Northern Foundation School (NFS)

Job Description – F1 Post in Psychiatry (In-patients)

Placement / F1 Psychiatry in Springrise(18 bedded male acute ward)
The department / The urgent care service includes the Initial response service, crisis and Home Treatment Team, Inpatient Wards, Psychiatric Intensive care unit, Liaison Service, Criminal Justice Liaison Service and Rehabilitation inpatient units. It provides a clear pathway for people with severe to critical mental health problems. It is part of the urgent care stream of the Working Aged Adult Directorate.
The adult acute inpatient service is all based at Hopewood Park with two 18 bedded male acute wards (Springrise and Shoredrift), one 18 bedded female acute ward (Longview) and Beckfield which is 14 bedded trust-wide mixed sex Psychiatric Intensive care Unit. The acute wards will have majority of inpatients from the South Tyneside and Sunderland localities though there will be patients from other localities in the trust. These units will have key relationship with the other inpatient units within the hospital i.e the male and female High dependency units (rehabilitation units for the male and female challenging patients) and the slow stream rehabilitation units. The service works closely with the community treatment teams in Sunderland and South Tyneside and the Early Intervention in Psychosis team. There is a section 136 suite for assessing patients detained by the Police under the section 136 of the Mental Health act 1983 (amended 2007).
The type of work to expect and learning opportunities / You will be part of the multi disciplinary inpatient team at Springrise, HopewoodPark hospital Sunderland with sessional input into the access and home treatment team. The multi disciplinary team consists of Psychiatric Nurses, Nursing Assistants, Psychiatrists, psychologist and Occupation Therapists. There will be a Foundation Year 2 trainee and a Core Trainee in Psychiatry who is placed along with you in your ward. You will shadow the consultant or join reviews/assessments with the other trainees/ clinicians based with the crisis team, and under no circumstances will be seeing patients on your own.
You will also be working along with other trainees of various grades working on the various inpatient units and community teams. These will be core trainees in Psychiatry, Foundation year 1 and 2 trainees, vocational trainee scheme trainees and higher trainees in Psychiatry. The trainees working in the various inpatient areas (including rehabilitation wards) will cross cover each other during the day for annual study and other leaves. You will not be expected to cross cover for any other trainees. It is anticipated that you will work under close supervision of your clinical supervisors. It is mandatory for you to discuss all patient management decisions that you make, prior to their being enacted.
Where the placement is based / HopewoodParkHospital, Sunderland.
Clinical Supervisor(s) for the placement / Dr Prathibha Rao
Curriculum outcomes expected to be achieved / 1. Professionalism
1.1 Behaviour in the workplace
1.2 Time management
1.3 Continuity of Care
1.4 Team-working
1.5 Leadership
2. Relationship and communication with patients
2.1 Treats the patient as the centre of care within a consultation
2.2 Communication with patients
2.3 Communication in difficult circumstances
2.4 Complaints
2.5 Consent
3 Safety and clinical governance
3.1 Risks of fatigue, ill health and stress
3.2 Quality and safety improvement
4 Ethical and legal issues
4.1 Medical ethical principles and confidentiality
4.2 Legal framework of medical practice
5 Teaching and training
6 Maintaining good medical practice
6.1 Lifelong learning
6.2 Evidence, guidelines, care protocols and research
7 Good clinical care
7.1 Makes patient safety a priority in clinical practice
7.2 Ensures correct patient identification
7.3 History and examination
7.4 Diagnosis and clinical decision-making
7.5 Undertakes regular patient review
7.6 Safe prescribing
7.7 Safe use of medical devices
7.8 Infection control and hygiene
7.9 Medical record-keeping and correspondence
7.10 Interface with different specialties and with other professionals
8 Recognition and management of the acutely ill patient
8.6 Manages acute mental disorder and self-harm
10 Patients with long-term conditions
10.1 Manages patients with long-term conditions
10.2 Supporting patient decision making
10.4 Discharge planning
10.5 Health promotion, patient education and public health
11 Investigations
Consultants that will be worked with / The other Urgent care Consultants that are ward based with whom you will have most contact other than Dr Rao are Dr Sharma, Dr Perera, Dr Harvey, Dr Berry, Dr Tocca, Dr S Brown and the Crisis team consultants Dr P Brown, Dr Reynolds and Dr Ali.
Departmental teaching activities / There is Thursday Morning Teaching Programme that includes Case Presentations, Journal Clubs and other teaching activities. In addition, you will be required to attend your local Foundation Teaching Programme in the acute trust as per the time table.
Study leave / You can avail of the study leave as per study leave police of the NDFS. You will be encouraged to use the time for ‘taster sessions’.
Induction / At the beginning of the placement you will take part in an induction programme. A General trust-wide induction will introduce you to the organisation. You will also be introduced to the workplace (local induction) and informed of the requirements of the post, including the nature of your on call commitments. You also will have an induction with your clinical supervisor that will help you write your individual learning plan for the placement and you will have the opportunity of meeting with your educational supervisor and/or tutor at regular intervals.
Main duties of the placement /
  • Undertake clinical assessment of patients with mental health problems
You will attend the Daily morning review MDT Meetings, 72 hr Formulation meetings, Care Coordination Reviews and Discharge Planning Meetings related to your patients or others whom you might cover. You will also meet with the patients admitted to the Ward at least once a week on your own and you will liaise with the ward manager/staff to arrange appointment times for the patients.
You will ensure that all new patients admitted under your team’s care are fully assessed, including an assessment of their physical state, so that a preliminary formulation of their problems is made, before the 72 hour formulation meeting or within two days of admission whichever is earlier. All inpatients should be reassessed as necessary and no less frequently than once per week, so that an update is made during the daily morning review.
  • Undertake clinical assessment of patients with mental health problems
You will attend the Daily morning review MDT Meetings, 72 hr Formulation meetings, Care Coordination Reviews and Discharge Planning Meetings related to your patients or others whom you might cover. You will also meet with the patients admitted to the Ward at least once a week on your own and you will liaise with the ward manager/staff to arrange appointment times for the patients.
You will maintain accurate, legible, contemporaneous and useful clinical records for all patients in whose care you are involved.
Also you will maintain the electronic records as per the appropriate standards.
  • Manage chronic illness
During the inpatient setting, you will participate in the management of severely mentally ill patients, many of whom have chronic illnesses with acute exacerbations. You will be involved in there transition to the Rehabilitation Services. You will monitor response to treatment of chronic illnesses including monitoring of adverse effects assessing residual symptoms and deficits and creating a management plan for further treatment.
. Decisions about access to care
  • Use the results of the clinical assessment to ensure effective patient management
Under supervision of a clinician, you will prescribe pharmacological and psychosocial treatments for the patients that you are working with. You will endeavour to understand the nature of patient’s illness, its contributory factors, complicating features and psychosocial aspects. You will make appropriate treatment plans and discuss with the team with a view to develop your own understanding, knowledge and alleviating the suffering of the patient. You will refer them promptly to other professionals as directed by your clinical supervisors.
Treatment in emergencies
  • Manage emergencies
During the course of your four month placement you will have the opportunity to join assessments of patients presenting in emergency settings; some of these consultations will involve patients referred from medical/surgical departments from SunderlandRoyalHospital and others will be patients you will see on the day of the crisis team work.
You may want to contribute assessing patients presenting to Deliberate Self Harm Team at the SunderlandRoyalHospital under supervision.
Maintaining good medical practice
  • Maintain and use systems to update knowledge and its application to any aspect of your professional practice
During the placement you will follow the Foundation Curriculum and maintain an up-to-date learning portfolio that you will bring to meetings with your clinical supervisor and education supervisor when asked to do so.
You will participate in a weekly teaching programme. During the four months, you will also participate in the Journal Club as per the local guidance and will present one/two cases at the Case Conference. You are also expected to participate in a Clinical Audit and present it in the local postgraduate teaching programme.
Maintaining performance
  • Monitor and maintain professional performance
You will participate fully in the workplace-based assessment programme of the Foundation Curriculum and will use the feedback that you receive from this process to inform your critical self-awareness.
Teaching and training, appraising and assessing
  • Plan, deliver, and evaluate teaching and learning in a variety of environments
You will participate in the teaching of medical students attached to the unit. This will include assisting the ‘bedside’ teaching of junior and senior students by helping identify suitable patients for the students to see and by helping the students develop their clinical skills by giving them opportunities to present and discuss the patients they have seen. You may also have the opportunity to be involved in small group teaching and lecturing to clinical medical students under the supervision of senior colleagues.
Relationships with patients
  • Conduct professional patient relationships
Whenever possible, you will obtain informed consent from patients for whom you provide treatment. You will observe patient confidentiality at all times. When guided by your clinical supervisors, you should share information appropriately with colleagues. Whenever possible, and especially towards the end of the placement, you will inform your patients of the ending of your relationship with them in a timely manner.
Dealing with problems in professional practice
  • Conduct or performance of colleagues
If you become aware of problems with the conduct or performance of a colleague, you must bring this to the attention of a senior colleague.
  • Complaints and formal inquiries
You must always cooperate fully with any complaints procedure or formal inquiry
  • Providing assistance at inquiries and inquests
You must always cooperate fully with any formal inquiry or inquest into a patient’s death.
  • Indemnity insurance
Early in the placement, you must discuss the provisions of the NHS indemnity insurance with your trainer.
Working with colleagues
  • Continuously promote value based non prejudicial practice
You must maintain a legal, ethical and fair approach toward working with colleagues and respect diversity.
  • Work effectively as a member and a leader of multidisciplinary team
During this placement you will be a full member of the inpatient team at HopewoodParkHospital and will attend its regular meetings. You will discuss your experience of the MDT in meetings with your educational supervisor.
You will cross cover for the other training post(s) in the inpatient team and from time to time, you may also be asked to provide cover for the core training posts in the community settings in general adult psychiatry.
Demonstrate appropriate leadership
You will be encouraged to take leadership role by conducting reviews of patients independently on suitable occasions.
  • Communicate effectively with other healthcare professionals
You will keep clear, accurate and contemporaneous clinical records. You will send regular written reports on patients to general practitioners and other professionals involved in patient care.
  • Appropriately assume, delegate and devolve responsibility
You may delegate responsibility to other professionals where appropriate after discussing it with your supervisor.
  • Access advice, assistance and second opinion when delegating and making referrals
Your trainer and clinical supervisors will give you guidance as to the level of responsibility you should assume in individual clinical situations. If you are unsure, you must always obtain advice and assistance
Maintaining probity
  • Ensure that reports, evidence and documents you have a responsibility for are complete, honest and accurate
Your written reports will use the standard report format and will be sent as follows: Standard discharge summaries within one working day of a patient’s discharge. They will be signed. You will have to maintain admission assessments on RiO for patients admitted in the wards.
Until instructed otherwise, all reports that you write must be checked by one of your clinical supervisors before being sent out. You will not provide any other written reports about patients, unless this has been sanctioned by one of your clinical supervisors.
  • Properly manage financial and commercial dealings
You must report receiving any gift from patients to your trainer and you must not solicit any fee or payment from a patient or third party unless your trainer has sanctioned this.
  • Avoid conflicts of interest and advise others on preventing and dealing with conflicts of interest
Inform your trainer of any real or potential conflict of interest you may have.
Health
  • Ensure that your health and the health of others does not put patients at risk
You must always obtain advice and treatment for mental and physical health problems and must ensure that your health does not put patients at risk. You must comply with the Trust’s occupational health policy.
Typical working pattern in this placement / NB, this programme is indicative only, it may vary in the light of the trainee’s learning needs and the needs of the clinical service.
Work Schedule
Monday / Tuesday / Wednesday / Thursday / Friday
Morning reviews
Ward work / Morning reviews
Ward work / Crisis team/ audit / Postgraduate meeting / Morning reviews on Springrise
Ward work
(alternate week- EAU)
72 hour formulation meeting
Ward work / Ward work / Crisis team/ audit
330-430- Educational supervision session / Ward work / 72 hour formulation review
Ward work on Springrise
(alternate week- EAU)
F1 This post is accompanied by on calls as part of the day time medical teams and night time hospital at night team (Rota 15, which is a 1:9)
Experience of Working on EAU: Once a fortnight you will spend a Friday working day shift on EAU at South Tyneside District Hospital from 0900-1700 (please note that you will not be on-call for this shift period however it is recommended that your ‘day’ on EAU is worked the same week as yourOn-Call Shift).
Wednesdays- you will remain in crisis team and will be unavailable to the wards
Other opportunities- ECT, community, old age, MHA assessments etc. will take priority over ward work unless emergencies etc. – but normally cross cover should be provided between other trainees.
Employer information / NTW Mental Health Foundation Trust
The Trust was established in April 2006 following the merger of South of Tyne and Wearside Mental Health Trust, Newcastle North Tyneside and Northumberland Mental Health Trust and Northgate and Prudhoe NHS Trust (Learning Disability Trust). The resulting Northumberland Tyne and Wear Mental Health Trust is the largest specialist Mental Health Trust in England covering an area stretching from the Scottish borders down to countyDurham in the South and to Cumbria in the West employing 7,500 staff. The total population served by the Trust is approximately 1.4 million. The Trust Headquarters is based at St Nicholas’ Hospital in Gosforth, Newcastle upon Tyne.
The Trust services are organised in a functional directorate model. There are currently Directorates Urgent care, Planned Care and Specialist services Directorate.
South Tyneside population consists of the close knit communities of South Shields, Jarrow, Hebburn, Boldon, Cleadon and Whitburn. According to the most recent (2012) ONS mid year population estimates there are 148,000 people in South Tyneside of which 27,200 are aged 65 and over. The district has above average levels of deprivation, unemployment and ill health. South Tyneside’s York Psychiatric Index Score is 130 which means that there is a 30% greater need for resources than the national average.
The City of Sunderland has a population of approximately 284000 (2012) and is the largest city between Leeds and Edinburgh. The BME population is 3.5%. Situated on the Northeast coast and the River Wear it is within easy reach of some of the most beautiful countryside in England such as Hadrian’s
The mental health indicators are worse than the average in England. MINI2K and AREA indices are significantly higher.
Below is a dos an donts documents for F1s for the wards, which you may also find useful
What can F1 doctors do?
1) Assessment of patients -developing a management plan in discussion with the consultant or ST trainee and document assessment. For initial few assessments, consultant may wish to validate documentation on the RiO.
2) Prescribe an agreed medication plan with the senior on the Kardex
3) Prescribe common physical medications if necessary and safely transcribe GP repeat prescriptions or rewriting kardexes
4) Perform physical examinations and discuss findings with seniors
5) Order investigations upon guidance from supervisors and review results with the supervisor
6) Review patients with a view to perform mental states and discuss with supervisor if new information obtained which would indicate change in risks or need for interventions
7) Discussion/ presentation of cases in MDT settings, contribute towards discharge planning
8) Complete discharge summary after confirming the diagnosis, medication plans and management plans with the consultant (most easily done with attendance at discharge MDTs).
What the F1s cant do
1) Assessment of new patients without the supervision of senior colleague
2) Review of patient observations- however, after certain experience and with discussions with the consultant, consultant may delegate the task of reviewing the patient, but decisions of change in observations only taken after consultation with the consultant
3) Commence psychotropic medications
4) Commence any physical medications that are not used commonly
4) Detain patients- use section 5(2)s
5) Review patients in seclusion
6) Assess patients on their own in crisis/ home/ A&E settings (any non ward settings) (Arrangements primarily placed in liaison settings may differ subject to trainer’s support).
7) Cover another trainee of any level other than a F1.
8) Make decisions regarding management plans such as leaves, discharges etc., but can certainly review the patients for these purposes and discuss with the consultant regarding the findings

It is important to note that this description is a typical example of your placement and may be subject to change.