8 PA + ON-CALL commitment
JOB DESCRIPTION
1. THE POST
The consultant will be based entirely at St Peter’s Hospice, with involvement in all coreclinical services of the hospice (inpatient care, day services and community services).
2.INTRODUCTION
2.1 St Peter’s Hospice – clinical services
St Peter’s Hospice is a well-established charityfocussed on supporting and delivering community-based Palliative Care to any patients with incurable, progressive disease in the wider Bristol area who have complex and/or intense needs. The hospice services are based on a large team of community nurse specialists who visit and advise patients and their families; with access available to in-patient, Day Hospice, out-patient, Hospice@Home and bereavement care. This range of services isprovided by a fully staffed multidisciplinary team and isfurther supported by the hospice Education Department which delivers a wide range of courses to external professionals as well as offering an extensive staff development programme.
The hospice has been operational for 35 years and the clinical services are now configured onto 1 main site (having previously been run from 2 hospice buildings); with an additional 3 community bases for the community nurse specialist teams – in Yate (to the North), Staple Hill (to the East) and Long Ashton (to the South). The hospice Commercial Team is also based at Long Ashton.
At any given time the hospice is involved in the care of over 600 patients in the community, along with 18 in-patients and up to 20 patients per weekday in the Day Hospice (which runs 4 days per week). The Day Hospice premises are also used for a Fatigue and Breathlessness Management programme and carers groups on the 5th weekday. The majority of the patients referred to the hospice have cancer, but there has been a clear policy of inviting referrals for patients with non-malignant disease for over 20 years now, and the numbers of patients with neurological (particularly MND), renal, cardiac and respiratory diseases is slowly growing (currently this stands at approx 20% of our total referrals). Over 2500 patients die of cancer each year in the area covered by the hospice (population approx. 850,000 served by over 480 GPs) and St Peter’s Hospice is involved in the care of up to 1800 patients each year.
2.2 St Peter’s Hospice – the charity
The hospice is a charity which is both well-established and financially secure – and there is an NHS contract in place with the local cluster of CCGs (Bristol, North Somerset and South Gloucestershire) which currently provides about 22% of the annual income. The hospice has also developed strong links with the local acute NHS trusts and other statutory and independent providers of palliative care; while hospice staff of all disciplines collaborate closely with their colleagues working in these other settings.
St Peter’s is the only adult hospice serving patients in the wider Bristol area and maintains a high profile, excellent reputation and impressive level of public support.
- THE WORK OF THE HOSPICE
3.1 Hospice clinical staffing
Medical Directorate
- F/T Medical Director – Dr Carole Dacombe
- Consultant post with United Hospitals Bristol NHS contract (8 PA + on-call) involving 7PA at the hospice and 1PA within the UHB Palliative Care Team / University of Bristol Palliative Medicine Department based at the Bristol Haematology and Oncology Centre – Dr Dida Cornish
- This post
- Associate Specialist (working 0.7WTE + on-call) – Dr Sophie Tower
- At least 1 Specialist Registrar (can vary from 0.6WTE to 1.2 WTE) – on the Severn Deanery Higher Specialist Training programme
- 2 ST1 doctors on the Severn Deanery GPVTS – 1 in a 6-month post and 1 in a 4-month post
- 1 part-time (currently 20hrs/week) medical secretary to support the Senior Medical Team (Medical Director, 2 consultants and Associate Specialist)
- Therapists Team of 2 part-time Physiotherapists and 2 part-time Occupational Therapists (total of 44hrs/week in each discipline) – with plans agreed to develop a team-leader post via internal recruitment later this year (with a small expansion in hours to support this).
Directorate of Patient Care
- F/T Director of Patient Care – Ms Julia di Castiglione
- F/T Community Services Manager – responsible for the community nurse specialist teams, triage team and hospice at home service
- 18 WTE community nurse specialists divided into 4 teams, each with a designated team leader and overall support provided by a part-time administrator
- Hospice@Home team, with a designated team leader and admin support – capable of delivering approx 16,000 hours of direct patient care per year
- Triage team of specialist nurses and administrator responsible for receiving and triaging all referrals to the hospice clinical services
- F/T Psychosocial and Spiritual Services Manager responsible for all PSS services offered at the hospice, along with the practitioners involved and the administrator
- 2 senior social workers
- 1 part-time music therapist
- 1 part-time art therapist
- A Bereavement Services Coordinator responsible for a team of trained bereavement volunteers
- A Spiritual Services Coordinator – currently being recruited
- F/T Day Services Manager responsible for the Day Hospice nursing team plus administrator, complementary therapy services and other services run within the Day Hospice premises
- F/T Inpatient Unit Manager responsible for the 2 teams of inpatient nursing staff supported by 2 sisters, an inpatient administrator and ward receptionists
3.2 Hospice Services
Domiciliary Care
The hospice receives up to 50 new patient referrals per week.
Initial face-to-face assessment for the majority of these patients is via the community nurse specialist team who visit and then, if appropriate, maintain regular contact with these patients, their families and their carers (lay and professional).
The role of the CNS team is advisory, supplementing the care provided by primary health care services and providing a link into all the other hospice services; while the GP remains medically in charge of their patient’s care.
Senior hospice doctors and other professionals within the team are availableto offer domiciliary visits as required, and the nurse specialists regularlyattendGSF or equivalent Palliative Care meetings at the GP practices within their area. 2 of the current hospice nurse specialists have qualified as non-medical prescribers and the intention is to increase this number over the coming years.
Day Hospice
Day Hospice services run 5 days per week at Brentry for up to 20 patients per day with a Fatigue and Breathlessness Management programme on Tuesday mornings, Carers and Bereavement groups on Tuesday afternoons; and full days offering a variety of clinical, complementary and diversional input within a defined 12-week programme of holistsic care on the other 4 days.
In-patient Care
The hospice is currently running an 18-bedded in-patient unit where patients are admitted for any combination of symptom control, psychosocial needs or terminal care. Approximately 60% of patients admitted to the unit are discharged. The average length of stay for in-patients is between 10 and 11 days, and there is an emphasis on full multi-disciplinary assessment and treatment with effective discharge planning.
Hospice@Home
Shifts of nursing care (up to 24-hr nursing) can be offered by the H@H team for a usual maximum of 7 days – often to support a patient in their wish to remain in their own home to die; but this service is also used to facilitate a complex discharge from hospital or the hospice, to help at a time of rapid, unpredicted change, and to offer short periods of respite within the patient’s own home.
Psychosocial support and Bereavement Care
Hospice social workers assess the needs of patients and carers in relation to Community Care, liaising closely with local authority social workers and Continuing Healthcare assessors. They also contribute to the psychological support offered to patients and families: while their music and art therapy colleagues, who have extensive psychotherapeutic skills, will work with patients and families who have more complex needs. This psychological support extends into bereavement with support offered to adults and children of all ages, where relevant. The hospice bereavement services also rely on input offered by trained and supervised volunteers, overseen by our bereavement coordinator.
Education
The hospice education department is actively involved in both pre-and-post registration Palliative and End of Life Care modules (up to Masters level) for nurses and other professionals, working in partnership with local universities and other hospice education teams. It is also involved in both the project management and delivery of End of Life Care training within our local cluster of CCGs.
A variety of study days and half-days are also run, both in-house and at local postgraduate centres, by hospice education and clinical staff – often in collaboration with local palliative care and primary care colleagues – for all disciplines and grades of healthcare professionals.
The delivery of all statutory and mandatory training for hospice staff is overseen by the education department – delivered via a mixture of electronic learning modules, face-to-face teaching in-house or external provision.
3.3 Partnership working with other voluntary and statutory sector organisations
The hospice is actively engaged with all those involved in End of Life Care strategy and service development planning in our catchment area (North Somerset, Bristol and South Gloucestershire) with hospice clinical directors and senior clinicians contributing within many of the current project development groups.
Over the past 2 years we have also had specific involvement in supporting End of Life Care within local prisons.
4.MANAGEMENT STRUCTURE
The appointee will be contractually accountable to the Chief Executive through line management by the Medical Director. All senior medical staff are required to undergo an annual consultant appraisal carried out in accordance with the hospice Medical Appraisal and Revalidation Policy.This supports the use of external appraisers and recommends the use of at least 2 different appraisers in any 5-year cycle.In addition, the post holder will undergo an internal hospice IPR (individual performance review) with the Medical Director each year which provides an opportunity to discuss the outcomes from the external appraisal.
The appointee will be required to take an active and co-operative approach to their job planning, which will be reviewed on an annual basis by the hospice Medical Director within the IPR process referred to above.
It is a requirement that if the employee has concerns about the professional performance of any member of the medical staff, they have a duty to raise this. If the matter is potentially serious or satisfaction is not obtained with a direct approach, such concerns must be discussed with the hospice Medical Director (who is also the Responsible Officer).
The appointee will be expected to be involved in the on-going development of thewider hospice strategy and clinical service development. They will also be expected to participate in, and adhere to, all aspects of Risk Management, Health and Safety and Clinical Governance as per the relevant hospice policies.
5.MEDICAL ADVISORY input
The postholder will be a member of:
a)The Clinical Services Advisory Committee of St Peter’s Hospice
b) The Senior Medical Team of St Peter’s Hospice
c) The Bristol Palliative Care Physicians group
6.LOCATION
The post is based at St Peter’s Hospice, Brentry where there is access to car parking and local public transport.
Other bases – the appointee will attend a hospice community nurse specialist base in the community 1 morning/week for a caseload review meeting and will also carry out domiciliary visits as agreed within the specificed allocated times in the job plan.
7.DUTIES OF THE POST
(a) Clinical Duties
The postholder will be directly responsible for the medical management of patients on the in-patient unit in collaboration with his/her consultant colleague. (Other members of the hospice Senior Medical Team will also be available to support this work during periods of leave on the part of the consultants.)The postholder will also share responsibility with their senior medical colleagues for the advisory support offered to the hospice community services, including the 24-hr Advice Line, and will support their senior medical colleagues who carry the lead responsibility for the hospice Day Services.
The on-call commitment for this post is to the hospice 1 in 4 second on-call rota, defined as a Category B (high frequency, low intensity) commitment with a salary supplement of 3%.
The hospice’s Senior Medical Team (the 2 consultants, Medical Director and Associate Specialist) provide cross-cover for each other for annual, study andshort-term sick leave.
All members of the Senior Medical Team undertake exceptionally to perform additional duties in the case of emergencies and unforeseen circumstances as necessary for the continuity of patient care.
(b)Teaching and Supervision of Junior Medical Staff & Students
The postholder will be responsible for the professional clinical supervision and management of junior medical staff working at the hospice in training-grade roles. Where appropriate, the postholder may be named in the educational contract of junior staff as the person responsible for overseeing their training and as an initial source of advice to such doctors regarding their careers.
The postholder will also contribute to the teaching and supervision of medical students who spend time at the hospice during their training, and other specialty trainees or GP registrars who may arrange clinical attachments at the hospice.
(c)Study & Research
The postholder will be entitled to 30 days study leave within a 3-year period (pro-rata for a part-time post). Continuing Medical Education (CME) planning for the Senior Medical Team at the hospice is managed proactively in order to ensure that the essential individual needs for all concerned are met along with any requirements relating to service development at the hospice.
The hospice is fully committed to ensuring that all necessary support is given for CME. The postholder will be expected to register, and fulfil the requirements, for CPDmonitoring with the Royal College of Physicians; and to fulfil the requirements for revalidation laid down by the General Medical Council.
The postholder will not necessarily be expected to undertake research: however opportunities do exist and encouragement is given to develop collaborative projects with other local Palliative Care Teams and with the University of Bristol and/or the University of the West of England.The post-holder will be required to submit all research development plans to the hospice Research Advisory Group (RAG).
There is a professionally staffed Medical Library in the Medical Postgraduate Centre at North Bristol NHS Trust and a University Library situated in the centre of Bristol city. A small library is also maintained within the Education Department of the hospice.
Specialty trainees and all local consultants in Palliative Medicine are invited to participate in the weekly Bristol Palliative Medicine Journal Club held most weeks at the Bristol Haematology and Oncology Centre (BHOC). (Once a month this Journal Club meets in the education department of the hospice.)
(d)Audit
The postholder will be required to take part in the hospiceclinical audit programme – including participation in local, network wide and national audit. Attendance at the quarterly Clinical Governance and Clinical Audit meetings within the hospice will be expected, and the postholder is also likely to be asked to chair 1 or other of these meetings in rotation with other senior colleagues.
(e) Management responsibilities
The appointee may be asked to participate in managerial and administrative work (as agreed within the Senior Medical Team) and will be expected to be aware of the broader context of Palliative Care and the voluntary sector in which St Peter’s Hospice operates.
(e)Leave
Locums are not employed to cover the absence of consultants who are on annual or study leave. The leave year runs from 1 April each year. Where the appointment is made after 1 April, leave will be adjusted on a pro rata basis. All leave in the medical team is booked according to the agreed rules for medical leave at the hospice.
8.RESOURCES AVAILABLE
(a)Facilities (eg wards, outpatient clinics, beds support services)
At the hospice the postholder will share medical responsibility for the 18-bedded in-patient unit with their consultant colleague, supported by the Medical Director and AssociateSpecialist when needed. They will also contribute to domiciliary visiting for the community patients and will offer out-patient appointments on an as-needed basis within designated slots of time within their job plan. (Rooms can be booked on an as-needed basis for such OP appointments but the hospice does not have a specific outpatient clinic facility at the present time.)
(b)Clinical Services (eg links with other clinical service departments)
At the hospice, the consultant will attend all relevant multidisciplinary team meetings and will participate in the Clinical Forum discussions about all aspects of hospice clinical services. There will also be opportunities to attend the Bristol Palliative Care Physicians meetings (bi-monthly) and the South West (SW) consultants training committee (twice a year) and SW consultants’ forummeetings.
(c)Secretarial Support/Office Accommodation
At St Peter’s Hospice the consultant will share an office with their consultant colleague and will be supported by the part-time medical secretary who works specifically for the Senior Medical Team. They will also benefit from the admin support arranged for all clinical services, along with the work of the clinical data manager.
Computers with internet access are available throughout the hospice and remote access to hospice systems can also be arranged for the postholder. A contract is in place for IT support/advice at the hospice.
(d)Activity/Contracts