NHS Lothian University Hospitals Division Directorate of Medicine Royal Infirmary of Edinburgh CONSULTANT PHYSICIAN IN CLINICAL PHARMACOLOGY/TOXICOLOGY AND GENERAL/ACUTE MEDICINE 1. Outline of the post An opportunity has arisen for the post of Consultant Physician in Clinical Pharmacology/ Toxicology providing a clinical commitment to the clinical toxicology service at the Royal Infirmary of Edinburgh and to the National Poisons Information Service Edinburgh unit. This is alongside a substantial role to an expanding General Medicine service in the Royal Infirmary of Edinburgh. The post is one of 3 jointly funded National Poisons Information Service & NHS Lothian posts providing clinical services to Lothian in Acute Medicine and Clinical Toxicology, and to the NPIS. The post is wholly based at the Royal Infirmary of Edinburgh. On call commitments include acute receiving duties (1 in 12) at the Royal Infirmary of Edinburgh. 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. Page 1 of 12 The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres, and is equipped with modern theatre and critical care equipment and monitoring. Within the main building is a dedicated, multidisciplinary, 5 theatre day surgery complex. The hospital provides for most specialities and is the centre for: General surgery with a focus on the upper GI tract Vascular surgery Hepato-biliary and Transplant medicine and surgery Cardiac and Thoracic surgery Elective and trauma Orthopaedics surgery Neonatology Obstetrics & Gynaecology Cardiology Renal Medicine Sleep Medicine Regional major Accident and Emergency centre. 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 clinical toxicology ward. 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 Page 2 of 12 Obstetrics & Gynaecology Child Health including Paediatrics and community child health The regional Burns and Plastic Surgery unit for SE Scotland Oral and Maxillofacial Surgery ENT Critical Care (ITU, HDU and CCU) Accident and Emergency General Surgery Orthopaedics Anaesthetics Mental Health including ICCU and ICPU Since 2005, general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH being developed as a major elective centre for the region. Lothian’s ENT service was relocated to SJH to create an integrated head and neck unit with OMFS and Plastic Surgery. Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E, 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: Page 3 of 12 The Astley Ainslie Hospital in Edinburgh Midlothian Community Hospital in Midlothian Rosslynlee Hospital in Midlothian 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 Page 4 of 12 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; 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. Acute and General Medical Unit Page 5 of 12 Acute Medicine was granted subspecialty status in 2005 and Edinburgh is one of the leading centres where training takes place in this specialty in the UK. The Acute Medical Unit is one of the busiest receiving units in the United Kingdom, and its work is considered the primary service priority for the directorate with an average medical take of 65 patients within a 24 hour period. There is a strong ethos and drive to provide high quality safe patient care providing real time consultant led assessment, diagnosis and treatment of patients to facilitate early discharge or prompt referral to the appropriate specialty. One of the strengths of the unit is well integrated multidisciplinary working. Having multiple disciplines involved in the patient’s journey from the time of admission ensures that over 50% of patients are safely discharged within 24 hours. NHS Lothian is investing substantially in the expansion of Acute and General Medicine capacity. Acute Medicine Consultants This post Dr Andrew Coull Dr Casey Stewart Dr Alan Patrick Dr Alan Jaap Dr Matthew Young Dr Nicola Zammitt Dr Fraser Gibb Dr Anna Dover Dr Pauline Jones Dr Kathy Strachan Dr Ross Murphy Dr Lynn McCallum Dr Simon Dummer Dr Johanne Simpson Dr Ann Lockman Dr James Dear Dr Arvind Veiraiah Dr Euan Sandilands Dr Simon Hart Dr Jo Renton Clinical Pharmacology/Toxicology and General/Acute Medicine Clinical Director General Medicine Diabetes/Endocrinology Diabetes/Endocrinology Diabetes/Endocrinology Diabetes/Endocrinology Diabetes/Endocrinology Diabetes/Endocrinology Diabetes/Endocrinology Acute Medicine Acute Medicine Acute Medicine Acute Medicine Acute Medicine Acute Medicine Clinical Pharmacology & Toxicology Clinical Pharmacology & Toxicology Clinical Pharmacology & Toxicology Stroke Medicine of the Elderly Senior Nursing Staff Linda Macintosh Debby McIlquham The Acute Medical Unit aims to provide safe and high quality care with rapid and real time consultant led assessment. The post-holder will be expected to support the Clinical Director in delivering the operational and strategic planning needs of the service. The new post-holder will be one of a group of 24 Consultant Physicians contributing to the acute medical intake on a 1 in 12 basis. When on take the consultant is present throughout the day (12.30 – 21.30) providing both real time senior decision making support but also close mentoring and supervision of junior staff. Two consultants lead the take for a 48 hour period with one consultant on call overnight (1 in 24 overall). The rota also requires input into 5 weekends per year. The rota is a ‘firm’ based system with a dedicated group of junior staffing to improve continuity of care and reduce handovers. The post holder will also take part in cover for the general medical wards at the weekend. This is an additional two weekends per year (0900 – 12.30). They will also have ongoing care commitments to patients admitted under their care for at least 48 hours after their on call period. Up to 80% of patients are discharged by this time and any patients requiring a longer length of stay are handed over to colleagues within the same ‘firm’ of consultants with ongoing general medical care Page 6 of 12 responsibility. The successful candidate would be expected to maintain a highly visible consultant presence at the front door whilst on call supporting junior staff in real time facilitation of management plans, discharge and speciality referrals. The successful applicant will also contribute to providing a rapid access medical and ambulatory care clinic supporting the delivery of unscheduled care. This is part of a range of initiatives to support General Practice with a same or next day responsive service to convert unscheduled care activity to scheduled activity. The contract for the post is based on a 10 PA commitment but this is subject to negotiation through early job planning. 6. Public Health England In 2013, the Health Protection Agency was incorporated into Public Health England (PHE) which took on the role of commissioning the NPIS through its Centre for Radiation, Chemical and Environmental Hazards (CRCE). Detailed working arrangements for collaboration between NPIS centres and PHE are in place. These include a CPD programme and working groups on service activity. The appointee will be expected to play a significant role in the UK structure of the PHE funded NPIS in respect of delivery of Clinical Toxicology advice and clinical management, and participate in a UK national rota for providing advice on the management of poisoning, and other relevant toxicological issues. The Edinburgh unit contributes extensively to the overall UK provision of service. This post is funded by the PHE for 5-programmed activities. NPIS Edinburgh also collaborates with the Health Protection Scotland and the Scottish Government in respect of clinical toxicology advice and advice on chemical incidents or contamination that occur within Scotland. National Poisons Information Service and Clinical Toxicology The clinical toxicology service at the Royal Infirmary comprises both the clinical facility described and the Edinburgh unit of the National Poisons Information Service (NPIS) (established in 1963 as the Scottish Poisons Information Bureau). This centre is responsible to the NPIS for the editorial oversight and management of the UK's clinical toxicology database TOXBASE. There are presently three Consultant Clinical Toxicologists who contribute to the work of the unit, and this post will replace an existing member of Consultant staff. NPIS Edinburgh is also responsible for provision of a telephone enquiry service for the NPIS, primarily in Scotland, and for supporting the management of clinical cases of poisoning throughout Scotland, and with colleagues in the rest of the UK for the whole country. There were in excess of a 550,000 database logons to TOXBASE in 2012-13, with over 1.3 million individual product accesses. Development of TOXBASE is regarded as a key part of poisons management in the United Kingdom and is one of the key responsibilities of NPIS Edinburgh. NPIS Edinburgh currently employs 5.5 full-time Information Officers and four clerical/ administrative staff, together with two specialist poisons nurses. Lecturers and SpRs training in Clinical Pharmacology in Edinburgh rotate through the unit, and there is a dedicated training post in Clinical Toxicology funded by the Postgraduate Dean. There is active research collaboration between the unit and the Department of Clinical Pharmacology and Therapeutics (Professor DJ Webb, Prof S Maxwell and Prof M Eddleston [Director of NPIS Edinburgh]). Prof Maxwell also heads the Yellow Card Centre (YCC) Scotland, the MHRA Adverse Drug Reaction Reporting Centre for Scotland and there is liaison between the YCC and the clinical toxicology unit. There are therefore opportunities for basic, clinical and pharmacoepidemiological studies on all aspects of Clinical Toxicology and health information technology. Page 7 of 12 The unit has an active research programme and publishes regularly in national and international journals. Current Staffing of NPIS Edinburgh 1. Prof Michael Eddleston (Director) 2. Consultant Physician (Dr Aravindan Veiraiah) 3. Consultant Physician (Dr James Dear) 4. Consultant Physician (Dr Euan Sandilands) 5. Consultant Physician in Emergency Medicine (Dr Jonathan Wraight) 5. Information Services Manager (Dr G Jackson) 6. Deputy Information Services Managers (Dr C McGrory, Dr Catherine Crawford) 7. Information Officers (Mr WJ Laing, Mr RD Adams, Dr Victoria Eagling, Mr Liam Perry) 8 Database officer (Mr David Lupton) 9. Specialist Nurses (Sisters Margaret Dow and Janice Pettie ) 10. Office Manager (Ms LD Gordon) 11. Clerical Officers (Ms A Bicknell, Mr A Bennet) * Details of the Post (Clinical Toxicology) The appointee will participate in NPIS Consultant duties for NPIS Edinburgh (in collaboration with colleagues). This will include participation in the UK NPIS on call rota (currently 1 in 16) providing appropriate clinical advice to the UK as a whole. Specific responsibilities within PHE may also be negotiated. Consultant responsibility, with colleagues, for clinical management of patients with toxicological problems admitted to the Royal Infirmary of Edinburgh. In particular this will include responsibility for patients admitted to the acute toxicology area, a 10 bedded dedicated unit. The post holder will be expected, together with the other Consultants, to support and develop the TOXBASE database within the context of the National Poisons Information Service. The on-call commitment will be undertaken by the three NPIS consultants supported by NHS trainees, and academic colleagues in Clinical Pharmacology. The NPIS is essentially functioning as a Supra-Regional clinical network. NPIS Consultant staff are expected to participate in, and contribute to, the regular NPIS CPD programme. Attendance at these is expected as part of the job plan. The post holder will, where appropriate, participate in the development of strategic plans for management of poisoning and chemical incidents in Scotland. This will include involvement in "outreach" activities to relevant health care facilities involved in the management of poisoning in Scotland, including NHS 24, the Scottish public access telephone service. The objective of these activities is to develop and facilitate the delivery of optimum care in the management of poisoned patients in Scotland. 5. Research and Development Research activities in Clinical Toxicology, Clinical Pharmacology and Acute Medicine will be encouraged. There are well-established links to the academic Department of Clinical Pharmacology and appropriate academic status would be sought for suitably qualified candidates. Page 8 of 12 6. Teaching Teaching activities are expected within the University of Edinburgh Medical School. In addition NPIS Consultant staff participate in teaching programmes at a postgraduate level to medical and allied staff. The successful applicant will be expected to contribute to a strong ethos of improvement and redesign in the Acute and General Medical unit. This will include attendance at weekly Medical Unit Meetings and monthly Acute Medicine Consultant meetings. The post-holder will also be expected to contribute to supervision of junior staff subject to the interests of the applicant and job planning. Page 9 of 12 7. Job Plan See attached 8. 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 Prof Michael Eddleston Director of the National Poisons Information Service - Edinburgh unit Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA Telephone: E mail: 0131 242 1383 or 0131 242 9214 m.eddleston@ed.ac.uk The NHS Structured Application and job description can be obtained by e-mailing lister.careerrec@luht.scot.nhs.uk The completed NHS Structured Application together with the names, email and postal addresses of three referees should be sent to the above email address by the closing date of ENTER CLOSING DATE HERE, no applications will be considered after this time. Please quote reference ENTER REFERENCE HERE. Please note that we no longer accept application by CV. In accordance with recent Home Office guidelines, doctors who require a work permit will only be appointed to posts which cannot be filled by UK/EEA applicants or doctors who do not require work permits We are working towards Equal Opportunities. Page 10 of 12 Job Plan Specialty: Consultant Physician in Clinical Pharmacology/Toxicology and General/Acute Medicine Principal Place of Work: R.I.E Contract: Full Time Programmed Activities: 10 Availability Supplement: 3% Managerially responsible to: Dr Andrew Coull Three PAs are attributed to the Acute Medicine on call rota, one of which is out of hours. On a 10 PA job plan the successful applicant is due a half-day. When not on call the consultant will provide clinical or PHE/NPIS commitment displaced because of on call commitments so the timetable is reflective of this and indicative only and will be subject to job planning. Five PAs are funded by PHE and include work with the NPIS Edinburgh unit. DAY Monday 0900 - 1300 HOSPITAL/LOCATION TYPE OF WORK DCC RIE Acute Receiving 1 RIE Administration associated with direct clinical care 1 0900 - 1300 RIE Clinical Toxicology ward cover 1 1330 – 1730 RIE PHE / NPIS 1 0900 - 1300 RIE PHE / NPIS 1 1330 – 1530 Thursday RIE PHE / NPIS 0.5 0900 – 1300 RIE Acute Receiving 1300 - 1700 RIE Half-day off in lieu of out of hours 0900 - 1300 RIE Medical Outpatient Clinic 1330 – 1730 RIE PHE / NPIS SPA Saturday From/To Sunday From/To On call RIE Acute Medicine Out of Hours on call 1 NPIS NPIS on call commitment (1:16) 0.5 9 1330 –1730 EPA SPA Tuesday Wednesday 1 Friday Total PAs Page 11 of 12 1 1 1 9. Person Specification REQUIREMENTS Qualifications and Training ESSENTIAL Experience Ability Academic Achievements Teaching and Audit DESIRABLE GMC registered medical practitioner MRCP(UK) or equivalent Be on, or be eligible for inclusion on, the GMC Specialist Register in General (Internal) Medicine or Acute Medicine within 6 months of interview Wide experience in both General (Internal) Medicine and Clinical Pharmacology or Toxicology Evidence of ability to take full responsibility for independent management of patients in relevant clinical areas Evidence of research, publications and presentations A specific interest and experience in Clinical Toxicology A postgraduate degree 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 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 Able to organise time efficiently and effectively Page 12 of 12 Additional post-graduate qualifications, e.g. MD, PhD Be on, or be eligible for inclusion on, the GMC Specialist Register in Clinical Pharmacology within 6 months of interview Able to motivate colleagues Specific managerial training and experience