NHS Lothian Lothian University Hospitals Division Directorate of Infectious Diseases Western General Hospital Consultant Physician Infectious Diseases & G(I)M 1. Outline of the post Applications are invited from registered medical practitioners for the post of Consultant in Infectious Diseases and G(I)M. This position is a fixed term locum appointment for 6 months, to join a team of seven consultant physicians based at the Regional Infectious Diseases Unit, Western General Hospital, Edinburgh. The unit has an active and growing remit in all aspects of infectious diseases medicine, including HIV, hepatitis C, OPAT, community acquired infection, travel/tropical medicine, antibiotic stewardship and the provision of an infection consult service to all acute sites in Lothian. The post holder will also contribute 5PA to the consultant rota for acute receiving bed cover (incorporating on-call), with the remainder of clinical activity contributing to day medicine cover in acute medicine. The post will become vacant from 1 February 2015. The appointment is for 10 PAs. It is subject to the Terms and Conditions for medical consultant grade staff under the new consultant contract (Scotland). For further details, please contact Dr D Wilks, Lead Clinician, 0131 537 2853 or david.wilks@luht.scot.nhs.uk. 2. NHS Lothian NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental health and hospital services. Mr Tim Davison is Chief Executive and Dr David Farquharson is Medical Director. The NHS Board determines strategy, allocates resources and provides governance across the health system. Services are delivered by Lothian University Hospital Services, the Royal Edinburgh Hospital and Associated Mental Health Services, 4 community health (and social care) partnerships (CH(C)Ps) in City of Edinburgh, West Lothian, East Lothian and Midlothian, and a Public Health directorate. NHS Lothian serves a population of 850,000. 2.1 University Hospital Services University Hospital Services provide a full range of secondary and tertiary clinical services to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The division is one of the major research and teaching centres in the United Kingdom. Hospitals included in the division are: The Royal Infirmary of Edinburgh The Western General Hospital The Royal Hospital for Sick Children, Edinburgh St Johns Hospital Liberton Hospital The Princess Alexandra Eye Pavilion. 1 The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres, and is equipped with modern theatre and critical care equipment and monitoring. Within the main building is a dedicated, multidisciplinary, 5 theatre day surgery complex. The hospital provides for most specialities and is the centre for: General surgery with a focus on the upper GI tract Vascular surgery Hepato-biliary and Transplant medicine and surgery Cardiac and Thoracic surgery Elective and trauma Orthopaedics surgery Neonatology Obstetrics & Gynaecology Cardiology Renal Medicine Sleep Medicine Regional major Accident and Emergency centre. There is a Combined Assessment Unit which takes unselected GP or direct emergency referrals, and from A&E. CAU includes the Dept of Liaison Psychiatry and the Scottish Poisons Bureau and Treatment Centre. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM and PET scanning will be available in 2008). There is a full range of lecture theatres, a library and AV facilities. The Western General Hospital (WGH) has 600 beds and 5 operating theatres and is equipped with modern theatre and critical care equipment and monitoring. The Anne Ferguson Building was completed in 2001 and the Royal Victoria Building in 2012 . The hospital provides for most specialties and is the centre for: Neurology, Neurosurgery and neuropathology UK CJD unit Colorectal Surgery Urology and Scottish Lithotriptor Centre Breast Surgery and Breast screening Gastro-Intestinal disease Rheumatology Infectious Diseases Haematology Oncology Medical Oncology Radiation Oncology (including 6 LINACs) Dermatology (Inpatient) There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance medical cases on a zoned basis within the city, and a nurse led Minor Injuries Unit. There is no trauma unit at this hospital. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM).There is a full range of lecture theatres, a library and AV facilities. 2 St John’s Hospital opened in 1989 and is located in the centre of Livingston, a new town about 30 minutes drive west from Edinburgh. The hospital provides for most common specialties but does not have emergency general surgery or orthopaedic trauma operating. The hospital has a paediatric ward and is the centre for: General Medicine with specialists in Cardiology, Diabetes & Endocrinology, Gastroenterology, Respiratory Medicine and Care of the Elderly Obstetrics & Gynaecology Child Health including Paediatrics and community child health The regional Burns and Plastic Surgery unit for SE Scotland Oral and Maxillofacial Surgery ENT Critical Care (ITU, HDU and CCU) Accident and Emergency General Surgery Orthopaedics Anaesthetics Mental Health including ICCU and ICPU Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH being developed as a major elective centre for the region. Lothian’s ENT service was relocated to SJH to create an integrated head and neck unit with OMFS and Plastic Surgery. Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, Ultrasound and NM). The hospital has been accredited full teaching hospital status by the University of Edinburgh. There is a full range of lecture theatres, a library and AV facilities. The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and specialist services for children. The hospital is situated in a residential area close to the centre of Edinburgh and is approximately 3 miles from the site of the New Royal Infirmary and the co-located University of Edinburgh Medical School and 3 miles from the Western General Hospital. The RHSC is the main paediatric teaching hospital for the South-East of Scotland providing general and specialised services on a local, regional and national basis. It acts as the local paediatric referral centre for the children of Edinburgh and surrounding areas, and as a tertiary referral centre for intensive care patients; gastroenterology, hepatology & nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal surgery; plastic surgery; orthopaedic surgery; urological surgery and aspects of general surgery. Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8 bedded Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3 bedded Neonatal Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full range of audio-visual equipment. All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy services. The local radiology department provides on site Magnetic Resonance Imaging, CT Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry, haematology, pathology and neuropathology services 3 2.2 Community Healthcare Partnerships The four established Lothian Community Health (and Social Care) Partnerships serve the population of Edinburgh, Midlothian, East Lothian and West Lothian. Hospitals in the CH(C)Ps include: The Astley Ainslie Hospital in Edinburgh Midlothian Community Hospital Herdmanflat Hospital Roodlands Hospital in East Lothian. The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian Councils bringing together those responsible for planning, managing and providing community-based health services for the population of Edinburgh and the Lothians. There are 7,500 members of staff. In addition, there are approximately 1,000 independent contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A population of 850,000 people is served across health board area. The range of services care of the elderly, medical rehabilitation, community mental health, substance misuse and learning disability, district nursing and health visiting, family planning, well woman, , comprehensive dental care and those provided by Professions Allied to Medicine, such as physiotherapy, pharmacies and optometrists. Specialist services provided include brain injury rehabilitation, bio-engineering and prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and Family Psychiatric Services. 2.3 Royal Edinburgh hospital and Associated Services The Royal Edinburgh and Associated Services provides a range of Mental Health services to the population of Lothian and other Boards within Scotland. The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the following range of specialities: Acute Mental Health Rehabilitation Psychiatric Emergency Team 24/7 Outpatients Assessment Psychiatry of Old Age Forensic Medium Security Unit Inpatient facilities for under 18s Psychotherapy Service Psychology Services Services for Eating Disorders Day Hospitals – Psychiatry of Old Age The hospital is currently housed in a mix of accommodation ranging from 19th century to present. There is a major project now in place to take forward a reprovisioning programme in line with the strategic vision with the “Delivery for Mental Health” Scottish Executive 2006. 4 2.4 Department of Public Health Medicine The purpose of the Department of Public Health Medicine is to improve the health of the people of Lothian in collaboration with many other partners. Using our range of knowledge, experience and networking capability, our distinctive contributions are: the promotion of specific measures to monitor and improve health; the collation and interpretation of health related information. The following objectives have been agreed as the basis for the Department’s work plans: 1. To monitor the health status and health needs of people in Lothian; 2 To promote improvements in the health of Lothian people directly, and by providing information and advice to the public on health matters; 3. To assist Lothian NHS Board to fulfil its statutory obligations; 4. To contribute to strategic changes within the NHS in Lothian by providing information on clinical effectiveness; 5. To facilitate improvements in health and health care services directly, and through ‘managed clinical networks’ and wider alliances; 6. To contribute on a 24 hour basis to the control and prevention of communicable diseases and environmental hazards; 7. To maintain commitments to teaching, training, professional development, audit and research. To enable efficient management of the Department: there are at present four groups in the Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health Information. 3. University of Edinburgh The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research university, graded within the top six multi-faculty British Universities in the last national research assessment exercise (90 percent of its academic staff were in units rated 4, 5 or 5*). It has 3,000 academic staff, over 16,000 undergraduate and over 4,000 postgraduate students and an annual expenditure of over £261M for teaching and research. The University is organised into 3 Colleges: Humanities and Social Science, Medicine and Veterinary Medicine, Science and Engineering. 4. NHS Library and Postgraduate Facilities There are excellent facilities on all sites. 5 5. REGIONAL INFECTIOUS DISEASE UNIT (RIDU) Physical environment The Regional Infectious Disease Unit (RIDU) is housed in a temporary two storey building at the Western General Hospital. It has 31 isolation rooms with en-suite showers/toilets. The Unit is capable of isolating all types of infections whilst providing the patient with a high standard of accommodation and is connected to the rest of the hospital via a link corridor into the Alexander Donald Building which contains the ICU, HDU and other medical and surgical wards. On the ground floor of RIDU there is a purpose built outpatient department, travel clinic, daybed area, dental suite and office accommodation. Medical staff 7 Consultants:Dr Oliver Koch Professor Clifford Leen Dr Claire Mackintosh Dr Diare O’Shea Dr Rebecca Sutherland Dr Jo Turner Dr David Wilks (Professional lead) Dr Ravneet Batra Consultant Psychiatrist Dr Hazel Rae Associate Specialist Physician 5 junior medical staff (currently 3 FY2, 1 ST1, 1 GPST1) 1 core medical ST2 6 Specialist trainees on rotation (not always available to unit) including one ID/microbiology and one ID/virology trainee 0.5 WTE Consultant Clinical Psychologist (Dr Richard Cosway) Specialist nursing staff 1 clinical research nurse 2 clinical nurse specialists (HIV) 4 clinical nurse specialists (hepatitis C) Travel medicine nurse practitioner 3 nurse counsellors Multi-disciplinary team comprising a dietician, occupational/physiotherapists, pharmacist and community psychiatric nurses principally concerned with the care of HIV patients. Inpatient and outpatient nursing staff have particular expertise in the management of IV drug users. Other specialist staff Full time data manager Part time data inputter The unit also hosts a number of specialist teams: Blood borne virus/substance misuse nursing team Antimicrobial management team City of Edinburgh social services BBV team 6 Special interests of the unit The Regional Infectious Diseases Unit (RIDU) provides in-patient and outpatient facilities for the diagnosis and management of all types of infections including HIV. It has 2 in-patient wards with 31 beds, an outpatient department and 5 day beds. There are approximately 1300 admissions p.a. of whom about 200 are HIV+ and ~95% are emergencies. RIDU see ~1400 new outpatients and ~5000 return outpatients p.a.. Of these ~100 new patients and ~3000 returns were HIV+. HIV The unit has a long history of providing care for patients with HIV, and has been particularly associated with patients infected through intravenous drug use following an epidemic of transmission in the early 1980’s. More recently the case mix has altered to reflect the distribution of risk groups nationwide, with an increasing number of patients infected heterosexually and abroad. This has been reflected in a broader range of opportunistic infections and we have a diverse and stimulating case mix. We have a longstanding commitment to multi-disciplinary working with a variety of specialists as listed above. Outpatient services for HIV are also provided by our colleagues at the Department of Genitourinary Medicine, Chalmers Hospital, with whom we enjoy close cooperation. We provide inpatient services to these patients when required, and the GUM department now provide sexual health services for patients with HIV from within our department. Hepatitis C A large proportion of our HIV+ patients are coinfected with hepatitis C. As a centre with recognised expertise in the care of drug users we are funded to provide a hepatitis C treatment service, for coinfected and HIV-negative patients. We have four clinical nurse specialists in hepatitis C, and have established nurse-led assessment and treatment clinics, with an active programme of outreach to local agencies working with drug users and to Saughton and Addiewell prisons. We are an active part of the new HCV managed clinical network, and have expanded our treatment service in accordance with the government’s HCV action plan. Community acquired infection We admit all types of community acquired infections, including diarrhoea and vomiting, soft tissue infection, pneumonia, meningitis and urinary tract infections. Management is consultant-led, and we have a well developed set of clinical protocols to ensure compliance with applicable national guidelines. Outpatient antibiotic therapy (OPAT) Following a successful bid for funding we now host, within the unit, a full time OPAT service with 6 full time specialist nurses. This functions 12 hours a day every day providing OPAT services to patients from many specialties on both major acute sites in Edinburgh. We have recently extended the OPAT service to St John’s Hospital Livingston where there is now a smaller OPAT unit, supervised by consultant staff from RIDU. Infectious diseases consult rounds We have a programme of consult ward rounds at RIE and WGH which are run in collaboration with colleagues from microbiology. These rounds, which have recently been developed and have proven extremely popular with wards visited, see patients by referral, or if there are significant microbiological results. This frequently results in transfer of patients with challenging infections into our own beds. We also have pilot funding for an “antimicrobial ward round”, which has a very explicit focus on reviewing patient on IV antibiotics to determine whether therapy can be stopped or stepped down. Audit has demonstrated significant immediate savings and we have applied for funding to extend this service to all acute sites. Successful applicants will work with colleagues to deliver a robust consult 7 service across the whole organisation and join existing consultants in running the successful antimicrobial stewardship service Antibiotic stewardship and the Lothian Antimicrobial Management Team Dr Wilks is currently lead clinician for the AMT and other consultants in the unit have also contributed to this service, which is physically based in RIDU. The AMT has a wide ranging remit, including the supervision of inpatient antibiotic use, surgical prophylaxis and primary care antibiotic prescribing. Chronic fatigue syndrome The unit has an assessment service for patients with unexplained fatigue, and close links with the rehabilitation service at the Astley Ainslie Hospital. We were a recruitment centre for the MRC-funded PACE trial. Tropical and travel medicine We admit many patients with proven or suspected tropical infections, and function as a referral centre for SE Scotland in this respect. We have a dedicated nurse-led travel clinic. Emerging infectious diseases RIDU has two isolation rooms which have ante-rooms and high capacity negative pressure ventilation systems. These are the only rooms in SE Scotland which are able to provide an adequate standard of isolation for patients with suspected infections such as Lassa fever, avian ‘flu or SARS. RIDU consultants have been closely involved in helping NHS Lothian develop policies for emerging infections, as well as local policies for the management of patients admitted to the ward with suspected infection. ACUTE AND GENERAL MEDICINE, WESTERN GENERAL HOSPITAL Acute medicine in the Western General Hospital has recently adopted a new medical receiving model with an expansion in ‘front door’ capacity. This incorporates 2 bedded areas (total 34 beds) and development of a day medicine and ambulatory care area. Downstream patients are cared for in wards 25/26, where we have 42 medical beds. In addition there is currently general medical capacity in ward 15. There are between 50 – 70 patients through ARAU trolleys area each day, the majority of which are medical. The consultant on-call for admissions leads a ward round starting at 08:30 weekdays and 09:00 at weekends. In the afternoon and evening, the consultant is expected to provide ongoing assessments on those patients admitted from the trolley area and facilitate patient flow. The on-call consultant is also expected to support the Trolley area from 18.00-21.30. ARAU has registrar level cover over the full 24 hour period, as well as cover at the support of a team of 7 FY1, 3 FY2s, 3 CMT1 and 1 GPST1. The acute medicine team also has 6.0 wte speciality doctors who contribute to the delivery of front and back door services, with plans for this number to increase with the proposed expansion in services. NHS Lothian has made a substantial investment in Acute Medicine services in the last 12 months, to support the increase in activity that has been seen at both the RIE and WGH sites. This has lead to greater integration with Medicine of the Elderly services and the establishment of a mobile team of specialist doctors, nurses and therapists to enhance the care provided to frail older people across the site. Respiratory medicine has also become incorporated into the acute medicine service on the WGH site. With closer integration of the three services we are seeking to enhance quality of patient care and improve patient flows. 8 The current on call rota for weekday acute receiving is on a 1:14 basis, but this will increase to 1:16 with 2 additional consultant posts in 2015. Weekend on call frequency will be 1:8. We are also seeking to develop and enhance our ambulatory care provision and day medicine service at the front door and expand our nationally-recognised patient safety activity. Consultant Team Consultant Professor John McKnight Professor Mark Strachan Dr Donald Macleod Dr Tim Morse Dr Matthew King Dr Claire Gordon Dr Stuart Ritchie Dr Emily McMurray Dr Ailsa Howie Dr Gareth Stewart Dr Friederike Boellert Dr Maeve Smith Dr Ganesh Arunagirinathan Dr Andrew Leitch Dr Phil Reid Speciality Interest Diabetes and Endocrinology Diabetes and Endocrinology Acute Medicine/Cardiology Acute Medicine Acute Medicine/Renal Acute Medicine Diabetes and Endocrinology Diabetes and Endocrinology Acute Medicine Respiratory Respiratory Respiratory Diabetes and Endocrinology Respiratory Respiratory 6. Details of the Post The advertised post is fixed term for 6 months. The post is for a locum Consultant in Infectious Diseases and G(I)M. The number of patients with HIV and hepatitis C is increasing, and an interest in the management of patients with blood-borne virus infection is essential, in addition to broad experience in community acquired infection and tropical medicine. Duties in Infectious diseases department will be tailored to the experience and interests of the successful applicant, but may include clinics in blood borne viruses, general ID and antibiotic stewardship. This 10 PA post will also include a 5 PA commitment to G(I)M. 5 programmed activities will be with acute / general medicine. Successful applicants will contribute to the consultant rota for acute receiving bed cover (incorporating on-call), with the remainder of clinical activity contributing to day medicine cover. The successful candidate will join an established group of 15 physicians working in Acute Medicine. They will have a highly visible Consultant presence in ARAU, offering senior support to training grade staff, with an emphasis on improving patient care through rapid Consultant-led inter-professional assessment. The successful appointee will be encouraged to play a major role in the on-going development and support of the day medicine / ambulatory care service and patient safety activities. 9 7. Research and Development Since 1986 the department has been involved in clinical research, participating in over 150 clinical trials. The unit has a reputation for providing high quality data and participation in a wide variety of collaborative studies. Professor Clifford Leen is currently Lead for clinical research. We have an active research department for HIV, HCV and HIV/Hepatitis C co-infection and are at the forefront of exciting new drug strategies including Interferon sparing treatment. Current cohort studies include- Eurosida, D:A:D, UK register of Seroconverters, HCV Research UK, UK CHIC. Recent treatment studies include-Telaprevir, Faldaprevir, Sofosbuvir, Maraviroc, Qutenza, Elvitegravir. We are participating in the multicentre OvIVA study, looking at the role of oral versus IV antibiotics in a range of bacterial infections. We were a recruitment centre for the MRC-funded PACE trial for management of chronic fatigue syndrome. The unit is associated with the University of Edinburgh Infectious Diseases framework and is taking part in discussions towards the establishment of an inter-disciplinary Centre of Infection Medicine which would draw together multidisciplinary academic and clinical research groups working across basic, clinical and translational aspects of infection medicine. 8. Teaching Students from Edinburgh University are regularly assigned to the unit as part of year 5 medical attachment. We also host elective students and Special Study Modules. There is ample opportunity to teach junior staff on the wards, or to take part in the formal programme of lectures. Consultant staff deliver a number of lectures on the undergraduate curriculum and this is an area which we have recently enhanced in collaboration with the department of Microbiology. 10 9. Job Plan Principal Place of Work: Western General Hospital, Edinburgh Contract: Full Time Programmed Activities: 9+1 Extra Programmed Activities: 0 Availability Supplement: High frequency Premium Rate Payment Received: 5 % Managerially Accountable to: General Medicine Clinical Director, WGH Location: RIDU Week 1 Day Monday Time 09:00 – 13:00 13:00 – 14:00 14:00 – 17:00 Activity HIV Clinic Unit meetings (3 in 4), HIV therapy mtg (1in4) SPA/ Patient Admin DCC 4 08:30 – 10:00 10:00 – 13:00 13:00-14:00 14:00-17:00 09:00 – 13:00 13:00 – 14:00 14:00 – 17:00 HCV Therapy Meeting SPA/ Patient Admin HIV MDT HCV Clinic Consultant Round Grand round OPD 1.5 Thursday 12:00-20:00 Day Medicine (Alternate with Fridays) 4 Friday 12:00 – 21:30 ARAU bed cover (1 week in 4) 1.5 Saturday 08:30 – 16:30 ARAU bed cover (1 week in 4) 1.6 Sunday 08:30 – 21:00 ARAU bed cover (1 week in 4) 2.5 Tuesday Wednesday PRA SPA 0.25 0.75 1 2 2 1 1 3 4 1 1.5 Total Pas (Average over 42 weeks) 10 Week 2 Day Monday Time 09:00 – 13:00 13:00 – 14:00 14:00 – 17:00 Activity HIC Clinic Unit meetings (3 in4), HIV therapy mtg (1in4) SPA/ Patient Admin DCC 4 08:30 – 10:00 10:00 – 13:00 13:00- 14:00 14:00-17:00 09:00 – 12:00 12:00 – 21:30 HCV therapy meeting SPA/ Patient Admin HIV MDT HCV Clinic Admin (3 weeks in 4) Acute Receiving beds (1 week in 4) 1.5 Thursday 08:30 – 17:00 12:00 – 20:00 Acute Receiving beds (1 week in 4) Day Medicine (3 weeks in 4) 1.25 3.7 Friday 08:30 – 12:30 Acute Receiving beds (1 week in 4) 0.6 Tuesday Wednesday PRA SPA 0.25 1 0.75 2 2 1 1 3 1.4 1.5 Saturday Sunday Total Pas (Average over 42 weeks) 11 10 Contact Details Dr David Wilks Consultant Physician Regional Infectious Diseases Unit Western General Hospital Edinburgh EH4 2XU Tel: 0131 537 2853 Fax: 0131 537 2878 david.wilks@luht.scot.nhs.uk 12 Person Specification Requirements Qualifications and Training Essential GMC Registered medical practitioner. Be on, or be eligible for inclusion on the GMC Specialist Register 6 months from interview date. CCT (or within 6 months of obtaining CCT at time of interview) in Infectious Diseases and either General (Internal) Medicine or Microbiology or Virology Relevant Experience General and Subspecialty experience Ability Ability to take full responsibility for independent management of patients. Previous experience in research. Research Teaching and Audit Personal Attributes Circumstances of Job Evidence of formal and informal teaching and training of junior doctors, medical students and other clinical staff. Commitment to learning and continuous professional development Evidence of commitment to patient focused care Excellent team player, good communication skills, experience of working in multidisciplinary teams. 1 in 5 on call requirement 13 Desirable Hold FRCPath (Medical Microbiology), or show evidence of equivalent training and experience Additional postgraduate qualifications e.g. MD/PhD, Diploma in Tropical Medicine and Hygiene. Diploma in HIV Medicine Commitment to research, publications and presentations. Research active. Previous experience of designing teaching programmes. Experience of designing and effecting audit programmes