Consultant
medicine for the elderly
Royalalexandrahospital
INFORMATION PACK
REF: 35793D
cLOSING DATE: nOON 16th january 2015
As you may be aware, the new SouthGlasgowUniversityHospital and new RoyalHospital for Sick Children are due to open on the current Southern site early in 2015.
With this in mind, please note that positions based within the Victoria Infirmary, Mansionhouse Unit, the Western Infirmary and the current RoyalHospital for Sick Children at Yorkhill will change location and move to the new hospitals.
Gartnavel GeneralHospital and Glasgow Royal Infirmary will also have some services affected by moves to the new Hospitals.
These changes mean your base may change after joining us and you will be informed as soon as possible prior to any change of base.
SUMMARY INFORMATION RELATING TO THIS POSITION
Post: consultant – 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 theRoyalAlexandraHospitalyouwill work with 6 other Consultantsto 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.
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 a CCT in Geriatric Medicine or eligibility for specialist registration (CESR) or be within six months of confirmed entry at the 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. 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 in the midst of dramatic and exciting change, brought about by the 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 five 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 Modernisation Programme ensures 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.
Ambulatory care centres for the south side of the city are in the new Victoria, a purpose- built hospital next to the current Victoria Infirmary. This state-of-the-art facility opened in 2008. 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 £235 million south-side hospital being built 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 mid 2015.
The children’s hospital will also relocate from Yorkhill to a new £100 million 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 rotas 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 CHCPs.
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
Paediatric Anaesthetics
Facilities Directorate
This Directorate includes:
Site maintenance for both acute and CHCP facilities
Hotel services
Laundry
TSSU
Supplies
Transport
Catering
Telecommunications
Waste management
1. 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.
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 399 admissions to the stoke 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
Currently orthogeriatric medical care in the RoyalAlexandraHospital is provided by two physicians (Dr Wilkieson and this post) supported by a specialty Doctor. Dr Kanthi visits to review patients from the Vale of Leven area. 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 Department of Medicine for the Elderly is strongly supported by Orthopaedics and has 22 dedicated beds in ward 3 which provide orthogeriatric rehabilitation
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.
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 13-14 days.
- THE POST
(a)Title:
Consultant Physician in 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)
Dr L.Erwin (DME RAH /VOL)
(ii)Names of Consultant members of the Department:
Consultant: / Special Interest:Dr L. Erwin / Stroke / Medicine for the Elderly
Dr G. Simpson / Movement Disorder
Dr H. Slavin / Stroke / Medicine for the Elderly
Dr C. Wilkieson / Falls and orthogeriatric medicine
Dr J Murtagh / Movement Disorder / Community
Dr O Lucie / Community / Medicine for the Elderly
Dr D. Mack / Vale of Leven /Movement Disorder
Dr K. Kanthi / Vale of Leven/GORU/Falls/Syncope
(iii)Support Grades
Please completeSpecialty Doctors 2 = 17 sessions
FY2 5
GPST 3
CMT 1
(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.
(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 1:8 This 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 medical 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.
- Acute stroke, stroke rehabilitation and specialist stroke 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
.