CLINICAL FELLOW, Older Adult Assessment Unit

CLINICAL FELLOW, Older Adult Assessment Unit

Older People and Stroke Service,

royalalexandrahospital

Information pack

REF: 47812D

Closing Date:14th July 2017

SUMMARY INFORMATION RELATING TO THIS POSITION

Post: CLINICAL FELLOW – OLDER ADULT ASSESSMENT UNIT

Base:ROYAL ALEXANDRA HOSPITAL

We are delighted to advertise two posts based at the Royal Alexandra Hospital (RAH). We are looking for a motivated, enthusiastic colleague to work within our Older Adult Assessment Unit (OAAU). These posts are available at FY2 level from 2nd August 2017 for a period of 12 months.

This award winning unit was initially a pilot project as part of the Renfrewshire Development Programme. The one year pilot was hugely successful and, as such, the OAAU is now a permanent facet of the Department of Medicine for the Elderly at the RAH. Our vision is to build on the current model with a view to widening the referral pathways to increase assessment numbers.

The main aim of the OAAU is to provide access to comprehensive geriatric assessment (CGA) at the front door. We have a dedicated unit, staffed by specialist nursing, medical and allied health professional (AHP) team. Extensive quantitative and qualitative analysis has shown that the unit leads to shorter length of stay for patients when compared to ‘usual care’ but, more importantly provides an excellent patient and carer experience. The development of the OAAU has had a positive ‘knock on’ effect across our wards leading to shorter waits for transfer to our general assessment and rehabilitation wards and fewer patients requiring interim transfer to other wards from the Acute Medical Unit (AMU).

There are currently four consultants providing input to the OAAU across the week. We would be looking for the successful candidate taking this post to work closely with the four Consultants and wider multi professional team within the OAAU, supporting the whole team to develop the unit and maintain the standard of care.

These posts do not hold educational approval from the Postgraduate Dean and are not recognised for training.

To practice medicine in the UK you need to hold both GMC registration and a licence to practice.

NHS Greater Glasgow & Clyde

Stroke and Older Peoples Service–Clyde Sector

Clinical Fellow – Older Adult Assessment Unit

RoyalAlexandraHospital

1.General Information

The RoyalAlexandraHospital (RAH) is situated in Paisley and provides acute health care services to Renfrew District (pop 205,000). The Hospital is a 968 bed modern District General Hospital (DGH) which opened in 1986 and is one of the largest and busiest teaching DGHs in Scotland. In addition, the hospital is currently the base for provision of surgical, orthopaedic, ophthalmology, paediatric and also the majority of maternity services to the population north of the Clyde served by the Vale of Leven Hospital.

The hospital provides a wide range of DistrictGeneralHospital specialties with excellent support facilities. The hospital has a first class modern radiology department and services. All departments participate in undergraduate teaching and there is an active postgraduate educational programme. The hospital enjoys an enviable reputation for undergraduate teaching and is highly popular with training grades. There is also a good medical library service.

2.Older People and Stroke Service

The Older People and Stroke Service in the RoyalAlexandraHospital (RAH)delivers all its in-patient services on the hospital site. There are, however, close links with the Vale of Leven Service (VoL), particularly with an integrated stroke care pathway

Interface with General Medicine

Patient in the Acute Medical Unit (AMU) and Medical Assessment Unit (MAU) are screened Monday-Friday, using a Frailty Assessment tool, for suitability for transfer to the Older Adult Assessment Unit. There is also a daily visit to the AMU to review patients identified at the post-receiving round by General Physicians using agreed criteria. Direct transfers from there to Medicine for the Elderly beds takes place dependent upon bed availability.

Regular liaison visits to medical wards are undertaken to ensure appropriate patients are transferred to Medicine for the Elderly beds later in the course of admission.

Patients are admitted to RAH from the VoL service according to agreed criteria - generally the more medically unstable patients and all stroke patients (except those needing thrombolysis who go to the QueenElizabethUniversityHospital, Glasgow). If appropriate, they are transferred back to the VoL once stable for ongoing rehabilitation. Currently some Medicine for the Elderly patients admitted to RAH are not fit to return to VoL and are transferred to the Medicine for the Elderly service at RAH. The group of medical patients who remain in the VoL are cared for under the supervision of a ‘Physician of the week’ rotating from RAH. Medicine for the Elderly Consultants triage patients on a daily basis for transfer to their wards.

Stroke Service (patients of all ages)

Beds for stroke patients (approx 25) are part of a 30 bedded Medicine for the Elderly ward. Work is ongoing to ensure direct admissions from A&E and early transfer to the Stroke Unit. There are approximately 400 admissions to the stroke unit per year. Thrombolysis for patients from the RAH catchment area is delivered by the South Glasgow Stroke Service and patients repatriated thereafter.

Rapid access TIA clinics are undertaken, with the number of clinics required to achieve national performance targets recently being agreed following review.

There is a neurology liaison service in RoyalAlexandraHospital and InverclydeRoyalHospital and a new member of that team has a special interest in Stroke Medicine.

The Stroke service is represented on the Greater Glasgow & Clyde Stroke Managed Clinical Network.

Geriatric Orthopaedic Service

The orthogeriatic service is provided by 3 consultants, supported by a Staff Grade doctor. The team works to a target of reviewing patients within 72 hours of admission. There are both inpatient and community rehabilitation teams and links to care homes through the Gerontology Nurse Specialist with an interest in Orthogeriatrics.

There is a fast track service where patients with a Fractured Hip can be transferred directly to the Geriatric Orthopaedic Unit either in the Royal Alexandra hospital or Vale of Leven Hospital as appropriate according to certain criteria. There are also over 300 liaison visits per year. There is a weekly multidisciplinary team meeting in orthopaedics. The Older People and Stroke Service is strongly supported by Orthopaedics and has 22 dedicated beds in ward 3 which provide orthogeriatric rehabilitation

VoL trauma admissions are admitted to RAH and, when appropriate, older patients transferred directly back to Ward 15 in VoL for further orthogeriatric rehabilitation under the care of the Geriatrician.

Movement Disorders

The RAH service is provided by 2 consultants, supported by a one Parkinson’s Disease Nurse Specialist. There are 3 outpatient clinics per week and inpatients are cared for in ward 5 wherever possible/appropriate. The team provides liaison support to other specialities within the hospital and provides domiciallary visits, where possible, to our local nursing homes.

DayHospital

A 5 day services is provided, supported by a Specialty Doctor. The recent development of Community work and the introduction of rapid access clinic slots has been part of a review of the DayHospital service as an alternative to admission to hospital with comprehensive geriatric assessment being led by a Consultant Geriatrician.DayHospital also provides an IV zolendronate service and can support outpatient blood transfusion.

Outpatient Clinics

Specialist clinics are available, for Stroke, Movement Disorders and Falls.

Community Geriatric Medicine

Community Geriatric Medicine was established in 2006 under the auspices of the Joint Planning Group. Our Community Geriatrician provides weekly MDT meetings with the Community teams including the Gerontology Nurse Specialists, Rehab and Enablement Team, Rapid Response and Interface Pharmacy.

Bed Numbers

Currently there at are 354 admissions to Wards 3 and 890admissions to 5 and 7 per year with an average length of stay of 13-14 days. The Older Adult Unit looks after 700-800 patients per year with average LOS of 3-4 days.

1. THE POST

(a)Title: Specialty Grade doctor in Medicine for the Elderly

(b)Relationships:

(i)Rehabilitation and Assessment Directorate

DirectorMrs M Farrell

Chief of Medicine Dr Chris Jones

General Manager Mr J Kennedy

Clincial Director Dr G Simpson

Lead Clinician (Clyde) Dr J Murtagh

(ii)Names of Consultant members of the Department:

(iii)Support Grades

(c)Duties of the Post:

(i)The postholder will be expected to work with local managers and professional colleagues in the efficient running of the service. Subject to the provisions of the terms and conditions of Service, the postholder is expected to observe NHS Greater Glasgow and Clyde’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 Health Board.

(ii)The postholder will be expected to ensure that there are adequate arrangements for hospital staff involved in the care of patients to be able to make contact with the postholder when necessary.

(iii)The postholder is required to comply with GG&C Health and Safety Policies.

(iv)Clinical

• The post is open to candidates who may wish to contribute to both the development of the Older Adult Assessment Unitand the wider Medicine for the Elderly Service. The clinical duties described will depend upon final agreement of the job plan.
• Assessment and management of patients admitted to the Older Adult Assessment Unit
• Care of assessment and rehabilitation patients in the Medicine for the Elderly beds
• Assessment and review of patients attending Day Hospital which provides rapid access to general practitioners, liaison with Community rehabilitation teams and supported discharge for OAAU patients.

(v)Supporting Professional Activities

• As part of supporting Professional activity, full involvement in the Clinical Governance programme of the Directorate

• Participation in Clinical Meetings and an audit programme
• The appointee will be expected to participate in annual appraisal
• Development of the Older Adult Assessment Unit model

With negotiation about total SPA time the following may be included:

• Clinical and educational supervision of trainee medical staff
• Undergraduate teaching for students from University of Glasgow
• Internal and external Health Service committees

4. Proposed Weekly Programme

The proposed indicative weekly programme is shown in Section 4c. 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 appointee.

The job plan will be reviewed with the successful candidate no later than 3 months following appointment and where possible discussion may take place in advance of appointment. Job plan review thereafter will be no less frequent than annually.

The agreed job plan will include all the doctor’s professional duties and commitments, including agreed Supporting Professional Activity.

1. Summary of the Post

The appointee will provide day-to-day medical cover to the Older Adult Assessment Unit as well as follow-up of patients via the Day Hospital.

1. Proposed Job Plan

A detailed job plan will in due course be agreed with the Clinical Director or Associate Medical Director/Chief of Medicine and thereafter this will be subject to periodic review and adjustment if necessary. The appointee may be required to support clinical activity elsewhere across Greater Glasgow and Clyde.

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Cover for study leave, holidays will be provided from within the existing team

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1. Notes on the Programme

Patient Administration. This activity covers the management of individual patients including Out Patient administration, results reporting, letters/phone calls to patients, carers, GP’S and members of the wider multidisciplinary team involved in the patients care. Office accommodation will be in the Royal Alexandra Hospital.

Ward Rounds: The time allocated is indicative and will be discussed with the appointee. Ward work will include teaching ward rounds as required.

Travel: Any travel allocation will be included within the Total Programmed Activities and will be determined by location at which Direct Clinical Care and Supporting Professional activities are carried out.

Supporting Professional Activities: A minimum of 1 SPA is included in the indicative job plan, 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 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.

1. Postgraduate and Undergraduate Training

Both the Medicine for the Elderly and Medical units have a postgraduate programme which includes a weekly unit meeting, morbidity and mortality meetings and SHO tutorial sessions. There are weekly hospital postgraduate meetings during term time. Mr Andrew Renwick is the postgraduate tutor at RAH.

The Medical Units teach a number of medical students from Glasgow University. As part of the new curriculum, teaching of years one to five is becoming established.

6. Further information

Candidates are strongly urged to make contact for further information and to arrange a visit to the department:

Please contact:

Dr G Simpson Clinical Director, Older People / Stroke (Sec 0141 314 6190)

Dr Janice Murtagh Lead Clinician, Older People, RAH (Sec 0141 314 6876)

7. DATE WHEN POST IS VACANT:August 2017

8. PERSON SPECIFICATION

TERMS AND CONDITIONS OF SERVICE

The conditions of service are those laid down and amended from time to time by the Hospital and Medical & Dental Whitley Council.

FURTHER INFORMATION