Royal National Orthopaedic Hospital Trust
Trust Board
Consultant Rheumatologist with an interest in Pain Management Business Case
Clinical Leader / Corporate Dept: Dr J Cowan & Dr R Wolman
Clinical Director: Dr M Cooper
Lead Director: Mrs Puckett
General Manager:Dr C Euesden
Funding Year: 09/10
1. Rational, Introduction and Strategic Context
Over the past few years both the Rheumatology and Rehabilitation medicine departments have developed in line with the needs of the service and increasing referral rates. This has led to the recruitment of part time locum posts in both specialties.
The Rheumatology service is being led using a part time locum consultant who undertakes both outpatient services and ward support at Stanmore. The Rehabilitation Medicine service is led by a permanent consultant supported by a part time locum consultant who supports both Stanmore and Bolsover outpatient services and ward patients.
The use of two locum posts means that that there is limited scope for development of either service and limits the long term service as either member of staff is not permanently contracted to the Trust.
Attempts to recruit a part time permanent Rheumatology consultant have been unsuccessful and the two departments have reviewed the needs of their services. This has led to the development of this business case for a full time cross-specialty consultant who can deliver key aspects of both specialties and also develop their own interests within the requirements of the Trust.
2. Current Service Provision
The job plans below show the current timetables for the two part time locum posts that cover Rheumatology (Dr Rosenberg) and Rehabilitation Medicine (Dr Saif). The new post will be able to cover the existing requirements of the service by using the remainder of the week:
Monday / Tuesday / Wednesday / Thursday / FridayRheumatology
am / Ward Round / OPD
pm / OPD / Ward & SPA
Rehabilitation
am / OPD / Ward Round / OPD (B’over)
pm / OPD & SPA / Ward Work / SPA
Over the course of a week, there are ten sessions of work between the two consultants.
Current Staffing:
Rheumatology
There is one locum consultant who works 4 PA and one shared registrar with Sports Medicine. Between them, the service is delivered at Stanmore in both outpatients and on the ward. Dr Wolman, who works 5 PA’s in Rheumatology (and 5 PA’s in SEM) provides comprehensive outpatient Rheumatology services to patients at Bolsover Street, with inpatient work being directed to Stanmore. Comprehensive outpatient Rheumatology work at Stanmore is currently provided by the locum Rheumatologist.
Rehabilitation Medicine
There is one permanent consultant (9 PA at RNOH, 2 PA for other NHS Trusts), one locum consultant (6PA) and a contract for a full-time registrar across six months of the year.
The service is undertaken in an outpatient setting at both Stanmore and in Bolsover Street and there is a ward service at Stanmore.
The registrar post is provided by the deanery and despite several years on concurrent service, during 2009 there will be no provision of service. To support this, there is a current intention to recruit a locum Staff Grade for 2009 to cover for the lack of service. From 2010 it is intended that that the registrar cover will be changed to a part time (0.5 wte) service for 12 months of the year – enabling ongoing, reliable cover of the service – particularly on the ward.
3. Demand
The future plans of the service are that by developing a Rheumatology post with an interest in pain management this will enable a well-developed cross-specialty role that can specifically cover key orthopaedic services and support the existing medical and Rehabilitation Medicine services.
4. Proposed Service
* This template is reflective and is subject to negotiation with the ideal candidate. The post would comprise of 10 programmed activities – 8 Direct Clinical Care and 2 Supporting Professional Activities.
For example:
Consultant / AM / PMMonday / OPD (Rehab) / SPA
Tuesday / SPA / Ward & MDT Service
Wednesday / Ward Services/. Minor Procedures / OPD (Rheum)
Thursday / Ward / OPD (alternative)
Friday / OPD / Ward Services, inc postgrad mtg at lunchtime
5. Additional Resource
5.1 Theatre/Clinics
No additional theatres or outpatient clinics required.
5.2 Imaging
No additional imaging required.
5.3 Consumables
There will be approximately £10 000 consumables required per annum.
5.4 Administrative Support
The administrative support will require additional support of 0.2 wte band 4 at an estimated £ 5 000.
5.5 Therapy support
Development of this role is expected to require 0.6 wte band 7 OT therapist and 0.6 wte band 6 physiotherapist at £48 00 per annum for both roles. This is not currently required by the existing consultants as this will result from the development of the specific joint service.
6. Financial Case
Table 1 Summary Revenue ImpactYear 1 / Year 2 / Year 3
£ / £ / £
Income
NHS patient Income - in-patients / 57600 / 57601 / 57602
NHS patient income - out-patients / 288400 / 288399 / 288398
sub-total - income / 346000 / 346000 / 346000
Expenditure
Consultant pay / 107000 / 107000 / 107000
Secretarial pay / 5000 / 5000 / 5000
Occupational Therapist pay / 26000 / 26000 / 26000
Physiotherapist pay / 22000 / 22000 / 22000
Consumables / 10000 / 10000 / 10000
sub-total - expenditure / 170000 / 170000 / 170000
Contribution (+/- advantageous/adverse) / 176000 / 176000 / 176000
*Based on 08/09 tariff and costs (£); there are no start up costs in the first year as the post is replacing existing locums.
7. Case for change
There has been a steady increase in medical support required at the RoyalNationalOrthopaedicHospital. This has been developed using locum consultants to support this increase.
The service requirements to deliver a sustainable service within the department require that these roles are substantiated to one permanent consultant with a dual interest. This role will support the Rheumatology service and the Rehabilitation medicine/ pain services.
8. Service Benefits and Risks
Benefit to purchasers / patients:
- Ability to deliver the necessary service required by the Departments of Rheumatology and Rehabilitation Medicine Services;
- Ability to meet the NHS Plan waiting time targets;
- Improved patient satisfaction and access to service;
- Enhanced recruitment & retention opportunities
- Development and planning within the department;
- Enhanced reputation for the Trust as a world class leader in treating patients with complex orthopaedic conditions, to support specialty departments to carry out research and teaching.
- Support of delivering continued excellent clinical standards by a dedicated, highly motivated, specialised consultant group with Medicine, Rehabilitation and Pain Management.
Risks of undertaking change:
- Failure to meet NHS Plan 18 week RTT maximum target;
- An inability to develop the medicine specialties in line with the needs of the rest of the Trust, including the recruitment of the new consultant surgeons;
- The profile of the RNOH would be adversely affected if specialist work were required to go elsewhere due to a lack of capacity.
9. Timetable and deliverability
All relevant paperwork (job description, weekly job plan and person specification) has been completed and is available for consideration prior to commencing formal recruitment. This process will be commenced as early as possible in the financial year 2008/ 09. It is anticipated that the process could flow effectively with a new permanent appointment in early autumn 2008.
10. Recommendation
The need to develop the departments of Rheumatology and Rehabilitation medicine in order to deliver a robust, sustainable service for the Trust requires the recruitment of a permanent cross-service consultant without delay.
Appendix 1: Activity by specialty shows 6% increase in activity undertaken since April 2007
Appendix 2: Estimated income for new Consultant, reflecting current activity and future timetable