ST HELENA GOVERNMENT

TERMS OF REFERENCE

Specialist Anaesthetist/Intensive Care with General Medicine Knowledge

1.Background

1.1 The island of St Helena is an internally self-governing Overseas Territory of the United Kingdom located in the South Atlantic approximately 4,000 miles from the UK. The Government comprises a Governor (who is appointed by the Crown) an Executive Council, which has the general control and direction of Government, and a Legislative Council. The Governor retains responsibility for internal security, external affairs, defence, the public service, finance and shipping.

1.2 The island’s population is around 4,500 and it has a typical small island economy with a high import dependency, a narrow economic base, a large public sector (around 790 staff), and significant outward labour migration. St Helena receives UK Government financial assistance to support recurrent and capital expenditure as part of their obligation to ensure that the reasonable needs of the population are met.

1.3 The overall vision of the St Helena Government (SHG) is

“Strengthened community and family life through vibrant economic growth, with opportunities for all to participate, within a framework of effective government and law.”

1.4 To support this vision there are three National Goals:

  • A vibrant economy providing opportunities for all to participate
  • Strong community and family life
  • Effective management of the environment

1.5 A new vision and mission has been agreed for the Public Service, which will be incorporated in future plans and strategies:

Vision – A great place to work and serve the people of St Helena

Mission – Provide Services that are responsive to the needs and expectations of the people of St Helena, by taking account of their views in decisions on the design, delivery and performance of services, and by working with our colleagues to create an environment that encourages everyone to do their best.

1.6In November 2011 Her Majesty’s Government agreed to fund an airport. Construction is complete and the airport has been certified, but there has been a delay in terms of the airport becoming operational. The major construction activity leading up to this will significantly enhance St Helena’s economic prospects and have a dramatic impact on the island community, bringing a period of accelerated social and economic change. Achievement of the Goals and Strategic Objectives will require sound management and transformation of the public sector to make it a professional, modern, and flexible organisation able to initiate and respond to change.

1.7SHG is implementing a modernisation programme that will enable the Public Service to improve its delivery of the government’s developmental objectives. Central to this programme has been the re-structuring of Government functions and directorates. There are currently five directorates reporting to the Chief Secretary who is the head of the Service; Education and Employment, Health, Safeguarding, Environment & Natural Resources and Corporate Services. The Police Service reports to the Governor.

1.8The role of the Health Directorate is to deliver a high standard of health care to improve the health status and well being of the population, with particular emphasis on the vulnerable and those members of our community who are ‘at risk’. It aims to promote healthy lifestyles and reduce the incidence of non-communicable diseases. The functions for which the Directorate is responsible include medical, dental and nursing care, both in the community, at the primary care and at the secondary care level; environmental health; pathology and microbiology services; pharmacy services; and administrative services dealing with staff recruitment, budgeting, procurement, divestment activities and overall support to other sections of the Directorate.

1.9 We deliver the following services:

  • Community Primary Care Services, including Outpatient clinics at 3 areas of the Island and in Jamestown clinic, community nursing services, specialist nurse led clinics for those with long term conditions, mental health services as well as family planning and women and child health clinics
  • Medical and Nursing services, including hospital services such as surgery, acute care, maternity and accident and emergency services
  • Physiotherapy and Occupational Therapy services
  • Dental services
  • Environmental Health services including meat and fish inspections, food hygiene safety, port health, pest control and workplace health and safety
  • Laboratory services including Phlebotomy services, haematology and bio-medical lab services, food and water testing services, pathology testing
  • Pharmacy services in Jamestown and mobile pharmacy services to support outpatient clinics
  • Administration services providing support to all sections of the Directorate, which employs approx. 111 full-time staff

2. Key Objectives

The overall essential objectives of the post of are:

  • Be responsible for anaesthetic procedures on the island. This would normally mean one or two theatre day a week.
  • Be responsible for all intensive care patients on the island.
  • The anaesthetist will be on-call 24/7 for anaesthetics and intensive care patients.
  • Responsible for stabilization and the care of critically ill patients.
  • Responsible for implementing resuscitation procedures.
  • Participate in the general practice clinics and share out-patient and in-patient duties
  • Be a member of the general on-call rota to provide emergency out-of-hours care with back-up support from other medical professionals on island as required (surgery, cardiology, internal medicine, obstetrics and gynecology).Usually this means being on-call for general medicine every 4th to 8th day or depending on the number of Doctors available.

3. Scope of Work

The duties of theAnaesthetistshall include, but not be limited to, the following:

3.1The preoperative preparation of surgical patients

3.2Provide anaesthetics to adult and paediatric patients alike which would include general anaesthesia (LMA or intubation), neuraxial blocks and axillary plexus blocks. Neonatal cases may also arise.

3.3 The resuscitation and stabilisation of patients in the Emergency Department

3.4 Intensive care medicine

3.5Transport of acutely ill and injured patients

3.6Pain medicine including:

-Pain relief in labour and obstetric anaesthesia

-The relief of post-operative pain

-Acute pain medicine and the management of acute teams

-Chronic and cancer pain management

3.7The provision of sedation and anaesthesia for patients undergoing various procedures. Examples of this include different endoscopic procedures, interventional radiology and dental surgery (this list is not exclusive).

3.8 Requesting peer review on island OR through distant support when required and for any patient requiring overseas referral in consultationwith the Senior Medical Officer.

3.9Reviewing/updating and developing relevant protocols based on UK NICE orinternational best practice.

3.10Complying with and contributing, as required, to the development of the Government of St Helena Health Policy and with the St Helena Formulary.

3.11Providing assistance to colleagues in particular areas of expertise when and where appropriate.

3.12Undertaking programmes of medical and clinical audit as required under the direction of the Senior Medical Officer (SMO).

3.13Actively participating in and contributing to the clinical governance committee.

3.14Assisting the SMO in collection of health information data as required.

3.15Submitting short but comprehensive contract completion report to the SMO as per agreed format.

3.16Carrying out other duties as required.

4. Qualifications and experience

4.1Essential

  • Full G.M.C. registration or equivalence and good standing with that body.
  • Employed at Consultant level or at Senior Specialist Registrar with at least 7 years’ post graduate experience
  • Intensive care experience of at least 5 years
  • FRCA or DESA or equivalent
  • ATLS, APLS or equivalent
  • Good command of the English language

4.2Desirable

-Overseas experience in a remote location.

-Experience in general medicine or A+E

5. Competencies

Under the SHG Competency framework, this post holder is required to have the competencies as outlined in the attached annex.

6. Outputs, Timing and Reporting

  • Action plan to be submitted to the Senior Medical Officer within 2 weeks of commencing post to be prepared in close consultation with the Senior Medical Officer
  • Monthlyreports against agreed action plan and on progress against key indicators to be agreed in advance with the Senior Medical Officer
  • Comprehensive annual progress reports and/or contract completion reports as per agreed format.

6.2The post is required from January 2017 for approximately 2 years. Performance will be measured with respect to the Directorate’s overall performance in service delivery and achievements of agreed action plan tasks and targets.

6.3 The post holder will report directly to the Senior Medical Officer

Annex

SHG Competency Framework Levels

Professional Development

  • Requirements for Continuous Professional Development met in terms of requisite number of hours/number of development sessions, etc., and when necessary submitted to Professional Institute to maintain professional status.

Planning and delivery of work

  • Plans and organises work to meet individual, team and directorate/departmental objectives whilst achieving quality and value for money.
  • Recognises good performance and tackles poor performance.
  • Ensures delivery against plan.
  • Identifies information needs and ensures they are delivered in a timely and effective manner

Analysis and use of information

  • Interprets complex written information.
  • Able to assess the validity, relevance and limitations of different sources of evidence.
  • Generates a range of options and appraises them based on evidence available.

Decision making

  • Solves problems that have significant short-term implications for the organisation.
  • Assesses the impact of decisions.
  • Identifies causes rather than just symptoms to inform solutions.
  • Uses trends and patterns in information for evidence based decisions.
  • Confident in making decisions within policy guidelines
  • Assembles available knowledge to ensure evidence based decisions.

Working with others

  • Informs, consults and influences others using a range of communication mechanisms.
  • Engages with others to gather information
  • Shares and implements good practice with others
  • Works with senior management and other stakeholders

Communication

  • Ensures important messages are understood.
  • Ensures written communications are well structured and have clear meaning.
  • Presents information so that it has a positive impact on the recipient.
  • Engages well with others to understand their needs and aspirations.

Influencing and persuading

  • Encourages and provides constructive feedback to improve performance.
  • Ensures alternative approaches to work are effective in meeting the organisation and individual needs
  • Remains constructive when disagreeing or challenging.
  • Challenges inappropriate employee behaviours.

Dealing with change

  • Supports individuals in their team through periods of change.
  • Listens and responds to constructive feedback.
  • Initiates new ways of doing things.
  • Recognises and deals with obstacles to change.
  • Promotes goals or new initiatives to others.

Continuous improvement

  • Makes business and efficiency improvements through use of appropriate systems and tools.
  • Able to coach and develop individuals
  • Shares knowledge and experience with others
  • Manages own development and performance
  • Learns lessons from both successes and failures

Managing resources

  • Ensures appropriate resources and levels of capability to deliver to plan
  • Uses management information to monitor/control resources.
  • Supports initiatives for new and more efficient use of resources.
  • Gains respect and credibility from team members through effective delegation, coaching and development.

Required Clinical Competencies

  • Effectively plans, delivers and evaluates care, interventions and/or treatments to meet peoples health and wellbeing needs
  • Identifies and implements the relevant overall care /treatment plan for patients that is consistent with evidence-based practice and/or clinical guidelines, identifying specific precautions or contraindications, whilst respecting the individuals privacy and dignity and ensuring patients consent is sought and given whenever possible.
  • Monitors individuals’ reactions to care / interventions/treatment and takes the appropriate action to address any issuesor risks.
  • Reviews the effectiveness of the interventions/treatments and other specific activities and makes anynecessary modifications, ensuring feedback to the MO responsible for patients overall care.
  • Maintains accurate records of the activities undertaken and outcomes.
  • Responds to, records and reports any adverse events or incidents relating to the intervention/treatment with anappropriate degree of urgency.
  • Effectively assess physiological and/or psychological functioning and develop, monitor and review related treatment plans.
  • Determines and records diagnosis and treatment plans according to agreed protocols/pathways/models.
  • Recommends changes to the protocols and guidelines to the Clinical Guidance Committee.
  • Identifies individuals whose needs fall outside protocols/pathways/models and makes referrals to the appropriatepractitioners with the necessary degree of urgency.
  • Effectively communicates with patient’s relatives and explains the patient’s care with them as appropriate
  • Displays sensitivity to relatives’ level of understanding, culture, background, body language, feelings and emotions andpreferred ways of communicating.
  • Identifies the purpose of the communication with the relatives and anticipates its effect, effectively explains the patients care in non-medical language.
  • Promote, monitor and maintain best practice in health, safety and security
  • Identifies the risks involved in work activities and processes.
  • Identifies how to manage the risks consistent with legislation, policies and procedures.
  • Takes the appropriate action to manage an emergency, summoning assistance immediately when this is necessary.
  • Reports actual or potential problems that may put health, safety and security at risk and suggests how they might be addressed.
  • Supports others in maintaining health, safety and security.
  • Effectively supervise people’s work during a shift
  • Gives people opportunities to contribute to the planning and organisation of their work
  • Develops and explains plans and work activities to people and enable them to carry out their work effectively, consistent with legislation, policies and procedures

Required Managerial Competencies

  • Proactively identifies the needs and expectations of patients and strives to meet these
  • Ascertains and / or anticipates patient requirements to ensure that where possible these are met.
  • Explains sensitive or complicated information in a manner focused on the patients perspective and understanding.
  • Establishes positive relationships with patients.
  • Obtains regular feedback and acts on it to improve patient service.
  • Always considers the impact on all patients when making decisions.
  • Ensures the quality of own work meets job requirements and encourages quality in others work
  • Works within the limits of own competence. Not to attempt any procedure not trained for and experienced in.
  • Organises and prioritises own workload to ensure provision of a quality service.
  • Identifies opportunities to improve quality of own work and where appropriate underlying working practices.
  • Pro-actively committed to developing own personal skills, knowledge and behaviours, in order to improve performance within current role and potentially prepare for career moves. Supports others in their development.
  • Undertakes self review and seeks feedback from others on own work, and emerging job requirements.
  • Acknowledges own development needs, suggests areas for learning, and agrees personal development objectives forcurrent role and career development areas.
  • Takes responsibility for own personal and/or professional development.
  • Takes an active part in learning opportunities, evaluating the effectiveness of these and providing relevant feedback.
  • Maintains up-to-date portfolio of own development activities
  • Contributes to the development of others (e.g. through sharing knowledge, skills, experience or information), and partakes in the weekly CPD sessions.
  • Contributes to developing the workplace as a learning environment.
  • Generates and uses appropriate learning opportunities and applies own learning to the development of practice.
  • Able to appropriately and effectively use a range of communication approaches in order to inform, influence or persuade people in relation to more difficult subjects and / or situations.
  • Demonstrates the ability to respond quickly, constructively and honestly when challenged, encouraging input and feedback.
  • Thinks ahead and prepares well for situations that involve persuasion and negotiation.
  • Enables the team to achieve objectives, through actively building and promoting an effective team, within a multidisciplinary environment.
  • Achieves commitment and ownership of the teams objectives through sharing responsibility with team members.
  • Demonstrates high standards of integrity, honesty and fairness, leading by example.
  • Keeps team members informed and up-to-date about all relevant or useful information.
  • Supports and champions the team, ensuring they understand their role in the wider organisation.
  • Supports team members in delivering change.
  • Adopts an open, visible approach, actively participating in the team and being readily available to team members for discussion, advice or consultation.
  • Required to comply with Good Medical Practice (GMC)as defined by the UK General Medical Council, details of which are available on the GMC website