Job Description
Consultant Physicians in Acute and/or General Medicine
Applications are invited for a Consultant Physician in Acute and/or General Medicine,
based at the Balfour Hospital in Orkney. The appointee will join the existing Medical Team
in developing services on the Acute Ward, A&E which incorporates the Acute Receiving
Unit and the Assessment and the Rehabilitation Ward. The Consultants will work with the
Rural Hospital GPs and be supported by up to 4GPSTs and nursing staff.
Candidates should be on the Specialist Register or be within six months of obtaining their
Certificate of Completion of Training (CCT) in Acute Medicine and/or General Internal
Medicine, and hold full GMC registration.
These are challenging but influential posts in the remote and rural setting. The successful
candidates will provide professional continuity of care for acutely ill medical patients. The
role will be supported by an obligate network arrangement with NHS Grampian.
This post will support the development of the Acute Medicine Service and will have an
integral part in planning and implementing the new hospital care campus. The appointees
will work closely with the Rural Hospital GPs, Anaesthetic and Surgical Consultants to
deliver optimum patient care and develop NHS Orkney as an innovative centre for remote
and rural health care. NHS Orkney is already recognised for its progressive approach to
telemedicine, and the post holders will be expected to support the further development of
this. In addition to the current team, we are looking to appoint colleagues who are
innovative and proactive, and who can demonstrate a commitment to excellent patient care.
We welcome applications from those wishing to develop an interest in or having an
established interest in Geriatric Medicine, Cardiology, Respiratory Medicine, Medical
Management and Service Development, or Education.
The post is for 7.5 Direct Clinical Care Activities and 2.5 Supporting Professional Activities.
Two Extra Programmed Activities will be included but will be open for negotiation.
An enhanced induction process tailored to individual needs will be provided to ensure full
competency in the requirements for work in remote and rural setting of Orkney, with the
support of NHS Education of Scotland and NHS Grampian.
NHS Orkney health board has one Remote and Rural General Hospital and serves a
population of 20,000. Complex medical and surgical cases are stabilized and transferred to
mainland Scotland and two high dependency beds are available. In the immediate future,
NHS Orkney is undertaking a number of major capital developments including the
development of a local CT scanning service, a new hospital and healthcare campus. These
developments present a hugely exciting opportunity to shape and deliver leading edge,
innovative acute medical care in the remote and rural setting.
1. Description of Hospital
The Balfour Hospital provides acute medical care, with 1200 medical admissions per
annum.
Currently services are configured as follows:A&E Dept, which incorporates the Acute Receiving Area - with
assessment, resuscitation and observation areas
Acute ward - male and female, medical and surgical 16 beds
Assessment and Rehabilitation Service
18 beds
Maternity Unit
6 beds
Macmillan Unit
4 beds
HDU
2 beds
Bed complement: 46 beds.
One of the beds in A&R is used as a Place of Safety/Mental Health Transfer bed.
The Day Surgery Unit has 6 beds.
The medical staffing in the Balfour Hospital currently consists of:
 The Acute Medical Team, consisting of 6.4 WTE Remote and Rural GPs with a
special interest in medicine. Due to vacancies, the team consists of Dr Charlie
Siderfin, Dr Elaine Toms and Dr Kevin Woodbridge
 The Surgical Team has two consultants in post: Mr Michael Dohrn, and Mr Caesar
Zawal. Recruitment of a third consultant surgeon will commence shortly.
 The Anaesthetic Team consists of two full-time consultants, Dr Marek Wolanski and
Dr Anita Sowinska, and a part time consultant, Dr Colin Borland. Recruitment to a
full-time consultant posts is currently underway.
 A locum obstetrician, Dr Ernest Akrong is currently leading the obstetric team.
 A part-time Consultant Orthopaedic Surgeon, Mr Marthinus Roos, also works in the
hospital
Medical, surgical, and paediatric patients are initially seen in the Acute Receiving Unit.
Minor cases are treated and discharged, with more major presentations being dealt within
the assessment or resuscitation areas as appropriate. Patients can be discharged, admitted
to an appropriate hospital bed or transferred to a major centre from here, with a High
Dependency Unit facilitating this process.
Very effective air ambulance retrieval services for adults, paediatric, neonatal, maternity
and mental health patients are regularly used for transfer of seriously ill patients to
appropriate hospitals in the Scottish Mainland – mainly Aberdeen Royal Infirmary.
Acute medical input is provided to the assessment and rehabilitation unit, which includes
four acute stroke beds, by the Medical Team in and out of hours.
Cancer and Palliative care services are provided in Macmillan House by the patient’s own
GP or the Skerryvore Medical Practice, and Cancer & Palliative Care Specialist Nurses.
There is a fully equipped modern Theatre Suite and a 6-bedded day surgery unit, which is
being developed to become a unit caring for all short term day cases (including medical).
Services for children are designed to be appropriate for a non-specialist unit. The clinical
care team, which is composed of nursing staff, the medical team, anaesthetists and
paramedics are responsible for the resuscitation, stabilisation and ongoing management of
critically ill children, until the arrival of the nation-wide retrieval team. It is recognized that
the competencies required in a remote and rural setting may be broader than those
obtained through a conventional training scheme, and supplemental training can be
provided to ensure the successful candidate can fully discharge the clinical duties of the
post. Training in the management of Paediatric Emergencies will be provided as part of
induction if required. Neonatal care is provided by the Obstetric Team and Midwifes, with
support from the Anaesthetists.
Patients requiring care which is not available in Orkney are transferred to the
Scottish mainland, predominantly to NHS Grampian, but depending on availability of
beds, expertise and weather conditions, patients may have to be cared for in the
HDU for periods of up to a day or two while awaiting transfer, which can be very
challenging. Such patients will be cared for by team-working between Physicians
and Anaesthetists. Training in the management of HDU patients will be provided as
part of induction if required.
Neonatal, Paediatric, Maternity, and Mental Health retrieval services, as well as the
Emergency Medical Retrieval Services (EMRS), are available to transport patients
requiring care not available on the island.
Visiting consultants from Grampian and Highland Health Board Areas support a wide range
of additional specialist clinics. Support services include laboratory and radiological services
(including diagnostic ultrasound), physiotherapy and occupational therapy departments.
Plans to locate a CT scanner on the island are far advanced.
2. PRINCIPAL DUTIES
The successful candidate will be expected to work flexibly and achieve high quality care
with particular emphasis on:
 The quality of care, with person-centred, safe and effective working the focus for all
activity.
 It is envisaged the post holder will have considerable experience in the management of
the acutely ill patient. Experience in high dependency medicine and/or experience in
A&E would be an advantage.
 To lead in the care of medical patients admitted to the Acute Receiving Area, the Acute
Stroke Beds and the specialist medical care of patients in the Assessment and
Rehabilitation Unit, working alongside and utilising a pool of other doctors and nurse
practitioners to ensure general medical cover and continuity of care.
 To provide outpatient clinics for selected patients discharged from the receiving unit,
including a “virtual ward” and to establish a rapid assessment service for General
Practitioners. The number of clinics will depend on need.
 To provide emergency care to paediatric patients in the Acute Receiving Unit, in close
liaison with Grampian Paediatricians and the Paediatric Emergency Care Network
currently being established in Grampian. Children that require admission are transferred
to the Aberdeen Royal Children’s Hospital for further care. Training to allow the
recognition of the seriously ill child, as well as the initial treatment of such children, will,
depending on need, be provided as part of the induction for the post.
 The consultant will be working with a team of doctors providing medical care during the
day, and care of all patients in the Balfour Hospital after hours. This team will comprise
of doctors with a wide (but varying) range of skills in Medicine, A&E, Surgery, HDU care
and Paediatrics, and who will be involved with psychiatric emergencies (with support
from the Community Mental Health Team and Grampian’s Cornhill Hospital.
 The successful candidates will be providing higher levels of care to patients, such as
those awaiting emergency transfer off the island, in the High Dependency Unit, in close
team-working with the Anaesthetists.
 The very broad range of skills and competencies required to practice in a Remote and
Rural setting such as Orkney differs from mainstream subspecialised medicine. To
ensure that the candidate appointed will have those skills, tailored support in acquiring
those skills will be addressed during the induction period, when the candidate will spend
time in NHS Grampian. The program for this period will be tailored for the individual
requirements of the successful candidate.
 To provide leadership and seamless team working, together with colleagues in the
hospital, in primary care and the community, to ensure effective management of acutely
ill patients as part of their clinical journey that straddles all the services.
 Providing leadership in the management of chronic disease in Orkney, with involvement
in the Managed Clinical Networks for Chronic Disease, such as Stroke Care, Diabetes
Respiratory Care etc.
 Developing appropriate services to meet clinical needs within available resources
 Facilitating early discharge and reducing the length of stay.
 Demonstrating a firm commitment to the principles of clinical governance and effective
clinical audit, and participate in Morbidity and Mortality Meetings, implementing
SIGN/NICE and other national guidance,
 Participating in the education and training of doctors, nurses and allied health
professionals including those in primary care, and fostering by example an atmosphere
within the hospital which encourages learning and reflective practice. It is expected that
the post holders will complete a course such as Training the Trainees to enable
compliance with the upcoming GMC requirements to train junior doctors.
 Participation in annual appraisal, revalidation and licensing, and CPD to maintain and
refresh their skills and competencies are required.
 A requirement to undertake other appropriate clinical and administrative work on behalf
of NHS Orkney such as participation in Major Incident planning and supporting work
around future service design options.
 Participation in the development and renewal of clinical care models in preparation for a
new build Care Campus.
 A requirement to meet performance targets as described in the HEAT targets (health
efficiency access treatment targets) set out by the Scottish Government Health
Department. HEAT targets form part of the NHS Orkney Local Delivery Plan (LDP).
 Hospital staff should be able to contact the post-holders when on-call, both in and out of
working hours. The Board will provide communications equipment as appropriate in
order to facilitate this.
 Due to the size of the clinical teams in Orkney, assistance from all medical staff might be
required during major incidents.
 A requirement to work within the strategy developed by NHS Orkney promoting closer
integration of services and closer working relationships, both between disciplines, and
with partner agencies, to ensure patient centred care.
 The candidates will be expected to take part in the activities of various committees, such
as the Resuscitation Committee, the Drug and Therapeutics Committee, the Area
Medical Committee and others
 Subspecialty interests can be accommodated by close working relationships with
Grampian services
3. EDUCATION, TRAINING AND RESEARCH
NHS Orkney supports the requirements for Continuing Medical Education and is committed
to providing reasonable amounts of time and financial support for these activities.
Study leave of 30 days in 3 years and an annual study leave allowance will be provided.
Twenty to 25 hours of external CPD should be funded with the study leave allowance. This
is in addition to the time spent in the Grampian Medical Departments. The CPD program
should be approved by the post-holder’s line manager to assure alignment with service
requirements as part of annual job planning. Generous allowances are made for travelling,
taking into account the challenges to attend activities on the Scottish mainland
NHS Orkney is keen to develop and support research and innovation, particularly in the
area of telemedicine.
A multi-professional Education and Training Suite was opened in 2011. This comprises an
e-suite of well equipped training rooms, with access to an extensive range of manikins,
including SIM-Man and SIM-Baby and audio-visual equipment, including videoconferencing facilities.
The role will involve teaching medical, nursing and AHP staff to ensure acute care
competencies and chronic disease management skills across the services. In particular,
ensuring the ongoing competency and development of the core skills within the multidisciplinary service by developing, promoting and contributing to a multi disciplinary
educational programme, including the Orkney Multidisciplinary Education Programme.
4. CLINICAL GOVERNANCE AND AUDIT
NHS Orkney is continuing to develop clinical governance and patient safety arrangements
building on existing frameworks. Consultant representatives are members of the
Operational Clinical Governance Committee which oversees all clinical governance activity,
including management of clinical risk. The health board has a Health Intelligence and
Clinical Governance Department which provides advice and support on developing audit
systems and research governance. The appointee will audit their practice as appropriate or
supervise juniors in medical audit.
Consultants will be encouraged to participate, either in established projects or to initiate
research topics of relevant interest.
All clinicians are expected to take an active part in clinical audit, as well as supervising
audits undertaken by their teams, ensuring that the audit cycle is completed, and any
required change in practice is implemented. They must be willing to develop a culture of
audit in the acute care situation and ensure that these activities are incorporated into the
day to day activities of the acute service.
The post holder is expected to contribute to the Clinical Governance of the Balfour Hospital
and NHS Orkney by:
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Developing (in conjunction with Aberdeen Royal Infirmary), maintain and promote
protocols for conditions contained in the defined Rural General Hospital Core Activity
and to work within these protocols.
Promoting and being actively involved in the audit programme.
Contribute and lead regular joint morbidity and mortality meetings.
Undertaking Significant Adverse Event Analysis of cases that warrant such analysis.
Undertaking annual individual appraisal.
Maintaining personal continuing professional development
Acting as a positive role model for good medical practice and positive ways of
working.
5 CLINICAL NETWORK WITH NHS GRAMPIAN
The successful candidates will have a primary appointment in NHS Orkney, where
the candidates will work and live. A joint appointment with NHS Grampian, in the
form of an honorary contract, will occur. The purpose of this is to encourage close
working relationship with colleagues in the Medical Departments in Aberdeen Royal
Infirmary and other Grampian hospitals, participation in their CPD programs and
access to their departments for training and support. It is envisaged that the
successful candidates will spend 2 or 3 weeks per year working in the Grampian
hospitals, over and above the post-holders’ usual CPD program.
6. JOB PLAN
This will be agreed, but will as a minimum include
 Daily ward rounds for all medical patients, as well as other patients with medical
problems
 Outpatient clinics – Rapid Access Clinics, with TIA patients included, and Virtual Ward
Rounds for patients cared for in the community.
 Availability for emergency/acute receiving when on duty
 Clinical Governance and Patient Safety.
 Teaching
 The service is provided on a 24 hour basis and includes an on-call rota, which equates to
1:3. There is an 8% allowance for this level of on-call, as well as an increase in annual
leave. Locum cover will be available for sickness or unexpected absences.
 The consultant team will be supported by a team of doctors, who will be in the hospital
24/7.
 Travel and subsistence expenses for all travel to the Scottish Mainland for NHS Orkney
related meetings, CPD and training, will be paid for by NHS Orkney.
 An annual job plan will be negotiated and agreed between the Hospital Manager and
each physician and will depend on service requirements.
7. CLINICAL MANAGEMENT STRUCTURE
This role will report managerially to the General Manager of the hospital and professionally
to the Medical Director.
In agreement with the appointee, NHS Orkney will provide a mentor to support those
undertaking their first Consultant appointment.
8. PATIENT BASED INFORMATION SYSTEMS AND DATA QUALITY
NHS Orkney has recognised that information technology serves an increasingly important
role and is undertaking an extensive EHealth programme, including implementation of new
patient-based information systems, critical to this is the electronic patient record in both
acute and primary care. The system will build to facilitate access to the patient’s radiology,
pathology, and theatre history together with decision support software and specialty
systems. There is a variety of health informatics initiatives, both established and soon to be
piloted, to enhance efficiency in patient care and clinical management. The use of speech
recognition software is encouraged.
It is recognised that the collection of patient information is vital to the quality of care
delivered to patients. It is expected that care and thought are applied to the quality of such
data and that it is managed and shared appropriately whether electronic or paper based.
9. INFECTION CONTROL
All staff have a duty to comply with all relevant NHS Orkney guidelines and policies in
relation to Infection Prevention and Control. You have a duty to ensure that you minimise
the risk of infection, infectious diseases and particularly Health Care Associated Infection.
This responsibility includes minimising the risk by highlighting any concerns you may have
to the appropriate person as identified in the policies and guidelines.
10. SAFEGUARDING CHILDREN AND VULNERABLE ADULTS
NHS Orkney has a responsibility for, and is committed to, safeguarding and promoting the
welfare of children and young people as well as vulnerable adults in our care and for
ensuring that they are protected from harm. The post holder will be expected to work in
accordance with the relevant policies, including the Adults with Incapacity Act.
11. CONDITIONS OF SERVICE
The post holder must be on the General Medical Council specialist register or entitled to the
same, within six months of the interview date.
The post is subject to the Terms and Conditions of Employment for Hospital Medical and
Dental Staff. The job plan is subject to annual review and may be changed on consultation
with the post holder and the Hospital Manager. The health board is implementing the
national appraisal system for consultants.
Successful candidates will be required to maintain a private residence within 10 miles from
Balfour Hospital, maintain telephone contact with the health board and provide own
transport arrangements for emergency call-outs.
12. SALARY
Subject to New Consultant Contract salary scale.
For further information, please contact
Mr Marthinus Roos, Medical Director, NHS Orkney (marthinus.roos@nhs.net, Tel 01856
888224
Mr John Trainor, Hospital Manager, NHS Orkney (john.trainor@nhs.net) Tel 01856 888291.
PERSON SPECIFICATION
Job Title:
Department:
Location:
FACTOR
Qualifications
Clinical
Experience
Consultant Physician in Acute/General Medicine
Clinical Services
Balfour Hospital
ESSENTIAL
Entry on specialist register - Acute and/or
General Medicine (or will attain within six
months of the interview date) or similar
MRCP(UK) or equivalent
Clinical training and experience
equivalent to that required for gaining UK
CCT in acute/ general (internal) medicine
Broad range of recent experience in
general (internal) or acute medicine
Training and experience to manage an
acute medical ‘take’
Expertise in relevant practical procedures
e.g. insertion of intercostal drains, central
venous lines, & lumbar puncture
Evidence of annual appraisal
DESIRABLE
Advanced life support
accreditation
Advanced Paediatric Life
Support
HOW TESTED
Certification
and Application
Experience at senior grade of
critical /emergency care
Stroke Medicine, Geriatrics
Application and interview
Management and
Administration
Experience
Able to work effectively within a team of
medical and nurse practitioner
colleagues
Ability to engage and
communicate the benefits of
organisational change to stake
holders
Application and interview
Able to develop an acute team
Adaptable
Open to new ideas and change
Evidence of developing and
delivering change
Clinical
Effectiveness
Understanding of principles of
governance and audit
Evidence of having
undertaken audit
Application and interview
Teaching
Experience of successfully supervising
and teaching junior doctors and other
staff
Evidence of having developed
learning opportunities for
others
Application and interview
Personal
Skills/Attributes
Leadership qualities
Effective communicator, able to work in a
multi-disciplinary team
Ability to create and sustain relationships
and motivate and influence others
through their enthusiasm.
Good inter-personal skills
Ability to work under pressure
Flexibility in working pattern
Commitment to CME/CPD
Familiarity with information technology
and general computer skills
Evidence of good time management of
self and workload
Ability to build strong relationships based
on mutual trust and respect.
Willingness to undertake
additional professional
responsibilities
Application and interview