Job Description

Consultant Physicians in Acute and/or General Medicine

Applications are invited for aConsultant Physician in Acute and/or General Medicine, based at the Balfour Hospital in Orkney. The appointeewill join the existing Medical Team in developing services on the Acute Ward,A&E which incorporates the Acute Receiving Unit and the Assessment and the Rehabilitation Ward. The Consultants will work with the Rural Hospital GPs and be supported by up to 4GPSTs and nursing staff.

Candidates should be on the Specialist Register or be within six months of obtaining their Certificate of Completion of Training (CCT) in Acute Medicine and/or General Internal Medicine, and hold full GMC registration.

These are challenging but influential posts in the remote and rural setting. The successful candidates will provide professional continuity of care for acutely ill medical patients. The role will be supported by an obligate network arrangement with NHS Grampian.

This postwill support the development of the Acute Medicine Service and will have an integral part in planning and implementing the new hospital care campus. The appointees will work closely with the Rural Hospital GPs, Anaesthetic and Surgical Consultants to deliver optimum patient care and develop NHS Orkney as an innovative centre for remote and rural health care. NHS Orkney is already recognised for its progressive approach to telemedicine, and the post holders will be expected to support the further development of this. In addition to the current team, we are looking to appoint colleagues who are innovative and proactive, and who can demonstrate a commitment to excellent patient care. We welcome applications from those wishing to develop an interest in or having an established interest in Geriatric Medicine, Cardiology, Respiratory Medicine, Medical Management and Service Development, or Education.

The post is for 7.5 Direct Clinical Care Activities and 2.5 Supporting Professional Activities. Two Extra Programmed Activities will be included but will be open for negotiation.

An enhanced induction process tailored to individual needs will be provided to ensure full competency in the requirements for work in remote and rural setting of Orkney, with the support of NHS Education of Scotland and NHS Grampian.

NHS Orkney health board has one Remote and Rural General Hospital and serves a population of 20,000. Complex medical and surgical cases are stabilized and transferred to mainland Scotland and two high dependency beds are available. In the immediate future, NHS Orkney is undertaking a number of major capital developments including the development of a local CT scanning service, a new hospital and healthcare campus. These developments present a hugely exciting opportunity to shape and deliver leading edge, innovative acute medical care in the remote and rural setting.

  1. Description of Hospital

The Balfour Hospital provides acute medical care, with 1200 medical admissions per annum.

Currently services are configured as follows:-

A&E Dept, which incorporates theAcute Receiving Area - with assessment, resuscitation and observation areas

Acute ward - male and female, medical and surgical16 beds

Assessment and Rehabilitation Service18 beds

Maternity Unit6 beds

Macmillan Unit 4 beds

HDU2 beds

Bed complement: 46 beds.

One of the beds in A&R is used as a Place of Safety/Mental Health Transfer bed.

The Day Surgery Unit has 6 beds.

The medical staffing in the Balfour Hospital currently consists of:

  • The Acute Medical Team, consisting of 6.4 WTE Remote and Rural GPs with a special interest in medicine. Due to vacancies, the team consists of Dr Charlie Siderfin, Dr Elaine Tomsand Dr Kevin Woodbridge
  • The Surgical Team has two consultants in post: Mr Michael Dohrn, and Mr Caesar Zawal. Recruitment of a third consultant surgeon will commence shortly.
  • The Anaesthetic Team consists of two full-time consultants, Dr Marek Wolanski and Dr Anita Sowinska, and a part time consultant, Dr Colin Borland. Recruitment to a full-time consultant posts is currently underway.
  • A locum obstetrician, Dr Ernest Akrong is currently leading the obstetric team.
  • A part-time Consultant Orthopaedic Surgeon, Mr Marthinus Roos, also works in the hospital

Medical, surgical, and paediatric patients are initially seen in the Acute Receiving Unit.Minor cases are treated and discharged, with more major presentations being dealt within the assessment or resuscitation areas as appropriate. Patients can be discharged, admitted to an appropriate hospital bed or transferred to a major centre from here, with a High Dependency Unit facilitating this process.

Very effective air ambulance retrieval services for adults, paediatric, neonatal, maternity and mental health patients are regularly used for transfer of seriously ill patients to appropriate hospitals in the Scottish Mainland – mainly Aberdeen Royal Infirmary.

Acute medical input is provided to the assessment and rehabilitation unit, which includesfouracute stroke beds, by the Medical Team in and out of hours.
Cancer and Palliative care services are provided in Macmillan House by the patient’s own GP or the Skerryvore Medical Practice, and Cancer & Palliative Care Specialist Nurses.

There is a fully equipped modern Theatre Suite and a 6-bedded day surgery unit, which is being developed to become a unit caring for all short term day cases (including medical).

Services for children are designed to be appropriate for a non-specialist unit. The clinicalcare team, which is composed of nursing staff, the medical team, anaesthetists and paramedics are responsible for the resuscitation, stabilisationand ongoing management of critically ill children, until the arrival of the nation-wide retrieval team. It is recognized that the competencies required in a remote and rural setting may be broader than those obtained through a conventional training scheme, and supplemental training can be provided to ensure the successful candidate can fully discharge the clinical duties of the post. Training in the management of Paediatric Emergencies will be provided as part of induction if required. Neonatal care is provided by the Obstetric Team and Midwifes, with support from the Anaesthetists.

Patients requiring care which is not available in Orkney are transferred to the Scottish mainland, predominantly to NHS Grampian, but depending on availability of beds, expertise and weather conditions, patients may have to be cared for in the HDU for periods of up to a day or two while awaiting transfer, which can be very challenging. Such patients will be cared for by team-working between Physicians and Anaesthetists. Training in the management of HDU patients will be provided as part of induction if required.

Neonatal, Paediatric, Maternity, and Mental Health retrieval services, as well as the Emergency Medical Retrieval Services (EMRS), are available to transport patients requiring care not available on the island.

Visiting consultants from Grampian and Highland Health Board Areas support a wide range of additional specialist clinics. Support services include laboratory and radiological services (including diagnostic ultrasound), physiotherapy and occupational therapy departments.Plans to locate a CT scanner on the island are far advanced.

  1. PRINCIPAL DUTIES

The successful candidate will be expected to work flexibly and achieve high quality care with particular emphasis on:

  • The quality of care, with person-centred, safe and effective working the focus for all activity.
  • It is envisaged the post holder will have considerable experience in the management of the acutely ill patient. Experience in high dependency medicine and/or experience in A&E would be an advantage.
  • To lead in the care of medical patients admitted to the Acute Receiving Area, the Acute Stroke Beds and the specialist medical care of patients in the Assessment and Rehabilitation Unit, working alongside and utilising a pool of other doctors and nurse practitioners to ensure general medical cover and continuity of care.
  • To provide outpatient clinics for selected patients discharged from the receiving unit, including a “virtual ward” and to establish a rapid assessment service for General Practitioners. The number of clinics will depend on need.
  • To provide emergency care to paediatric patients in theAcute Receiving Unit, in close liaison with Grampian Paediatricians and the Paediatric Emergency Care Network currently being established in Grampian. Children that require admission are transferred to the Aberdeen Royal Children’s Hospital for further care. Training to allow the recognition of the seriously ill child, as well as the initial treatment of such children, will, depending on need, be provided as part of the induction for the post.
  • The consultant will be working with a team of doctors providing medical care during the day, and care of all patients in the Balfour Hospital after hours. This team will comprise of doctors with a wide (but varying) range of skills in Medicine, A&E, Surgery, HDU care and Paediatrics, and who will be involved with psychiatric emergencies (with support from the Community Mental Health Team and Grampian’s Cornhill Hospital.
  • The successful candidates will be providing higher levels of care to patients, such as those awaiting emergency transfer off the island, in the High Dependency Unit, in close team-working with the Anaesthetists.
  • The very broad range of skills and competencies required to practice in a Remote and Ruralsetting such as Orkney differs from mainstream subspecialised medicine. To ensure that the candidate appointed will have those skills, tailored support in acquiring those skills will be addressed during the induction period, when the candidate will spend time in NHS Grampian. The program for this period will be tailored for the individual requirements of the successful candidate.
  • To provide leadership and seamless team working, together with colleagues in the hospital, in primary care and the community, to ensure effective management of acutely ill patients as part of their clinical journey that straddles all the services.
  • Providing leadership in the management of chronic disease in Orkney, with involvement in the Managed Clinical Networks for Chronic Disease, such as Stroke Care, Diabetes Respiratory Care etc.
  • Developing appropriate services to meet clinical needs within available resources
  • Facilitating early discharge and reducing the length of stay.
  • Demonstrating a firm commitment to the principles of clinical governance and effective clinical audit, and participate in Morbidity and Mortality Meetings, implementing SIGN/NICE and other national guidance,
  • Participating in the education and training of doctors, nurses and allied health professionals including those in primary care, and fostering by example an atmosphere within the hospital which encourages learning and reflective practice. It is expected that the post holders will complete a course such as Training the Trainees to enable compliance with the upcoming GMC requirements to train junior doctors.
  • Participation in annual appraisal, revalidation and licensing, and CPD to maintain and refresh their skills and competencies are required.
  • A requirement to undertake other appropriate clinical and administrative work on behalf of NHS Orkney such as participation in Major Incident planning and supporting work around future service design options.
  • Participation in the development and renewal of clinical care models in preparation for a new build Care Campus.
  • A requirement to meet performance targets as described in the HEAT targets (health efficiency access treatment targets) set out by the Scottish Government Health Department. HEAT targets form part of the NHS Orkney Local Delivery Plan (LDP).
  • Hospital staff should be able to contact the post-holders when on-call, both in and out of working hours. The Board will provide communications equipment as appropriate in order to facilitate this.
  • Due to the size of the clinical teams in Orkney, assistance from all medical staff might be required during major incidents.
  • A requirement to work within the strategy developed by NHS Orkney promoting closer integration of services and closer working relationships, both between disciplines, and with partner agencies, to ensure patient centred care.
  • The candidates will be expected to take part in the activities of various committees, such as the Resuscitation Committee, the Drug and Therapeutics Committee, the Area Medical Committee and others
  • Subspecialty interests can be accommodated by close working relationships with Grampian services

3.EDUCATION, TRAINING AND RESEARCH

NHS Orkney supports the requirements for Continuing Medical Education and is committed to providing reasonable amounts of time and financial support for these activities.

Study leave of 30 days in 3 years and an annual study leave allowance will be provided. Twenty to 25 hours of external CPD should be funded with the study leave allowance. This is in addition to the time spent in the Grampian Medical Departments. The CPD program should be approved by the post-holder’s line manager to assure alignment with service requirements as part of annual job planning. Generous allowances are made for travelling, taking into account the challenges to attend activities on the Scottish mainland

NHS Orkney is keen to develop and support research and innovation, particularly in the area of telemedicine.

A multi-professional Education and Training Suite was opened in 2011. This comprises an e-suite of well equipped training rooms, with access to an extensive range of manikins, including SIM-Man and SIM-Baby and audio-visual equipment, including video-conferencing facilities.

The role will involve teaching medical, nursing and AHP staff to ensure acute care competencies and chronic disease management skills across the services. In particular, ensuring the ongoing competency and development of the core skills within the multi-disciplinary service by developing, promoting and contributing to a multi disciplinary educational programme, including the Orkney Multidisciplinary Education Programme.

4.CLINICAL GOVERNANCE AND AUDIT

NHS Orkney is continuing to develop clinical governance and patient safety arrangements building on existing frameworks. Consultant representatives are members of the Operational Clinical Governance Committee which oversees all clinical governance activity, including management of clinical risk. The health board has a Health Intelligence and Clinical Governance Department which provides advice and support on developing audit systems and research governance. The appointee will audit their practice as appropriate or supervise juniors in medical audit.

Consultants will be encouraged to participate, either in established projects or to initiate research topics of relevant interest.

All clinicians are expected to take an active part in clinical audit, as well as supervising audits undertaken by their teams, ensuring that the audit cycle is completed, and any required change in practice is implemented. They must be willing to develop a culture of audit in the acute care situation and ensure that these activities are incorporated into the day to day activities of the acute service.

The post holder is expected to contribute to the Clinical Governance of the Balfour Hospital and NHS Orkney by:

  • Developing (in conjunction with Aberdeen Royal Infirmary), maintain and promote protocols for conditions contained in the defined Rural General Hospital Core Activity and to work within these protocols.
  • Promoting and being actively involved in the audit programme.
  • Contribute and lead regular joint morbidity and mortality meetings.
  • Undertaking Significant Adverse Event Analysis of cases that warrant such analysis.
  • Undertaking annual individual appraisal.
  • Maintaining personal continuing professional development
  • Acting as a positive role model for good medical practice and positive ways of working.

5 CLINICAL NETWORK WITH NHS GRAMPIAN

The successful candidates will have a primary appointment in NHS Orkney, where the candidates will work and live. A joint appointment with NHSGrampian, in the form of an honorary contract, will occur. The purpose of this is to encourage close working relationship with colleagues in the Medical Departments in Aberdeen Royal Infirmary and other Grampian hospitals, participation in their CPD programs and access to their departments for training and support. It is envisaged that the successful candidates will spend 2 or 3 weeks per year working in the Grampian hospitals, over and above the post-holders’ usual CPD program.

6.JOB PLAN

This will be agreed, but will as a minimum include

  • Daily ward rounds for all medical patients, as well as other patients with medicalproblems
  • Outpatient clinics – Rapid Access Clinics, with TIA patients included, and Virtual Ward Rounds for patients cared for in the community.
  • Availability for emergency/acute receiving when on duty
  • Clinical Governance and Patient Safety.
  • Teaching
  • The service is provided on a 24 hour basis and includes an on-call rota, which equates to 1:3. There is an 8% allowance for this level of on-call, as well as an increase in annual leave. Locum cover will be available for sickness or unexpected absences.
  • The consultant team will be supported by a team of doctors, who will be in the hospital 24/7.
  • Travel and subsistence expenses for all travel to the Scottish Mainland for NHS Orkney related meetings, CPD and training, will be paid for by NHS Orkney.
  • An annual job plan will be negotiated and agreed between the Hospital Manager and each physician and will depend on service requirements.

7.CLINICAL MANAGEMENT STRUCTURE

This role will report managerially to the General Manager of the hospital and professionally to the Medical Director.

In agreement with the appointee, NHS Orkney will provide a mentor to support those undertaking their first Consultant appointment.

8. PATIENT BASED INFORMATION SYSTEMS AND DATA QUALITY

NHS Orkney has recognised that information technology serves an increasingly important role and is undertaking an extensive EHealth programme, including implementation of new patient-based information systems, critical to this is the electronic patient record in both acute and primary care. The system will build to facilitate access to the patient’s radiology, pathology, and theatre history together with decision support software and specialty systems. There is a variety of health informatics initiatives, both established and soon to be piloted, to enhance efficiency in patient care and clinical management. The use of speech recognition software is encouraged.