Medicine for Elderly

consultant in

medicine for elderly

royalalexandrahospital

Information pack

ReF: 39065D

Closing Date:Noon on 23rd october 2015

SUMMARY INFORMATION

Post: MEDICINE FOR THE ELDERLY

Base:royalalexandraHOSPITAL

This is an exciting opportunity to join a team of Consultants providing Medicine for the Elderly services across the Renfrewshire and East Renfrewshire catchment areas. Based at the RoyalAlexandraHospitalyouwill work with 6 other Consultants to provide a comprehensive Older Peoples Service.This post will have a specific role on the management of Orthogeriatric cases and support the development of a new needs-led service for Older Acute Medical Admissions. There is flexibility to accommodate the interests of applicants with opportunities for development.

For further information contact Dr Graeme Simpson, Lead Clinician, Dr Carol Wilkieson, Consultant Geriatrician, Dr Alisdair Maccrae, Consultant Geriatricianor Dr Oona Lucie Consultant Geriatrician via the hospital switch board on 0141 887 9111

Applicants must have full GMC registration and a licence to Practice. 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

ROYALALEXANDRAHOSPITAL

PAISLEY

INFORMATION PACK

FOR THE POST OF

CONSULTANT IN MEDICINE FOR THE ELDERLY

1. GENERAL INFORMATION

RoyalAlexandraHospital, Paisley. (RAH)

The town of Paisley is situated less than 10 miles to the West of Glasgow and 4 miles from GlasgowAirport (average flight time to London Heathrow 1 hour). The RoyalAlexandraHospital provides an extensive range of acute health services to the Renfrew District and beyond, with a population of 220,000 mainly concentrated in and around Paisley.

The Hospital first opened in 1986 and has a current bed complement of 520. There are also facilities on site for General and Geriatric Psychiatry. In any one year the hospital treats nearly 30,000 inpatients, over 103,000 outpatients and day cases, and there are some 2,400 births in the Maternity Unit.

The Emergency Department (ED) is situated in a purpose built area which includes Fracture/Orthopaedic Clinic facilities. The Intensive Care Unit is located on the floor directly above the Emergency Department. During 2014, the Department treated 75,000 new attendances. In addition, the Emergency Department team managed approximately 1,200 patients admitted with head injury and 2,000 patients attending the weekly Soft Tissue clinics.

The major specialties are General Medicine, General Surgery and Urology, Anaesthetics, Stroke, Geriatric Medicine, Gynaecology, Obstetrics, Paediatrics, ENT, Ophthalmology, and Orthopaedic Surgery. The Radiology Department – with dedicated Emergency X-ray, Ultrasound, MRI and CT Scanner (available 24 hours) – is adjacent to the ED. There is a 24 hour laboratory on-call service for Haematology, Microbiology, Blood Transfusion, and Biochemistry.

The hospital has an active postgraduate education program and has excellent educational facilities including a clinical skills area equipped with a simulator suite.

There is a Helipad in the Hospital grounds with direct access to the main Hospital building.

InverclydeRoyalHospital, Greenock. (IRH)

InverclydeRoyalHospital is a modern, 450-bed DistrictGeneralHospital in Greenock with magnificent views over the River Clyde and beyond. The Hospital serves a population of around 125,000 in Inverclyde, Largs, Bute and the CowalPeninsula. The major specialties within the hospital include general and vascular surgery, urology, orthopaedic surgery, general medicine, rheumatology and clinical haematology. There is also a new geriatric assessment unit.

The Emergency Department is situated on the ground floor in a purpose built facility and was completely refurbished in 2014. The department has a varied case load with 35,000 annual attendances in 2014 and approximately 1500 ED return patients. The department is well supported by the adjacent Radiology department (MRI on site and 24 hour CT scanning) and on-site laboratory facilities.

The Hospital has an active post-graduate education centre consisting of a well-stocked library, lecture theatre, four seminar rooms and reception area. The lecture theatre has seating for 80 with comprehensive audio-visual facilities. The library has a bank of computers with easy access to the internet for literature searches etc.

Vale of LevenDistrictGeneralHospital, Alexandria. (VOL)

Alexandria (19 miles from Paisley and Greenock) is located on the southern shores of Loch Lomond marking the boundary between the urban area of the Central Belt and the peace and tranquillity of the hills and lochs that makes the West of Scotland one of the most beautiful areas in the world.

The Vale of Leven Hospital has 333 beds and serves a population in excess of 80,000, providing general and specialist hospital and mental health facilities for the Dunbartonshire district as well as part of the Argyll and Bute District.

A Nurse-led Minor Injuries Unit is in operation from 9am – 9pm 7 days a week. Telemedicine support for the MIU is provided by the ED consultants during the hours of operation as well as twice weekly soft tissue returns clinics at the Vale of Leven. A Medical Receiving Unit operates at the hospital 24 hours per day. The combined work load is approximately 16,000 patients per year.

The Primary Medical Care provided within the catchment area of all Hospitals is of an extremely high standard.

All major Regional Specialties are available in Glasgow. These include Interventional Cardiology, Plastic Surgery, Burns Unit, Maxillofacial Surgery, Cardiothoracic Surgery, Vascular Surgery, Neurosurgery and Neurology.

2. WORK OF THE DEPARTMENT OF MEDICINE FOR THE ELDERLY

The Department of Medicine for the Elderly (DME) 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

A daily visit to the Medical Admissions unit is undertaken 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 Western Infirmary, Glasgow)

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.

Trauma admissions are admitted to RAH and when appropriate older patients transferred directly back to Ward 15 in VoL for further geriatric-orthopaedic rehabilitation under the care of the Geriatrician.

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. Appropriate patients may be transferred directly from medical wards to VoL Medicine for the Elderly beds.

Older Adults Assessment Unit (Clinical Services Review Pilot)

Running since Autumn 2014, this pilot ward (ward 6) has 6 assessment and 6 short stay beds, accepting direct admissions from A&E and the medical admission unit, based on frailty and illness criteria. The aim is to provide rapid CGA and enable same day or asap discharge. A decision on consolidation of this unit into the service is awaited.

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 399admissions to the stoke unit peryear.

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 new post holder will work with 2 consultant colleagues (Dr Macrae and Dr Kanthi), and the specialty doctor to develop and improve the Geriatric-Orthopaedic liaison service to meet National Review targets. There will be a shared commitment to daily visits and new patient review, and to early transfer for rehabilitation. There will be opportunities to develop pre-operative assessment, and to develop plans for ECON nurse support, and review arrangements for slow stream rehabilitation.

At present there are over 300 liaison visits per year. There is a weekly multidisciplinary team meeting in orthopaedics, currently attended by the specialty doctor. Ward 3 has 22 beds identified for orthopaedic patients, though precise allocation has depended upon bed pressures in the recent past.

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 lead by a Consultant Geriatrician.

An out-patient IV ZOL service has been the responsibility of the existing post-holder. A Database of existing patients has been maintained.

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. One geriatrician currently supports the Joint Planning Group. There are clinical links between geriatricians and the Gerontology Nurse Specialists, Parkinson’s Nurse Specialist, Rehab and Enablement Team and Interface Pharmacy. Further developments are proposed around this area.

Bed Numbers

Ward 3 / 30 beds / GORU (22) & Assessment/Rehabilitation (8)
Ward 4 / 30 beds / Stroke (25) & Assessment/Rehabilitation (5)
Ward 5 / 30 beds / Assessment/ Rehabilitation
Ward 6 / 12 beds / Older Peoples Assessment Unit
Ward 7 / 30 beds / Assessment/ Rehabilitation
Ward 36 / 28 beds / NHS Continuing Care and Interim Care

Currently there at are 354 admissions to Wards 3 and 890admissions to 5 and 7 per year with an average length of stay of 23 days.

1. THE POST

(a)Title:

Consultant Physician in Medicine for the Elderly

(b)Relationships:

(I)Clyde sector

Director: Mrs M Farrell

Chief Medic Dr Chris Jones

General Manager Older People / StrokeMr J Kennedy

Clinical DirectorOlder People / Stroke Dr Graeme Simpson

(ii)Names of Consultant members of the Department:

Consultant: / Special Interest:
Dr Julie McManus / Stroke / Medicine for the Elderly / Heart Failure
Dr G. Simpson / Movement Disorder
Dr H. Slavin / Stroke / Medicine for the Elderly
Vacant post / Falls and orthogeriatric medicine
Dr J Murtagh / Movement Disorder / Community
Dr O Lucie / Community / Medicine for the Elderly
Dr A Maccrae / Falls and orthogeriatric medicine
Dr D. Mack / Vale of Leven /Movement Disorder
Dr K. Kanthi / Vale of Leven/GORU/Falls/Syncope

(iii)Support Grades

Please complete
Specialty Doctors 2 = 17 sessions
FY2 5
GPST 3
CMT 1

(c)Duties of the Post:

(i)The post holder 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 post holder 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 post holder 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 post holder when necessary.

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

(iii)Clinical

• The post is open to candidates who may wish to contribute to both the development of Orthopaedic Care and a Geriatric Service. The clinical duties described will depend upon final agreement of the job plan.
• Needs-led acute receiving for older people in the RoyalAlexandraHospital.Weekend cover to receiving is provided by the on-call Consultant 1:9This is on call for the service which includes input to medical receiving and covering the Rehabilitation and Assessment beds ( Stroke and Medicine for the Elderly)
• Liaison and advice for appropriate older patients in orthopaedic wards.
• Care of assessment and rehabilitation patients in the Medicine for the Elderly beds
• Assessment and review of patients attending DayHospital which provides open access to general practitioners and liaison with Community rehabilitation teams.
• General Geriatric and falls clinic,
• 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

.

(iv)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

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

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

• The Consultant would be expected to take part in the undergraduate

teaching for students from University of Glasgow

• The Consultant may be expected to contribute, by agreement with

Clinical Director, to internal and external Health Service committees

4. Proposed Weekly Programme

4.1Job Plan

The proposed indicative weekly programme is shown in Section 4a with a programme described based on an orthopaedic interest. 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.

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 consultant’s professional duties and commitments, including agreed Supporting Professional Activity.

Opportunities may exist for Extra Programmed Activities to be undertaken subject to service requirements and in accordance with national terms and conditions of service.

4.2 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 RoyalAlexandraHospital.

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.

On call arrangements: The post holder will be part of the current Medicine for Elderly rota based at RoyalAlexandraHospital. This rota is a 1:8. Availability supplement is 5%.

A half programmed activity based on premium time per week has been included within the allocation of DCC to recognise the predictable and unpredictable hours of work associated with the provision of emergency cover.

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 out with 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.

5a. Indicative Job Plan

Name:- VACANCY (With special interest in Orthogeriatric Medicine)

Speciality: Medicine for the Elderly

Principal Place of Work:- RoyalAlexandraHospital

Contract:- Full timeTotal No. of Programmed Activities: 10

Extra Programmed Activities: TBA Availability Supplement: 5%

Premium Rate Payment Received: Nil

Managerially Accountable to: John Kennedy, General Manager

Professionally responsible to: Prof Paul Knight, Associate Medical Director

DAY / HOSPITAL/LOCATION
RoyalAlexandraHospital / ACTIVITY / Hrs / SPA/
DCC
FROM / TO
Monday / 08:00-12:30 / Ward 3(15 patients) / Ward round / 4 / DCC
12.30-1400 / Various / Consultant meeting(alt weeks) / 1.5 / DCC
14:00 15:00 / Ward 3
Office / MDT
Patient admin / 4 / DCC
Tuesday / 0900-12:30 / Falls Clinic(Day hospital consulting rooms) / Clinic / 3.5 / DCC
13:30- 17:00 / Office
Various / Clinical Admin
Patient reviews / 3.5 / DCC
Wednesday / 09:00 – 12:00 / Ward 36 / Ward round(long stay) / 3 / DCC
12:00-13.00 / Office / Patient administration / 1 / DCC
13:00-16:00 / DayHospital / IV Zol patients / 3 / DCC
Thursday / 09:00-1200 / Ward 3 / Ward round / 4 / DCC
12:30-13:30 / Unit meeting / Education / 1 / SPA
1300-16.00 / Out-patients / General clinic / 3 / DCC
Friday / 0900-12:30 / Orthopaedic wards / Liaison and patient assessment / 3.5 / DCC
12:30-13.30 / Hospital meeting / 1 / SPA
13:00-16.00 / Office / SPA / 2 / SPA
Saturday
Sunday / } / RAH 1:8 / Ward 2 Liaison
Review patients
Wards 3 - 7 / 2 / DCC

6.DATE WHEN POST IS VACANT