WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST CLINICAL FELLOW IN EMERGENCY MEDICINE ______

WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST

DIRECTORATE OF EMERGENCY MEDICINE

JOB DESCRIPTION FOR CLINICAL TEACHING FELLOW

EMERGENCY MEDICINE

ALEXANDRAHOSPITAL, REDDITCH

WORCESTERSHIREROYALHOSPITAL

EMERGENCY CARE DIVISION

TRUST PROFILE

ALEXANDRAHOSPITAL, REDDITCH

The AlexandraHospital opened in 1986 on the borders of Worcestershire and Warwickshire, providing 360 day and acute care beds and serving a population of approximately 200,000. The hospital provides acute services on site for General Medicine including a Medical Assessment Unit, CCU and Stroke unit, Acute Surgery, Paediatrics, Obstetrics and Gynaecology and Trauma & Orthopaedics. The site is the trust focus for Urology and Orthopaedic service. The site has access to 24 hour Radiology service including a multi slice scanner and to all general lab services. The unit is supported by adult ITU beds. Educational facilities include a new Education Centre within the hospital building.

WORCESTERSHIRE ROYALHOSPITAL

The Worcestershire Royal Hospital (550 beds) opened to patients in March 2002 serves a population of approximately 220,000, housed mainly within a new PFI build whilst additional buildings provide accommodation for Ophthalmology, Care of the Elderly, Rheumatology and the Charles Hasting Education Centre.

The site also offers Acute General Medical, Surgical, Paediatric and SCBU services as well as Obstetric & Gynaecology and Trauma & Orthopaedic support. Trust Vascular, Maxillofacial and ENT in patient services are based at the Worcester site. The Worcester site is also supported by Radiology and 24 hour CT scanner facilities and lab services. Worcester is also at times able to offer acute PCI for cardiac patients.

KIDDERMINSTER TREATMENT CENTRE:

A 24 hour Minor Injury is based at the Kidderminster treatment centre which has links directly with both Emergency Departments and is run by ENP’s.

Management Structure of the Trust

There is a strong commitment to clinical leadership within the Trust with a Trust Operational Board comprising Executive Directors , Medical Directors and lead clinicians reporting directly to the Board, as the main decision making body. Each division has its own Clinical Board chaired by a Divisional Medical Director in which Clinical Directors supported by Executive Directors and the local management teams manage local services. The Trust works closely with the Local Negotiating Committee (LNC) which is appointed by the Medical Staff Committee (MSC).

GENERAL BACKGROUND

Worcestershire is a largely rural County, with four main towns, Bromsgrove, Kidderminster, Redditch and Worcester, lying between the Cotswolds, Welsh Border and Birmingham. There are four further substantial market towns of Malvern, Pershore, Evesham and Droitwich. Acute medical services are provided by two District General Hospitals, a Treatment Centre and a number of Community hospitals.

The major motorway network of the M42, M5 and M6, providing excellent communications, intersect the county. Local leisure facilities are well developed and the area has easy access to Birmingham/Solihull where the National Indoor Arena, International Convention Centre with the Birmingham Symphony Hall and the National Exhibition Centre are located. Stratford and the Royal Shakespeare Company are on the doorstep. WorcesterCity lying on the banks of the River Severn has the world famous cathedral, County Cricket Ground, Premiership Rugby and is home to the Royal Worcester Porcelain Factory. The Malvern Hills and the WyreForest are in the locality.

Redditch is a new town within 40 minutes by rail of the centre of Birmingham. The area is famous for its needle production and has museum dedicated to this set with the central lake and parkland of the town which also boasts many leisure activities.

Worcestershire has many sites of historical interest and natural beauty. The economy of the county is based on agriculture, horticulture, light engineering and increasingly service industries.

There are a wide range of high quality State and Private schools serving the county.

Emergency Departments

The AlexandraHospital

The Emergency Department is based in the main hospital building and forms part of the county wide Emergency Department directorate. The department currently has a 3-bedded Resuscitation Room, 11 adult trolley bays, 3 dedicated paediatric bays, 6 cubicles for adult walking wounded patients, 1 ophthalmic room and a 4 bedded observation area beside the Department. The Emergency Consultants run a daily follow-up clinic in the Department from Monday-Friday. There is a separate seminar room, which is in regular use.

The hospital has dedicated cardiac arrest teams and a Consultant-led Trauma Team. The Department itself runs cardiac arrests and trauma resuscitation in-house during office hours. Middle grade doctors are encouraged to lead these teams.

There are close working relations with Radiology which recently installed new CT and MRI scanners which are easily accessed for emergencies. The Department undertakes ED clinician led Thrombolysis in acute ischaemic stroke patients prior to their admission to the acute stroke unit at present this is on a 9-5pm based but is hoped to extend to 08-23 in the next few months, middle grades are trained in this treatment.

The Department has an average yearly attendance of about 51,000 patients. Approximately 23% of these numbers are paediatric. This reflects the demographical fact that Bromsgrove and Redditch have a younger population.

The Department has a lower than average primary care attendance ratio owing to both the high quality of the general practice services and the out of hours primary care centre.

Emergency Departments nationally continue to show an increase in annual attendance and this Department is no exception.

Patients arrive in the Department either by public/private transport or via ‘999’ (emergency) or GP arranged ambulance. West Midlands Air Ambulance also transport seriously injured/ill patients to the Department.

Consultant sub-specialty interests include medical education (the Department runs a successful MCEM course), paediatrics and major trauma courses.

The Department has its own 4 Bedded Emergency Decision Unit (EDU) which is used for observation of certain patient groups, the ED middle grade is responsible for overseeing this unit during their shift.

Certain categories of patients requiring specialist care are transferred appropriately:

ENT-Worcester Royal Hospital/QEH

Burns/Plastics-UniversityCollegeHospital (Selly Oak)

Psychiatry-HillcrestHospital (same site)

Neurology/Neurosurgery-Walsgrave Hospital/QEH

Vascular-Worcester

JOB PLAN AND TIMETABLE

Week1 demonstrated( full rota available on request)

Rota rotates though 9 weeks with bold shifts being float shifts providing cover if others way.

The rota gives a 1 in 3 weekends

Week 1 / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
MG 1 / 1400-2200 / 1600 - 2400 / 2200 – 0800 / OFF / OFF / 0800 – 1600 / 0800 – 1600
MG 2 / 0900 – 1700 / 1400 – 2200 / 1600 – 2400 / 2200 – 0800 / OFF / OFF / OFF
MG 3 / OFF / OFF / 0900 – 1700 / 0800 – 1600 / 1400 – 2200 / OFF / OFF
MG 4 / OFF / 0900 – 1700 / 1400 – 2200 / 1600 – 2400 / 2200 – 0800 / 2200 -0800 / 2200 -0800
MG 5 / 1100 – 1900 / 1100 – 1900 / 1100 – 1900 / 1100 – 1900 / 1100 – 1900 / OFF / OFF
MG 6 / 1600 – 2400 / 2200 – 0800 / OFF / OFF / 0800 – 1600 / OFF / OFF
MG 7 / 1300 - 2100 / 1300-2100 / 1300 - 2100 / 1300 – 2100 / 1300 – 2100 / OFF / OFF
SPR 1 / 2200 – 0800 / OFF / Teach/
1800 – 2200 / 0900 – 1700 / 1600 – 2400 / 1400 – 2200 / 1400 – 2200
SPR 2 / 0800 -1600 / 0800 – 1600 / 0800 – 1300/
Teach / 1400 – 2200 / 0900 – 1700 / OFF / OFF

Remuneration will be at the appropriate point on the Specialty Registrar (FT) payscale, dependent on experience. And is normally at 44 hours/11 pa’s inclusive of time for CPD and teaching

The post holder will be based at the Alexandra Hospital, however the post holder may be required to work at any location within the Trust should the service need arise, and may also be required to undertake duties at locations outside the Trust.

Annual leave is granted with 6 weeks notice –only 2 middle grades can be on leave or study leave at any one time. Cover is prospective for all leave via the float shifts.

REVIEW OF JOB DESCRIPTION

This job description, together with the job plan, will be reviewed annually (if applicable) and agreed with the Clinical Director and Lead Consultant to ensure that it continually reflects the areas of work, clinical responsibility of the post and purchaser requirements.

STAFFING

Consultants

Mr Richard Morrell, Complaints & EDU

Mr Christopher Hetherington, Paediatric Lead

Dr David Gemmell, Governance lead

Dr Sarah Crawford, Thrombolysis lead & college tutor

Middle grade

3 Specialty Doctors

4 Clinical Fellows

2 Specialist Registrars

Junior Grade

2 Specialty Registrars (CT/ST3 Level)

2 Specialty Registrars (CT1 Level)

4 Foundation House Officer Year 2

2 Foundation House Officer Year 1

Clerical & Secretarial Staff:

Secretaries 1.6 wte

Admin/clerical staff 6.0 wte

Nursing Staff:

46 wte in total

The nursing side of the Department is run by a Modern Matron (A&E and MAU) and Lead Nurse. The Department has 3 wte Registered Paediatric Nurses and 2 Emergency Nurse Practitioners who are involved in streaming of minor injuries within the Department.

The Worcestershire Royal Hospital –Emergency Department

The Worcestershire Royal Hospital, Emergency Department is based in the PFI hospital and deals with approximately60,000 patients per year. It has facilities to resuscitate, assess and treat acute illness and injury and patients of all ages by appropriately trained and experienced staff, according to current national and local standards and the onward referral of patients as appropriate.

The Emergency Department forms part of the countywide Emergency Service. The department is situated on Level 2 “Woodland” at the northern end of the hospital. There are 2 entrances for patients, one of which is designated for patients arriving by 999 ambulances.

The Emergency Department reassesses and has follow up clinics of defined conditions to total less than 10% of all attendances and provides a Consultant-led Review Clinic to the MIU.

The department has a separate paediatric area for our patients between 0 – 16 years of age, ensuring children and their families are cared for within an appropriate setting. Consultant review clinics are held Monday – Friday 9.30 am to 11.00 am. Emergency Department medical and nursing staff are able to refer patients to this clinic

The department has ample clinical areas including:

  • Decontamination room
  • Twelve examination/treatment bays
  • Minor injury assessment area
  • Large reception and waiting area
  • Plaster Room
  • 4 bay resuscitation area
  • Clean Procedures Room
  • Triage Room
  • Dedicated paediatric area
  • Psychiatric interview room
  • 6 bedded observation area

PROVISIONAL JOB PLAN AND TIMETABLE

The successful applicant will form part of the ED Middle Grade rota, this a nine week rolling rota as detailed below.

The post holder will be based at the Worcestershire Royal Hospital, however the post holder may be required to work at any location within the Trust should the service need arise.

Example of present Timetable

Example clinical fellow rota

Mon / Tues / Wed / Thurs / Fri / Sat / Sun
WK 1 / 12-22 / 17-01 / 12-22 / 09-17.00
WK 2 / 12-22 / 22-08 / 07.30-17.00 / 07.30-17.00 / 07.30-17.30 / 07.30-17.30
WK 3 / 12-22 / 17-01 / 12-22 / 09-17.00
WK 4 / 12-22 / 22-08 / 07.30-17.00 / 07.30-17.00
WK 5 / 12-22 / 17-01 / 12-22 / 09-17.00 / 22-08 / 22-08 / 22-08
WK 6 / off / 22-08 / 07.30-17.00 / 07.30-17.00
WK 7 / 12-22 / 17-01 / 12-22 / 09-17.00
WK 8 / 12-22 / 22-08 / 07.30-17.00 / 12.30-22.30 / 12.30-22.30 / 12.30-22.30
WK 9 / 12-22 / 17-01 / 12-22 / 09-17.00

Remuneration will be at the appropriate point on the Specialty Registrar (FT) payscale, dependent on experience. And is normally at 44 hours inclusive of time for CPD and teaching

REVIEW OF JOB DESCRIPTION

This job description, together with the job plan, will be reviewed annually and agreed with the Clinical Director and Lead Consultant to ensure that it continually reflects the areas of work, clinical responsibility of the post and purchaser requirements.

STAFFING - WORCESTERSHIRE ROYAL HOSPITAL

Consultants (4.5 WTE)

Ms Rose Johnson, Head of Local Academy

Mr Ian Levett, Audit and majax lead

Dr Beth Williams, Paediatric lead

Dr James France,

Dr Paul Shone,lead of Observational Medicine

2 Associate Specialists

6 Specialty Doctors/clinical fellows

1 Specialty Registrar (ST5 Level)

5 StR GP VTS Trainees (1 post currently vacant)

6 Foundation House Officer Year 2

1 Clinical Assistant

Supported by:

Clinical Nurse Manager

6 ENP’s

40 WTE Nursing Staff

DUTIES OF THE POST at both Emergency Departments ( in addition to these duties there are also those required by the medical school )
  • You will assist the Consultants in the day-to-day clinical care of the ED patients.
  • Manage the resuscitation room cases including leading the trauma and cardiac arrest teams.
  • Co-ordinate, supervise and support the junior medical staff.
  • Conduct review of patients on the observation unit
  • Assist the consultant in the management of the follow up clinics.
  • Participate in the Clinical Audit programme and the quality control of the department.
  • Actively participate in the weekly departmental teaching programme for both the junior doctors and

middle grades.

  • Support the Trust in the delivery of a high standard of care and meeting Trust and departmental objectives by timely service and quality led clinical care.
  • Comply with relevant trust policies including those relating to data protection.
  • Actively pursue professional development maintaining a portfolio of evidence so that you are able to participate satisfactorily the appraisal process in accordance with GMC requirements. To support you in this you will have a named consultant mentor.

Education;

As well as developing their own personnel portfolio the successful post-holders are expected to play a full role in the teaching and development of medical students within the 2 departments and support the medical school and academies. Please see the specific generic job description

CLINICAL DEVELOPMENT AND RESEARCH

The Charles Hastings Education Centre, part of the Worcestershire Royal Hospital complex, is an innovative £4 million training centre that has been built adjacent to the new hospital, ideal for training/teaching and research. It houses a 170 seat lecture theatre, smaller teaching rooms, a practical skills suite and a library with extensive printed and on-line resources.

The Alexandra Hospital has built a new multi-disciplinary education faculty accessible 24 hours a day. The hospital is in close proximity to Birmingham University Medical School and the local teaching hospitals.

The Trust recognises the importance of the availability of opportunities for research, in attracting the right candidate for this post. There is a thriving Research and Development Department, with key areas being cellular transplantation, respiratory medicine and cancer services. The R & D Department has been successful in obtaining Culyer II funding, which will be available to support projects over the next 3 years, and is applying for support for science monies.

There are strong links with University College, Worcester, through the SHARE agreement and at present 3 PhD students are jointly funded by the Trust and UCW.

Developments of Career:

The directorate realises that successful candidate wish to develop their careers and will sympathetically consider and explore options with successful applicants

COMPETENCE

The post holder is responsible for limiting his/her actions to those which s/he feels competent to undertake. If the post holder has any doubts as to his or her competence during the course of his/her duties then s/he should immediately speak to their line manager or supervisor.

CODES OF CONDUCT

All employees of the Trust who are required to be registered with a professional body, to enable them to practise within their profession, are required to comply with their code of conduct and requirements of their professional registration. Those staff who are not required to be registered with a professional body are required to comply with the Trust’s codes of conduct.

CONFIDENTIALITY

The post holder must maintain confidentiality, security and integrity of information relating to patients, staff and other Health Service business.

RECORDS MANAGEMENT

All employees of the Trust are legally responsible for all records that they gather, create or use as part of their work within the Trust (including patient, financial, personnel and administrative), whether paper or computer based. All such records are considered public records and all employees have a legal duty of confidence to service users. Employees should consult their manager if they have any doubt as to the correct management of records with which they work.

HEALTH AND SAFETY

Employees must be aware of the responsibilities placed on them under the Health and Safety at Work Act (1974) and the Manual Handling Operations Regulations (1992). This ensures that the agreed safety procedures are carried out to maintain a safe environment for employees, patients and visitors to the Trust.

INFECTION CONTROL

Employees must accept personal responsibility and accountability for Infection Prevention and Control practice. Employees should ensure they are familiar with, and comply with, all relevant Infection Control policies for minimising the risk of avoidable ‘Health Care Associated Infection’. All Employees must undertake annual mandatory updates in Infection Control.

RISK MANAGEMENT

It is a standard element of the role and responsibility of all employees of the Trust that they fulfil a proactive role towards the management of risk in all of their actions. This entails the risk assessment of all situations, taking appropriate actions, and reporting all incidents, near misses, and hazards promptly. It is a contractual obligation that all employees must co-operate with any investigations undertaken.

CHILDREN AND VULNERABLE ADULTS

You have a responsibility for promoting and safeguarding the welfare of the children/young people/vulnerable adults that you come into contact with or are responsible for in your job role and sphere of competence.

CRIMINAL RECORDS BUREAU

The Trust aims to promote equality of opportunity for all, with the right mix of talent, skills and potential. Criminal records will be taken into account for recruitment purposes, only when the conviction is relevant. As the Trust meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a criminal record check from the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Postholders may periodically be asked to undertake a re-check.

VETTING AND BARRING SCHEME

The Trust is legally required to check all staff against the ISA Children’s and Vulnerable Adults barring lists if they engage in what is defined as “Regulated Activity” or “Controlled Activity”: Regulated Activity is defined as working closely with children or vulnerable adults, paid or unpaid, on a frequent or intensive basis. Controlled activity is work that provides opportunities for contact with children or vulnerable adults, or their records. This includes caterers, cleaners, administrators, contractors, maintenance workers and their managers and supervisors.