NHS Lothian
University Hospitals Division
Directorate of Medicine
Royal Infirmary of Edinburgh
CONSULTANT PHYSICIAN IN MEDICINE OF THE ELDERLY AND STROKE MEDICINE
1.
Outline of the post
An opportunity has arisen for the post of Consultant Physician in Medicine of the Elderly
(MoE) and Stroke Medicine based at the Royal Infirmary of Edinburgh. The successful
applicant will join an enthusiastic and motivated group of clinicians providing excellent care to
the frail elderly, along with providing evidence based care within our Acute Stroke Unit. On
call commitments include a joint on call with MoE for South Edinburgh alongside the stroke
thrombolysis service in South-East Scotland. Edinburgh is a highly desirable place to live with
affordable accommodation, excellent amenities and home to the internationally renowned
Edinburgh Festival but plenty to do all year round in the city and surrounding areas. It has
excellent transport links.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental
health and hospital services. 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 hospitals division, 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 Hospitals Division
The University Hospitals Division provides 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
Royal Victoria Hospital
Liberton Hospital
The Princess Alexandra Eye Pavilion.
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
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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:
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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.
The Acute Medical Unit (AMU) is an assessment unit which takes unselected GP or direct
emergency referrals, and from A&E. AMU 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). 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. The hospital provides for most specialties and
is the centre for:
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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)
Medicine of the Elderly/Stroke Medicine
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.
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:
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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
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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, and the Regional Eating Disorders
Unit, which opened in February 2012. 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 a 151-bedded Hospital, and 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
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 in Midlothian
Rosslynlee Hospital in Midlothian
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Herdmanflat Hospital in East Lothian
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:
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Acute Mental Health
Rehabilitation
Psychiatric Emergency Team 24/7
Outpatients
Assessment Phychiatry 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
There are an additional 46 beds and a day hospital for Psychiatry of Old Age in the north
of the city at the Royal Victoria Hospital.
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 outlined in the Scottish Executive publication
“Delivery for Mental Health” in 2006.
2.4 Department of Public Health Medicine
The aim 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;
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 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 people in Lothian 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 on 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 and within the top 5 Universities in Europe for its Biomedical
Sciences.
The University of Edinburgh’s College of Medicine and Veterinary Medicine (CMVM; Head
Professor Sir John Savill) is an internationally leading force in basic-to-clinical translational
research. The College has a consistent 30-year strategy of interdisciplinarity and integration
of basic and clinical sciences. In the most recent Research Assessment Exercise (2008), the
University of Edinburgh was top in the United Kingdom within the UoA4 category of Hospitalbased Clinical Subjects. In 2008/9, CMVM attracted over £120 million in external peerreviewed grant funding.
4.
NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
5.
Medicine of the Elderly (RIE site)
Medicine of the Elderly Consultants and Associate Specialists (with special interests)
This post
Dr Andrew Coull
Dr Wendy Morley
Dr Olayinka Ogundipe
Clinical Director, RIE Acute Medicine, MoE and Stroke
Acute MoE and Quality Improvement Lead
Acute MoE, Orthogeriatric Rehab., Medical Education Lead
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Dr Simon Hart
Prof Alasdair MacLullich
Prof Gillian Mead
Dr Gayle Campbell
Dr Nolan Alruraj
Dr Jo Renton
Dr Fergus Doubal
Dr Richard O’Brien
Prof Martin Dennis
Stroke and General Medicine
Delirium and Dementia
Stroke
General MoE, COMPASS, Medical Education
Acute MoE , Stroke, COMPASS.
Acute MoE, Orthogeriatric Trauma, and General Medicine
Acute MoE and Stroke
Acute MoE and Stroke
Stroke Lead
Specialty Doctors:
Dr Umar Saleem
The Medicine of the Elderly (MoE) Service within Lothian University Hospitals Division
(LUHD) provides high quality care and a comprehensive scope of services for the elderly
population in Lothian across four main hospital sites; Royal Infirmary of Edinburgh (RIE),
Western General Hospital (WGH), Liberton Hospital, & St John’s Hospital (SJH). These
comprise of; acute inpatient assessment, acute stroke services, general rehabilitation and
specialist rehabilitation (stroke and orthopaedic), liaison work to other departments and a
range of outpatient services including day hospital, geriatric clinics and specialist Parkinson
services.
Additional inpatient and outpatient MOE services are also provided to Lothian patients by
Edinburgh, East and Midlothian Community Health Partnerships. Furthermore whilst the day
to day management of NHS Inpatient Complex Care (formerly ‘Continuing Care’) facilities
throughout Lothian are provided by local general practices or specialty doctors; consultant
input is provided by the MoE service.
MOE provides a comprehensive service to older people within Lothian, concentrating on
those who have complex needs and require specialist input. There is a clear nationally driven
goal to provide safe, high quality care to the ageing population enabling older people to
remain at home for as long as possible and limiting hospital stays to acute phases of illness.
The goal of the MOE service in Lothian is to support patients to maximise their functional
potential or recover to an optimal level of health with the view of maintaining an independent
life at home or alternatively in a suitable home in the community. This is achieved by way of
multidisciplinary team working: Medical staff working alongside nursing staff, allied health
professionals and Health and Social care colleagues to provide comprehensive geriatric
assessment (CGA) There is no specific age limit on the patients seen, though the majority
seen are in the age range 80 plus.
The MOE service is configured into North and South Zones, with a team of consultants on the
North side providing care for older patients mainly at the WGH (acute medicine for the elderly,
acute stroke wards and assessment and rehabilitation wards); and a team on the South side
providing care to patients mainly at the RIE (acute medicine for the elderly, acute stroke
wards) and Liberton Hospital (assessment and rehabilitation wards).
Within the main acute hospital sites, the Medicine for the Elderly Liaison service continues to
develop links with all areas involved in the care of older frail adults including primary care.
Innovative models include ECAT (Elderly Care Assessment Team) at the RIE and TEAM 65
(Targeted Early Assessment and Management of the over 65’s) at the WGH, developed as
nurse led teams who proactively assess patients in the admission areas of the hospitals. The
COMPASS service has been developed to provide CGA to the frail elderly in a range of
settings spanning primary and secondary care. It provides a single point of contact for GPs
seeking advice for the frail elderly, early access to Day Hospital or direct admission to MoE
wards and proactive identification and targeted assessment of the frail elderly in any ward in
the hospital. There is also a weekly community multidisciplinary team meeting attended by a
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wider variety of community services to discuss those identified as high risk of admission and
manage them appropriately.
The MOE Service within LUHD is currently undergoing an exciting redesign in order to
respond to the call for Geriatricians to do more work outside of hospital and to continue to
forge greater links with community services and Health & Social Care. Following a successful
pilot of the COMPASS model in the South East, the Medicine of the Elderly service is now
looking at expanding this model to provide a single point of assessment to direct/advise the
treatment and care of older people across Edinburgh. The service has secured significant
investment and support to extend and develop this model of care including the integration,
extension and enhancement of ECAT & TEAM65. The model of care formerly managed
within a Day hospital continues to develop and evolve to respond to change. Redesign of
Day Hospital and out patient delivery is ongoing as demands change and the service requires
more rapid access to comprehensive geriatric assessment, and outpatient multidisciplinary
rehabilitation services.
6.
Details of the Post
The post-holder will join an enthusiastic and committed team to provide ongoing inpatient
care to patients within the Medicine of the Elderly Department within the RIE.
All the current consultant job plans are under revision in order to create a new style of service
where consultants are based on a single site and able to deliver high quality care to patients
with a short length of stay despite their complex needs.
In relation to the general MoE component of this job, there will be opportunities for the
successful applicant to utilise (or to develop upon) subspecialty interests such as: working in
specialist liaison services (e.g. stroke liaison), acute trauma, or to work in the community
supporting COMPASS related MoE work. We hope to develop our ‘Hospital at Home’ service
in late 2014.
The typical number of acute inpatients under the care of one consultant under usual
circumstances is ~ 10 patients / 3 PA of DCC time (or pro-rata equivalent). There is an
expectation that this time allocation incorporates covering colleagues’ patients during periods
of leave.
The general on-call commitments currently average ~ 1 in 12 weekdays; and ~ 7
weekends/year, with cover being for both MoE and Stroke wards at the RIE and Liberton
Hospital.
From Aug 2014, it is envisaged that the general on-call rota for MoE + Stroke wards during
the weekdays will continue to be site-based between 0900 -1700hrs; but from 1700hrs to
0900hrs next day cover, the service will be evolving into a regional MoE/Stroke ward cover
(RIE, Liberton and Roodlands Hospitals).
The on-call / OOH access from 1700hours is mostly via telephone consultation, but with a
contractual obligation to be physically accessible within ~ 30minutes travel time in the event
of direct clinical review being required. The consultant weekend cover arrangements has
recently transitioned into a two consultants on call per weekend format, to cover for expanded
clinical services across the RIE Edinburgh and Liberton Hospitals (MoE + Stroke wards).
The current on-call / OOH commitment currently attracts 1.0 PA; but is subject to periodic
reviews in line with standard job planning requirements.
Administrative support is available via site-based teams of medical secretaries and
administrative staff.
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Leave arrangements are in line with standard NHS Scotland policies and procedures, with
eligibility for Annual Leave, Study Leave, Professional Leave, Discretionary Leave, etc.
Prospective cover arrangements apply to leave.
7.
Stroke Medicine
The Acute Stroke Unit at the RIE is currently a 22 bed unit taking the bulk of acute strokes
across Lothian. It is currently under considerable redesign to provide a world class
hyperacute stroke unit aspiring to all patients admitted directly to the stroke unit. The
successful applicant will join a motivated group of clinicians providing excellent stroke care
alongside a dedicated nursing and multidisciplinary team. The stroke service is currently
undergoing a significant and exciting redesign as the internationally renowned Stroke
Research Group currently based at the WGH relocates to the RIE. As part of this service redesign, it is anticipated that the Acute Stroke Unit will expand to 32 beds from early August
2014.This will provide increased academic and clinical input into the service allowing
improved provision of care over seven days and robust opportunities for research. This
redesign will also allow all staff to gain experience in all aspects of the service within acute
stroke, liaison, rehabilitation, clinics, thrombolysis and neuroradiological meetings. There are
excellent links with Liberton Stroke Unit and the Royal Victoria Building at the Western
General Hospital for ongoing rehabilitation. Younger patients with stroke (~ < 65 years but
guided by clinical needs) have their rehabilitation at the Astley Ainslie Hospital, Edinburgh
under the care of Rehabilitation Medicine consultants with an interest in Stroke rehabilitation
and Brain Injuries, alongside additional input into Vocational Rehabilitation.
The successful applicant will be expected to contribute to a Stroke Physician of the Day
model in which all new and unwell patients will be seen, new referrals reviewed with the StR,
and form part of the stroke thrombolysis team.
The successful applicant will also contribute to out-patient/neurovascular clinics (this is
currently designed on a rotational basis), and the post-holder will be expected to contribute to
a regional TIA hotline service.
The Stroke Thrombolysis Rota provides a Regional service via Telestroke, and currently
attracts 0.25PA. The Stroke Thrombolysis on-call frequency is ~ 1 in 11 for Telestroke (OOH)
and ~ 1 in 7 for Weekday Thrombolysis. Subject to rotas flexibility, most on-call sessions for
MoE and Stroke Thrombolysis can be synchronised.
Telemedicine and IT support is available for provision of a telemedicine service at/from home.
The post holder will also provide supervision and teaching to the stroke team junior medical
and nursing staff, and work to provide timeous discharge letters.
The contract for the post is based on a 10 PA commitment but this is subject to discussion
prior to any interview, and subject to negotiation through early job planning. NHS Lothian is
actively in the process of transitioning from a paper-based, into an electronic job planning
system.
8.
Teaching
The successful applicant will be expected to contribute to a strong ethos of improvement and
redesign in the Medicine of the Elderly unit. This will include attendance at weekly educational
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meetings, regular quality improvement meetings and also participation in teaching. The postholder will also be expected to contribute to supervision of junior staff subject to the interests
of the applicant and job planning.
9.
Appraisal and GMC Revalidation
The post-holder is required to maintain appropriate CPD, and to take part in annual appraisal
and the revalidation process. NHS Lothian has systems in place to support this. The
secondary care clinician component of the SOAR website currently serves as a highly
recommended platform and resource to support this process.
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10.
Job Plan
See attached
11.
Contact Details
For further information and arrangements to visit contact:
Dr Andrew Coull
Clinical Director
Directorate of Medicine, RIE
Royal Infirmary of Edinburgh
51 Little France Crescent
Edinburgh EH16 4SA
Telephone:
E mail:
0131 242 1294 (secretary) or 01312426927
andrew.coull@luht.scot.nhs.uk
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Job Plan
Specialty: Consultant Physician in Medicine of the Elderly and Stroke Medicine
Principal Place of Work: R.I.E
Contract: Full Time
Programmed Activities: 10
Availability Supplement: 5%
Managerially responsible to: Dr Andrew Coull
One PA is attributed to the MoE on call rota out of hours so on a 10 PA job plan the successful applicant
is due a half-day. The sample job plan is indicative, not prescriptive, and will be subject to job planning.
DAY
Monday
HOSPITAL/LOCATION
TYPE OF WORK
0900 - 1300
RIE
MoE Ward Round
1300 – 1400
RIE
MoE Education Meeting
1400 - 1700
RIE
Stroke Ward Round
0900 - 1300
RIE
MoE / Stroke liaison activity
1300 – 1600
Wednesday
0900 – 1300
RIE
SPA
RIE
MoE Ward Round
DCC
EPA
SPA
1
0.25
0.75
Tuesday
1300 – 1700
Thursday
0900 – 1700
1
0.75
1
Half-day in lieu of out of hours work
RIE
Stroke Physician of the Day
Ward round, liaison and
thrombolysis referrals, TIA hotline,
education and training, X-Ray
meeting and MDT, discharge letters.
2
0900 - 1300
RIE
MoE Ward Round
1
1300 – 1700
RIE
Family meetings and administration
associated with direct clinical care
1
Out of Hours on call for MoE +
Stroke Wards
Regional Telestroke
1
Friday
Saturday
From/To
Sunday
From/To
On call
South Edinburgh MoE
On call -
Telestroke
Total PAs
0.25
9
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1
12.
Person Specification
REQUIREMENTS
ESSENTIAL
DESIRABLE
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GMC registered medical practitioner
MRCP(UK) or equivalent
Be on, or be eligible for inclusion on,
the GMC Specialist Register in
Medicine of the Elderly & General
Medicine within 6 months at the time of
interview.
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Experience
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Experience in working at
the community interface
Ability
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Academic
Achievements
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Wide experience in Medicine of the
Elderly, Stroke Medicine and General
(Internal) Medicine
Evidence of ability to take full
responsibility for independent
management of patients in relevant
clinical areas
Evidence of research, publications and
presentations
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A postgraduate degree
Teaching and
Audit
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Evidence of commitment to formal and
informal teaching and training of
SpRs/StRs, other junior doctors and
medical students.
Participation in audit projects
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Previous experience of
teaching and designing
and effecting audit
programmes
Evidence of specific
training in teaching and
assessment methods
Experience of designing
and effecting audit
programmes
Clear commitment to
developing services
Qualifications and
Training
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Motivation
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Evidence of patient focused care,
learning and continuous professional
development, effective and efficient
use of resources
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Personal
Attributes
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Able to work in a team with colleagues
in own and other disciplines
Experience of working in multiprofessional teams
Fluent communication skills in English
Language
Able to organise time efficiently and
effectively
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Additional post-graduate
qualifications, e.g. MD,
PhD
CCT in Stroke Medicine
Able to motivate
colleagues
Specific managerial
training and experience