JOB DESCRIPTION

CONSULTANT IN GERIATRIC MEDICINE AND GENERAL INTERNAL MEDICINE

10 PROGRAMMED ACTIVITIES

JOB DESCRIPTION

POST: Consultant in Geriatric Medicine and General Internal Medicine

BASE: Hospital

CONTRACT: 10 PAs

 Chief Executive Mr Nick Broughton  Medical Director Dr Karl Marlowe ACCOUNTABLE TO:  Responsible Officer Dr Karl Marlowe

CLINICAL MANAGER:  Clinical Director Dr Rachel Anderson KEY WORKING  Divisional Director of Operations Laura Rothery RELATIONSHIPS:  Medical Director Dr Jeremy RowlandDivisional Director of Nursing Ben Goodwin

1) INTRODUCTION

Southern Health NHS Foundation Trust (SHFT) wishes to appoint a full time Consultant Physician in Geriatric and General Internal Medicine. The post-holder will be based at Lymington New Forest Hospital. Applicants must hold CCTs in the specialties of Geriatric Medicine and General Internal Medicine.

2) THE TRUST

Southern Health NHS Foundation Trust is the largest Community Services Provider Trust in the country. It was formed on the 1st April 2011 following the merger of Community Health Care with Hampshire Partnership NHS Foundation Trust.

We are a major provider of Physical, Community and Mental Health services with thousands of staff working in hospitals, clinics, health centres and the community. We provide a range of services including: hospital medicine; community based services to support adults and children including community nursing, pediatrics, health visiting and school nurses along with a mix of therapies; care services; management and administrative support; mental health and clinical psychology; multi-professional triage; nursing; pharmacy and medicines management; podiatry; support services and facilities management; and therapy services. We manage one acute hospital and several community hospitals providing a variety of rehabilitation, diagnostics, inpatient and outpatient services.

Lymington New Forest Hospital is a key component within a Multispecialty Community Provider and has developed close relationships with community teams and GPs. It can offer acute and specialist services close to people’s homes and is in a unique position to develop greater integration across the health and social care system. The new post holder will be

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part of the Community Geriatric Medicine team supporting and developing integrated services between the acute and community services which better meet the needs of an older / frail population.

We also work closely with partners at University Hospitals to deliver high quality care across a wider population. The postholder has the opportunity to work with UHS to develop some shared support for more acutely unwell older patients, for example by working within the SDEC.

3) THE LOCAL AREA

Lymington is a beautiful, Georgian . Lymington (population 14,330) is situated on the southern edge of the New Forest, between Southampton and Bournemouth and at the western end of the Solent. The town is world renowned as a sailing resort; there are two large marinas and two sailing clubs. Lymington is surrounded by outstanding natural beauty; to the north are the ancient woodlands and heathlands of the New Forest, covering an area of about 145 square miles, and to the south, the Solent and the Isle of Wight.

4) LYMINGTON NEW FOREST HOSPITAL- OVERVIEW The purpose built £36 million facility opened in 2007 has a wide range of features that benefit both patients and staff working at the new hospital.

Acute Medicine in Lymington Hospital forms a significant part of the acute medical provision for patients in the New Forest, who otherwise would have to travel to Southampton or Bournemouth.

There are a total of 74 beds, of which 50 are acute medical, 16 rehabilitation, 8 stroke.

The hospital has a 24-hour Emergency Medical Admissions Unit (MAU) providing a full range of acute medical services (excluding acute GI bleed and ST elevation MI) to patients referred by GPs and South Central Ambulance Service.

The Medical Unit is staffed by 10 Consultants and three Specialty doctors .There are 11 doctors in training, six of whom are GP Specialist Trainees, there are three Foundation Year 2 doctors and two Foundation Year 1s.

Consultants have been providing a 7 day service in line with the national initiative of ‘7 day working’ working a one in nine rota with prospective cover providing General medical services to all patients regardless of age. Despite the unit’s small size, the excellent working relationship between the Consultants and the doctors in training both in day-to- day work and out of hours has led to educational approval for the posts from the Royal College of Physicians and the Wessex Deanery. Continuity of care is excellent due to the working system of the hospital, allowing high quality of care and excellent patient satisfaction ratings.

Frailty Support Team This innovative service has been commissioned by West Hampshire CCG after a successful pilot in Lymington in 2016/7. The service,is delivered by a multiprofessional

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team from a variety of backgrounds and has two roles – firstly to provide a viable alternative to hospital admission for older people with frailty who decompensate and present in crisis( falls, immobility and delirium for example) and secondly to provide proactive care to older people in selected care homes in the local area. We are very proud of this service which is continuing to evolve and grow with increasing evidence that the team has successfully reduced admissions from the South West New Forest where it operates

Integrated Community Teams. These multiprofessional community teams support the work of Primary Care in delivering services to people in their own homes, many of which are older people living with frailty. The teams comprise community nursing, community therapy and older peoples mental health services, the trust is committed to improving integrated working between these professionals to create an efficient high quality service. The Community Geriatric Medicine service aims to support this transformation.

Community Geriatrician service. Working alongside the Acute Medical service, FST and the Integrated community teams (ICTs) is the Community Geriatric Medicine service which comprises a mixture of Consultant Community Geriatricians, a specialist GP in frailty, a Specialist Trainee in Community Geriatric Medicine and a specialty doctor. This service provides comprehensive geriatric assessment in a variety of settings including patients’ homes and specialist clinics (supported by a frailty practitioner). The service offers leadership and expertise to the ICTs through weekly MDT meetings, and the GPs via monthly virtual wards. The consultants also offer support to the older persons mental health team and contribute to the governance and team development of the FST.

There is a full range of support services at Lymington from Allied Health Professionals, with Clinical Pharmacy and Pathology services provided from Southampton as well as Speech and Language Therapy and Dietetics. There is an active Day Case Unit where one-third of the District’s endoscopy services are provided.

There is a Radiology Department which is able to provide most types of plain imaging, gastrointestinal contrast studies and all types of ultrasound. We are fortunate to have a “top of the range” 64 slice CT scanner with access to all CT investigations including CTPA and HRCT as well as a whole body MRI scanner.

Besides acute medicine, there is a full range of specialist outpatients including Rheumatology, Gastroenterology (Surgical and Medical), Endocrinology, Haematology, Cardiology, Movement Disorders and Diabetes. Weekly educational meetings are held for all medical and multidisciplinary staff which includes clinical audit and case presentations.

a) Medical Staff:

Consultants:

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Dr Giles Durward (Geriatrician Special interest Stroke) Dr Rachel Anderson ( Respiratory Medicine) Dr Richard Russell (Respiratory Medicine) Dr Katherine Spinks (Respiratory Medicine) Dr Chris Roseveare (Special interest acute medicine and GI medicine) Dr Michael Devane (Special interest GI medicine and endoscopy) Dr Marianne Plater (Community Geriatrics) Dr Gill Turner (Community Geriatrics and Movement Disorders) Dr James Waller (Cardiology) Dr Mark Jackson (Respiratory Medicine) Dr Victoria Wright (Specialist GP in Frailty)

Specialty doctors

Dr Jenny McNaught – Geriatric Medicine Dr Tom Sterling- General Medicine Dr Gul Baluch- General Medicine Dr Gerri Salmon – General Medicine

Trainees

. 3GP ST2, 3GP ST1; 3 Foundation Year 2; 2 Foundation Year 1 posts

b) Medical Admissions

The Physicians (Drs Anderson, Devane, Durward, Russell, Jackson, Waller, Roseveare, Spinks and this postholder) all have acute medical inpatients in Lymington and the trainees share the on call in-patient work on the Medical Admissions Unit (MAU-16 beds). Referrals are taken from GPs, the ambulance service and the Frailty Support Team or sometimes via the nurse led Minor Injuries Unit (MIU). 7 Day working commenced in December 2014 with a consultant presence supporting the acute medical take 7 days/week from 8.30 am – 8.30pm.

Patients requiring >24 hour stay are moved from MAU to the medical inpatient beds (Longbeech 1, 2, Wilverley 1) – 30 beds). They are organised into two teams with the 10 trainees split between the two as well as one FY1 allocated to each team.

The post holder will be the consultant overseeing our 12 medical rehabilitation beds (Longbeech 2). They will work with our experienced nursing and therapy teams to offer high quality care for patients to optimise their health and well being and prepare them for discharge. We also have a Stroke Unit (Deerleap 8 inpatient beds) under the supervision of Dr Durward.

We also have community rehabilitation beds at Hospital. Dr Durward provides consultant cover for this, and junior doctors attend on a rotational basis. Alongside others, the postholder may be asked to provide consultant cover for Fordingbridge inpatients when Dr Durward is on leave.

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c) Forest Assessment Centre (FAC)

We have developed an Ambulatory Care and Rapid Assessment Centre which provides rapidly accessible, high quality, emergency medical care as close to home as possible whilst avoiding unnecessary hospital admission.

This is staffed by advanced nurse practitioners, band 5 nurses, healthcare support workers and 3 Specialty Doctors and operates Monday to Friday with cover out of hours provided by the MAU. The service offers immediate access to assessment, investigation and treatment of conditions such as DVT, cellulitis, chest pain and TIA which do not always require hospital admission.

FST may utilise this area for diagnostic purposes either at the direction of the admitting consultant or their own specialist GP cover.

The service operates from Monday to Friday 9am – 7pm and will take direct referrals from GP and ambulance services as well as MIU and MAU as appropriate.

d) Outpatient Clinics

There are General Medical Outpatient clinics at LNFH as well as clinics in other specialties. These include Respiratory, Cardiology, Rheumatology, Diabetes, Haematology, Gastroenterology,Movement Disorders and Endocrinology.

5) TRAINING AND RESEARCH DUTIES

Undergraduate medical students from the University of Southampton Medical School are taught throughout the Trust and the post-holder is required to participate in undergraduate clinical teaching. The post-holder is expected to participate in clinical audit and Continuing Professional Development. There is a weekly ‘academic teaching morning’ held on Fridays. This involves a rolling rota of interesting Case Presentations, Journal Club, Research and Audit, and Clinical Updates to teach both under- and post-graduate students and doctors.

6) KEY DUTIES OF THE POST

 2 inpatient General medical ward rounds – usually of between 7 and 15 medical in- patients admitted via acute on call commitments.

 Acute medical on-call 1 in 9 days, evenings and 1 in 10 weekends. Consultants are on site 8.30 to 20.30 and when on call cover the phone to GPs after 5pm and at weekends. On weekends, an onsite presence from 8.30 to 17.30 Saturday and Sunday, and 12 hours on the Friday. There are usually around 6-10 admissions over 24 hours.

 Hold consultant triage phone for admissions 1 afternoon per week

 Provide consultant care for 12 patients in rehabilitation beds with weekly ward round and MDT

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 Work with community geriatricians and UHS to assist in offering comprehensive services for older people with frailty living in the local area. Whilst 2 PA is set aside in the weekly timetable for this, the exact role for the postholder will be developed in consultation with the other members of the team depending on the postholder’s experience and preferences.

 Provide one clinic per week. Besides general medical patients the postholder would be encouraged to identify a subspecialty interest for this clinic which would complement our existing services.

The postholder would be expected to play a full part in the department’s teaching programme, teaching undergraduates and postgraduates. Furthermore, the Trust is committed to the principle of continuing medical education for senior staff and will provide study leave and financial support within the limits of the study leave budget.

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PLAN AND WORKING ARRANGEMENTS

The job plan is subject to annual review which is the responsibility of the Medical Director, but may be carried out by the General Manager or Lead Clinician on their behalf. Under the terms of the current contract the Job Plan contains 8 PAs Direct Clinical Care and 2 SPAs). The duties of the post may be changed with the agreement of the postholder. Time off in lieu is given for working bank holidays and in return for working weekends.

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Provisional weekly timetable MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

AM 0.25 General medical Ward round Wider system MDT and Ward round PA clinic working with frailty rehabilitation ward followed by MDT team/UHS round – Longbeech with therapy team 0.25 2 PA Clinical admin 0.25 PA Clinical Admin 0.25 PA 0.25 PM Triage phone with Half day Wider system SPA SPA PA frailty service working with frailty 0.25 support team/UHS Monthly consultant PA meeting 0.25 PA

0.25 PA 0.25 Evening On call –variable PA days, 1 in 9 – 0.25 post take ward PA round following 0.25 morning PA 0.25 PA

On Call – Category A – Medium Intensity 1 PA – on call 2 SPA 1.5 PA inpatient ward rounds 1 PA rehabilitation ward round and MDT 1 PA triage phone 1PA clinical admin 2 PA time on wider system working with frailty team/UHS 1PA general medical clinic( including sub speciality interest)

Total 8 PAs DCC and 2 SPA

ACCOUNTABILITY

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The postholder is managerially accountable for the use of resources to the Chief Executive and professionally accountable to the Medical Director. This may be amended in the light of the Trust’s management arrangements.

CONDITIONS OF APPOINTMENT

This is a full time post (10 PAs). Applicants wishing to job share will be considered. The post-holder will be provided with office space, secretarial support and IT access. This post will be subject to the Terms and Conditions Consultants () 2003 and will comprise of a main contract of employment for ten programmed activities and a supplementary annual contract for any temporary additional programmed activities. Temporary additional programmed activities will be reviewed at the same time as the job plan. The postholder will have office space in the hospital management suite and will be given a laptop and secretarial support to carry out their duties.

CLINCAL GOVERNANCE

The Trust has established a robust and workable framework for Clinical Governance The appointee will be expected to contribute and, where appropriate, take the lead in [e.g.] the following • Mortality and morbidity meetings; • Clinical audit; • Development and application of agreed clinical guidelines.

CONTINUING PROFESSIONAL DEVELOPMENT The Trust is committed to supporting the development of its entire staff. The successful candidate is expected to participate in the Newly Appointed Consultants Development Programme and the Trust’s LEAD educational department. These programmes offer new consultants the support of mentorship in their new role.

The post holder is entitled to 30 days study leave over three years pro rota. He or she is also expected to be involved in a peer group to plan and support professional development. The post holder is expected to attend and participate in the academic programme of the Trust, including lectures and seminars as part of the internal CPD programme. Academic links with Southampton University are actively encouraged.

A full range of additional training and development courses and opportunities are available both within the Trust and externally. This provides a diverse programme of high quality multi-professional courses locally, involving the participation of national and international experts.

APPRAISAL AND REVALIDATION The Trust has a robust but supportive approach to appraisal and revalidation, with a clear process on the Trust’s website. The post holder will undergo annual appraisal with a fully trained appraiser.

We have introduced an electronic Revalidation Management System which all doctors who

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are appointed to the Trust are required to use. Our processes are quality assured. We have an HR team and Revalidation Lead who support the development of doctors to undertake appraisal or to be appraisers and run regular updates of current processes.

The Trust has documentation to support revalidation and maintains links with the GMC through the Employer Liaison Advisor. We have a revalidation mailbox and keen to encourage dialogue if there are areas of uncertainty or concern.

TEACHING AND TRAINING

All medical staff are encouraged to participate in Audit. There is an undergraduate teaching element to the job as both 3rd and 5th year medical students are attached to Lymington. The successful candidate will be expected to provide teaching for the doctors in training in their department. There is a well-equipped library with all the main medical journals, UpToDate, IT access and the services of a Librarian.

There are clinical postgraduate meetings held at Lymington Hospital once a week with presentations by Consultant staff, external speakers and trainees. A bi-monthly Mortality Meeting is established and postholders participate in preparation for these.

There are opportunities for research projects to be started through the Southern Health Research facility.

ANNUAL AND STUDY LEAVE

Study and Annual Leave is as laid down in Terms and Conditions of Service for Consultants, and is to be taken with the agreement of the Medical Director The Trust is fully committed to supporting continuing medical education (CME) and study leave will be available according to statutory guidelines.

TRAVEL EXPENSES

Travelling expenses are payable at full standard mileage rates for all duty visits to other Hospitals from the base Hospital.

DISCLOSURE AND BARRING SERVICE (DBS) As part of our recruitment procedure this post will be subject to a DBS check (previously CRB). A Disclosure is a document containing information held by the police and government departments. Disclosures provide details of a person’s criminal record including convictions, cautions, reprimands and warnings held on the Police National Computer. Where the position involves working with children, Disclosures will also contain details from lists held by the Department of Health (DoH) and the Department for Education and Skills (DfES) of those considered unsuitable for this type of work.

REHABILITATION OF OFFENDERS

This post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. Applicants are, therefore, not entitled to withhold information about convictions and, in the

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event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Trust. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the exemption order is applied.

MEDICAL CLEARANCE

Appointment to this post is subject to satisfactory medical clearance.

RESIDENCE

Residence within ten miles or thirty minutes by road, of the post holder’s base is usually required unless alternative arrangements are agreed with local management. The post holder must normally have a current driving licence and his/her private residence must be maintained in contact with the public telephone service.

POLICIES AND PROCEDURES

Subject to the provisions of the Terms and Conditions of Service, the post-holder will be expected to observe the Trust’s agreed policies and procedures, drawn up in consultation with the profession on clinical matters, and to follow the standing orders and financial instructions of the Trust.

Southern Health NHS Foundation Trust expects all medical and dental staff to work within the Guidelines of the “General Medical Council Guide – Good Medical Practice”.

In particular, where the post-holder manages employees of the Trust, he/she will be expected to follow the local and national employment and personnel policies and procedures. The post-holder will be expected to make sure that there are adequate arrangements for hospital staff involved in the care of his/her patients to be able to contact him/her when necessary.

All medical and dental staff employed by the Trust are expected to comply with its Health and Safety Policy and procedures.

VISITING

Candidates are encouraged to visit and should contact:

Dr Rachel Anderson – Clinical Services Director, West Hampshire Integrated Care (Rachel [email protected]) Ms Laura Rothery – Interim Area General Manager, West Hampshire Integrated Care

Please contact Laura Rothery, Area General Manager via the LNFH Management team secretaries, Tel. No. 01590 663263 to arrange appointments or email: [email protected]

Applicants will be reimbursed for the following interview expenses:- i. attendance for interview ii. Pre-interview visits for short-listed candidates only (maximum of two visits)

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SOUTHERN HEALTH NHS FOUNDATION TRUST

PERSON SPECIFICATION: CONSULTANT IN CARDIOLOGY AND GENERAL INTERNAL MEDICINE

REQUIREMENTS ESSENTIAL DESIRABLE MEASUREM ENT/EVIDEN CE

Qualifications MBBS or equivalent MD/PhD or higher Application MRCP or equivalent degree/diplomas

Full registration with the General Medical Council (GMC) with licence to practice

Entry on Specialist Register in Geriatric medicine

Holder of Certificate of Completion of Training (CCT) in Geriatric medicine, or within 6 months of award of CCT by date of interview

Experience Ability to provide expert clinical Application/In opinion across a wide range of terview problems within General Internal Medicine and Geriatric medicine Ability to take full and independent responsibility for the care of patients.

Skills Excellent communication skills Interview and Knowledge Ability to work flexibly and under pressure

Ability to work effectively with good time management and organisational skills

Ability to take responsibility and provide leadership where appropriate

Ability to work in a team environment and to develop effective working relationships on an individual and multidisciplinary basis with all levels of staff

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REQUIREMENTS ESSENTIAL DESIRABLE MEASUREM ENT/EVIDEN CE

Management Commitment to plan and develop Evidence of service Application/In Skills quality services development terview Experience of committee work/project management

Audit/Governanc Working knowledge and experience of Involvement in research Application/In e governance frameworks projects and published terview papers

Evidence of participation in audit

Ability to use research outcomes in Application/In clinical practice terview

Evidence of participation in Continuing Professional Development (CPD)

Teaching Skills Evidence of teaching experience with Experience of teaching Application/In a range of medical and allied health medical students terview professional staff Formal training in teaching skills

Other Computer Literate Interview

Ability to fulfil the travelling commitment of the post with transport within the parameters of the Equality Act

Ability to fulfil all duties of post including on call

Satisfactory DBS and Health checks

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