Job Description and Information Pack
November 2020
DIVISION OF UNSCHEDULED CARE
Appointment of Full Time (10 Sessions) Plus 0 Additional Temporary Sessions
CONSULTANT ACUTE PHYSICIAN Special Interest: Negotiable Based at Cross Sites http://www.wales.nhs.uk/sitesplus/866/page/40418
Job Reference: 040-CON436-CF
Anticipated Start Date: IMMEDIATE
DIVISIONAL CONTACT FOR ENQUIRIES ABOUT THIS POST DR LLIFON EDWARDS, CLINICAL DIRECTOR ACUTE MEDICINE TEL 01633-234053
Links to Additional Information Aneurin Bevan Homepage Aneurin Bevan Values and Behaviours Framework Aneurin Bevan Demography Profile Medical Training/Careers in Wales Visit Wales Train Work Live
Medical Resourcing Department, Ground Floor Portacabins, Llanfrechfa Grange, Cwmbran, NP44 8YN Email [email protected] Tel 01633 623935
Index
Index ...... 2 Introduction ...... 3 Details for Visiting ...... 5 JOB DESCRIPTION ...... Error! Bookmark not defined. Purpose of the Post and General Responsibilities ...... 6 Specific Responsibilities of the Post ...... 6 Clinical ...... 6 Teaching/Training (as agreed with Clinical Director) ...... 7 Audit (as agreed with Clinical Director) ...... 7 Quality and Standards ...... 7 Learning Organisation ...... 7 Patient Experience...... 7 Patient Safety ...... 7 Personal Development ...... 7 Management (as agreed with Clinical Director) ...... 7 Location ...... 8 Review ...... 8 Provisional Job Plan ...... 9 Person Specification ...... 12 The Specialty...... 13
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Introduction
This is a new substantive consultant post, developed to meet the needs of the Aneurin Bevan University Health Board’s (ABUHB) Clinical Futures (CF) programme. The opening of the Grange University Hospital (GUH) near Cwmbran has been brought forward from March 2021 to November 2020 in response to anticipated demand from COVID19. The CF programme has led to a redesign of acute services with most acute surgical services, paediatrics, obstetrics and gynaecology as well as hyperacute medical specialties such as cardiology, stroke, gastroenterology and much of respiratory being centralised at GUH. To support the acute intake, part of the workload of acute medicine has shifted to GUH, whilst retaining services at previous sites at the Royal Gwent Hospital (RGH), Newport and Nevill Hall Hospital (NHH), Abergavenny. These two sites along with Ysbyty Ystrad Fawr (YYF) near Caerphilly form our enhanced local general hospital (eLGH) network. It is important for any prospective candidate to be aware that with services moving and bedding in, there will be an expectation that you will be able to work flexibly, potentially across different sites, in order for the Health Board to be able to set up and modify new services, whilst maintaining some current services, and providing high quality, safe care to the population of Gwent and south Powys. You will be joining an established team of nine WTE equivalent Acute Physicians (APs) based at RGH and 4 WTE at who provide between 5 and 7 sessions each to Acute Medicine, depending on their job plan. There are currently 2 locum APs at NHH and 2 other AP/CoTE physicians who job share. A new AP will start with ABUHB in early 2021. The APs will look after the Acute Medical Unit (AMU) at GUH, as well as at RGH and NHH. We will also provide Ambulatory Care services at the latter 2 sites. There is an expectation that APs will also input into the ABUHB Flow Centre which deals with acute referrals to the health board as well as arranging patient transfers between sites.
Currently this appointment does not include participation in the Consultant Physician on-call rota, but candidates may participate on a voluntary basis, with agreement from the Divisional Director, as long as on-call work does not impact on core acute medicine services.
AMU and the Acute Medical Model at the GUH site
Aneurin Bevan University Health Board is committed to developing an acute medical model of care and consequently an exciting opportunity has arisen for dynamic individuals to join the existing Acute Physician team within the health board. AP base sites will be at either RGH or NHH but approximately 1/3 of our time will be spent at GUH.
The AMU at GUH has 21 spaces, of which 3 are triage or rapid assessment spaces, 7 are cubicle spaces (2 with en suite facilities) with provision for a procedure room. The team will see all acute medical admission to GUH which come through the AMU, as well as seeing Emergency Department (ED) referrals which are not directed at the front door to specialty teams. The patients on AMU will be handed over to specialty teams as appropriate, discharged, kept under the care of Acute Medicine, or transferred out to eLGHs for ongoing care. APs will be on site on the AMU for 12 hours between 0800 and 2000 7 days a week.
The unit has appropriate levels of nursing staff and skill mix, as well as a team of 4 dedicated on-call doctors. The Acute Medical team itself has 5 trainees assigned to it (F2, 3 ACCS trainees and an ST) who will perform various roles as required by their training needs. There is a team of 4 Advanced nurse Practitioners (ANPs) and 4 Physician Associates (PAs) across the health board who will provide support on a rotational basis to the Acute Medical team at GUH, whilst also continuing to work at their base hospital sites. The unit will also have a dedicated pharmacist and will have inreach support from physiotherapists and occupational therapists as appropriate.
Adjacent to AMU will be our short stay ward (A1) which will be shared by the ED team for their short stay patients. This is a 32 bedded ward, of which Acute Medicine currently has 8 beds, though this is likely to rise to 16. Our patients on this ward will be a mix of likely short stay acute medical patients who can be discharged following investigations, and more general medical patients who do not have a specific specialty problem but who are too unwell to be transferred to the eLGH sites. APs will provide a morning ward round on A1 7 days a week, supported by our acute medicine trainees and ANPs/PAs.
It is important to note that the function of A1 may well change during the winter period as it forms part of the GUH site COVID19 plan.
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eLGH model
As far as is possible, the aim is to have an identical model on the 2 eLGH sites that the AP team are responsible for. This will enable seamless cross-site working, and if necessary, will make cross covering easier in the event of any staffing difficulties. APs will spend most of their clinical time on the eLGH sites.
In the morning, one AP will provide a ward round in the AMU to cover any overnight admission who had not been seen by a Consultant the previous evening. The intake at the eLGHs is open between 0800 and 2200 currently. Additionally they will review any potential discharges on the ward, especially the Acute Medicine defined patients. Currently, we are unable to provide a weekend ward round but any successful applicant will be asked whether they would wish to provide weekend round for additional payment. Depending on the amount of successful appointees, we may provide a weekend service at eLGHs in future. Patients who are admitted to eLGHs during the day will be reviewed by other physicians on the on-call rota.
A further AP will provide input into the Medical Ambulatory Care Unit (MACU) between 1000 and 1800. MACU will open at 0800 staffed by ANPs, PAs and nurses to deliver pre-planned treatments and to organise the day’s referrals.
Flow Centre
In order that patients can be correctly streamed to the correct service at the correct healthcare setting, ABUHB have set up the Flow Centre. This was set up during the initial phases of the COVID pandemic by APs along with assistance from other general physicians. It has now developed into a Flow Centre and Transfer Hub, based at Vantage Point house in Cwmbran, co-located with the local Welsh Ambulance Service Trust call centre. Whilst it does not form part of the formal job plan, there will be an opportunity for any successful candidate to undertake sessions here, supervising and advising the Band 3 call handlers and Band 6 senior nurse.
Role of APs
APs will provide clinical leadership and direction for the multi professional team in the management of the acute medical patients. It is expected that they will lead ward rounds, direct the management of patients, perform practical procedures, teach both junior medical and other staff, attend multidisciplinary meetings, take part in the governance activity of the department, participate in the management and administration of the service and liaise with other professionals both within and outside the Health Board as required.
It is expected that when on duty the working day will commence at 8.00am, apart from MACU, and that weekend working will be part of the job plan. Patients who attend AMUs during the period of AP cover will be reviewed as soon as results become available to expedite further management plans and facilitate early discharge where appropriate.
The service for acute medicine is rapidly developing and evolving to meet the needs of patients whilst aiming to reduce the need for hospital admission. You will be expected to participate in service redesign and development with the aim of improving outcomes and reducing length of stay.
The right person for this job will be keen, energetic and motivated, with an enthusiasm for acute medicine. They will be supported in developing the services, which will improve outcomes and quality of care of patients, hence the importance of auditing practice.
At present the on call commitment for Acute Take remains with the general physicians.
Office accommodation and IT facilities will be provided. There are currently 3 WTE secretaries in Acute Medicine within the Health Board. For consultants with sessions in other specialties, the secretarial and administrative tasks specifically associated with specialty sessions are undertaken by the secretaries from those departments.
Special Interest
Whilst not essential to the post, candidates may have a specialty interest and, depending on negotiations with those particular specialties, may be released for a maximum of 2 sessions per week.
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Details for Visiting
Those wishing to discuss the post informally in the first instance, or visit the department are encouraged to contact:
Divisional Director Clinical Director Dr Paul Mizen Dr Llifon Edwards Consultant Physician Consultant Physician Royal Gwent Hospital Medical Assessment Unit Newport Royal Gwent Hospital NP20 2UB Newport NP20 2UB Tel: 01633 656342 Tel: 01633 234053 E-mail: [email protected] E-mail: [email protected]
Shortlisted candidates are encouraged to visit and contact:
Dr Sarah Aitken Mrs Judith Paget Interim Medical Director Chief Executive Aneurin Bevan University Health Board Aneurin Bevan University Health Board
Tel: 01633 435971 Tel: 01633 435958
Please note that pre-interview visits to other AAC panel members are neither required nor expected.
Notes
A candidate for a consultant appointment shall not be reimbursed for more than three attendances. Where an authority invites such a candidate to attend prior to shortlisting, it may reimburse the candidate’s expenses provided that he or she is subsequently shortlisted, but not otherwise. In the case of candidates travelling from abroad, travelling expenses are payable only from the point of entry into the United Kingdom.
Applications are welcome from candidates wishing to work part time. If such a person is appointed, modification of the job content will be discussed on a personal basis.
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Job Description
The Job Itself
Title: Consultant in Acute Medicine (New Post)
Professionally responsible to: The Medical Director
Managerially accountable to: The Divisional Director, with ultimate accountability to the Chief Executive
Responsibility for Staff as Part of this Post: All trainees and junior medical staff, as allocated
Base: The Royal Gwent Hospital, Newport, and Nevill Hall Hospital, Abergavenny, SE Wales
Other hospitals at which duties are performed: In view of the fact that the organisation is currently undertaking a review of its services and the locations at which they are undertaken, it is important to be aware that work patterns may change and the place(s) of duties modified.
The Clinical Strategy of the Health Board is under constant development and the job holder may be required to undertake different duties agreed at the time of appointment.
Purpose of the Post and General Responsibilities
To provide additional support for the development of services within Acute Medicine and provide senior cover from 8am to 8pm.
Specific responsibilities of the post are listed in the next section.
As a senior employee of the Health Board the post holder will work in close co-operation with, and support other clinical, medical professional and managerial colleagues in providing high quality healthcare to the Health Board’s patients.
Integral to the responsibilities of the post are the following requirements:- To ensure the provision of a first class clinical service To provide effective leadership to all staff engaged in the specialty To sustain and develop teaching and research wherever appropriate To undertake all work in accordance with the Health Board’s procedures and operating policies To conduct clinical practice in accordance with contractual requirements and within the parameters of the Division’s and Health Board’s service plans To maintain the confidence of business plans and development strategies formulated for the specialty, the Medical Division or the Health Board
Specific Responsibilities of the Post
As laid out above
Clinical Responsible for providing clinical management of patients presenting to MAU, ED and Ambulatory Care. In addition will have responsibility for all patients managed within medical short stay beds. To participate in the AP weekend rota. To conduct clinical practice in accordance with contractual requirements within the parameters of the Division’s and Health Board’s agreed objectives All clinical staff are accountable and responsible for their own clinical competence and should limit their actions to those for which they are deemed competent. Clinical staff are also required to comply with the requirements of their professional organisations regarding supervision
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Teaching/Training (as agreed with Clinical Director) To provide conditions for improved training opportunities in line with national and local recommendations arising out of MMC and related requirements To participate in the undergraduate teaching programme To assist and participate with the development of postgraduate training for F1s, F2s, SpRs, STs and other staff as appropriate Where agreed, to act as Educational Supervisor to junior and middle grade medical staff
Audit (as agreed with Clinical Director) To promote evidence-based clinical practice To undertake regular audit
Quality and Standards To be familiar with and actively promote adherence to the regulatory framework including NICE and National Service Framework Guidance and to actively promote professional standards “The Duties of a Doctor” To undertake all work in accordance with the Health Board’s procedures and operating policies
Learning Organisation To be involved in and actively manage complaints and any medico legal claims in their area of practice, management of serious incidents and responsibility for sharing any organisational learning from these
Patient Experience To monitor and respond to measures of patient experience
Patient Safety To work actively to reduce unintended harm to patients To contribute actively to the content areas of the 1000 Lives Plus Campaign and any other subsequent patient safety campaign To adhere to the Health Board’s Clinical Incident Policy
Personal Development To attend accredited conferences and meetings to update personal level of clinical practice, teaching and management skills in line with CME requirements To participate in an annual Job Planning Review process To participate in the Health Board’s Annual Appraisal process The Health Board will provide support for CPD in accordance of the Royal College
Management (as agreed with Clinical Director) To provide medical information for the development of systems appropriate for Health Board needs To participate in departmental consultant and senior staff meetings To attend other departmental, Divisional and Health Board meetings as necessary To attend regional and national meetings as necessary To undertake all work in accordance with Health Board procedures and operating policies To work within the financial and other restraints decided upon by the Health Board. Additional expenses of any kind will not be committed without the approval of the appropriate manager/budget holder
The post holder has a general duty of care for their own health, safety and wellbeing and that of work colleagues, visitors and patients within the hospital. This statutory duty is in addition to any specific risk management or clinical governance accountabilities associated with the post.
Finally, the post holder is expected to: Observe the rules, policies, procedures and standards of Aneurin Bevan University Health Board together with all relevant statutory and professional obligations Observe and maintain strict confidentiality of personal information relating to patients and staff Be responsible, with management support, for their own personal development and to actively contribute to the development of colleagues
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Location
The principal place of work for this post is currently Royal Gwent Hospital, Newport or Nevill Hall Hospital, Abergavenny. The post holder will generally be expected to undertake their programmed activities at the principal place of work or other locations agreed in the Job Plan. Exceptions will include travelling between work sites and attending official meetings away from the workplace. A planned and cost effective approach is expected, and is included in the DCC sessional allocation. The post holder may be required to work at any site within the Health Board, including new sites.
Review
This job description will be regularly reviewed. It 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 holder.
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Provisional Job Plan (As required under paragraph 30a of the Terms and Conditions of Service)
The duties described here are provisional and will be the subject of annual review and will form a composite part of the job plan which will be agreed between the post holder and the Chief Executive or nominated deputy.
The work programme will be based on a contract for 10 sessions under the Contract for Consultants in Wales, incorporating 7 direct clinical care sessions (DCC) and 3 sessions for Supporting Professional Activities or ‘SPA’ (teaching, meetings, clinical governance activity, research, etc) if agreed in the job plan. Uncontracted time will be taken and organised flexibly so as not to impact on service delivery or outpatient service delivery.
The job plan for this post is quite complex and will vary from week to week. Due to the fact that we are soon to open the GUH, it is important to note that the job plan presented below may not be accurate at the time a successful appointee takes up their post.
On a monthly basis the successful candidate will have to cover a combination of the following:-
- A long day in the AMU at GUH (0800-2000) including weekends - A1/Acute Medicine ward cover at GUH (0800-1200) including weekends - Acute Medicine ward rounds at eLGH (0800-1200) 5 days a week - Ambulatory Care at eLGH (1000-1800) 5 days a week - Specialty Interest Sessions (up to 2 per week)
The table below gives an indication of the sessions that we would aim to cover given a full complement of ACPs. The commitments shown will be covered by all consultants working in acute medicine and will be undertaken within their contracted hours. Sessions not covered by APs will be covered by general physicians as part of their on-call commitment.
MON TUES WED THURS FRI SAT SUN TOTAL SESSIONS
8-4pm 2 2 2 2 2 2 2 14 sessions AMU sessions sessions sessions sessions sessions sessions sessions GUH 4-8pm 1 1 1 1 1 1 1 7 sessions session session session session session session session
A1 8-12pm 1 1 1 1 1 1 1 7 sessions GUH session session session session session session session
AM eLGH 1 1 1 1 1 10 sessions 8-12pm WR sessions sessions sessions sessions sessions (5x2 sites)
Amb care 2 2 2 2 2 20 sessions 10-6pm eLGH sessions sessions sessions sessions sessions (10x2 sites)
58 Total
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Due to the extremely varied nature of the work undertaken by the ACPs, there are no fixed weekly sessions (apart from agreed specialty sessions). An example of a current individual weekly timetable is given below:
No. of Day Time Location Work Category Sessions AM Acute Medicine DCC 1.0 Monday PM Acute Medicine DCC 1.0
AM Acute Medicine DCC 1.0 Tuesday PM SPA/Admin SPA 1.0
AM Specialty Clinic SPA 1.0 Wednesday PM Admin/SPA SPA 1.0
AM Acute Medicine (MACU eLGH) DCC 1.0 Thursday PM Acute Medicine (MACU eLGH) DCC 1.0
AM SPA DCC 1.0 Friday PM SPA SPA 1.0
Predictable 1:7 DCC 0.40 weekend work Total Sessions 10.00
Programmed Activity Sessions Direct Clinical Care (including unpredictable on-call) 7 Supporting Professional Activities 3 Other NHS Responsibilities External Duties Total Sessions 10.00
In line with the terms and conditions, the final job plan is subject to the agreement of the Health Board through the Clinical Director and the appointee.
Specialty Interest Sessions Currently, most Aps working for the Health Board work between 1 and 2 sessions in specialties other than Acute Medicine.
Supporting Professional Activity (SPA) The job plan comprising 10 sessions with a split of 7 DCC’s and 3 SPA’s although the split of DCC/SPA time will be subject to Job Plan review and agreement. If sufficient evidence cannot be produced for 3 SPA’s then one session may be reallocated as a DCC session by agreement. During SPA time you will be expected to participate in teaching and training, audit and research, quality improvement, protocol development, database management, general management related duties, attending non-clinical meetings, service development clinical supervision and support, and personal development. The Health Board supports the requirements for continuing professional development as laid down by the Royal College of Physicians and is committed to providing time and financial support for these activities.
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Appraisal The Health Board expects all consultants to participate in annual appraisal and has the required arrangements in place, as laid down by the Royal College of Physicians, to ensure that this will be done with a trained appraiser. Through the MARS (Medical Appraisal and Revalidation System) scheme, run by the Welsh deanery, doctors will be supported through the appraisal and revalidation process.
Mentoring Following a successful appointment, should the appointee so desire, a mentoring process can be set up within the Health Board such that the appointee can obtain the support and advice of a senior clinician when their post begins. This would be outside of, but in addition and complimentary to, the appraisal process and would take into account guidance laid down by the Royal College of Physicians.
Review of this job description in relation to job plans This job description will form part of a job plan which will be subject to annual review by the post holder and the Clinical Director and Chief Executive or other manager on their behalf. In line with the terms and conditions, the final job plan is subject to the agreement of the Health Board through the Clinical Director and the appointee.
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Person Specification
CONSULTANT ACUTE PHYSICIAN (040-CON436-CF)
Requirements Essential Desirable Measurable by - Full GMC Registration and Licence to Practise - Relevant Higher Degree e.g. MD; PhD; MSc - On the GMC Specialist Register (including via CESR/European Community Rights) or will have a Qualifications CCT/CESR(CP) date within 6 months of interview Application - MRCP or equivalent - Valid Certified Advanced Life Support Skills (or equivalent international qualification) - Broad based experience in general medicine, including acute medicine - Experience of NHS - Knowledge of UK hospital systems (or equivalent) - Wider experience, research and training in acute medicine - Knowledge and participation in CPD - Evidence of above average performance Clinical Application/ - Competence in general medicine Experience Interview - Able to apply knowledge - Safe and effective written and verbal communication skills - Meet the requirement of the GMC’s “Good Medical Practice” - Evidence of participation in clinical audit and understanding role of audit in improving medical - Knowledge of risk management Clinical Application/ practice Governance Interview - Comprehension of core philosophy and building blocks of Clinical Governance - Experience and knowledge of critical appraisal of evidence - Evidence of initiating, progressing and concluding research Application/ Research projects with publication Interview - Research degree - Evidence of organising programmes and teaching medical students and junior doctors - Organisation of further teaching programmes in medical Application/ Teaching - Willingness to teach medical undergraduates and postgraduates education Interview - “Training the Trainers” experience - Knowledge of the management and structure of the NHS - Evidence of management training Application/ Management Interview - Ability to cope with stressful situations and undertake responsibility - Evidence of leadership attributes Personal - Excellent interpersonal skills and team-working skills - Motivational skills Interview Qualities - Ability to work as part of a multidisciplinary and multi-agency team - Ability to work flexibly in response to the changing needs of the service - Demonstrable skills in written and spoken English adequate to enable effective - Ability to speak Welsh or willingness to learn communication about medical topics with patients and colleagues Other Application/ - Satisfactory pre-employment checks compliant with National Standards Requirements Interview - Ability to fulfil all duties of post, including on-call commitments and travel to meet requirements of the post
The Specialty
Senior and Consultant Members of the Service Group
Dr, P Mizen ...... Divisional Director, Consultant Respiratory Physician with an interest in Gastroenterology
Dr, L Edwards ...... Clinical Director/Consultant Acute Care Physician with Interest in Respiratory Medicine Miss, C Randall ...... Service Group Manager
Mr, A Smith ...... Assistant Directorate Manager
Mrs, N Skyrme ...... Senior Nurse
Mr, M Cameron ...... Ward Manager, MAU
Clinical Staff in Acute Medicine (RGH)
Dr, H Saleem ...... Consultant Acute Care Physician with an interest in Gastroenterology
Dr, F Cavelle ...... Consultant Acute Care Physician with an interest in Cardiology
Dr, H Brothers ...... Consultant Acute Care Physician with an interest in Respiratory Medicine
Dr, E Mason ...... Consultant Acute Care Physician with an interest in Palliative Medicine
Dr, T Cozens ...... Consultant Acute Care Physician and RCP tutor
Dr, V Mathrani ...... Consultant Acute Care Physician with an interest in Renal Medicine
Dr R Ravindran ...... Consultant Acute Physician with an interest in Diabetes & Endocrinology
Dr S Akhtar ...... Consultant Acute Physician with an interest in Respiratory Medicine
Sessions in Acute Medicine are also provided by Dr, Andrew Williams RAMC (RGH-Cardiology)