SECTION 1 – SUMMARY OF POST Job Title: Consultant Immunologist, specialising in Immunodeficiency & Allergy (Replacement post)

Grade: Consultant

Directorate: Medicine

Location/Base: Brunel Building,

SECTION 2 – ABOUT THE TRUST North NHS Trust (NBT) is the largest Trust in the South West region, and one of the largest trusts in the country. It is a progressive and ambitious provider of health services, delivering for a large local population and with specialist regional services for major trauma, neurosciences, vascular centre, urology, plastics and burns, orthopaedics and renal services. With a turnover of £550m and 9,000 staff, our clinical teams have built a strong reputation for exceptional healthcare. NBT provides medical, surgical and maternity care for a population of approximately half a million people in the North Bristol, and North Somerset areas.

In May 2014 the Trust relocated the majority of its acute services to the Brunel Building, one of the most advanced hospitals in Europe offering state-of-the-art care in a beautiful and purpose built environment, designed with the patients privacy and dignity in mind.

As well as Southmead Hospital, the Trust also has Cosham Hospital, in Kingswood, that recently underwent a £19m refurbishment, the Bristol Centre for Enablement, at Cribbs Causeway (Bristol) and the Trust also runs children’s community health services across Bristol and South Gloucestershire.

The Trust has University Teaching status and is associated with both the and the University of the West of England.

Southmead Hospital is located to the North of Bristol and has easy access from the motorways (M32/M4/M5) and by public transport. For those who cycle, Bristol boasts excellent cycling facilities and was chosen as England’s first cycling city in 2008, and was the European green capital 2015. In 2014 Bristol was nominated by the Times as the best

city to live in the UK, citing: “one of the lowest unemployment rates in the country, varied and beautiful housing stock, decent schools, buzzy culture and night life and access to some fantastic countryside”. The location also allows easy access to the town centre which has theatres, a large shopping centre and a historical harbour-side. There is an array of annual festivals and events including the Bristol International Balloon Fiesta and the Bristol Harbour Festival.

SECTION 3 – THE WORK OF THE DEPARTMENT

Type of test/Properties measured/Range of measurement

The Department is the regional Immunology and Allergy service for the northern end of the southwest region. It has referrals from Avon, Gloucestershire, Wiltshire and Somerset, as well as outreach clinics. The Allergy service is fully accredited and provides for all allergy patients. This includes diagnosis and testing for allergy, desensitisation, challenge clinics, anaesthetic allergy clinics and a specialist urticaria service for omalizumab patients. This is supported by a nurse practitioner and a team of nurses. The Clinical Immunology service has a caseload of 160 antibody deficiency patients on immunoglobulin replacement therapy supervised by the consultants, with registrar and nursing support. It also has a number of other diagnosed and undiagnosed immunodeficiency patients which are being investigated or followed up. There is a paediatric immunology and allergy service which links to the Adult service with joint clinics (allergy) and transition clinics (immunodeficiency). There are joint meetings to discuss cases. Accreditation will be applied for in June 2020. In addition there are 3 satellite services for Immunology and allergy based in Bath, Taunton and Gloucester. They provide an outreach service. The commissioners have indicated that the service will be reformed with the service coming under Bristol for all patients, but with a local delivery. This is currently being modelled for feasibility. The department is a lively and active department with all consultants being involved in teaching, training and/or research. It has a good academic output as well as successful training. We are looking for an enthusiastic colleague(s) to join this team. Workload

Type of activity Requests in year 2018/2019 Clinical Workload (Immunology and Allergy) 4000 (New cases 1300)

Immunology % (approx.) 25% GPvs Secondary and tertiary care 75% GP referrals

The repertoire of tests and breakdown of workload should be provided in sufficient detail to allow an appreciation of the breadth of activities undertaken in the laboratory. This should include information on tests referred externally.

Note the method used for each test offered and the equipment available next to the workload list. Scope of Work: Immunopathology. The Following tests are carried out within the

Department Immunology examination activities for the purpose of clinical diagnosis and Immunopathology oversite.

Test Total NBT Total UBHT Total Weston Total tested

VES V1 (COMMON WASP PHOSPHOLIPASE A1) 1 1 1 3

VES V5 (COMMON WASP ANTIGEN 5) 1 2 1 4

WINE (WHITE) 0 1 0 1

YEAST 2 2 1 5

ADALIMUMAB AB 110 0 17 127

ADALIMUMAB LEVEL 109 0 16 125

ALLERGEN NOT LISTED 112 8 2 122 API M1 (HONEY BEE PHOSPHOLIPASE A2) 1 4 1 6

APRICOT 3 3 0 6

AQUAPORIN 4 92 37 1 130

ARA H8 (PEANUT PR-10) 0 1 0 1

BETA-2-GLYCOPROTEIN 1 34 0 4 38

ANTI BASAL GANGLIA 1 0 0 1

CARDIAC 8 0 0 8

CALCIUM GATED CHANNEL 39 12 2 53 CSF NEURODEGENERATIVE MARKERS 46 0 0 46

ENTEROCYTE 16 0 0 16

GANGLIOSIDE SCREEN 125 15 0 140 HMGCOAR ANTIBODIES 7 0 0 7

HISTONE 9 0 0 9 INTRINSIC FACTOR ABS 527 283 189 999

INFLIXIMAB AB 25 0 20 45

INFLIXIMAB LEVELS 21 0 17 38 INSULIN ANTIBODIES 12 0 0 12

IMMUNOLOGY SENDAWAY NOT LISTED 216 2 0 218

POTASSIUM GATED CHANNEL 321 79 11 411 MYELIN ASSOCIATED GLYCOPROTEIN 28 17 2 47

MANNAN BINDING LECTIN 105 0 0 105 MANNOSE BINDING LECTIN PATHWAY 0 83 0 83

MUSCLE SPECIFIC KINASE ABS 56 53 0 109

FIXED NMDA RECEPTOR ANTIBODY 241 67 3 311 NEURONE SPECIFIC ENOLASE 0 10 0 10

ANTI OVARY ANTIBODIES 12 6 1 19 PNEUMOCOCCAL SEROLOGY 246 0 0 246

PNEUMOCOCCAL AB REFERRAL 247 0 0 247

INFLIXIMAB - REMSIMA 81 0 0 81

SKELETAL MUSCLE 2 7 0 9

SALIVARY GLAND 6 0 0 6

TETANUS ANTIBODIES 23 0 0 23

TOTAL IGD 11 0 0 11

ANTI-THSD7A 80 0 0 80

TSH RECEPTOR ABS 312 207 73 592

BEEF 5 5 0 10 SAVED SAMPLE - PRE IVIG 29 0 0 29

SECTION 4 – ORGANISATION AND ACCOUNTABILITY The appointee will be contractually accountable to the North Bristol NHS Trust for the provision of services. The appointee will be managerially responsible to the Chief Executive through the Clinical Director. All consultants are required to undergo an annual appraisal carried out in accordance with the Trust policy. Consultants are also required to take an active and co-operative approach to their job planning, which will be reviewed on an annual basis by their Clinical Director.

The appointee will be expected to be fully involved in the development of the service, to take account of the Trust policies, including Risk Management Strategy and developments in Clinical Governance. The appointee may be asked to participate in managerial and administrative work and will be expected to be aware of the broader context within the NHS in which Consultants operate.

Directorate Management Team: Clinical Director – Dr Kiaran Flanagan General Manager – Ms Valerie Clarke Head of Nursing – Ms Luisa Goddard

Clinical Consultants - Immunology & Allergy Dr Mark Gompels – Specialty Lead – Consultant Immunologist, Allergist & HIV Dr Sarah Johnston - Consultant Immunologist, Allergist & HIV Dr Philip Bright – Consultant Immunologist, Allergist & HIV Dr Joe Unsworth (retired, fixed term only) - Consultant Immunologist, Allergist

Associate Specialist - Allergy Dr Nikos Tsiougkos

Spr Trainee Dr Alexandra Grammatikos, and there is likely to be a second specialty registrar post in the future

Nursing staff - Clinical Immunology & Allergy Sister Lisa Smith Sister Jen Whittle Sister Catherine Fox Sister Violetta Alvarez Carbonell Sister Gaynor Rogers

SECTION 5 – MAIN DUTIES & RESPONSIBILITES OF THE POST

The post holder will be responsible for the diagnosis and clinical management of patients managed by the Clinical Immunology & Allergy Service at North Bristol NHS Trust.

The successful applicant will be responsible for;

(i) Teaching and Supervision of Junior Medical Staff & Students

The post holder will be responsible for the professional supervision and management of junior medical staff.

Where appropriate, the post holder will be named in the educational contract of junior staff as the person responsible for overseeing their training and as an initial source of advice to such doctors regarding their careers.

In liaison with the Director of Postgraduate Medical Education the post holder may be required to contribute to undergraduate and postgraduate education.

Identification of training opportunities and needs across the pathway.

Delivery of appropriate ad hoc training as required.

Attendance at relevant conferences as required.

Be responsible for and maintain own competencies in relation to CPD.

Update and extend own clinical and managerial skills appropriate to speciality by attending relevant study sessions and courses.

(ii) Study & Research

The post holder can request up to a maximum of 30 days study leave within a 3-year period (pro rata for part-time posts) as stated in the Terms and Conditions of Service.

The Trust is committed to ensuring that support is given for Continuing Medical Education. The post holder will be required to fulfil the requirements laid down by the relevant Royal College, and to fulfil the requirements for revalidation laid down by the General Medical Council.

The post holder will not necessarily be expected to undertake research, however opportunities do exist and encouragement is given to develop collaborative projects with other departments within Trust or with the University of Bristol and the University of the West of England. The post-holder will be required to submit all research development plans which have resource implications to the Clinical Director prior to implementation.

There are professionally staffed Medical Libraries at Southmead Hospital, with a rapid service between this and the University Library situated in the centre of Bristol City. A computer literature search facility is available for which a charge is made and the library has links with other networks. The libraries are at the forefront of developments in electronic knowledge delivery.

(iii) Audit

The post holder will be required to take part in a Clinical Audit Programme. The Trust has an audit department which supports and monitors such activity. There is an active Trust Clinical Audit Committee.

(iv) Professional and Legal Responsibilities

Maintain accurate and relevant documentation and patient records.

Participate in education, research, quality improvement and risk management activities

Take the responsibility for one’s own Professional Development by undertaking appropriate activities to update clinical knowledge and skills.

Undertake appropriate audit and research projects and as appropriate support papers for publication.

Participate in ongoing Trust initiatives to provide expertise and support in Trauma Care.

Be aware of and work within the policies of North Bristol NHS Trust carrying out such duties as may be required and are consistent with the responsibilities of the Grade.

Be aware of and comply with Health and Safety regulations, cardiac resuscitation procedures, fire procedures and equipment safety.

To ensure confidentiality at all times, only releasing confidential information obtained during the course of employment to those acting in an official capacity.

To have responsibility for the Health, Safety and Welfare of self and others and to comply at all times with the requirements of the Health and Safety Regulations.

Promote equal opportunities for staff and clients, in accordance with NBT’s Healthcare Policies, to ensure that no person receives less favourable treatment than another on the grounds of gender, marital/civil partnership status, religion or belief, nationality, ethnicity, national origin or sexual orientation.

SECTION 6 – LOCATION

All posts are regarded as being Trust wide however the base Hospital will be Southmead Hospital. Please note that the base could change as a consequence of clinical requirements.

SECTION 7 – WORKING CONDITIONS / EFFORT Working in dynamic and diverse multidisciplinary team conditions.

Working with distressed and anxious /aggressive patients and relatives, often daily.

Working in an environment where emotional issues may occur as a small percentage of patients, may die on the ward within any week.

Working with patients with severe physical disability, cognitive impairment and communication problems.

To be able to concentrate for long periods of time and deal with repeated interruptions from staff, patients and the unpredictable nature of ward work e.g. patients unavailable for treatment or needing to be seen more often, varying numbers of patients needing treatment and patients being/becoming unwell.

To maintain sustained periods of concentration when dealing with complex patients.

To work within infection control, and health and safety guidelines in order to deal appropriately with frequent unpleasant conditions related to client contact as they arise in

clinical work on a daily basis; for example, exposure to body fluids and infectious conditions.

To have due regard for your own personal safety and that of clients/carers, in particular relating to moving and handling regulations, and ensuring the safe positioning of self and others.

The post holder will have the support of the departmental secretarial team (5), a denoted office space, PC, internet access and the full support of the whole team.

SECTION 8 – MAIN CONDITIONS OF THE POST The appointee will be expected to work within the facilities available to the Group and any new service developments are subject to the provision of necessary resources within the Trust. There is an active appraisal and development programme and all consultant staff will take part in this process.

The post holder must be fully registered with the General Medical Council with a licence to practise and is advised to maintain up to date membership of a recognised medical defence organisation. The Trust has arrangements in place to ensure that all Medical staff receive an annual appraisal with a trained appraiser and supports all Medical staff through the revalidation process.

The Trust has a list of identified Mentors which is used to allocate a suitable support to new consultants during the first year in post

The appointee will be required to live within a distance that allows safe discharge of all clinical commitments and no more than a 10 mile distance from the base (unless there is prior agreement with the Medical Director) or 30 minutes travelling of your base hospital.

An applicant who is unable, for personal reasons, to work full-time will be eligible to be considered for the post; if such a person is appointed, modification of the job content will be discussed with the Trusts on a personal basis in consultation with Consultant colleagues.

The successful candidate is expected to be aware of local policies and procedures and comply with the standing orders and standing financial instructions of the Trusts.

Consultant appointments are made to North Bristol NHS Trust as services are developed and changed, the base of posts may alter and any employee of the Trust will be expected, within an agreed clinical strategy, to move their sessions as the service requires.

Your attention is drawn to the confidential nature of information collected within the NHS. The unauthorised use or disclosure of patient or other personal information is a dismissible offence and in the case of computerised information, could result in a prosecution for an offence or action for civil damages under the Data Protection Act 1998.

The appointment is subject to pre-employment health screening.

DBS checks Any successful interviewee will be subject to a disclosure and barring service check and any final appointment is subject to this being satisfactory. UK visas and immigration Applicants should be aware that regardless of country of origin, their ability to communicate in written and spoken English to the standard required to carry out the post will be assessed

during the selection process.

Applications from job seekers who require Tier 2 sponsorship to work in the UK are welcome and will be considered alongside all other applications.

Condition of appointment The appointment will be made in accordance with the NHS (Appointment of Consultants) Regulations.

Canvassing of any member of the Advisory Appointments Committee will disqualify the applicant.

Visiting arrangements Candidates are welcome to visit the department priot to or after shortlisting. Please contact the secretarial team (Helen Harris or Michelle Miller) on 0117 414 8392 or 8393 to arrange this. The following personel are available:

Chief Executive: Andrea Young Laboratory medicine lead: Mr Paul Virgo Directorate Management Team: Clinical Director – Dr Kiaran Flanagan General Manager – Ms Valerie Clarke Head of Nursing – Ms Luisa Goddard

Clinical Consultants - Immunology & Allergy Dr Mark Gompels – Specialty Lead – Consultant Immunologist, Allergist & HIV Dr Sarah Johnston - Consultant Immunologist, Allergist & HIV Dr Philip Bright – Consultant Immunologist, Allergist & HIV

Travelling expenses Travelling expenses are paid in accordance with the terms and conditions of the employing body.

Potential applicants wishing to visit the employing body will be reimbursed for two preliminary visits (one informal visit prior to application and one formal visit before interview), plus actual interview expenses. If a post is offered and subsequently refused, expenses will not be reimbursed.

Interviewed candidates travelling from outside the UK will be entitled to travelling and subsistence expenses; however, these only apply in respect of the journey from the point of entry in the UK to the interview location.

SECTION 8 – PERSON SPECIFICATION

Assessment at Shortlisting Stage Category Essential Desirable Scoring Matrix Qualifications and Speciality register for MD. MSc, PhD Qualifications and Registration Medicine MRCP or equivalent Experience

FRCPath or show evidence of equivalent qualification

Full and Specialist registration (and with a licence to practise) with the General Medical Council (GMC), or be eligible for registration within six months of interview.

Applicants that are UK trained, must ALSO be a holder of a Certificate of Completion of Training (CCT), or be within six months of award of CCT by date of interview

Applicants that are non-UK trained, will be required to show evidence of equivalence to the UK CCT

Training and Recent experience Experience Experience and familiarity of UK hospital systems and practices (or equivalent). Recent experience in the Practice of Clinical Immunology.

Further Training, Evidence of recent Completion of a Knowledge Management, Audit CME/ reasonable general training progression management course

at this stage of or programme. career.

Experience in audit project and written up

Knowledge of contemporary NHS management issues.

Knowledge of political context within which we operate.

Able to demonstrate leadership capability within multi- disciplinary teams and across organisations

Research, Teaching, Proven teaching Proven track record Skills Publications ability. in research and willingness to Willingness to undertake further undertake teaching research. of medical under- graduates & Evidence of relevant postgraduates. publications in peer reviewed journals. Ability to gain the trust and confidence Demonstration of of colleagues and involvement in patients. clinical directorate management. Ability to teach effectively.

Personal Ability to lead a team Management Other Requirements (e.g. and form effective Communication, working relationships Leadership skills, within a team. Flexibility Ability to inspire, motivate and develop junior medical staff.

Effective communicator, able to work in a close- knit team and co-

operate with all medical and paramedical staff.

Flexible, able to cover colleagues’ absence

Professional attitude towards work, reliability, good record of attendance and tidy personal appearance

Ability to work independently as well as part of the Medical Directorate.

To balance the individual requirements against those of the Trust.

SECTION 9 – PROPOSED JOB PLAN – Illustrative only

A provisional job plan is as follows:

Monday 09.30- Office Immunology Laborator DCC 0.25 10.30 MDT y 10.30- Meeting room Immunology MDT DCC 0.25 11.30 MDT 11.30- Brunel/medical Ward Work /clinic Day case DCC 0.55 13.30 day care (Immunology) 13.30- Office Clinic admin Clinic DCC 0.75 16.30 admin Tuesday 09.00- Brunel Clinic Clinic DCC 1 13.30 13.00- Office Clinic Admin Clinic DCC 0.25 14.00 admin 14.00- Brunel Ward Day case DCC 0.5 16.30 Work/challenge work Wednesda 08.30- Gloucester Gloucester Imm Clinic DCC 1.0 y 12.30 Hospital and allergy clinic

12.30- Gloucester Gloucester Imm Clinic DCC 0.5 14.30 Hospital and allergy clinic admin

14.3018.0 Immunopatholog Gloucester Laborator DCC 0.875 0 y Management laboratory y

Thursday 08.45- Office SPA SPA SPA 0.25 09.45 9.45-10.15 MDM X-ray Brunel MDT DCC 0.125

10.30- Brunel Day unit work Ward DCC 0.5 12.30 work 12.30- Brunel Gate 36 Clinic Clinic DCC 1 16.30 Friday

08.30- Office Immunopatholog Laborator DCC 0.5 10.30 y y 10.30- Office SPA SPA SPA 1.25 15.30 15.30- Office Clinical admin Clinic DCC 0.5 17.30 admin

The job plan will be based on a 10 PA contract with 8.5 PAs for Direct Clinical Care (DCC) and 1.5 for Supporting Professional Activities (SPA). Further SPA’s may be available in the department, for specified duties and will be agreed by job plan discussion as per trust policy e.g. clinical supervisor, appraiser. Programmed activity Number

Direct clinical care (including unpredictable on-call) 8.5

Supporting professional activities 1.5

Other NHS responsibilities (to be discussed with Clinical

Director)

External duties (to be discussed with Clinical Director)

Total Programmed Activities 10

Job Plan Weekly Summary DCC PAs SPA*/other PAs

Clinics (number per year if 3.5 Core SPA* 1.5 annualised)

Daycase 0.75 Educational Programmed Activity EPA 0

Ward Rounds and work 0.5 Research Programmed Activity RPA 0

MDT’s 0.55 Management Programmed Activity MPA 0

Admin/Clinical Diagnostic 1.75 Additional NHS 0 Responsibilities/Extended Roles AR

On-call* 0 External responsibilities ER

(give details)

TOTAL DCC 8.5 TOTAL non-DCC 1.5

TOTAL Job Plan 10

*Refer to Schedule 5 Terms and Conditions Consultants England 2003 and rota frequency commitment for guidance and application as well as any supporting diary card information undertaken.

2. ON-CALL AVAILABILITY SUPPLEMENT No On Call