JOB DESCRIPTION FOR CONSULTANT in PALLIATIVE MEDICINE at Pilgrims Hospices in East Kent (Honorary contract with East Kent Hospitals NHS University Foundation Trust) SUMMARY This post is an exciting opportunity to become part of a dynamic team of Palliative Medicine consultants in East Kent. Currently 5 Consultants work between Pilgrims Hospices (PH) (inpatient and community services) and East Kent Hospitals NHS University Foundation Trust (EKHUFT). This clinically focussed post will replace an Associate Specialist who is retiring. It is based at Pilgrims Hospice, Margate. The hospice sits on the acute hospital site (the Queen Elizabeth the Queen Mother Hospital, Margate) making working relationships between the sectors close and effective. The post holder will be expected to undertake clinical commitments at other sites (Canterbury and Ashford). Part-time or job sharing arrangements would be enthusiastically considered provided that the delivery of an excellent service for patients and families and the smooth running of the organization can be assured. GENERAL INFORMATION The East Kent Hospitals University Foundation Trust serves a population of over 720,000 (approximately 20% over the age of 65). The population is spread across a geographical area of over 700 square miles of a largely rural area with main urban population in Ashford, Folkestone, Canterbury, Dover, Margate, and Ramsgate. Pilgrims Hospices serve the same population apart from the Swale area. Local authority population figures are as follow: Ashford (111,200), Canterbury (146,200), Dover (106,400), Shepway (99,600), Swale (128,500) and Thanet (128,600). Ashford is an expanding business and agricultural centre and has an International Station linking it to the Continent via the Channel Tunnel. It is a designated area for growth. Canterbury is an ecclesiastical and business centre and the University of Kent is based in the city. Margate and the surrounding coastal towns have a high proportion of elderly and disadvantaged people and the population increases in the summer with the influx of visitors. Thanet is an area of regeneration receiving European funding and Manston airport is being developed to serve Kent. There are many areas of unspoilt countryside and a wide variety of quiet secluded beaches. The countryside is mainly arable farm land, but in the 2|P age immediate vicinity of Canterbury fruit and hop farming predominate. The Stour valley runs through the area and there are areas of great natural beauty and charm. The Thanet coast is on a list of best wildlife sites in Europe. Places of historic interest include Canterbury Cathedral and Dover, Deal and Walmer castles. There are excellent schools, both private and state. Regular train services and the M2 and M20 motorways provide easy access to London, and the Continent is within immediate reach through the Channel ports and Channel Tunnel. There are also outstanding sporting facilities, both indoor and outdoor. Sports associated with the coast such as sailing and windsurfing are well served and golfers can enjoy many courses, including championship golf courses. HOSPICE and PALLIATIVE CARE SERVICES Pilgrims Hospices provides inpatient specialist Palliative Care on 3 sites with a total of 48 beds. The medical team is supported by 9 Advanced Nurse Practitioners in Specialist palliative Care and 12 Palliative Care Specialist Nurses. The hospice provides a multi professional community service, undertaking outpatient clinics, home visits and support for families. A hospice at home service staffed by senior Healthcare Assistants serves the whole area and is currently managed from the Canterbury site. Each site runs Day Hospice, staffed by Associate Practitioners running full days and programmes of activities with support from other members of the MDT. Full multiprofessional Palliative Care is delivered by a well-resourced multiprofessional team on each site including: social work, counselling, chaplaincy, physiotherapy, occupational therapy, complementary therapy. From the summer 2012, the hospice will be hosting a new Navigation Centre for End of Life Care. The centre will support all Pilgrims Hospices’ patients and also all patients on a Palliative Care register in East Kent. At Consultant level the EKHUFT funds one WTE post which is delivered at each locality (Canterbury, Ashford and Margate) by locally based Consultants working with Macmillan Palliative Care Clinical Nurse Specialists based in the hospitals. THE TRUST East Kent Hospitals University Foundation Trust (EKHUFT) received authorisation from Monitor in March 2009 and manages three acute district general hospitals (at Margate, Canterbury and Ashford), two supporting hospitals (at Dover and at Folkestone) and many teams of healthcare 3|P age professionals working in child care centres. It was originally formed from the merger of three previous Trusts – April 1999. The Chairman of the Trust is Mr Nicholas Wells and the Chief Executive is Mr Stuart Bain. The Medical Director is Dr Neil Martin. The Trust is one of the largest in the country, employing over 6500 staff with many part-time employees. The Trust serves a population of over 720,000 and the budget in 2009/10 was in the region of £450m. The Trust has the vision to be known throughout the world as one of the top ten hospitals in England and the Kent hospital of choice for patients and those close to them. The EKHUFT’s mission is to provide safe, patient focused and sustainable health services with and for the people of Kent. The Trust recognises that to achieve this it has a special responsibility for the most vulnerable members of the population that it serves. The Trust aims to work with local partners to develop excellent, modern clinical services, reducing both the length of time patients wait to be seen and to be treated and to make sure that it meets all the financial obligations. HOSPITAL SERVICES EKHUFT provides the majority of its services from the following hospitals: Queen Elizabeth the Queen Mother Hospital (QEQMH), Margate The Queen Elizabeth, the Queen Mother Hospital (QEQMH), Margate provides the full range of accident, emergency and elective services. The hospital dates back to the 1930's when the St Peters Road building was constructed. Between 1996 and 1998 many services were relocated and expanded into the main site of the QEQMH. Recent developments have included new operating theatres; ITU facilities; children’s inpatient and out patient facilities; a cardiac catheter laboratory; out patient department and a cancer unit completed in 2007. Kent and Canterbury Hospital The Kent and Canterbury Hospital provides a range of important inpatient services, which includes an unselected medical take as well as a new Emergency Care Centre. The hospital is located on the outskirts of the Cathedral City of Canterbury. The main hospital building was constructed in 1937, but has been developed considerably since then. The hospital stands 4|P age adjacent to the Kent County cricket ground. New investments have included a day surgery suite, an endoscopy suite and a state of the art child ambulatory day centre. It hosts the base for the renal services for Kent which have been expanded and developed in conjunction with vascular surgery and interventional radiology within purpose built accommodation. A birthing unit provides low risk deliveries on this site. The hospital site hosts one half of a split site Cancer Centre for Kent and Medway with regular oncology clinics, radiotherapy and chemotherapy treatments on site. William Harvey Hospital (WHH), Ashford The William Harvey Hospital (WHH), Ashford provides a full range of accident, emergency and elective services. This hospital is located on the outskirts of Ashford 2 miles from the Ashford International Station and adjacent to the M20, junction 10. The hospital was commissioned in 1977 and the site has been developed and substantially upgraded over the years and more recently been re-organised into medical and surgical floors. Recent developments have included the development of a NICU (neonatal intensive care unit); robotic pharmacy facilities; women’s health and stroke units. The site accommodates the single head and neck unit which will soon include maxillofacial services. It has a cardiac catheter laboratory which undertakes therapeutic interventions; Primary Coronary Angiography Services began in April 2010. EKHUT also provides a smaller range of services from two community hospitals sites. The Royal Victoria Hospital (RVH), Folkestone The Royal Victoria Hospital (RVH) provides an important supporting role. The hospital building is Victorian, but has been upgraded over the years to provide a minor injuries unit, a Walk-in Centre, a thriving outpatients department, the Derry Unit which offers specialist genito-urinary outpatient procedures. Many of these services are provided in partnership with the Eastern & Coastal Primary Care Trust. Recent plans have been agreed and are progressing to concentrate services to the west of the site and sell off the remaining properties. Buckland Hospital (BH), Dover The Buckland Hospital (BH) also provides an essential supporting role. The hospital was built at the turn of the last century in Coombe Valley, Dover. It has a minor injuries unit; out patient facilities; birthing unit and children’s 5|P age ambulatory unit. There are plans for a purpose built community hospital in Dover. Further details about the services available from the different hospitals and departments can be found at http://www.eastkenthospitalstrust.nhs.uk. HOSPICE and PALLIATIVE CARE MEDICAL STAFFING CONSULTANTS Dr Claire Butler (PHC), Director of Medicine and Research Dr Pauline Dand (PHC) Dr Andrew Thorns (PHT) This post (PHT) Dr Declan Cawley (PHA) Dr Jane Marshall (PHA) Vacant post (PHC/PHA) NON CONSULTANT STAFF One Specialty Registrar at each site – London and KSS Deanery rotation Specialty doctors (0.7/1.0) at PHC/PHA GP Specialist Trainees at each site Clinical assistants/GPSI posts The hospice hosts medical students on attachment from St George’s Hospital Medical School. DUTIES OF THE POST Pilgrims Hospices To provide Consultant level clinical care and input to the multidisciplinary team for patients under the care of the Pilgrims Hospice, Margate (PHT) (including hospice inpatients, community patients, outpatients and patients attending Day Hospice). To support and encourage the development of good practice in Palliative Care in the community served by Pilgrims Hospice in Thanet, through clinical practice, liaison with primary care services and education. To participate in the supervision and training of medical trainees (GPSTs and Palliative Medicine StRs) working at the Pilgrims Hospices. 6|P age To participate in the education of undergraduate medical students from St George’s Medical School To assist the Consultant team in the development and implementation of policy and strategy for Pilgrims Hospices. To take an active role in clinical and integrated governance in Pilgrims Hospices and EKHUFT. To maintain a full programme of personal CPD in line with current recommendations and to take appropriate study leave. To participate in annual appraisal and job planning and to comply with the requirements of revalidation. To assist in liaison with such voluntary or other bodies as may assist in promoting the efficiency and welfare of the hospice. To ensure that adequate clinical records and case notes for each patient are maintained in the hospice. To assist the Nurse Manager and nursing staff at the hospice in the safe custody and correct usage of all controlled drugs for the hospice and its patients. To participate in Kent and Medway Cancer Network palliative care forums and initiatives. East Kent Hospitals University Foundation NHS Trust To share the provision of Consultant level clinical care and input to the multidisciplinary team for Palliative Care patients in the Queen Elizabeth the Queen Mother Hospital (QEQM). To support and encourage the development of good practice in Palliative Care at the QEQM through clinical practice, liaison and education. Other responsibilities include: Junior staff: NA Budget: None for this post directly, relevant budgets are held by the Director of Medicine and Research (Pilgrims Hospices) and the Nurse Consultant, Palliative Care (EKHUFT). Communication: This will include responsibility for and arrangement of:Communication and liaison with all other medical and service departments within the hospital including:General Management, Medical Records, Social Work Department Communication with General Practitioners will include telephone discussion of problems and (i) (ii) 7|P age (iii) Teaching writing of letters about cases seen in the department Communication with other hospitals and special departments in other hospitals Junior doctors and medical students, nurses and other paramedical staff in the team in speciality and special interest ON CALL ARRANGEMENTS The Consultants share an on-call rota each taking a full share regardless of their in-hours working time (i.e. part time and full time posts contribute equally). The rota will be 1 in 7 once this post and the other vacant post are filled and is currently worked one week at a time, Monday 9am – Monday 9am providing 2nd on call to support junior and middle grade doctors who cover 1st on call for the PH. From June 2012, this will include cover for a new Navigation Centre for End of Life Care which the hospice is hosting for the locality. This will attract a supplement of 5% of a FTE salary. In addition, from June 2012, a weekend ward round at one site (1PA) on each of Saturday and Sunday will be required during the 1 in 7 on call week. The allocation of direct clinical care PAs for the on call commitment will be reviewed depending on the activity levels of the new Navigation Centre one calendar year after its commencement. The duties and responsibilities in this job description may need further discussion in the future to ensure that they continue to meet the needs of the service, future service developments and the post holder. PATIENT SAFETY, TRAINING CLINICAL GOVERNANCE, EDUCATION AND The PH and the Trust are fully committed to improving patient safety and experience. Consultants are expected to comply with the Clinical Risk Management processes. They must audit their own clinical outcomes, report 8|P age clinical incidents, alert the trust to risk, participate in annual appraisal and work to foster good team relationships. It is expected that the appointee will plan a programme of personal development and continuing medical education (CME) and through the appraisal process ensure that adequate training is undertaken both to maintain their skills, knowledge and expertise and to ensure revalidation. There is extensive local support and reasonable costs for formal study leave. An annual review of the job plan will take place with the Director of Medicine and Research of PH and the Consultant in accordance with Trust arrangements. This will include discussions regarding the needs of the service, with agreement of objectives for clinical standards, goals and workload. Each of the three main EKHUFT hospital sites has a well-equipped multidisciplinary Education Centre, including internet facilities and a library. Each runs full programmes of educational meetings. All Consultants have responsibilities for teaching doctors, students and nonmedical healthcare professionals, and should ensure they use the time allowed in their working week for duties of teaching and supervision. All Consultants should include some element of educational development within their personal development plan, using at least one half day per year of their external study leave to this end. RESEARCH The Pilgrims Hospices has an actively growing research portfolio and links with the University of Kent. Research is encouraged and supported both within the Comprehensive Local Research Network (CLRN) and by an active Research & Development Department. EKHUFT has strong links with the University of Kent at Canterbury and Christchurch University. MAIN CONDITIONS OF SERVICE The post is covered by the Terms and Conditions of Service of Hospital Medical and Dental Staff as amended from time to time. The post-holder is required to be fully registered with the General Medical Council and on the Specialist Register or eligible for inclusion on the Specialist Register within six months of the date of interview. 9|P age The appointee will be required to reside not more than 30 minutes away from their main base. The post-holder's private residence shall be maintained in contact with the public telephone service. The Consultant will be provided with suitable office accommodation at PH with adequate secretarial support and IT facilities. The passing of a medical examination is a condition of employment. Any Consultant, who for personal reasons is unable to work full-time will be eligible to be considered for this post; if such a person is appointed modification of the job content will be discussed on a personal basis in consultation with the Director of Medicine and Research. The Consultant salary scale is currently £74,504 rising to £100,044 for a 10PA job plan. Annual leave The annual leave entitlement is six weeks and two days. A minimum of eight weeks notice of leave arrangements is requested so that adequate cover arrangements can be made. Annual leave entitlements increased for consultants with seven or more years of completed service with effect from 1 April 2005 by an additional 2 days. A lieu day will be given for any Bank Holidays that are worked. Study leave Study leave is available according to local agreements. All clinical staff are required to give eight weeks notice. Removal Expenses There will be an allowance for removal expenses. Pilgrims Hospices before committing to any costs. Please confirm with Mentoring Professional advice and support is available from the Director of Medicine and Research at Pilgrims Hospices. Opportunities for mentoring are available at EKHUFT and through the Association for Palliative Medicine. VISITING ARRANGEMENTS 10 | P a g e Further details and information may be obtained by contacting Dr Claire Butler (01227 459700) or Dr Andrew Thorns (01843 233920). Visits by prospective applicants are encouraged and may be arranged through Human Resources (01227 459700). CONTROL OF INFECTION In accordance with the Health Act (2006) all staff are expected to comply with National and local Infection Control policies and procedures, and any other related infection prevention policies or procedures. In addition, all staff whose normal duties are directly or indirectly concerned with patient care should ensure they have received annual mandatory training (including hand hygiene). It is expected that all Consultants will lead by example in this area which receives maximum attention. PROPOSED JOB PROGRAMME Please see attached job programme. The programme is open to negotiation following a period of induction and thereafter will be reviewed on annual basis within the job planning cycle. The 10 PAs contract will include both direct clinical care (DCC) and supporting activity (SPA). 11 | P a g e PILGRIMS HOSPICES (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST) CONSULTANT RECRUITMENT PERSON SPECIFICATION Title of Post: Directorate: Consultant Palliative Medicine Pilgrims Hospices/Oncology Mandatory Requirements 1. Qualifications Generic Requirements 2. Clinical/ Technical expertise Essential 3. Intellect and Education 4. Organisation & planning (both personal & departmental) Date: January 2012 Professional qualifications Full GMC registration Holds CCT or Specialist Registration in Palliative Medicine or will obtain within 6 months of interview date Essential Desirable Assessment Method Application form/CV Desirable Assessment Method Application form/CV Interview References BLS Possesses range of clinical knowledge, skills & information technology expertise. Concerned to maintain & develop this knowledge. In depth expertise in at least one specialist field Displays sound professional judgement Exercises sound clinical risk management Sees patients within a holistic context Shows an approach based on critical enquiry and evidencebased medicine Embraces evidence-based practice & audit Interest in research & development Shows breadth of awareness & a range of problem-solving skills Encourages ongoing learning & an educative culture, both for self and others Postgraduate qualification Application form/CV Interview References Able to operate effectively in a committee; contributes to strategic decision-making Understands the issues of risk management & of operating Application form/CV Interview References Displays management & financial competence 12 | P a g e 5. Communication & Interpersonal Skills 6. Teaching skills 7. Ability to operate within wider NHS context 8. Decisiveness and Accountability 9. Partnerships with Patients within a litigious & complaints culture Shows self-discipline eg recordkeeping & legibility Able to juggle a large number of demands by setting priorities & planning effectively Able to manage conflicting & unpredictable demands Strong leadership & coordination skills with ability to direct & organise teams Able to communicate clearly, avoiding jargon, with a range of different people Builds strong & effective relationships with patients, families & colleagues with the ability to gain their trust & confidence Ability to cope with considerable pressure as well as to adapt to constant change & new demands Demonstrates energy, enthusiasm & initiative in pursuing innovation and the highest standards for patients, juniors, others, colleagues & the organisation Application form/CV Interview References Willing to supervise juniors, spots talent & nurtures it Evidence of teaching experience Able to operate within a teaching/training culture Understands the NHS system: nationally, regionally & locally Aware of the issues affecting current & future NHS practice Understands the concepts & principles of clinical governance Is able to justify decisions Recognises clinical constraints & the realities of rationing of care Application form/CV Interview References Works with patients as individuals & not purely as a collection of symptoms Able to manage patient expectations Application form/CV Interview References Application form/CV Interview References Application form/CV Interview References 13 | P a g e Specialty Specific Requirements 11. Ability to work as part of multidisciplinary team 12. Understanding of voluntary hospice funding and organisation Able to negotiate treatment plans with patients Essential Desirable Assessment Method Application form/CV Interview References Understanding of voluntary hospice funding and organisation Application form/CV Interview References Ability to work as part of multidisciplinary team 14 | P a g e TIMETABLE This post is 10 PAs: 8 DCC, 2 SPA am pm Monday Tuesday Wednesday Thursday Friday Saturday Sunday DCC PA: 0900-1300 Hospice WR SPA: 0900-1300 Clinical governance and CPD 1330-1430 DCC Hospice MDM 1430-1530 SPA: local management team meeting 1530-1730 time in lieu of for call DCC: 09001300 Community out-patients and home visits 1300-1600 DCC QOF meeting attendance. (Times may vary within the week) 1600-1700 SPA (clinical admin) DCC: 0900-1300 Community: out-patients and home visits DCC: 09001300 Hospice WR DCC: 10am-1pm ward round one hospice site (1 in 7) DCC: 10am-1pm ward round one hospice site (1 in 7) 1300-1500: SPA Training and development of clinical staff, CPD 1500-1700 time in lieu for on call DCC: 13301730 Ward supervision and admissions DCC PA: 13301730 Community: out-patients and home visits