Dumfries and Galloway Royal Infirmary
THE POST
NHS Dumfries and Galloway is committed to developing and improving services for older people. Redesign of services at Dumfries and Galloway Royal Infirmary is currently underway, with our new District General due to open in Spring 2018. In addition to the clinical commitment the successful candidate will have opportunity to contribute to planning of the new hospital and in particular appropriate facilities for Care of the Elderly. This new post available will form part of our team of 4 Consultants in the Directorate across Dumfries and Galloway. This post will be based at Dumfries & Galloway Royal Infirmary, will provide cover at Community Hospitals in Stewartry and Nithsdale and contribute to managing patients at front door. Cover at other peripheral sites across Dumfries and Galloway may be required, dependent on future service modelling. A further sub-speciality interest may be agreed depending on individual interests and service needs.
This appointment will be to support front door and services in the community. The successful candidate will also participate in the Frailty Pathway and acute medical on-call rota. Dual accreditation in General Medicine and Geriatric Medicine is essential.
The main duties and responsibilities of the post:
· Responsibility for Comprehensive Geriatric assessment for frail elderly either at front door or in the community- Patient pathway and consultant involvement will be agreed following mutual discussion with the present frailty team
· Participation in 1:12 Medical Receiving Rota
· Provision of outpatient service for elderly patients with general medical problems
· Provision of out patient service depending on consultant’s sub-speciality interest.
· Provision of cover for consultant colleagues during periods of annual and study leave
· Professional supervision and management of Junior Medical Staff as required.
· Responsibilities for carrying out teaching, accreditation and examination duties as required, and for contributing to undergraduate and postgraduate medical education. The successful candidate will be expected to comply with College recommendations on Continuing Medical Education.
· Compliance with NHS Dumfries and Galloway’s Policies on Clinical Governance.
· The successful applicant will be encouraged to participate in research and to develop a relevant subspecialty interest, subject to resources and local priorities.
· Requirement to participate in medical audit and continuing medical education.
· Managerial, including budgetary, responsibilities (where appropriate).
DEPARTMENT OF MEDICINE FOR THE ELDERLY
2.1 Facilities
Care of the Elderly and Rehabilitation services are responsible for providing a comprehensive range of care for older people across Dumfries and Galloway. The Clinical Lead is currently Dr Roger Holden.
Medicine for the Elderly Services are provided from two core acute sites – Dumfries and Galloway Royal Infirmary, Dumfries and Galloway Community Hospital in Stranraer – and input into nine cottage hospitals.
A brief description of the services provided on each of these sites is outlined below:
Dumfries and Galloway Royal Infirmary, Dumfries
· 35 Acute Care of the Elderly Assessment beds, divided between two separate wards [14&18]
· 9 bedded Acute Stroke Unit, in ward 12
· Outpatient department which supports General Medicine, Movement Disorder, Stroke and TIA clinics.
Galloway Community Hospital Stranraer (Wigtownshire)
· 20 Acute Medical Beds in the Garrick Ward
· 26 Care of the Elderly and Rehabilitation beds in the Dalrymple Ward
· Day Surgery and Outpatients
Moffat Hospital, Moffat (Annandale and Eskdale)
· 12 assessment, slow stream rehabilitation and palliative care beds; GP led
· MIU
Lochmaben Hospital, Lochmaben (Annandale and Eskdale)
· 12 assessment, slow stream rehabilitation and palliative care beds; GP led
· Day Hospital
Annan Hospital, Annan (Annandale and Eskdale)
· 18 assessment, slow stream rehabilitation and palliative care beds; GP led
· Outpatients
· Day Hospital
Thomas Hope Hospital, Langholm (Annandale and Eskdale)
· 12 assessment, slow stream rehabilitation and palliative care beds; GP led
· Dementia Day Services
Allanbank, Dumfries (Nithsdale)
· 24 assessment, slow stream rehabilitation and palliative care beds - this post
Thornhill Hospital, Thornhill (Nithsdale)
· 13 assessment, slow stream rehabilitation and palliative care beds; GP led
Castle Douglas Hospital, Castle Douglas (Stewartry)
· 19 assessment, slow stream rehabilitation and palliative care beds – this post
· Outpatients
· Day Hospital
· MIU
Kirkcudbright Hospital, Kirkcudbright (Stewartry)
· 11 assessment, slow stream rehabilitation and palliative care beds; GP led
· Outpatients
· MIU
Newton Stewart Hospital Newton Stewart (Wigtownshire)
· 22 assessment, slow stream rehabilitation and palliative care beds; GP led
· Day Hospital
· MIU
· Out of Hours hub
2.2 Education
The successful candidate will have the opportunity to participate in, and contribute to, educational activities run by the Department and jointly with colleagues in the Division of Medicine. This involves Wednesday lunchtime educational sessions and a Friday lunchtime Journal Club.
The successful candidate will contribute to the training of non-consultant medical staff of all grades and other multi-disciplinary team members as required and participate in the teaching of under-graduate students. They will be expected to help with induction training of junior and middle grade medical staff.
2.3 Duties to Others
The successful candidate will at all times conduct themselves in a professional manner and work in accordance with recognised best practice. As multi-disciplinary working is central to the post, the successful applicant will be an effective team player and will involve him or herself with all team members including consultant colleagues. In planning and organisational matters the successful applicant will put the needs of the service first, will accept change and re-organisation when necessary and will contribute to the reaching of consensus when policies are being determined.
The successful candidate will communicate effectively with patients, their relatives and carers and with all multi-disciplinary team members. The successful candidate will provide time within their allocated sessions to meet with relatives and carers in the interests of good practice or when requested to do so.
2.4 Key Result Areas
- Maintaining high quality cost effective clinical care, with feedback from all available sources.
- Contribute to good patient flow.
- Yearly appraisal and job planning.
- Maintaining or further enhancing the high quality of clinical teaching for medical students that has existed in Dumfries & Galloway for many years, with the feed-back reports from students being used as an outcome measure.
- Taking part in clinical audit and all aspects of clinical governance, as required by the Department and by the GMC.
- Completing satisfactory CPD.
- The Hospital has a Research Department, and the post-holder will be able to obtain support in the preparation and carrying out of research projects, as clinical time allows.
- The successful candidate will be expected to work well with an extended multi-disciplinary team, ensuring good communications and co-operation.
2.3 Medical Staff Resources
The staffing of the Care of the Elderly and Rehabilitation unit is as follows:
Consultant Staff / Post Holder / Specialist InterestConsultant / Dr Ian Hay / Stroke
Consultant / Dr Roger Holden / Orthopaedic-Geriatric & Falls
General Geriatrics
Consultant / Dr Konstantinos Graikos / General Geriatrics
Other sub specialty to be determined
Rehabilitation
Consultant / Dr Alison McKendrick / Rehabilitation
VACANCY (this post) / Geriatric Medicine/Front Door/Community
Associate Specialist / Base / Specialist Interest
Dr Shona Donaldson / DGRI / Parkinson’s Disease/Movement Disorder
Specialty Doctors
Dr R Malik / DGRI / Stroke Medicine
Dr L Craig/ Dr E Reid / DGRI / Rehabilitation
Dr K Boyle / DGRI
Training Grades / Base / Specialty
GPVST/ST1/FY2 / DGRI / Geriatric/Medicine Rotation
FY1 (2 x WTE) / DGRI / Geriatric/Medicine Rotation
2.4 Activity Medicine for the Elderly (2012-13, average per annum):
Locality / Hospital / In-patient nos. / % Occupancy / Ave length of stay / Newout-patients / Return
out-patients
Nithsdale / DGRI / 1,590 / 95 / 9.7 / 474 / 298
Nithbank / 147 / 180
Allanbank (Craigs) / 2 / 82 / 19.0
Thornhill / 76
Stewartry / Castle Douglas / 87 / 20
Kirkcudbright / 68 / 16
Annandale & Eskdale / Moffat / 1 / 74 / 5.0
Lochmaben / 96 / 94 / 40.0
Thomas Hope / 2 / 60 / 7.0
Annan / 157 / 94 / 34.8 / 1 / 33
Wigtownshire / GCH / 202 / 84 / 30.7 / 48 / 162
Newton Stewart / 4 / 69 / 1.3
3. FUTURE PLANS FOR MEDICINE FOR THE ELDERLY
Retirements and the recent Health and Social Care Integration has led to the opportunity to change the model of medicine for the elderly within Dumfries and Galloway and we are now looking to extend community services designed to allow older people to remain in their own homes. We have well established Short Term Assessment and Rehabilitation Services, Community Rehabilitation teams and Allied Health Professional services, Homecare services and step-up beds within community. These Reablement and rehabilitation teams are closely linked with the Directorate in terms of access to specialist clinical advice and for education and training. There is ongoing work to develop sustainable service models to meet anticipated rising demand. The successful applicant will have the opportunity to participate in and lead aspects of these developments.
We are currently testing a Frail Older People’s Pathway in Dumfries and Galloway Royal Infirmary with the aim of providing person-centred care for all frail older people attending the Acute Medicine Unit. Future plans include extending the development of a seven discharge team to support timely discharges back to the community. The successful applicant would be encouraged to take an active role in these developments.
4. PROPOSED WEEKLY PROGRAMME
Principal Place of Work: Stewarty and NithsdaleTotal No. of Programmed Activities: / 12 ( including on-call)
Extra Programmed Activities: / 0
DAY / HOSPITAL/ LOCATION / ACTIVITY
FROM / TO
Monday
a.m. / Castle Douglas / Ward round and patient reviews
p.m. / Allanbank / Ward round and patient reviews
Tuesday
a.m./p.m. / Castle Douglas / Patient reviews
Wednesday
a.m. / Castle Douglas / Patient reviews
p.m / Allanbank / Patient reviews
Thursday
a.m. / Castle Douglas / Patient review
p.m. / Castle Douglas / Patient review
Friday
a.m. / Castle Douglas / Patient review
p.m. / Allanbank / Patient review
Saturday/
Sunday / nil
nil
Activities with current fixed time commitments will be carried out as detailed in the work programme eg clinics. Other DCC and SPA activities are shown with indicative timings within the weekly programme and will be discussed with the successful candidate. This timetable will be reviewed three months following appointment and should therefore be regarded as an interim programme. Opportunities may exist for Extra Programmed Activities to be undertaken subject to service requirements and in accordance with national terms and conditions of service.
GENERAL PROVISIONS
Policies & Procedures
§ The successful candidates are required to work within the local management structure and co-operate with other professional colleagues to ensure the efficient running of the service and will take part, with other consultant colleagues in the medical contribution to management.
§ Subject to the provision of terms and conditions of service, the postholder is required to observe the organisation’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 organisation.
§ The postholder is required to ensure that there are adequate arrangements in place for hospital staff involved in the care of patients for contacting him/her when necessary.
§ The postholders are required to comply with the Organisation’s and the Department’s Standing Operating Procedures including Health and Safety Policies.
§ The post-holder will be professionally accountable to the Clinical Director.
§ The post-holder will be managerially responsible to the General Manager.
Travel
Any travel allocation will be included within the Total Programmed Activities and will be determined by the location at which Direct Clinical Care and Supporting Professional activities are carried out.
Administration
This activity covers the management of individual patients including out patient administration, results reporting, letters/phone calls to patients, carers, GPs and members of the wider multidisciplinary team involved in the patients care.
Supporting Professional Activities
A minimum of one SPA is included in the indicative job plan, amounting to 168 hours per annum which shall normally be sufficient to reflect activities such as revalidation, appraisal, personal audit, and professional development (occurring outwith the 30 days of study leave entitlement in any three year period). Time permitting, it may also cover minimal teaching, training and non-clinical administration. Any additional SPA allocation will require to be evidenced as being mutually beneficial and required by the department. Adjustment to the programme to incorporate additional SPA will require other activities to be reviewed to accommodate any increase as necessary. It will be requested that SPAs are delivered at the normal place of work, unless there are mutual advantages to it being performed elsewhere. The exact timing and location of SPAs, and flexibility around these, will be agreed during the 1:1 meeting with the Clinical Director/Associate Medical Director and included in the prospective job plan.
Private Practice
If the postholder wishes to undertake any private practice, he/she is obliged to inform his/her employer at the time of appointment of his/her intention to do so. This should be submitted in writing to the Medical Director.
The postholder shall be free to undertake private practice without approval provided such work is undertaken outside the time agreed in the job plan for programmed activities and is in accordance with the national terms and conditions to service. (Refer Section 6 of the New Consultant Contract).
Annual Appraisal & Job Planning
You shall also be required to participate in annual appraisal. Job planning is linked closely with, but is separate to, the agreed appraisal scheme for consultants. The job plan review will take into account the outcome of the appraisal discussion and reflect the agreed personal development plan.
TERMS & CONDITIONS OF SERVICE
The terms & conditions of service offered are those determined by the Consultant Contract 2004 Scotland (as amended from time to time).