domestic abuse very seriously. All employees have a responsibility to support the organisation in our duties by;

 Attending mandatory training on safeguarding children and adults  Familiarising themselves with the Trust's processes for reporting concerns  Reporting any safeguarding child or adult concerns appropriately

14. APPRAISAL & JOB PLANNING

Annual appraisal is a contractual requirement in the NHS. You have a responsibility to have an appraisal within twelve months of your last appraisal or within six months of starting at King’s if you have not had an appraisal previously in the UK. ARCPs count as previous appraisals for former HEE trainees.

Job planning review is conducted annually in line with the departmental/Divisional operational plan.

The above represents an outline of the duties of the post and will, together with the job plan, be reviewed on an annual basis in accordance with the Trust’s performance review scheme for consultants. Consultants will be expected to be compliant with statutory and mandatory training.

CONSULTANT in CRITICAL CARE Full Time

JOB DESCRIPTION AND OUTLINE JOB PLAN

GENERAL

The remit of the post-holder will be to work within the multi–disciplinary team providing and further developing care for critically ill patients and developing Critical Care services.

Major areas of critical care in King’s (Denmark Hill and PRUH) include Medical, Surgical, and Neurosciences Critical Care together with aspects of Trauma and resuscitation, and an iMobile outreach service. It is envisaged that the appointee will contribute to the development and delivery of aspects of these services depending upon their interests and experience

PURPOSE OF JOB

This new post will be based at either at King’s College Hospital on the Denmark Hill (DH) or PRUH sites; a proposed Job Plan is attached. There will be an average of 8.5 Programmed Activities (PA’s) of Direct Clinical Care per week, with normally 1.5 PA’s being allocated for Supporting Professional and/or other Activities.

The clinical components of the posts for the sessions in the various Critical Care areas (DH and PRUH) involves resident day (7 days/week) shifts from 8 am to 8 pm and the night time cover is paid at 1 PA annualised. DH iMobile sessions are resident from 8am to 8pm Mon-Sun. All on-call duties are classed as Category A. When individuals are not on clinical service they will either be undertaking SPA activity or have time back following clinical service (i.e.) time without commitment to Kings. The rota is annualised and thus holidays and study leave should be taken within the rota in co-ordination with colleagues to ensure appropriate clinical cover.

We are looking for candidates who would be interested in working on both Denmark Hill and PRUH sites and just the PRUH site.

The Trust has recently identified core areas for future strategic development - Trauma, Cancer Services (including a major expansion in haematological oncology), and Stroke Medicine, all three areas have potential for major impact on demand for critical care services along with expansion in tertiary specialities of liver and neurosciences as well as developing the emergency pathways. In response to these evolving pressures the aim has been to double our baseline capacity from 79 (April 2020) to 170. This is being bridged by our current interim expansion to a 118 bed capability across both sites.

The Princess Royal University Hospital is a component of the Critical Care (CC) services at Kings and is a 10 bed general CC area with plans for permanent expansion.

As a senior employee of the Trust you will work in close co-operation with, and support other clinical, medical professional and managerial colleagues in providing high quality healthcare to the Trust’s patients. Integral to these responsibilities is the following: -

. The provision of a first-class clinical service . Effective leadership to all staff engaged in the specialty . Sustaining and developing teaching and research in conjunction with King’s College London . Undertaking all work in accordance with the Trust’s procedures and operating policies . Conducting clinical practice in accordance with contractual requirements and within the parameters of the Trust’s service plans . Maintaining the confidence of business plans and development strategies formulated for the specialty, the Care Group or the Trust

KEY DUTIES AND RESPONSIBILITIES

1. Together with the other Consultants, to provide a comprehensive critical care service within the Trust. This includes all aspects of treatment and relevant management duties for the proper functioning of the department.

2. Responsible also for covering colleagues’ periods of annual leave, study leave and short- term sickness. The job plan is designed with an annualised profile with provision of holiday and study leave cover.

3. Clinical supervision of junior medical staff as a shared responsibility with other consultant colleagues to provide educational supervision for trainees and to contribute to the programmed teaching sessions, M&M, audit and journal club.

4. Responsible for carrying out teaching, examination and accreditation duties as required and contributing to Continuing Medical Education and clinical governance initiatives.

5. Responsible for any out-patient clinic commitments as agreed by the Critical Care Theatres and Diagnostics Divisional management team for follow up of CC patients.

6. To contribute to departmental research interests in accordance with the Trust’s R&D framework.

7. To contribute to the Audit Programme and Morbidity and Mortality Meetings. To contribute actively to the risk and governance programme within the department and division.

8. To take an active role in the formulation, implementation and monitoring of the Care Group’s Business Plans. This may include assisting with discussions regarding service plans and developments with both internal and external agencies. To take an active part in consultant committee meetings and service development. To comply with protocols and policies as determined by Division and Trust.

9. To conduct all activities within the contracted level of service and operating plan for Critical Care services.

10. To exercise professional leadership for all staff working in the specialty. This will include fostering and developing projects focused towards these ends and ensuring that the momentum of post qualification professional education and other appropriate training is maintained.

11. To work in conjunction with clinical and professional colleagues to ensure that the productivity of staff within the specialty is maintained and their job satisfaction is enhanced. This may include involvement in the appraisal process for junior colleagues.

12. To undertake Care Group management duties as agreed with the Clinical Director. There are clinical leads for the geographical units and also leads for M&M/ Audit, Risk and Governance, I Mobile, clinical information system and new build lead in addition to a Cardiac lead. We have 3 FICM tutors (2WTE) to support the volume of trainees in the department.

13. To be aware of, and comply with, all Trust infection prevention and control policies, to include hand hygiene, personal hygiene, environmental and food hygiene. To undertake annual training/updates in infection prevention and control.

14. To be accountable for implementation of the Code of Practice within the department/area of responsibility.

15. To prepare for and undertake the protective interventions that you are responsible for in a manner that is consistent with evidence based practice and maintaining patient safety.

16. You have a general duty of care for the health, safety and well-being of yourself, work colleagues, visitors and patients within the hospital in addition to any specific risk management or clinical governance accountabilities associated with this post.

17. You are required to observe the rules, policies, procedures and standards of King’s College Hospital NHS Foundation Trust together with all relevant statutory and professional obligations.

18. You are required to observe and maintain strict confidentiality of personal information relating to patients and staff.

19. You are required to be responsible, with management support, for your own personal development and to actively contribute to the development of colleagues.

20. The post holder has an important responsibility for and contribution to make to infection control and must be familiar with the infection control and hygiene requirements of this role. These requirements are set out in the National Code of Practice on Infection Control and in local policies and procedures which will be made clear during your induction and subsequent refresher training. These standards must be strictly complied with at all times.

21. All employees must hold an 'nhs.net' email account which will be the Trust's formal route for email communication. You are therefore required to check this regularly and to deal with such communication promptly.

22. This job description is intended as a guide to the general scope of duties and is not intended to be definitive or restrictive. It is expected that some of the duties will change over time and this description will be subject to review in consultation with the post holders.

THE ABOVE REPRESENTS AN OUTLINE OF THE DUTIES OF THE POST AND WILL, TOGETHER WITH THE JOB PLAN, BE REVIEWED ON AN ANNUAL BASIS IN ACCORDANCE WITH THE TRUST’S PERFORMANCE REVIEW SCHEME FOR CONSULTANTS

PERSON SPECIFICATION

ATTRIBUTES ESSENTIAL DESIRABLE

1. Qualifications Registerable medical qualification

European or UK Diploma in Intensive Entry on the specialist register or within 6 2. Higher Qualifications Care Medicine. months of a CCT for ICM (either solely or

as dual and joint CCT with a partner FRCA or MRCP or equivalent specialty)

Full Registration with GMC 3. Registration

4. Training and Wide experience in all aspects of critical ALS, ATLS and/or APLS accredited care, including the management of Poly- Experience trauma, Acute Neurology, Neurosurgical Management of Difficult Airway and Cardiothoracic emergencies,

Cardiology and Haematological Experience with NAVA malignancy

Experience with ECMO

Recognition or equivalence for training at

Advanced Level in Intensive Care Medicine or equivalent

ALS accredited

Practical skill set as appropriate for CC medicine (bronchoscopy, tracheostomy, echocardiography etc.)

5. Administration Experience in day to day organisation of Familiar with current structure of Critical Care Services in a busy Teaching Health Service and conversant with Hospital recent initiatives and changes

6. Management and Able to demonstrate leadership capability Management course and/or Leadership within multi-disciplinary teams qualification

Experience of development of clinical guidelines Organisation of Audit/Journal Thorough understanding of principles of 7. Audit Clubs and Morbidity & Mortality medical audit. Meetings.

Must have undertaken, completed and

supervised audit projects.

8. Research and Experience of clinical research Publications

Publication of relevant peer reviewed papers in the field of Anaesthesia/ Critical

Care.

9. Personal Skills Effective communicator, able to work in a Undertaken equality and diversity close-knit team and co-operate with all training medical and paramedical staff

Familiarity with information technology

and general computer skills

Flexible, able to cover colleagues’ 10. Personal attributes absence

Excellent communication skills with

patients and family members.

Ability to communicate and function

calmly and efficiently when under stress.

11. Kings Values Professional attitude towards work, reliability, good record of attendance and tidy personal appearance

Able to demonstrate an understanding of Kings Values

Commitment to uphold Kings Values 12. Teaching Experience of undergraduate and post- Teaching skills course/qualification graduate teaching and exam preparation.

CONSULTANT JOB PLAN (2003 Contract)

NAME: SPECIALTY: Critical Care YEAR: COMMENCEMENT DATE OF JOB PLAN: REVIEW DATE:

1. CONTRACT DETAILS a. Please indicate below which type of Contract(s) you hold.

 KCH NHS Foundation Trust Whole-Time Indicate number of Programmed Activities if Part- Time:______

Notes on Job Plan:

The job plan is annualised and based on the work being distributed across the various areas of critical care delivery – Consultants work individualised job plans in order to both facilitate their own areas of interest and expertise and ensure that service delivery is maintained effectively across the units - the specifics of each individual’s commitments are part of the job planning and appraisal process.

The annualization is based upon 8.5 DCC and 1.5 SPA within a 10 PA standard contract.

The areas covered across the Consultant group include the following clinical activities:

Location Detail PA allocation

Frank Stansil (Medical Critical Care) - Critical care with o/night on call 7 days of critical care - 14 beds - Worked as either split or full weeks constitute to 31.42 PA (e.g. 4/3 days or 7 days) which is 0.9 PA on an annualized job plan Jack Steinberg (Neuro Critical Care) - Critical care with o/night on call 7 days of critical care - 18 beds - Worked as either split or full weeks constitute to 31.42 PA (e.g. 4/3 days or 7 days which is 0.9 PA on an - Co-located with NCCU & covers on annualized job plan call for all 18 beds Christine Brown (Surgical Critical Care) - Critical care (level 2/3) 7 days of critical care - 18 beds - Worked as either split or full weeks constitute to 31.42 PA (e.g. 4/3 days or 7 days) which is 0.9 PA on an annualized job plan Mobile Critical Care Service (iMobile) - Mobile critical care service 7 days of iMobile constitutes to 12 PA which is 0.35PA on an annualised job plan Liver ITU (15 beds + 4 HDU beds) - not included in this role 7 days of LITU constitute to 30.92 PA and his is 0.9 PA on an annualized job plan PRUH - Critical care with o/night on call 7 days of critical care -10 beds - Worked as either split or full weeks constitute to 31.42 PA (e.g. 4/3 days or 7 days) which is 0.9 PA on an annualized job plan

SPA:

Consultants at King’s College Hospital NHS Foundation Trust are afforded the opportunity to pursue, amongst other things, educational interests, research and service development during their SPA commitments as well as being assured that there is adequate resource for ongoing CPD. The department of critical care has Consultant with a wide range of interests across all these areas and new Consultants are supported in finding their own niche and developing their own interests.

With the expansion of the critical care services, there is a consultation process to allow individuals to pursue changes to the personalised job plans and new Consultants will be expected to undertake duties across a range of areas where critical care is delivered.

NB 1. Calculation of predictable on-call based on 12 hours of clinical duties / ward rounds and clinical on the floor working on Saturday, Sunday and evenings ( 8 am to 8 pm)

 Equates to 24 hours of premium time.  Equates to 24/3 = 8 PAs of premium time.

NB 2. Calculation of un-predictable on-call based on an average of 2 hours of phone calls on each on-call night and staying in the Unit for sick patients and handover in the evening and an average of 2 return visits to hospital out of hours (3.5 hours each) per week. 1 PA is paid for each night on call. Note that

 Equates to 7 x 2 = 14 hours of premium time.+ 7 hours for returns = 21 hours of premium time  Equates to 21/3 = 7 PA per week  Equates to 1 PA per on-call night (including Saturdays and Sundays)

NB 3. The 20% additional PA allocation to internally cover A.L./S.L./P.L. is incorporated into the rota, and assumes that leave is not taken during on-call weeks.

NB 4. Funded additional sessions in Anaesthesia or another speciality may be added to the basic rota on a pro rata basis, following a job plan review and agreement from Clinical Director and Service Manager

NB 5. Additional SPAs may be added to basic allocation of 2 on production of the necessary supporting documentation of activity this is subject to an annual job plan review and proof of funding stream.

The job plan for an individual is a 10 PA outline with 1.5 SPA and 8.5 of direct Clinical Care. As part of an annualised job plan this is worked over a 42 week programme. Depending on individual preference candidates can opt to work a 7 day clinical service or a 4 and 3 day model. The PA for 7 days of CC is 32 PA and a week of I Mobile 12.5. A 1:5 undertaking CC alone is a 1:5 (i.e.) 10 weeks / year.

3. ACTIVITY SUMMARY ACTIVITY CLASSIFICATION JOB PLAN Pas x 4 = HRS

No. Of PA’s No. Of Hours

8.5 34 hours DIRECT CLINICAL CARE (including unpredictable On- Call)

SUPPORTING Under/postgraduate 0.25 PA 1 hour PROFESSIONAL Teaching: ACTIVITIES

Clinical Supervision 0..25PA 1 hour

CPD 1 PA 4 hours

SUB-TOTAL:

OTHER NHS RESPONSIBILITIES

EXTERNAL DUTIES

TOTALS 10 40

4. ON-CALL AVAILABILITY SUPPLEMENT 1 in 5 Agreed On-Call Rota (e.g. 1 in 5) :

Agreed Category (indicate A or B) : Category A

On-Call Supplement % (e.g. 5% - see chart below) 5%

Frequency of rota commitment Value of supplement as a percentage of full-time basic salary Category A Category B High Frequency: 1 in 1 to 1 in 4 8% 3% Medium Frequency: 1 in 5 to 1 in 8 5% 2% Low Frequency: 1 in 9 or less frequent 3% 1%

5. ADDITIONAL PROGRAMMED ACTIVITIES

1 Are you undertaking private medical practice as defined in the terms YES  NO  of services 2 If YES, are you already working an additional Programmed Activity YES  NO  above your main commitment? 3 If NO, has the Trust offered you an additional Programmed Activity YES  NO  this year? 4 If YES, has this been taken up? YES  NO  5 If NO, have other acceptable arrangements been made (e.g. taken YES  NO  up by a colleague)?

6 If YES to 5 – please describe arrangements:

6. PAY PROGRESSION (not applicable for new appointments)

At the end of the Job Plan Review, the Clinical Director should complete the following table. The table details the criteria that the individual has to meet in order to pay progress in the current year. If any of the boxes are ticked ‘no’, then this should be highlighted to the Medical Director, before they are asked to counter-sign the form.

The Consultant has: 1 made every reasonable effort to meet the time and service YES  NO  commitments in the Job Plan 2 participated satisfactorily in the appraisal process; YES  NO 

3 participated satisfactorily in reviewing the Job Plan and setting YES  NO  personal objectives; 4 met the personal objectives in the John Plan, or where this is YES  NO  not achieved for reasons beyond the consultant’s control, made every reasonable effort to do so; 5 worked towards any changes identified in the last Job Plan YES  NO  review as being necessary to support achievement of the employing organisation’s objectives; 6 taken up the offer to undertake additional Programmed YES  NO  Activities that the employing organisation has made to the consultant in accordance with Schedule 6 of the Terms and Conditions; 7 met the standards of conduct governing the relationship YES  NO  between private practice and NHS commitments set out in Schedule 9

7. WORKING TIME REGULATIONS (as applied to NHS working hours)

The Working Time Regulations set out minimum statutory health and safety requirements for employers in relation to working time. The Regulations provide for certain aspects of these rights to be applied flexibly or set aside for workers providing healthcare and/or those who work shifts. Further information is available from the Medical HR Department. Declaration: (Please delete as applicable)

i. I do not believe my working week exceeds 48 hours of work on average per week based on a 26- week reference period from April to September OR ii. I believe my working week exceeds 48 hours of work on average per week (based on a 26 week reference period from April to September and I have signed the individual agreement to opt-out of the 48 hour (average) weekly maximum working time, attached to this job plan review form. OR iii. I believe my working week exceeds 48 hours of work on average per week (based on a 26-week reference period from April to September but I do not wish to sign an opt-out and would like to review a reduction in my working hours.

Signed (Consultant): ______

8. SIGNED OFF AND AGREED

Consultant: ______(Name)

Signed: ______(Consultant)

Date: ______

Clinical Director: ______(Name)

Signed: ______(Clinical Director)

Date: ______

Medical Director: ______(Name)

Signed: ______(Medical Director)

Date: ______

9. JOB PLAN : AVERAGE NUMBER OF WEEKLY HOURS SPENT ON NHS DUTIES – BREAKDOWN OF SECTION 2

TYPE OF DUTY Direct Supporting Other Trust Other External Clinical Care Professional Responsibilities Responsibilities Activities Out-Patient (or Other) Clinic N/A Ward Rounds N/A Operating (inc. Anaesthetists) N/A

Other Patient Treatment 27.28 Investigative/Diagnostic or Laboratory N/A Clinical Correspondence and/or Administration N/A

Teaching – Under-Graduate (* Nb. See below) N/A 2

Teaching – Post-Graduate (*Nb. See below) N/A 2 Training of other NHS Staff (including doctors and N/A dentists) (*Nb. See below)

Professional Development / Study including CME N/A 4 Audit / Clinical Governance N/A

Clinical Research N/A Management of the Service (e.g. Lead Clinician/ N/A Clinical Director duties)

On-Call/Emergency Attendance 4

TOTAL (* Nb. See below)

NB * The hours in this schedule should total to the hours shown in Section 3. Where an activity occurs concurrently, for example, undergraduate or postgraduate teaching which happens as part of a clinical activity, this time should only be counted once. For example: If you have a 2 hour outpatient clinic during which teaching occurs, you may want to show it as Outpatient Clinic - 2 hours and in the Post Graduate Teaching box would indicate (1) – which is then not counted in the total, or you could show it as Outpatient Clinic – 1 hour and Post Graduate Teaching – 1 hour – both of which would then be counted to total 2 hours.

OPT-OUT AGREEMENT – D Career Grade Doctors (Consultant, Associate Specialist and Specialty Doctor)

(TO BE COMPLETED BY CONSULTANTS/CLINICIANS WITH 12 PAs)

I ______employed as ______with King’s College Hospital NHS Foundation Trust agree that Regulation 4(1) of the Working Time Regulations 1998 which states that a worker’s working time, including overtime, in a reference period of 26 weeks, shall not exceed an average of 48 hours for each seven days shall not apply to me, and that I may work in excess of 48 hours in each 7-day period.

I agree to give 3 months’ written notice to my Clinical Director or General Manager if I wish to terminate this agreement. Subject to this, this agreement shall apply indefinitely.

Signed ______Dated ______

Signed ______Dated ______[GM/CD signature to acknowledge receipt]

Please return to the Medical Workforce Manager, Human Resources Department HR Department, King’s College Hospital, Jennie Lee House