Consultant in Stroke and Geriatric Medicine

Consultant in stroke and Geriatric medicine

inverclyde royal

Hospital

INFORMATION PACK

REF: 36385D

SUMMARY INFORMATION RELATING TO THIS POSITION

Post: CONSULTANT in stroke and geriatric medicine

Base:Inverclyderoyalhospital

This is an exciting opportunity to join a team of Consultants providing Stroke and Medicine for the Elderly services across the Inverclyde catchment area. Based at InverclydeRoyalHospitalyouwill work with1 other Consultant (Dr J Akhter) to provide a comprehensive stroke service. Each of the Stroke consultants will maintain an interest in the Medicine for the Elderly service (3 to 4 sessions per week) This post will also participate in the provision of the hyper acute stroke thrombolysis service at the new South Glasgow Hospital (2 sessions)

Applicants must have full GMC registration and a licence to Practise. Those trained in the UK should have evidence of higher specialist training leading to CCT or eligibility for specialist registration (CESR) or be within 6 months of confirmed entry from date of Interview. Non UK applicants must demonstrate equivalent training.

ACUTE SERVICES DIVISION

Rehabilitation & Assessment Directorate

INVERCLYDEROYALHOSPITAL

INFORMATION PACK

FOR THE POST OF

CONSULTANT IN STROKE AND MEDICINE FOR THE ELDERLY

1. GLASGOW – A GREAT PLACE TO LIVE AND WORK

Greater Glasgow and the ClydeValley is one of the world’s most thrilling and beautiful destinations. There is a wealth of attractions to discover, with the UK’s finest Victorian architecture, internationally acclaimed museums and galleries, and Glasgow’s own unique atmosphere.

Glasgow is one of Europe’s top cultural capitals with a year-long calendar of festivals and special events - all located within a stone’s throw of some of the country’s finest parks and gardens. The area also stands at the gateway to some of Scotland’s most spectacular scenery, with Loch Lomond and the Trossachs only 40 minutes away.

What’s more, we are easily accessible by air; rail and road, with excellent local transport links.

2. THE HOSPITAL MODERNISATION PROGRAMME THE SERVICES OF TOMORROW

Health services in Glasgow are on the verge of dramatic and exciting change, brought about by Hospital Modernisation Programme. This ten-year £700 million strategy sees the transformation of acute services across the city including the replacement of out-dated Victorian buildings and the creation of one-stop/rapid diagnosis and treatment models for the vast majority of patients.

Core adult acute care is currently delivered from six sites within Glasgow. The Western Infirmary and Gartnavel General Hospital operate in tandem delivering acute care in the west-end of the city. In the north-east of the city acute care is delivered from Glasgow Royal Infirmary. The Victoria Infirmary serves the south-east and the Southern General Hospital the south-west of the city. Services for children are provided centrally from the RoyalHospital for Sick Children, Yorkhill. Full adult Accident and Emergency services are provided at the Western Infirmary, Glasgow Royal Infirmary, the Victoria Infirmary and the Southern General Hospital.

The Hospital ModernisationProgramme will ensure that walk-in/walk-out hospital services are provided for the majority of patients. The pattern of service provision will shift to reflect moves towards ambulatory care. Currently 85% to 90% of patient encounters with acute hospital services are on a walk-in/walk-out same day basis. These include out-patient attendances, diagnostic tests, imaging procedures, and a range of day surgery procedures. In future, these services will be provided from ambulatory care centres designed to deliver the streamlined process of care, which patients want - to be seen quickly by the appropriate specialist, to undergo clinical investigation, and to receive treatment without delay.

The ambulatory care centre for the south side of the city opened in 2008 in the new VictoriaHospital. It houses the main out-patient centre and day surgery service for the south side of the city. In-patient services will be concentrated in a new south-side hospital on the site of the current Southern General Hospital. This new facility, housing some 850 beds, will replace ageing acute wards in both the Southern General Hospital and the Victoria Infirmary. The new facility will work alongside some of the relatively modern buildings housing specialist services, which will be retained on the Southern General Hospital site as part of the Strategy. The new south-side hospital will be home to one of two Accident and Emergency and Major Trauma Units covering the whole of the city. The new south side hospital is planned to open mid2015.

The children’s hospital will also relocate from Yorkhill to a new building on the Southern General Hospitals site in 2015 to sit alongside and be fully integrated with maternity and adult services.

The redesign and redevelopment of Glasgow’s acute services will address many of the pressures currently facing the hospital service. The new services will be provided in modern facilities rather than in 19th century buildings not designed for modern healthcare. The purpose-designed facilities will enable the one-stop/rapid diagnosis and treatment models required for the future. Continuity of service will improve with the elimination of the need for patients’ notes and results to be moved from building to building. Concentration of services will allow the requirements of junior doctor’s hours and issues arising from increasing sub-specialisation of medicine to be addressed through the creation of larger staff teams and sustainable rotes for both junior and senior staff.

The formation of larger clinical teams will make sure that programmes of work, including the need to cover emergencies without interfering with waiting list and ambulatory care sessions, can be planned effectively. The concentration of in-patient services on fewer sites will help strengthen specialist services and maximise the capacity of the service.

3. GREATER GLASGOW & CLYDE ACUTE SERVICES DIVISION

8 Hospitals

5,800 beds

26,500 wte staff

The Acute Division brings together all acute services across the city and Clyde under a single management structure led by the Chief Operating Officer. The Division is made up of six Directorates of clinical services each managed by a Director and clinical management team along with a Facilities Directorate.

These are:

Emergency Care and Medical Services

Surgery and Anaesthetics

Rehabilitation and Assessment

Diagnostics

Regional Services

Women’s and Children’s Services

Facilities

In the Emergency Care and Medical Services, Surgery and Anaesthetics and Facilities directorates the General Managers will combine a city wide role with a local sectoral role for one of three sectors in the city – north and east, west and south.

Emergency Care and Medical Services

The specialties included in this Directorate are:

Accident and Emergency services

Acute Medicine

Cardiology

Respiratory Medicine

Renal Medicine

Gastroenterology

Diabetes

Infectious Diseases

Rheumatology

Dermatology

This Directorate also includes management of the out-of-hours

GP service.

Acute medicine is managed by general managers on a sector basis with a lead strategic role for a citywide specialty.

Surgery and Anaesthetics

This Directorate includes:

General Surgery – including vascular and breast surgery

Orthopaedics / trauma

Anaesthetics – including critical care [with the exception ofCoronary care]

Ophthalmology

Optometry

ENT Surgery

Audiology

Endoscopy

Urology

The smaller surgical specialties of ophthalmology, urology and ENT surgery have a single citywide general management structure. In each of the larger surgical specialties, in addition to a pan Glasgow structure, there will be sector-based general management

Rehabilitation and Assessment Directorate

The Rehabilitation and Assessment Directorate brings together the management of services that have strong inter-relationships to related CHCP's.

The Directorate manages the following services:

Stroke

Frail elderly

Palliative Care

Inpatient Physically Disabled

West of Scotland Mobility and Rehabilitation Centre (Westmarc)

Physiotherapy

Dietetics

Speech and Language Therapy

Rehabilitation

In addition, the Directorate will manage a range of community services including palliative care, a number of specialist community disability services, pain services, continence, services to care homes and falls prevention.

Regional Services

This Directorate includes:

Neuro-sciences [including all sub-specialties except neuro-

Radiology and neuropathology]

Specialist Oncology services [including haemato-oncology]

Plastic Surgery and Burns

Cardiothoracic Surgery

Renal Transplantation

Oral and Maxilofacial surgery

Homeopathy

Diagnostics Directorate

This Directorate includes:

All Laboratory Medicine including Paediatrics

Diagnostic imaging [including Beatson radiological services and Paediatric Radiology]

Vascular and Interventional Radiology

Breast Screening services

Women and Children’s Services

This Directorate brings together maternity, gynaecology and children’s services.

The Directorate includes:

Obstetrics

Gynaecology

Neonatology

Paediatric Medicine

Paediatric Surgery

Paediatric Accident and Emergency

PaediatricAnaesthetics

Facilities Directorate

This Directorate includes:

Site maintenance for both acute and CHCP facilities

Hotel services

Laundry

TSSU

Supplies

Transport

Catering

Telecommunications

Waste management

4. Brief Description of the Department of Medicine for the Elderly including the all ages Stroke Service.

The Department of Medicine for the Elderly (DME) Service in Inverclyde Royal Hospital (IRH) delivers all its in-patient services on the hospital site.

Stroke Service (patients of all ages)

17 Beds for stroke patients are housed in Ward KS in the Inverclyde Tower Block. The ward has a full complement of nursing and rehabilitation staff including social work and clinical Psychology input.

Referrals for admission from GPs are assessed by the medical ST in the A&E Department for suitability or not for thrombolysis and clarification of likely diagnosis. 999 attenders are seen by the A&E staff. If thought suitable for thrombolysis transfer to the Southern GeneralHospital is immediately arranged for this to take place. If not for thrombolysis but likely stroke or TIA depending on bed availability direct admission to the IRH stroke unit is arranged with if possible CT scan carried out on the way to the Unit.

There were 365 discharges from the stoke unit in 2014.

Currently stroke care is provided by one physician (Dr Akhter) supported by a Stroke Liason Sister (Marlene Mc Kinney) and Stroke Sister ( Eileen Bowie). These Nurse Specialists provide outreach services (including Home Visits if necessary), inpatient drop in services, nurse led clinics and support for the consultant in managing outpatient clinics and stroke referrals from within the hospital.

Twice weekly stroke clinics are held in the MFTE Day Hospital, both allowing full rapid assessment of TIAs.

A full stroke outreach community rehabilitation team is based in the Unit to follow patients in the community and help early discharge.

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

The service providesInverclyde patients acute stroke care and rehabilitation. North Ayrshire,Cowel and Bute patients are provided acute stroke care but are transferred back to their local service for rehabilitation .

Medicine for the Elderly Service

The Medicine for the Elderly service is based in the Larkfield Unit ( part of Inverclyde Royal Hospital). It consists of two 30 bed assessment and rehabilitation wards, a 24 bed long stay/supported care ward and a MFTE Day Hospital. Full rehabilitation and social work input is given to the assessment and rehabilitation wards.

There are 2 consultants in Medicine for the Elderly each responsible for a 30 bed assessment and rehabilitation ward and part of the 24 bed supported care ward.

Outpatients in Movement Disorders and Falls are held in the DayHospital along with a General clinic. The Falls clinic is part of the Greater Glasgow and ClydeFalls prevention program. A Parkinson’s Disease Nurse Specialist is attached to the Movement Disorder service including providing a nurse led clinic.

The service has grown considerably in the past 5 years. There were 800 discharges from the assessment and rehabilitation wards in 2014 in the Larkfield Unit. With the drive for shorter lengths of stay we anticipate this will continue to grow. To meet this need we plan a reduction of beds looked after by one consultant from 30 to 20 beds allied to an extra ward round each week and greater throughput of patients per bed. Our 60 assessment and rehabilitation bed complement would therefore be divided as 20 to each of the MFTE consultants and 20 to be shared between the 2 stroke consultants with an interest in MFTE.

A 5 day Fast Track service is provided in the Day Hospital, supported by a Specialty Doctor and a Gerontology Nurse Specialist. Community work and the fast track clinic have been developed as part of the DayHospital service as an alternative to admission to hospital. Other services including blood transfusions and zolendronate infusions are also carried out in the Day Hospital. The Day Hospital has a newly appointed Advanced Nurse Practitioner who is developing his role to provide links between acute hospital services and community services. An Interface Pharmacist is attached to the Day Hospital.

Links with other Departments within InverclydeRoyalHospital

Inverclyde Royal Hospital is a District General Hospital with access to a full range of services including onsite ITU, HDU and CCU. There is good interdepartmental communication.

Our service work closely with medical specialties and our Advanced Nurse practitioner carries out a daily visit to the Medical Admissions unit to review patients identified at the post-receiving round by General Physicians using agreed criteria. Direct transfers from there to Medicinefor the Elderly beds takes place, dependent upon bed availability.

Regular liaison visits by the Advanced Nurse Practitioner to all wards are undertaken to ensure appropriate patients are transferred to Medicine for the Elderly beds as expeditiously as possible.

We work closely with orthopaedics and one of our two wards is designated for elderly hip fracture rehabilitation.

Two of our current consultants take part in the acute medical receiving Rota. This would not be expected from the new post holder who will have on call duties related to the new South Glasgow Hospital Stroke Service (see below-Duties of the Post).

1. Description of the Post

(a)Title:

Consultant Physician in Stroke / Medicine for the Elderly

(b)Relationships:

(I)Rehabilitation and Assessment Directorate

Director: Mrs M Farrell

Associate Medical Director Prof Paul Knight

General Manager (Clyde):Mr J Kennedy

Lead Clinician (Clyde)Dr H Slavin (Stroke)

(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 wish to contribute to both the development of Stroke Care and the Geriatric Service. The clinical duties described will depend upon final agreement of the job plan. The main role will be along with the other Stroke Consultant to provide inpatient and outpatient care for stoke patients in the Inverclyde area.
• Participation in the South Glasgow Hospital Stroke Consultant on-call rota for night time and weekend cover.
• Care of assessment and rehabilitation patients in Medicine for the Elderly beds in the Larkfield Unit IRH (10 beds out of a complement of 60)).
• Assessment and review of Stroke patients attending DayHospital which provides open access to general practitioners and liaison with Community rehabilitation teams.
• Acute stroke, stroke rehabilitation and specialist stroke clinics
• The Consultant will be expected to share cover for absent colleagues on annual or study leave by prior arrangement and short-term, unplanned sick leave

.

(v) Supporting Professional Activities

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

• Participation inClinical Meetings and an audit programme

• The appointee will be expected to participate in annual appraisal

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

• The Consultant will be responsible, in conjunction with colleagues, for theclinical and educational supervision of trainee medical staff.

• The Consultant has the opportunity to take part in the undergraduate teaching for students from University of Glasgow

• The Consultant may be expected to contribute, by agreement with the Clinical Director, to internal and external Health Service committees

Proposed Weekly Programme (Job Plan)

The proposed indicative weekly programme is shown below with a programme described based on stroke interest in IRH with responsibility for 10 MFTE assessment and rehabilitation beds. The South Glasgow Hospital on call Stroke Rota input is also described in the plan. Activities with current fixed time commitments will be carried out as detailed in the work programme e.g. clinics. Other DCC and SPA activities are shown with indicative timings within the weekly programme and will be discussed with the appointee.