,ST4-6 Post in General Adult Psychiatry
Nottingham City CATS Team and PICU
Base: Nottingham City Community Assessment and Treatment Service (CAT), Highbury
hospital, Nottingham.
Trainers: Dr Heather Flambert / Dr Stephanie Sommers
The Service
CAT Team
Nottingham City CAT team is based in Laurel Suite, Highbury. It receives all non emergency
referrals for aged 18-65 to Secondary Mental Health Services in Nottingham City via the
Single Point of Access (SPA). The CAT Team has been developed along the lines
advocated in New Ways of Working with Multidisciplinary practices. Team decision making is
advocated and distributed responsibility encouraged. The team provides liaison with primary
care, IAPT, secondary and tertiary psychiatric services, assessment, and provision of
treatment for up to one year (extendable when appropriate). Treatments provided by the
team include medication management, social and psychological interventions including CBT
and IPT based treatments.
PICU
The Psychiatric Intensive care Unit (PICU) known as the Willows is a 10-bedded male ward.
There is a de-escalation area and a seclusion room. It takes patients who require psychiatric
intensive care from the assessment and treatment wards.
PIC is an important element of care within the wider system of inpatient services. The
primary function of PIC is the rapid assessment and intensive management of acute mental
illness and behavioural disturbance within an integrated care pathway. It facilitates
stabilization through active engagement and treatment. PIC should provide short periods of
intensive treatment before or during a longer period of inpatient care. The emphasis is on
intensive treatment combined with a range of physical, procedural and relational security
measures that will help to reduce risk, disturbance and vulnerability. The care and treatment
needs of patients requiring PIC will not be able to be managed safely in the patient’s usual
ward setting.
Patients admitted to PIC are likely to display acute behavioural disturbance that seriously
compromises their physical and or psychological wellbeing or themselves or others, be at
notable risk of aggression, suicide or serious self harm, be at risk of increased vulnerability
because of sexual disinhibition or over activity in the context of mental disorder.
Post Summary
The Trainee will work with the CAT team and on PICU working as an integral part of both
teams gaining a wide range of clinical experience and working at a number of clinical
interfaces.
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During CAT sessions the trainee will conduct outpatient clinics alongside other team
members allowing for joint assessment where appropriate, multidisciplinary discussion and
review. There is a robust clinical supervision structure within the team, in which the trainees
will participate as a senior clinician. The trainee will have the opportunity to chair the SPA
referral meetings managing the process of referral into and the pathway through psychiatric
services and be involved in providing liaison consultation to primary care and other
secondary and tertiary services as well as to non statutory services.
On PICU the sessions will involve participation in and running ward reviews, providing
supervision to junior medical staff and Mental Health Act work including tribunal work.
Management role and experience. The post provides opportunities to develop managerial
skills required to work as a consultant in the changing climate of NHS. The trainee can
achieve management experience by shadowing or working with Dr Flambert, Lead
Consultant for the CAT and Recovery services. During this session projects relevant to the
CAT team/PICU or local services can be taken on by the trainee to achieve the above skills.
There are regular cross team audit meetings held across the City AMH and the CAT team
has a training programme in which the trainee can participate as appropriate. A weekly
journal club/case conference is held at the Wells Road Centre and the trainee will be
involved in chairing these meetings on a rota basis. The trainee will be included in the
Nottingham on-call rota, providing supervision to junior trainees and advice to other
professionals, and participating in emergency assessments such as mental health act
assessments (there is a Section 136 suite at the QMC).
Professional relationships
Dr Flambert is the lead Consultant for the CAT and Recovery services. Dr Sommers is the
Consultant on PICU and also works within the CAT service. Dr Tsoi, gavelu also provides
consultant input to the CAT team and Dr Fahy provides cover to PICU.
In the CAT team Glen Owen is the team manager. There are Core Trainee and Foundation
and GP trainees with the team. The team has a full time clinical psychologist, two secondary
care Gateway workers (CPNs), a Non Medical Prescriber (CPN) in addition to a band 7 and
four full or part time band 6 nurses, 8 full or part time social workers.
On PICU there is a band 7 post, 2 band 6 team leader posts and a non-medical prescriber.
There is a CT3 trainee. A psychologist works for 5 sessions across the PICU and 2 adjacent
wards
Clinical Supervision
Dr Flambert and Dr Sommers will share educational and clinical supervision for the CAT
team work. Dr Sommers will provide clinical supervision for the work on PICU. The other
consultants for the CAT team and PICU will provide clinical supervision in their absence.
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Trainee Timetable
Flexibility, particularly regarding CATS sessions, Research/special interest and some PICU
sessions by negotiation.
Monday
am
Ward Review PICU
Tuesday
Wednesday
Special Interest
CATS
(Management
meetings/Admin)
(day negotiable)
Journal Club/
Case Conference
pm
PICU
Research
1-2 Supervision
(day negotiable)
PICU
Thursday
CATS
SPA referral
meeting and MDT
supervision
2-5 CATS
emergency work/
MDT supervision
Friday
PICU ward work/
MHA work
CATS OPC
Timetable (Dr Flambert)
Monday
am
Day off
Tuesday
OPC
Wednesday
SPA
Thursday
Friday
9.15-11
CLAHRC
SPA referral
meeting
Depression study
12-1
Team supervision
pm
Day off
1.30-3.30
1-2 ST supervision
1-3
Clinical admin
SPA
SPA referral
meeting
3-4
MDT case review
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Lead consultant
session
Timetable – Dr Sommers (9PA’s)
Day
Monday
am
9am - 1pm PICU
pm
CAT Team
1-3pm Urgents/home visits
3-5pm - MDT
Tuesday
9am – 1pm PICU
(tribunals)
Flexible SPA
Wednesday
SPA
1-3pm PICU formulation meeting
(ST supervision)
3-5pm CAT New Patient
9am – 11am CAT (paperwork)
-
Thursday
11am – 1pm PICU
Friday
PICU
CAT Follow up clinic
Duties and opportunities
The duties of the post, performance criteria and the learning opportunities available are set
out following the structure of the specialty curriculum for General Psychiatry, which in turn, is
based on the headings of the GMC’s Good Medical Practice.
Intended learning outcome 1
Be able to perform specialist assessment of patients and document relevant history
and examination on culturally diverse patients.
The trainee will undertake assessments on patients with the full range of psychiatric
disorders and presentations from a wide variety of social and cultural backgrounds. As a
senior trainee they will often see the more complex presentations. These assessments and
treatments will be carried out in the out patient setting, at home or GP surgeries. There will
be the opportunity for multidisciplinary working and the trainee will provide supervision to
medical and non medical staff including a non medical prescriber.
Intended learning outcome 2
Demonstrate the ability to construct formulations of patients’ problems that include
appropriate differential diagnoses, liaising with other specialties and making
appropriate referrals
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The trainee will assess and manage people with a variety of presentations. They will be
expected to make a differential diagnosis and formulation for complex cases for whom the
appropriate care pathway is often unclear. Through liaison with colleagues they will resolve,
often difficult questions about which interventions and services are appropriate both in the
outpatient and in patient setting.
Through managing and providing medical leadership to the multidisciplinary SPA referral
meetings the trainees will work across the primary secondary care interface, developing
decision making skills regarding access to psychiatric services and pathways into and
through these services. They will liaise regularly with primary care and non statutory
providers working closely with the Gateway workers whose role is to assess and manage
patients at this interface.
Members of the CATS team liaise regularly with other specialties including the
Psychotherapies, Personality Disorder and Development Network, Nottingham Eating
Disorders service, Early Intervention and ADHD service, with opportunity to develop joint
working with these services where appropriate.
Intended learning outcome 3
Demonstrate the ability to recommend relevant investigation and treatment in the
context of the clinical management plan. This will include the ability to develop and
document an investigation plan including appropriate medical, laboratory,
radiological and psychological investigations and then to construct a comprehensive
treatment plan addressing biological, psychological and socio-cultural domains
Following assessment the trainee will develop appropriate management plans including the
appropriateness of further investigations, and biopsychosocial treatments. They will have
the opportunity to prescribe, monitor and, where appropriate, deliver the full range of
physical treatments that are required to treat the psychiatric problems that are experienced
by working age adults. They will have the opportunity to deliver psychological treatments
including CBT within the CATS team under the supervision of Dr Flambert or Dr Fairbank
(clinical psychologist) whose areas of interest include PTSD
Intended learning outcome 4
Based on a comprehensive psychiatric assessment, demonstrate the ability to
comprehensively assess and document patient’s potential for self-harm or harm to
others. This would include an assessment of risk, knowledge of involuntary
treatment standards and procedures, the ability to intervene effectively to minimise
risk and the ability to implement prevention methods against self-harm and harm to
others. This will be displayed whenever appropriate, including in emergencies
The trainee will gain experience of a variety of emergency situations including managing
patients who pose a risk of harm to themselves, others and those at risk of
exploitation/neglect. The trainee will participate in decisions about appropriate management
for new referrals for whom full information may not be present, liaising where necessary with
both referrers and the CRHT. They will undertake risk assessment and management of
patients and will be involved with Mental Health Act Assessments, tribunals and
management of patients on CTOs.
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Intended learning outcome 5
Based on the full psychiatric assessment, demonstrate the ability to conduct
therapeutic interviews; that is to collect and use clinically relevant material. The
doctor will also demonstrate the ability to conduct a range of individual, group and
family therapies using standard accepted models and to integrate these
psychotherapies into everyday treatment, including biological and socio-cultural
interventions
The trainee will develop skills in conducting therapeutic interviews. They will be required to
provide expert advice to other health and social care professionals on psychological
treatment and care. They will explain, and if appropriate initiate, conduct and complete a
range of psychological therapies using standard accepted models and to integrate these
psychotherapies into everyday treatment, including biological and socio-cultural
interventions. Within the CAT team they will be able to access supervision, provided by Dr
Flambert and Dr Sommers, Dr Fairbank, other members of the team or the psychotherapy
unit.
Intended learning outcome 7
Develop the ability to carry out specialist assessment and treatment of patients with
chronic and severe mental disorders and to demonstrate effective management of
these disease states
The trainee will be involved in the management of patients with severe and enduring mental
illness both as inpatients and in clinic and be expected to develop professional and
therapeutic relationships with patients.
Intended learning outcome 9
To demonstrate the ability to work effectively with colleagues, including team working
The trainee will function as full member of these multidisciplinary teams. There will be a
need to develop an understanding of team working, management structures, the roles and
responsibilities of different team members and the role of the psychiatrist within it. New
Ways of Working is integral to the CATS team with the more senior members of the team
seeing the more complex patients and providing supervision to others. The trainee will be
expected to work autonomously whilst discussing difficult and risky cases within the
structures provided and providing leadership in the team.
Intended learning outcome 10
Develop appropriate leadership skills
The trainee will have the opportunity to gain managerial experience. There will be
opportunities for the trainee to take on a leadership role or shadowing experience.
Within the CATS team and on PICU they will develop leadership skills with the opportunity to
lead and chair team meetings and ward reviews.
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Intended learning outcome 11
The trainee will be expected to produce timely and clear written communication to
colleagues, both within and without the service. Where legal reports are requested the
trainee will be given the opportunity to complete these.
Intended learning outcome 12
Develop the ability to conduct and complete audit in clinical practice
There is a city wide audit meeting, to which the trainee will be expected to attend and
contribute. The trainee will be involved in the audit process of the teams and will have the
opportunity to develop their own topics.
Intended learning outcome 13
To develop an understanding of the implementation of clinical governance
The trainee will be involved in clinical governance with involvement in risk management
issues. Report and take appropriate action following serious untoward incidents.
Intended learning outcome 15
The trainee will be involved in the CATS Team monthly training and development meeting,
with opportunities to teach colleagues. They will be allocated medical students for task
presentations and provide supervision for junior trainees.
Intended learning outcome 17
To ensure that the doctor acts in a professional manner at all times
Given the wide range of services (both statutory and voluntary) involved in the care of our
patients, the trainee will be expected to manage confidential information appropriately whilst
maintaining necessary communication.
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