NHS Western Isles

CONSULTANT PSYCHIATRIST Old Age

VACANCY

Consultant in Old Age Psychiatry Western Isles Hospital 40 (+8) hours per week £80,653 (GBP) to £107,170 (GBP) per annum Tenure: Permanent

This is an interesting and exciting time to become part of the mental health team in NHSWI. The service is undergoing redesign to become a truly community facing, fully integrated, team.

We are looking for an individual who can embrace change and help lead the mental health team whilst providing expertise in old age psychiatry.

Although this is an Old Age Psychiatry post, a better description is that of a rural Psychiatrist, also able to work with general psychiatry patients and, according to previous experience, provide input into other areas such as learning disability, addiction services and liaison services.

The post is for 8PAs + 2 SPAs + 2EPAs totalling 12 programmed activities per week, subject to agreement of a satisfactory job plan, plus an 8% availability allowance. The Terms and Conditions of service area those determined by the New Consultant Contract () 2004.

The Consultants currently share responsibility for on-call duties (1:2).

NHS Western Isles has an enhanced role GP/Speciality doctor out of hours system, in which these doctors are first on call for psychiatry and deal with most cases without consultant input. The current consultant OOH arrangements are being reviewed with a view to developing a less frequent telephone only consultant on call input.

Working in the largest and what are considered to be the most attractive of Scottish Islands offers a unique opportunity to combine modern and progressive clinical practice with a life style that is difficult to match. The Western Isles are located 40 miles off the North West coast of Scotland, and are 130 miles long from the Butt of Lewis in the North to the Isle of Barra in the South. The total population is approximately 26,500. There is easy access to the mainland, with regular flights between and Glasgow, Edinburgh, Inverness, and Aberdeen.

Applicants must have full GMC registration, a licence to practice and Completion of Higher Training in Old Age Psychiatry and inclusion on the GMC Specialist Registrar or within six months of CCT or CESR (Old Age Psychiatry) at time of interview.

For further information or to apply for this exciting role, please contact the NHS Scotland International Recruitment Service:

Telephone: +44141 278 2712 Email: [email protected] Web: www.international.scot.nhs.uk

GLOSSARY

AHP Allied Health Profession CAMHS Child and Adolescent Mental Health Service CAPA Choice and Partnership Approach CBT Cognitive Behavioural Therapy CCT Certificate of Completion of Training CESR Certificate of Eligibility for Specialist Registration CPD Continuing Professional Development DCC Direct Clinical Care EEA European Economic Area FBT Family Based Treatment GIRFEC Getting it Right for Every Child GMC General Medical Council HR Human Resources HSCP Health and Social Care Partnership LD Learning Disabilities MRCPsych Member of the Royal College of Psychiatry NHS National Health Service OOH Out of Hours PA Programmed Activity PVG Protection of Vulnerable Groups RMN Registered Mental Nurse SCA Scottish Centre for Autism SPA Supporting Professional Activity UK United Kingdom WTE Whole Time Equivalent

JOB DESCRIPTION

NHS Western Isles

Consultant Psychiatrist Old Age Psychiatry

The Western Isles The Western Isles, otherwise known as the , lie approximately 30 miles off the West Coast of Scotland and consist of several larger inhabited Islands with a multitude of uninhabited small islands. The main islands are Lewis, Harris, the Uists and Barra, with a total population of 27,400. They are easily accessible by ferry from Ullapool, Skye and Oban. There is an excellent air service from Inverness, Edinburgh and Glasgow and also from Aberdeen. There is a bus service to Inverness from Ullapool which runs in conjunction with the ferry timetables and links with rail services from Inverness.

There are good ferry and air links from Lewis and Harris to the Uists and Barra.

Stornoway is the administrative ‘capital’ of the Western Isles. It has a population of approximately 8,000 and has all the facilities one would expect to find in a town of this size. There are many primary schools on the islands as well as secondary schools. They are all well equipped and have a good reputation for academic achievement. Adult education is provided through the Lews Castle College which is part of the University of the Highlands & Islands. Degree courses are available at the College. The Islands still retain their unique Gaelic speaking heritage.

Ospadal Nan Eilean (Western Isles Hospital) The Western Isles Hospital is one of six Rural General Hospitals in Scotland and serves the Outer Hebrides area. The hospital was opened in 1992, is modern and well equipped. The Western Isles Hospital in Stornoway is one of three hospitals located in the Western Isles, the others being St Brendan’s on the Isle of Barra and the Uist and Barra Hospital in Benbecula. The Western Isles Hospital is the main hub hospital which has 96 beds covering specialties in General Medicine, , Orthopaedics and Trauma, Obstetrics and Gynaecology, Psychiatry, Paediatrics and Radiology.

The Western Isles Hospital has an up-to-date laboratory service covering the main disciplines of haematology, microbiology and biochemistry with ready access to more specialised investigations at Raigmore Hospital, Inverness, and other specialised laboratories in Scotland.

The Radiology Department is well equipped for routine radiology, CT scanning, ultrasound and Doppler studies.

Locally based consultant services  General Medicine  General Surgery,  Orthopaedics  Anaesthesia

 Paediatrics  Obstetrics and gynaecology  Psychiatry  Radiology  Dental Services  ENT  A&E, covered by enhanced roles GPs/speciality doctors out of hours and junior doctors/consultants in hours

Visiting consultant services  Respiratory Medicine  Rheumatology/rehabilitation  Dermatology  Oncology  Neurology  Ophthalmology  Renal Medicine  Urology  Child & Adolescent Mental Health

Tertiary referrals The main referral centres are in Inverness and Glasgow, but other hospitals in Scotland are used when necessary in accordance with Service Level Agreements and via extra contractual referrals.

Department of Psychiatry NHS Western Isles’ mental health services are currently undergoing a transformational process, moving from a focus on hospital provision for people with dementia and with acute psychiatric needs to a community facing and focused model. The post holder will have a leadership role in the formulation and implementation of these changes.

The present community resources consist of a Community Mental Health Team based in Stornoway covering the cojoined Islands of Lewis and Harris and one Community Psychiatric Nursing (CPN) team in Benbecula covering the Islands of Uist and Barra.

The Stornoway team consists of 4 CPNs, 2 community learning disability nurses, 2 substance misuse nurses, 2 part time counsellors, 2 part time psychologists (adult, CAMHs, older people and LD), 1 MH OT, 1 nurse CBT therapist.

The Benbecula team consists of 3 CPNs and 1 substance misuse worker.

There are a number of social workers who are designated as mental health officers in terms of the Mental Health (Care and Treatment) (Scotland) Act 2003 who are employed by Comhairle nan Eilean Siar (Western Isles Council). There is a close working relationship with the social work department . There is 1 dementia nurse consultant, 1 dementia post diagnostic link worker, 1 dementia specialist nurse working within primary care.

Mental health services are part of the Integrated health and social care partnership arrangements.

Mental health services work closely with third sector agencies for example, Penumbra.

The mental health inpatient facilities are based in the Western Isles Hospital in Stornoway. This consists of a 5 bed acute psychiatric ward and a reducing number of dementia assessment beds within a dementia assessment unit. There are, at present, plans to relocate these dementia assessment facilities, including outpatient assessment, outside the hospital environment. The post holder will have involvement in leading, planning and implementing these developments.

Psychiatric outpatient clinics are held in a variety of locations across the Western Isles, both hospital based and GP surgeries.

The Post The post holder will be involved in assessment and treatment of people suffering from mental health disorders within the Western Isles area. This would include a consultative role to multi disciplinary colleagues, including GPs. This will involve work predominantly in the community and supporting clinicians in the hospitals.

There is another consultant psychiatrist in post who works in adult general psychiatry. The post holder will provide cross-cover for his/her consultant colleague for absences including annual leave, study leave, administrative meetings on the mainland, and trips to other parts of the Western Isles. This arrangement will be reciprocal. Consultants are supported by one full time medical secretary.

The Post Holder will initially have his/her office in the Western Isles Hospital with future plans to be based in the community.

The Consultants currently share responsibility for on-call duties (1:2). NHSWI has enhanced role GP OOH system, in which these GPs are first on call for psychiatry and deal with most cases without consultant input. The current consultant OOH arrangements are being reviewed with a view of developing a 1:3 - 1:4 telephone only consultant on call input.

It is expected that the post holder and his/her consultant colleague will participate in continued professional development as per professional requirements.

The post holder is expected to use and develop tele-consultation with colleagues elsewhere in the western Isles and in mainland facilities. The post holder will also be expected to develop the use of tele health facilities to consult with patients.

It is essential for the post holder to be eligible to be an Approved Medical Practitioner under Section 22 of the Mental Health (Care & Treatment) (Scotland) Act 2003. If the appointed Post Holder is not an approved Medical Practitioner under the terms of this Act then NHS Western Isles will provide access to training to obtain this

Certificate. It is expected that the Post Holder will take advantage of this opportunity at the earliest opportunity.

The post holder is expected to participate in the supervision and training of undergraduate medical students and junior doctors in training.

Research The Post Holder will be encouraged to undertake research in areas of interest relevant to the delivery of health care in the Western Isles. It is hoped that the post holder will play a part in the development of the concept of rural psychiatry.

Continuing Personal Development The Post Holder will be expected to identify their requirements for, and engage in, continuing personal development. Opportunities to link in with mainland programmes will be supported and funded as appropriate.

Clinical Governance The conducting of regular clinical audit and the supervision of clinical audit by junior staff is part of the Consultant’s responsibility supported by the Medical Director and Associate Director of Mental health & Learning Disabilities. The post holder will be expected to provide clinical leadership on the implementation of local and national strategy and initiatives pertaining to mental health.

Contractual Details The post holder will be professionally responsible to the Medical Director and managerially responsible to the Associate Director of Mental Health & Learning Disabilities.

The two consultants in the department will agree arrangements for cover of duties.

The terms and conditions of service applicable to this appointment are the Consultant grade terms and conditions of service as amended from time to time.

NHS Western Isles will require each consultant to agree with the Medical Director and Associate Director of Mental Health & Learning Disabilities, a job plan of fixed and other commitments, which will be reviewed on an annual basis and revised as necessary to meet the requirements of local and national service issues.

Consultants will be required to participate in appraisal and job planning.

Formal appointment to this post will be conditional upon satisfactory completion of all pre-employment checks, including satisfactory medical screening.

The successful candidate will be expected to be registered for CPD with the Royal College of Psychiatry and to fulfil requirements for annual certification and for appropriate General Medical Council revalidation.

Annual leave entitlement is 42 days per year (12 of those are weekend days), with additional statutory holiday entitlement as agreed by the Local Negotiating Committee.

Psychiatric Care to be provided by Post Holder The Post Holder has an opportunity to take part in and develop psychiatric care in an exceptionally remote but beautiful area of Scotland. It is the hope that the post holder would help to develop the concept of “rural psychiatry” delivering psychiatric health care in an integrated way to a remote and rural area.

The post holder would have an input into different areas of psychiatry, which will include, as a minimum, Care of the Elderly, General Adult Psychiatry and Liaison work

Care of the Elderly The population for the Western Isles is 27,400 of which 6,266 are over age 65.

Patients with severe behavioural and psychological symptoms of dementia can be assessed and treated in the community and also in Clisham Ward, Western Isles Hospital. Currently Clisham ward provides 5 beds but this number will reduce as the service shifts towards a community focus. Patients with dementia may be admitted to the Uist and Barra Hospital and St Brendan’s Hospital, Barra.

The Local authority provides 127 beds in a number of care homes across the Western Isles, and whilst there is no specific dementia unit they are equipped to meet the needs of people with dementia. The private sector provides 76 beds plus 9 respite beds.

Day care is not provided exclusively within Residential Care facilities, but through a combination of service provision within local authority owned Care Units & Day Centres, and through third sector provision e.g. Alzheimer Scotland, Crossroads.

The Post Holder will have a major input into the care of elderly patients with psychiatric problems both organic and functional. The Post Holder will be responsible for providing clinical leadership to the management of this patient group and in providing outpatient clinics in Stornoway, Uist and Barra. The post holder will also provide a liaison service to the Local Authority and private homes and in the community. The Post Holder will be expected to maintain good working relationships between the mental health services, acute services and the various 3rd sector and local authority departments, and local general practitioners.

Learning Disability There are no designated beds in the Western Isles for inpatient treatment for the psychiatry of learning disability although the acute ward may admit patient with learning disability who experience acute psychiatric illness. The NHS Western Isles has a service level agreement to admit patients to New Craigs Hospital in Inverness although other specialist in patient learning disability services may be accessed depending on patient requirements and bed availability. Subject to the experience of the appointee, the post holder may be expected to assess patients with a learning disability in clinics and in the community, maintain a close working professional relationship with the community learning disability nurses and dedicated part time Consultant Clinical Psychologists and develop a liaison relationship with mainland colleagues.

General Adult Psychiatry The Post Holder would be expected to have consultant responsibility for a proportion of General Adult Psychiatry patients to be defined through the job planning process. The post holder will work closely with his consultant colleague, and community mental health team, and contribute to the clinical leadership of the Acute Psychiatric Unit.

Drugs & Alcohol Psychiatry Subject to reconfiguration of the service, the post holder may be expected to support the substance misuse nurses, GPs and the local social work department in the provision of services to people with addiction problems

Liaison Psychiatry The Post Holder would be expected to share the responsibility for liaison psychiatry in the Western Isles Hospital, Uist & Barra Hospital and St Brendan’s Hospital, Barra with his/her colleague. This will include support of the junior doctors and on call enhanced role GPs on assessing overdose assessment and suicide risk and in the support and development of liaison psychiatry provided by trained non-medical personnel.

The post holder, with his/her colleague, will advise GPs in Uist and Barra on patients with psychiatric problems admitted to the community hospitals there. The post holder will work closely with the CPNs in helping the GP s assess and treat patients in hospital there.

General Aspects It can be seen that the Post Holder’s role could seem relatively wide however the Post Holder will see their various roles as being part of the wider delivery of psychiatric services in a remote and rural area (“rural psychiatry”) rather than attempting to be a multiple mini specialist.

Specialist Psychiatric Services ECT is not provided in the Western Isles Hospital. Patients requiring such treatment would be transferred to a mainland facility under the terms of an extra contractual , or service level agreement.

There is no Intensive Psychiatry Care Unit in the Western Isles. Patients requiring this level of care are transferred to a mainland facility such as New Craigs Hospital in Inverness. It will be expected that the Post Holder develop close working relationships with his or her colleagues in New Craigs Hospital, Inverness. It will be expected they will be in regular telephone contact with their colleagues there and there may be a requirement to travel to Inverness for education, professional development and clinical purposes.

Child and Adolescent Mental Health Services This service is provided by 3 nurses, 1 support worker and a visiting consultant who travels from Inverness on a bi monthly basis. The post holder, with their colleague, will occasionally be asked to input into the care of CAMHS patients, particularly in the absence of the visiting consultant.

PERSON SPECIFICATION

NHS Western Isles

Consultant Psychiatrist Old Age Psychiatry

Attributes Essential Desirable Qualifications MRCPsych qualification (or Dual accreditation in old age equivalent) and general adult psychiatry.

Full Registration with the GMC and a licence to practice

Completion of Higher Training in Old Age Psychiatry and inclusion on the GMC Specialist Register or within six months of CCT or CESR (Old Age) at interview

Eligible for (or in receipt of) approval under Section 22 of the Mental Health (Care and Treatment) (Scotland) Act 2003

Work General Adult Psychiatry. Experience of managing Experience patients with learning disability. Care of Elderly Psychiatry. Experience of other sub- Demonstrable leadership skills. specialties in psychiatry.

Knowledge Excellent communicator. Research experience and skills High level of interpersonal Experience and skills in tele- skills. medicine

Knowledge of Mental Health Skills in the provision of legislation. psychological therapies.

Competent and effective use of Knowledge and experience of office IT based systems. working in community based mental health services Leadership skills

Training Evidence of continuing personal and professional

development

Disposition High personal integrity

Commitment to quality of service

Able to work collaboratively

TERMS AND CONDITIONS OF SERVICE

NHS Western Isles

Consultant Psychiatrist Old Age Psychiatry

Type of contract Permanent

Grade and salary Consultant: £80,653 to £107,170 per annum (GBP) New Entrants to the NHS will normally commence on the minimum point of the salary scale, (dependent on qualifications and experience). Salary is paid monthly by Bank Credit Transfer.

Hours of duty 40 (+8) hours per week (10 sessions (+ 2 extra sessions) per week)