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 Page 1 of 12 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. 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: 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: 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 Page 2 of 12 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 Page 3 of 12 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: 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; Page 4 of 12 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 Page 5 of 12 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 Page 6 of 12 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. Page 7 of 12 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 Page 8 of 12 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. Page 9 of 12 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 Page 10 of 12 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 Page 11 of 12 1 12. Person Specification REQUIREMENTS ESSENTIAL DESIRABLE 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. Experience Experience in working at the community interface Ability Academic Achievements 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 A postgraduate degree Teaching and Audit Evidence of commitment to formal and informal teaching and training of SpRs/StRs, other junior doctors and medical students. Participation in audit projects 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 Motivation Evidence of patient focused care, learning and continuous professional development, effective and efficient use of resources Personal Attributes 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 Page 12 of 12 Additional post-graduate qualifications, e.g. MD, PhD CCT in Stroke Medicine Able to motivate colleagues Specific managerial training and experience