MEDICAL DIRECTOR
10 PA + ON-CALL commitment
JOB DESCRIPTION

1. THE POST

The Medical Director will be an active senior clinician involved in all coreclinical services of the hospice (Inpatient care, Day Services and Community Services), will head the hospice medical team, and will be a member of the hospice Executive Team. They will work in closepartnership with their fellow clinical director (the Director of Patient Care) at the hospice in developing and monitoring the hospice clinical services, fostering effective and mutually supportive multidisciplinary working; and ensuring that all necessary elements of clinical governanceare in place to support patient safety and professional revalidation for all disciplines of hospice staff.

2.INTRODUCTION

2.1 St Peter’s Hospice – clinical services

St Peter’s Hospice is a well-established charityfocussed on supporting and delivering community-based Palliative Care to any patients with incurable, progressive disease in the wider Bristol area who have complex and/or intense needs. The hospice services are based on a large team of Community Nurse Specialists who visit and advise patients and their families; with access available toIn-patient, Day Hospice, Out-patient, Hospice at Home and Bereavement care. This range of services isprovided by a fully staffed multidisciplinary team and isfurther supported by the hospice Education Department which delivers a wide range of courses to external professionals as well as offering an extensive staff development programme.

The hospice has been operational for 36 years and the clinical services are now configured onto 1 main site (having previously been run from 2 hospice buildings); with an additional 3 community bases for the Community Nurse Specialist teams – in Yate (to the North), Staple Hill (to the East) and Long Ashton (to the South). The hospice Commercial Team is also based at Long Ashton.

In addition, the hospice is now involved in the launch of a new End of Life Care Coordination service, in formal partnership with Bristol Community Health, for the Bristol Clinical Commissioning Group. This is to be based at Avonmouth and as part of this ‘Test and Learn’ project our Hospice at Home team have moved from Brentry to this new location.

At any given time the hospice is involved in the care of up to 700 patients in the community, along with 18 in-patients and up to 20 patients per weekday in the Day Hospice (which runs 4 days per week). The Day Hospice premises are also used for a Fatigue and Breathlessness Management programme, while our Garden Rooms are used for a range of individual and group work (with patients, carers and wider family members) offered by our Psychosocial and Spiritual (PSS) team. The majority of the patients referred to the hospice have cancer, but there has been a clear policy of inviting referrals for patients with non-malignant disease for over 20 years now, and the numbers of patients with neurological (particularly MND), renal, cardiac and respiratory diseases is slowly growing (currently this stands at approx 20% of our total referrals). Over 2500 patients die of cancer each year in the area covered by the hospice (population approx. 870,000 served by over 480 GPs) and St Peter’s Hospice is involved in the care of up to 2,500 patients each year.

2.2 St Peter’s Hospice – the charity

The hospice is a charity which is both well-established and financially secure – and there is an NHS contract in place with the local cluster of CCGs (Bristol, North Somerset and South Gloucestershire) which currently provides about 22% of the annual income.

The hospice has also developed strong links with the local acute NHS trusts and other statutory and independent providers of palliative care; while all disciplines of hospice staff collaborate closely with their colleagues working in these other settings.

St Peter’s is the only adult hospice serving patients in the wider Bristol area and maintains a high profile, excellent reputation and impressive level of public support.

  1. THE WORK OF THE HOSPICE

3.1 Hospice clinical staffing

Medical Directorate

  • F/T Medical Director (10 PA + on-call) – currently Dr Carole Dacombe
  • Consultant post with United Hospitals Bristol NHS contract (8 PA + on-call) involving 7 PA at the hospice and 1PA within the UHB Palliative Care Team / University of Bristol Palliative Medicine Department based at the Bristol Haematology and Oncology Centre – Dr Dida Cornish
  • Consultant post of 8PA + on-call entirely based at the hospice – Dr Beth Wright
  • Locum Consultant fixed-term post of 6 PA + on-call – Dr Rebecca Bhatia
  • Associate Specialist (working 0.7WTE) – Dr Sophie Tower
  • At least 1 Specialist Registrar (can vary from 0.6WTE to 1.2 WTE) – on the Severn Deanery Higher Specialist Training programme
  • 2 ST1 Doctors on the Severn Deanery GPVTS – 1 in a 6-month post and 1 in a 4-month post
  • 1 part-time (currently 20hrs/week) Medical Secretary to support the Senior Medical Team (Medical Director, 3 Consultants and Associate Specialist)
  • Band 7 Therapists Team Leader (OT by discipline) leading a team of 2 part-time Band 6 Physiotherapists and 1 part-time Band 6 Occupational Therapist (total of 44hrs/week in each clinical discipline for service delivery and an additional 7.5hrs for the leadership role).

Discussion is on-going about the future configuration of the Senior Medical Team – with a

full acknowledgement that the current fixed-term locum post will need to be followed up

by a permanent post, the job plan for which can only be determined once the Medical

Director role is appointed and its job plan affirmed.This will also offer the opportunity to

agree an overall set of job plans that can provide resilient senior medical cover for all our

services 52 weeks/year along with clearly defined medical leadership roles within each of

the service areas.

Directorate of Patient Care

  • F/T Director of Patient Care – Ms Julia di Castiglione
  • F/T Community Nurse Specialist Team Manager – responsible for the 4 community nurse specialist teams:
  • 20WTE Community Nurse Specialists divided into 4 teams, each with a designated team leader and overall support provided by a 1.5 FTE Administrators
  • F/T Clinical Access Service and Projects Manager – responsible for:
  • Hospice at Home team, with a designated team leader and admin support – capable of delivering approx 17,000 hours of direct patient care per year
  • Access team of specialist nurses and administrator responsible for receiving and triaging all referrals to the hospice clinical services and all advice calls to our Specialist Palliative Care Advice-Line – within their 7-day working hours.
  • End of Life Coordination Service in partnership with Bristol Community Health and Bristol CCG
  • F/T Psychosocial and Spiritual Services Manager responsible for all PSS services offered at the hospice, along with the practitioners involved and the administrator:
  • 2 Senior Social Workers
  • 1 part-time Music Therapist
  • 1 part-time Art Therapist
  • A Bereavement Services Coordinator responsible for a team of 30 trained Bereavement volunteers
  • A F/T Spiritual Services Coordinator
  • F/T Clinical Services and Quality Manager - responsible for the overall management of the Day Services and Inpatient Unit nursing teamsand quality issues across all hospice services:
  • The Day Services team is led by a Band 7 Team Manager who manages the Band 6 Nursing Team Leader, the Complementary Therapy Coordinators and the Administrator for Day Services.
  • The IPU team is currently led by 3 Band 6 Sisters (the Band 7 manager post being vacant at present)who have support from an IPU Administrator and 3 part-time IPU Receptionists.

3.2 Hospice Services

The hospice has a clear focus on meeting the needs of patients wherever they may be

within the community we serve; and our services continue to be adaptedas those needs

change and/or increase.

Domiciliary Care

The hospice receives up to 50 new patient referrals per week.

Initial face-to-face assessment for the majority of these patients is via the Community Nurse Specialist team who visit and then, if appropriate, maintain regular contact with these patients, their families and their carers (lay and professional).

The role of the CNS team is advisory, supplementing the care provided by primary health care services and providing a link into all the other hospice services; while the GP remains medically in charge of their patient’s care.

Senior hospice Doctors and other professionals within the team are availableto offer domiciliary visits as required, and the Nurse Specialists regularlyattendGSF or equivalent Palliative Care meetings at the GP practices within their area. 2 of the current hospice Nurse Specialists have qualified as non-medical prescribers and the intention is to increase this number over the coming years.

Day Hospice

Day Hospice services run 5 days per week at Brentry for up to 20 patients per day with a Fatigue and Breathlessness Management programme on Tuesday mornings, open afternoons or groups on Tuesday afternoons; and full days offering a variety of clinical, complementary and diversional input within a defined 12-week programme of holistsic care on the other 4 days.

In-patient Care

The hospice is currently running an 18-bedded in-patient unit where patients are admitted for any combination of symptom control, psychosocial needs or terminal care. Approximately 55% of patients admitted to the unit are discharged. The average length of stay for in-patients is between 10 and 11 days, and there is an emphasis on full multi-disciplinary assessment and treatment with effective discharge planning.

Hospice at Home

Shifts of nursing care (up to 24-hr nursing) can be offered by the HatH team for a usual maximum of 7 days – often to support a patient in their wish to remain in their own home to die; but this service is also used to facilitate a complex discharge from hospital or the hospice, to help at a time of rapid, unpredicted change, and to offer short periods of respite within the patient’s own home.

Psychosocial Support and Bereavement Care

Hospice Social Workers assess the needs of patients and carers in relation to Community Care, liaising closely with local authority Social workers and Continuing Healthcare assessors. They also contribute to the psychological support offered to patients and families: while their music and art therapy colleagues, who have extensive psychotherapeutic skills, will work with patients and families who have more complex needs. This psychological support extends into bereavement with support offered to adults and children of all ages, where relevant. The hospice bereavement services also rely on input offered by trained and supervised volunteers, overseen by our bereavement coordinator.

24/7 Specialist Palliative Care Advice-Line

The hospice has run a 24/7 advice-line for many years and has recently developed this further, with the introduction of our Access Team, into a 7-day nurse-led service with senior medical support for more complex calls or admission requests.In the out-of-hours periods not covered by the Access Team the calls are directed to our inpatient nursing team who then decide if they need to pass the call on to the on-call medical staff.

Patients, family members and healthcare professionals all access this busy service, and we also support the medical staff at 1 of our local acute trusts (North Bristol Trust) out-of-hours, as their Palliative Care Team does not provide an on-call service at present.

Education

The hospice Education department is actively involved in both pre-and-post registration Palliative and End of Life Care modules (up to Masters level) for nurses and other professionals, working in partnership with local universities and other hospice Education teams. It is also involved in both the project management and delivery of End of Life Care training within our local cluster of CCGs.

A variety of study days and half-days are also run, both in-house and at local postgraduate centres, by hospice Education and clinical staff – often in collaboration with local palliative care and primary care colleagues – for all disciplines and grades of healthcare professionals.

The delivery of all statutory and mandatory training for hospice staff is overseen by the Education department – delivered via a mixture of electronic learning modules, face-to-face teaching in-house or external provision.

3.3 Partnership working with other voluntary and statutory sector organisations

The hospice is actively engaged with all those involved in End of Life Care strategy and service development planning in our catchment area (North Somerset, Bristol, South Gloucestershire and a small area of BANES) with hospice clinical directors and senior clinicians contributing within many of the current project development groups.

The End of Life Care Coordination project for Bristol is the outstanding example of this: requiring over 18 months of collaborative planningto achieve fruition.

Over the past 2 years we have also had specific involvement in supporting End of Life Care work within local prisons, for the homeless and for hepatobiliary patients.

4.MANAGEMENT STRUCTURE

The appointee will be contractually accountable to, and managed by, the Chief Executive.All senior medical staff are required to undergo an annual consultant appraisal carried out in accordance with the hospice Medical Appraisal and Revalidation Policy.This supports the use of external appraisers and recommends the use of at least 2 different appraisers in any 5-year cycle.In addition, the post holder will undergo an internal hospice IPR (individual performance review) with the Chief Executive each year which provides an opportunity to discuss the outcomes from the external appraisal.

The appointee will be required to take an active and co-operative approach to their job planning, to be reviewed on an annual basis within the total complement of job plans within the senior medical team and then discussed with the Chief Executive.They will be managerially responsible themselves for the other senior medical staff employed at the hospice and for liaison with the employing trusts for those senior and junior medical staff who work on the hospice premises although contracted elsewhere (see responsibilities).

The appointee will be expected to participate in, and adhere to, all aspects of Risk Management, Health and Safety and Clinical Governance as per the relevant hospice policies.

5.LOCATION

The post is based at St Peter’s Hospice, Brentry where there is access to car parking and local public transport.

Other bases – the appointee may attend any of the hospice Community Nurse Specialist bases in the community for caseload review meetings when required, will carry out domiciliary visits as agreed within the specified allocated times in the job plan and may need to attend local, regional or national meetings in relation to the on-going development of hospice services or EoL Care/Palliative Care in general.

6.PRINCIPAL RESPONSIBILITIES OF THE POST

(a)Managerial / Executive

The Medical Director will contribute fully to the on-going development of the Executive Team at the hospice as a cohesive, mutually supportive group that is completely engaged in furthering the ability of the hospice to care for its patients, their carers and their families; alongside the further enhancement of all aspects of End of Life and Palliative Care in the areawe serve.

The Medical Director will maintain effective professional management and leadership of the hospice medical staff, motivating them to work to the highest possible standards and continually develop their knowledge and skills in a manner that supports quality, flexibility and innovation across the hospice’s clinical, educational, audit and research domains. Safety and resilience will be maintained within all aspects of medical input to hospice services via appropriate monitoring of all job plans, rotas, timetables etc. in line with statutory and professional guidance.

The Medical Director will provide professional advice to the Chief Executive and Board of Trustees on key service and medical staffing issues relating to general medical professional standards and the specialty of Palliative Medicine; and will work jointly with the Director of Patient Care on clinical strategy planning for the hospice. This will include sharing in the necessary representation of the hospice at meetings with NHS commissioners and other external advisory groups.

The Medical Director will also work in close partnership with the Director of Patient Care in overseeing all systems of clinical governance and professional appraisal that are necessary for professional revalidation for medical, nursing and allied healthcare professional staff at the hospice. They will be expected to be proficient in the conduct of enhanced appraisals to support medical revalidation and aware of all of the requirements of case investigation and management that might be needed should concerns be raised about the performance of any medical staff based at the hospice.They must also specifically ensure that the legislative requirements of The Medical Profession (Responsible Officer) Regulations 2010 are met in relation to the active participation of all medical staff in the clinical governance systems at the hospice.