Generic Job Description
Foundation Year 2 Posts
INTRODUCTION
The Whittington Hospital Trust is one of London pilot sites for the development of Foundation Year 2 posts, which are part of Modernising Medical Careers (MMC). These are equivalent to the first year of being a Senior House Officer (SHO). MMC will introduce a significant change in the way in which postgraduate education is offered in the UK. From August 2005, all UK graduates will undertake a 2 year Foundation Programme designed to ensure that at the end of the programme doctors have robust and assessed clinical skills in acute medicine, understand and can practice medicine using the professional practices required by the General Medical Council and have the opportunity to have experience, where appropriate, in several different specialties. The Whittington is participating in a pilot of the second year of such a programme.
The London Deanery educationally approves all the posts. All Emergency Dept posts and all the Medical Posts have educational approval from the Royal College of Physicians. All Emergency Dept posts and all the Surgical Posts have educational approval from the Royal College of Surgeons.
Posts available
The posts available in this one-year programme are listed below:
· Emergency dept (6 months) followed by Surgery (6 months) – 1 post
All Emergency dept FY2 posts will include a “taster” week in another speciality.
Education and Training Programme
Educational supervisor: each trainee will have a designated educational supervisor to support his or her education and training.
Induction: Trainees will receive an induction programme into the Foundation 2 year to introduce them to the Programme, the Hospital and their individual placement. Whenever a trainee moves to a different training placement during the year, there will be an induction into the new department. All trainees must participate in the induction.
Appraisal: regular appraisal will be held with the educational supervisor in “protected” time. These should take place at least every 3 months, but may be more frequent if required.
Training agreement: learning objectives will be agreed within 2 weeks of taking up post between the educational supervisor and the trainee. These will be documented in the Deanery learning portfolio (see below) and will be used to inform appraisals and progress.
Generic training programme: trainees will have a core-training programme in professional skills and attitudes. Attendance at this is mandatory and will part of the study leave allocation of the trainee.
Clinical training: clinical training will be largely experiential, focussed and supervised in order to ensure that the clinical competencies required are obtained.
Portfolio: each trainee will have a Deanery learning portfolio to support his or her education and training. It will be used for both formative development and to record summative assessments and should be used in appraisals. The portfolio is based on a curriculum, which has been designed to help the trainee develop the clinical and professional areas of competencies required to complete the Foundation Year 2.
Assessment: formative assessment will be undertaken using assessment tools which are being developed and validated by the London Deanery. These will be work place based and will be supported by the learning portfolio.
Clinical audit: all trainees will be expected to complete at least one audit project during their year of training.
Study leave: A proportion of the 30-day entitlement to study leave (subject to the requirements of the service) will be used to participate in the generic professional teaching programme. Study leave will need to be arranged through the Trust’s Director of Medical Education, according to local arrangements. As for other SHOs, Foundation Year 2 trainees will be entitled to 3 hours/week of bleep-free, relevant teaching or attendance at events such as grand rounds, journal clubs, clinical-pathological conferences, etc. In addition, it is anticipated that trainees will use some of their study leave time to undertake short, focussed “tasters” in other specialties by arrangement with their educational supervisors and the relevant departments. Some posts will offer the opportunity to spend ½ day/week in General Practice in focussed training opportunities.
THE HISTORY OF THE WHITTINGTON HOSPITAL
Medical services were first provided on the site of the Whittington in 1473. Originally a leper hospital during the reign of Edward IV, by the time of Elizabeth I the hospital was caring for the poor chronic sick who had been transferred from St Bartholomew’s and St Thomas’. In 1848, a new hospital was built on the St Mary’s Wing site. This had 108 beds and cared for patients with smallpox. During the great smallpox epidemic between 1855 and 1859, the hospital admitted 1185 patients of whom 20% died. The Smallpox and Vaccination Hospital is currently known as the Jenner Building and is used as office accommodation.
Independently managed hospitals were opened on the Highgate Wing site in 1866 the Archway Wing site in 1877. These hospitals had 543 and 625 beds respectively. In August 1900, Highgate Hill Infirmary with 780 beds opened adjacent to the Smallpox and Vaccination Hospital. The two hospitals soon amalgamated and the Smallpox Hospital was transformed into a nurses’ home.
Edith Cavell worked as a night sister for three years from 1901 at the Infirmary on the current Highgate Wing site. Florence Nightingale had described the Infirmary as ”by far the best of any workhouse infirmary we have” and indeed “the finest metropolitan hospital”.
In 1947/8 the hospitals were brought together under Dr Cecil Coyle, who as Medical Superintendent was responsible for the administration of all three sites. The three hospitals had between them just under 2000 beds. With the coming of the NHS in 1948, the sites began to modernise. The past 50 years have seen the consolidation of all clinical services onto the St Mary’s Wing site with a reduction of beds from nearly 2000 to around 500. In 1977 a new block was opened which currently houses the emergency department, outpatient clinics and the pathology laboratories. In 1992 the Great Northern Building opened with its modern ward accommodation, staff restaurant and education facilities.
As clinical services moved to the main site, so both Archway Wing and Highgate Wing changed function. Highgate Wing has been chosen by Camden and Islington Community Trust as the site for the consolidation and development of the district’s mental health services. Archway Wing is owned by UCL and The Middlesex University as an education and research campus.
Despite its two new buildings and a programme of continual refurbishment, much of the external fabric of our remaining mid 19th century hospital on the St Mary’s site is in poor condition and in urgent need of replacement. This has been recognised with the publication of the ‘Turnberg Report’ on health services in London. The report recommended urgent capital investment in the site and the hospital is now anticipating a period of very considerable redevelopment.
The future of our historic hospital is very bright. Praised by the Turnberg Report for our rôle as a community facing general teaching hospital, plans are currently being laid to develop the Trust as a model of the urban hospital of the 21st century.
THE HOSPITAL TODAY
The Whittington Hospital is a medium sized district teaching hospital. The site contains a mixture of modern, good quality accommodation and older buildings. A new build is well underway which will deliver new assessment; critical care and ambulatory care facilities and is due for completion in 2005. This new building will double the capacity of critical care and day surgery and will significantly improve the environment in which staff work. Planning for further site development is now in progress.
The hospital is well provided with equipment, with considerable ongoing investment to ensure that practitioners have the ‘tools to do the job’. The hospital is proud of its tradition of providing high quality medical education. We seek to provide academic and clinical excellence without losing sight of our rôle as a community based hospital supporting our local GPs.
We are located in Archway, North London and have traditionally served the populations of North Islington and West Haringey. Our catchment population is around 240,000. Our local population is a diverse mix in terms of social class, economic status and ethnicity and the communities we serve embrace Highgate, Finchley, Haringey, Camden and Islington. We have close working relations with tertiary centres at the Royal Free Hospital and the UCLH group of hospitals.
All main branches of medicine and surgery are provided at The Whittington Hospital with the exception of neurosurgery and cardiothoracic surgery. Plastic surgery and ophthalmology are represented by outpatient services.
A combined Diagnostic and Outpatient block is situated on the site. This block accommodates the newly upgraded Emergency Department, together with main supporting services such as Pathology, Radiology and Pharmacy. The Radiology Department has an MRI scanner and a spiral CT scanner to provide a comprehensive investigatory facility. The first phase of a Picture Archiving and Communication System (PACS) has been rolled-out in Emergency, with electronic links to the Hospital for Nervous Diseases at Queen Square anticipated in the near future.
A seven-bedded General Intensive Care Unit (5 ITU, 2 HDU beds) is located adjacent to the six-bedded Coronary Care Unit. Both units are well equipped and well staffed.
An 89 bedded Mental Health Unit is located adjacent to Whittington Hospital on Dartmouth Park Hill and is managed by the Camden and Islington Mental Health Services Trust. The Sexual Health Clinic, managed by Camden & Islington Community Trust, is located in Archway Campus.
The hospital is divided into four main divisions each managed by a Divisional Manager who reports to the Director of Operations (Tara Donnelly) or her deputy (Kate Slemeck) as follows:
Divisional Manager Acute Medical Services: Fiona Elliott
Divisional Manager Medicine and Clinical Services: Adam Smith
Divisional Manager Surgery: Shaun Stacey
Divisional Manager Children & Women’s Health: Anne Gibbs
Mrs Celia Ingham Clark is the Executive Medical Director for the Trust as a whole.
Dr Jane Young is the Trust’s Director of Medical Education.
Apart from medical undergraduate and postgraduate training commitments, the hospital provides recognised training for nurses, midwives, Allied health Professionals, Biomedical Scientists and operating department practitioners.
Approximate Bed NumberS
Surgery 104
Medical 221
Orthopaedic 56
Gynaecological 19
Maternity 47
Paediatrics 35 (of which 8 are day care)
Neonatal Unit 18 (including 6 intensive care cots)
Day beds 22
Emergency 8
ITU 7
All figures are approximate because beds are used flexibly and because ongoing strategic planning processes may affect individual speciality provision from time to time.
WHITTINGTON HOSPITAL NHS TRUST
EMERGENCY DEPARTMENT
SENIOR HOUSE OFFICERS
FOUNDATION YEAR 2 PILOT PROGRAMME
JOB DESCRIPTION
THE DEPARTMENT
A purpose built, expanded Emergency Department opened in June 1995. About 77,000 new patients are seen each year with about 5,000 return visits.
The department comprises a four-bed Resuscitation room with one dedicated paediatric bay. There are fourteen adult cubicles, including those designated specifically for gynaecology, infectious disease and psychiatric patients. There is a specially equipped cubicle for children requiring close monitoring and separate children’s waiting area. There is a dedicated minor injury treatment area comprising consultation rooms and treatment cubicles for adults and children. An Emergency Nurse Practitioner service for minor injuries runs seven days a week. There is an eight-bed Clinical Decision Unit within the department for those patients who require a prolonged period of observation or further investigation. The department has rapid access to OT and Social work referral. A limited number of review clinics are run from within the department dealing with wound dressings and soft tissue problems.
Twenty four-hour reception cover is provided and a computerised record system is maintained. The department is provided with 24-hour biochemistry and haematology services.
A Radiologist is available during working hours on weekdays for help with interpretation of imaging and assistance with selection of further studies. The department has access to intravenous urography, same day ultrasound and to CT and MRI scanning. A computer based x-ray viewing and retrieval system (PACS) is in operation.
A teaching / seminar room with computer and Internet access is located within the department. There is a staff restroom within the department.
On site security provision is made on a 24-hour basis, with dedicated security personnel within the department at nights. The working areas are monitored by closed circuit TV.
ESTABLISHMENT
3 Consultants (full time)
1 Locum Consultant
1 Staff Grade
2 Specialist Registrars (on rotation)
3 Senior SHOs
12 SHOs
Clinical Assistant sessions
Primary Care Practitioner sessions
1 Services Manager
1 Senior Nurse H grade Lecturer Practitioner
2 Modern Matrons
10 Emergency Nurse Practitioners
12 Nursing Shift Leaders
44 Staff Nurses (D and E Grades)
2 Communications Co-ordinators
SENIOR COVER
During daytime from 8 am there is a Middle Grade or Consultant present in the department. Middle Grade cover continues 24/7, except Tuesdays & Wednesdays when it is until 2am.
There are Primary Care Practitioner sessions every evening and at weekends.
Out of hours, the Consultants participate in a 1 in 3 rota and are contactable by pager or telephone at all times.
DUTIES OF THE POST
· The assessment, diagnosis and initial management of all patients attending the Emergency Department at the Whittington Hospital except those already accepted for assessment / admission by the On Call teams. To ensure that the disposition of these patients is in accordance with Department and Trust policies.
· To participate in the duty rota of the Emergency Department. This is a twelve-week rota for the Senior House Officers and is designed to provide the department with a sufficient number of SHOs on duty at all times.
· To help the Consultants and Middle Grades in supervising the activities of the medical students attached to the department and to provide these students with “on the floor” teaching.
TEACHING
· All ED SHOs will attend the two-day Whittington Hospital induction programme. Attendance is compulsory.
· There is twice weekly teaching – in the department on a Tuesday lunchtime and in the Postgraduate Centre on a Thursday afternoon – for the full six months of the post. This is protected training time and no clinical duties are expected of the SHOs during these periods.