NWC2014.63 (V1)
Cumbria Partnership NHS Foundation Trust
Consultant Psychiatrist in CAMHS
Job Description
South Cumbria
10 PAs: Full Time/Part Time/Job Shares will be considered
Professionally Accountable to: Medical Director
Operationally Accountable to: Clinical Director/General Manager
Contents
1. The Trust 4
2. Support for Consultants 5
3. Clinical Roles 5
4. Job Planning 7
5. The Service – CAMHS 8
6. CPD and Research 10
7. Interview Arrangements and how to apply 11
Appendix 2 – Senior Leadership Team 12
1. The Trust
Cumbria Partnership NHS Foundation Trust (CPFT) operates in a county that includes the Lake District National Park with opportunities for living in beautiful places and accessing a wide range of outdoor pursuits. Carlisle in the north east and Barrow in the south west are the biggest centres of population but there are attractive market towns dotted across the county.
State and private schools have excellent reputations with a number of secondary and primary schools having outstanding Ofsted reports. Housing is affordable and high quality in many areas.
Although Cumbria is primarily rural it is well connected to the rest of Britain and hence the world. Some indicative journey times include:
Carlisle to Newcastle 75 minutes by car
Carlisle to Edinburgh 90 minutes by train
Kendal to Manchester 90 minutes by train
Kendal to London 3 hours by train
The Trust uses technology to reduce the need to travel around the county and all consultants will have their own desk PC and smartphone.
CPFT has been a Foundation Trust since 2007 and since 2010 has been responsible for community and mental health services.
In summer 2013 Claire Molloy began as our new CEO and has accelerated the process of designing high quality sustainable services for the dispersed population of Cumbria. We are working increasingly closely with colleagues in social care and clinical commissioning both of which operate across the whole county. As part of this process, a vision for mental health services is being developed with input from clinicians, patients, carers and others. A draft is supplied in the list of additional documents.
A key theme of this redesign is enabling more effective clinical leadership by the creation of clinical divisions (Appendix 3 for draft organisational structure). We have very skilled leaders of psychosis and non-psychosis and older people’s pathways – we now need to better enable the delivery of high quality pathways across the Trust. Existing and new consultant psychiatrists have key leadership roles in this improvement journey. Psychosis and ADHD pathways have been created and Eating disorders pathway is being created within CAMHS.
Corresponding and integrated redesign is taking place in the other divisions with opportunities for increased roles for consultant psychiatrists in primary care and liaison.
The Trust has close links to the medical schools in Newcastle (North Cumbria) and Lancaster (South Cumbria) and it is expected that consultants contribute to undergraduate and post graduate teaching and learning. Honorary lecturer positions are available for interested candidates.
2. Support for Consultants
Consultant psychiatrists in CPFT are supported to take on roles that support excellent services and their own development. There is an active mentoring system for new consultants and a highly regarded action learning set that enables new consultants to develop the skills they need to thrive.
Appraisal and revalidation for all CPFT doctors is managed by the Medical Director and Responsible Officer with support from a dedicated team. We have a skilled team of appraisers and new consultants working to become (or continue as) appraisers will be supported to do so.
All consultants have smartphones and a desk PC in their own office. Each has access to a whole time equivalent medical secretary.
3. Clinical Roles
The variety of clinical roles that may be taken on by consultant psychiatrists in CPFT include
· Community roles
· Leadership
· Educational and academic roles
A - Community Roles
Role description / TasksNew out-patients or home visits, including meetings with relatives and carers
Follow up out-patients or home visits
Team meetings
Multidisciplinary patient reviews
Clinical advice to team members
Liaison with colleagues
Mental health and capacity legislation / Assessment, diagnosis and formulation of management plan
Shared decision-making with users and carers
On-going review of formulation and management plans
Shared decision-making with patients and carers
Communication about patients and carers, sharing organisation policies and objectives
Care programme approach (CPA) reviews, Multi-agency Public Protection Arrangement (MAPPA) meetings, risk reviews
Regular or ad hoc supervision on clinical matters
Discussion about patient care with primary care, secondary care, tertiary care or specialist provisions
Meeting the requirements of emergency work, assessments of capacity and others in line with the MHA
B - Leadership Roles
Role description / TasksLeadership role
Lead clinical roles
Lead consultant / Implementing and reviewing standards, innovation in service delivery, clinical governance, patient safety, modelling high-quality patient care, supporting colleagues, building relationships with GPs and other external organisations
Provide leadership role for specific and defined areas
of development or practice
Provide leadership and often line management for consultants and other medical staff within the service, often lead for quality within a directorate.
C - Education and academic roles (in line with post holder’s CPD needs)
Role description / TasksSupervision of trainees
Meeting requirements for revalidation
Training medical students
Education
Research / Each trainee requires 1 hour of trainee-centred educational supervision per week
Additional supervision will be required for clinical work
Revalidation activities including continuing professional development and quality improvement activities and reflection on serious incidents.
One to one teaching, lectures, examining and skills-based workshops
Lectures, small group teaching, skills workshops
Clinical and service research, peer reviewing of papers.
Including department programme, trainee doctor programme, medical student programmes, college tutor, deanery roles
Opportunities for part-time or other flexible models of employment are available via discussion and might include annualised job plans.
Job plans are for 10 PAs but additional responsibility payments are available for specific roles and additional payment possible for some out of hours work and agreed hours beyond 10 PAs.
4. Job Planning
The nature of such roles and more specific tasks is determined by job planning. The full time week is split 7.5 direct patient care and 2.5 for supporting professional activities.
Building your job plan
4.1. Agreeing your job plan
The successful candidate will agree their job plan with the Clinical Director. The job plan will be reviewed at least annually to ensure flexibility and to avoid burnout. The post holder will be managed by and accountable to the Clinical Director and will work closely with the broader MDT.
4.2. Indicative timetables
Here is an example of an indicative timetable. Job plans may vary slightly between Consultants to accommodate Candidates CPD requirements and local clinical needs.
MON / TUE / WED / THU / FRIAM / Clinic / Clinic / Consultation / CPD- Monthly Peer meeting/ Audit/ Research / Consultants Meeting-monthly /Teaching and training / Local Teaching sessions/ Admin
PM / Consultation / Admin / Clinic / Admin / MDT Meeting / Clinic / Clinic / Urgent Assessments
The combined job plans of the whole consultant team need to meet the needs of the service. Existing consultants are committed to flexibility around who does what so that each member of the consultant team is enabled to have a “do-able” job with the expectation of being able to develop particular clinical interests.
Each consultant will have 2.5 SPA that can be used to support CPD, other professional activities, project work or other specific tasks as agreed with clinical director. There is scope for development of specialist interests that complement the aspirations and skills of potential candidates and meet service needs. Applicants with special interests in Forensic and LD would be particularly welcome.
5. The Service – CAMHS
As previously noted the service delivery model is changing and evolving following the external CAMHS review over a year ago. There’s currently a Clinical Director with county wide responsibility and 3 medically led teams and we’re working towards more integration between the teams to facilitate the delivery of standardised care pathways and high quality care. The post holder would be expected to meet with all CAMHS consultants at the monthly meetings to ensure county-wide processes are followed. The post holder would be supported by Consultants already in post.
CAMHS services are currently provided by 3 multi-disciplinary teams:
East {based in Carlisle, covering Carlisle District and Eden}
South {bases in Barrow and Kendal, covering Furness and the South Lakes}
West {based in Workington, covering Maryport, Workington, Millom and Whitehaven}
Each multi-disciplinary team provides Specialist CAMH services [Tier 3]. We’re currently in the process of agreeing commissioning arrangements for a Tier 2 provision which will be closely linked to the Tier 3 service provided by us. We are working towards stablishing a Tier 2 provision for those with milder presentations for mental health needs within a step-up/step-down wider system linking with Tier 3 in order to avoid further referrals, waits and disjointed care. Each team is currently staffed by a variety of disciplines. The exact make up of each team is currently changing and the number of staff in each team increasing and is expected to change further to the external review of Specialist CAMHS commissioning and provision across Cumbria. Clinical processes are also being reviewed and the new post holder will be joining the service at a time when there are excellent opportunities to lead and shape care pathways.
Cumbria Partnership NHS Foundation Trust does not currently provide Tier 4 services in the county, although there are contractual arrangements for out of area [OOA] in-patient services at The Junction in Lancaster and Prudhoe Hospital in Newcastle.
Cumbria CAMHS are provided within the county wide integrated Children and Families Care Group of the Trust. The Care Group also provides and manages community paediatricians, school nurses, health visitors, children’s community nurses, children’s learning disability nurses and children’s therapists. This provides established opportunities for liaison and co-ordination of clinical care and services. The Associate Medical Director for this Care Group, who is also the Clinical Director for the paediatricians, is Dr Wendy Rankin, who is based in Bridge Mills, Kendal.
There is a good relationship with Community paediatricians and close liaison particularly with children presenting with disorders such as ADHD and ASD. In principle CAMHS is responsible for the diagnosis and treatment of ADHD and paediatricians for ASD but as children and young people often present with both disorders the need for close liaison and coordination of care is evident in clinical practice.
CAMHS is expected to provide high quality care for:
Mood Disorders [Bipolar and Depressive Disorders], Anxiety Disorders [including OCD, PTSD, Social Anxiety Disorder and other Anxiety Disorders], Self-Harm and emerging Personality Disorder, Psychosis [in conjunction with the EIS team for 14-18 year olds], Eating Disorders, Conduct Disorder, Paediatric Liaison, Complex and Co-morbid presentations, specialist mental health services for Looked After Children, and multi-disciplinary team input. County wide leadership on assessment and treatment of joint ADHD pathway with Paediatricians as well as consultation and collaboration with assessment and diagnosis of paediatrics led ASC pathway/ Multi Agency Autism Team (MAAT). Hence post holder is not expected to have a role in the formal assessment process for ASD diagnosis. Post MAAT diagnoses, many patients with ASD attend CAMHS for management of co-morbid difficulties such as anxiety, depression, self-harm. These are managed within CAMHS, sometimes requiring medication and/or Consultations with CAMHS staff. Specialist CAMHS Forensic opinion and support can be accessed via the FACTS team in Manchester.
The role of the Consultant within this framework includes a clear emphasis on leadership, clinical support to the multi-disciplinary team staff with most cases having named Case Coordinators, a key role in service development, audit and governance, and is fully in line with New Ways of Working.
Acute Paediatrics is provided by Morecombe Bay NHS Foundation Trust in the South of Cumbria.
Within Tiers 1 and 2, there has recently been an initiative regarding developing community based pathways ['Health Builder Pathways' as multiagency collaborative care provision] to coordinate the care delivered by universal and targeted services and promote self-based care.
This new post will be part of a team of 4.5 Child and Adolescent consultants distributed across the county but there will need to be an element of cross cover for leave, usually arranged by South and North geographical areas.
The 4.5 current post holders are at present hosted within the locality based teams as follows:
Dr Luisa Sanz – Consultant based in South Cumbria (Kendal)
Dr Melanie Dix – Consultant based in East Cumbria (Carlisle)
Dr Roger Williams – Consultant based in East and West Cumbria (Carlisle/Workington)
Vacant – Consultant based in South Cumbria (Barrow/Kendal) (post advertised for)
Vacant (covered by Locum) – Consultant based in West Cumbria (Workington)
Currently, there is no Junior Doctor support related to these posts. Consultants are currently not on the on call rota for out of hours CAMHS. However discussions are underway within the trust to have Consultants on the rota. Such arrangements and payments will be in line with National standards and after discussions with the Consultant body.
The post holder will be accountable to the Clinical Director. Post holder will be based in the South team which caters to a total population of about 170,000. 963 cases were referred to the South team from January 2013 till December 2013. Caseloads of clinicians vary from 30-60 depending upon the complexity of the case and whether the clinician works part-time or full-time. Consultant caseload for the post can range from 80-120 depending on the complexity of the cases. The team comprises of 1.6 Psychologists, 1 Assistant Psychologist, 1 Cognitive Behavioural Therapist, 1 Specialist Therapist, 8.8 Nurses, 1 Health Care Assistant, 2 Social Workers, 1 Youth Offending worker, 2 Drug and Alcohol workers, Admin Team and a Team Leader. The post holder will be expected to review 10-12 follow up patients and 1-2 new patients every week.
Patients are only seen on Paediatric wards when urgent admissions have taken place. Assessments on Paediatric wards are undertaken by team members who may request a Consultant opinion if required on the ward. Such admissions commonly occur due to self-harm, overdose, or eating disorders. Patients would get admitted to either Furness General Hospital or Royal Lancaster Infirmary Paediatric ward depending on their geographical location in the county. Close liaison with Paediatric colleagues at these hospitals are maintained for any admitted patients who require CAMHS inputs. If patients are admitted Out of County to a Tier 4 unit, Consultant and Case Manager are invited to CPA reviews. Referrals are made to Outreach team in Lancaster for gatekeeping purposes when Tier 4 admission is warranted for a patient.