NHS Lothian
University Hospitals Division
Directorate of
Plastic Surgery.
SENIOR FELLOW IN PLASTIC SURGERY x 2 Posts
Hours: Full-time
Post 1 – Available immediately until October 2015
Post 2 – Available for 1 year
Responsible To: Clinical Lead in Plastic Surgery
Accountable To: Clinical Director, Surgery
1. Outline of the post
This is a post of 10 sessions, available immediately.
The post is at Senior Fellow level in the Plastic Surgery department. The hospital
base would be St Johns Hospital with outpatient work at satellite units covered by
both services. The Plastics service is a supra-regional service covering Lothian and
Borders. This post will include an on-call commitment, under the terms and
conditions provided by the new Consultant contract.
NHS Lothian is an integrated NHS Board in Scotland providing primary,
community, mental health and hospital services.
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. The plastic surgery department in
addition serves NHS Borders and NHS Highland giving a catchment population of
1,120,000.
1.1 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 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
Hepatobiliary 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.
There is a Combined Assessment Unit which takes unselected GP or direct
emergency referrals, and from A&E. CAU 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
• Gastroenterology
 Rheumatology
 Infectious Diseases
 Haematological 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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A supraregional Plastic and Reconstructive Surgery unit and Burns Unit.
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
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.
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 audiovisual 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
1.2 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
Rosslynlee Hospital in Midlothian
Herdmanflat Hospital
RoodlandsHospital 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.
1.3 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
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Psychotherapy Service
Psychology Services
Services for Eating Disorders
Day Hospitals – Psychiatry of Old Age
There are an additional 46 bed and 1 day hospitals 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 with the “Delivery for
Mental Health” Scottish Executive 2006.
1.4 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;
 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 Lothian people 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 of
communicable diseases and environmental hazards
7. To maintain commitments to teaching, training, professional development,
audit
and research
8. 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.
2.
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, graded within the top six multi-faculty
British Universities in the last national research assessment exercise (90 percent of
its academic staff were in units rated 4, 5 or 5*). It has 3,000 academic staff, over
16,000 undergraduate and over 4,000 postgraduate students and an annual
expenditure of over £261M for teaching and research. The University is organised
into 3 Colleges: Humanities and Social Science, Medicine and Veterinary
Medicine, Science and Engineering.
3.
NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
4.
Departmental Information
The Department of Plastic Surgery and Burns is staffed by 9 plastic surgery
consultants, 2 hand surgery consultants and 1 Associate specialist. It is a supraregional referral unit, serving the Lothians, Fife, Borders and Inverness, for adult
and paediatric plastic and burns surgery. Based in St John’s, the consultants also
cover all in-patients and emergencies at RHSC, and support trauma at the Royal
Infirmary of Edinburgh (trauma and reconstruction). Some services provided by
consultants with sub-specialist interests are provided on a National basis.
The population served is 1.12 million, (Lothians, Borders, and Highland Health
Boards).
The 9 Consultants share the on-call for the region, and the general plastic surgery
work. In addition to general plastic surgery,
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2 consultants share adult burns work,
4 consultants share the paediatric burns work.
All consultants share lower limb trauma (from the region) and reconstruction
The unit provides input into the Edinburgh Breast Unit, for highly complex
breast
reconstruction work.
The unit provides input to the multi-disciplinary head and neck cancer clinics in
Lothian,
with operating on-site at St John’s.
Hand trauma surgery is shared by all surgeons at the adult centre.
at the RHSC, congenital hand surgery would be covered by this post.
Highly complex genito-urinary reconstruction is shared by one consultant at
RHSC.
Other specialist work includes surgery for lipoatrophy.
1 consultant has specialist training for ear reconstructions, (for congenital and
acquired abnormalities). This is also a national service.
2 plastic surgeons share the “malignant melanoma and sentinel node”
surgical
work
for
the region.
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2 consultants share soft tissue sarcoma work, linking with the cancer group at
the WGH.
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there is a laser service for paediatrics and adults.
Adult Hand Service
The regional adult Hand Surgery Unit is largely based in the plastic surgery
department at St John’s, where it benefits from input by both Plastic and
Orthopaedic consultants. Hand trauma surgery is also undertaken by the
orthopaedic department based at the ERI, and there is an aim to work towards
amalgamation of hand service provision by the plastic surgery and orthopaedic
departments.
Currently the Hand Surgery team at St John’s is led by two full-time hand surgeons
and one consultant with significant input into the hand service:
Dominique Davidson is a full-time plastic surgery hand surgeon, whose special
interests include Dupuytrens disease (with academic research into the condition),
rheumatoid arthritis and osteoarthritis. Philippa Rust is a full time orthopaedic hand
surgeon, whose special interests include wrist surgery, tendon reconstruction and
an academic interest in thumb-base arthritis. Stuart Hamilton is a plastic surgeon
with a significant input into the hand trauma service, and a special interest in upper
limb reconstructive surgery.
All the consultants play an active role in the management of hand trauma. There
are day-surgery dedicated trauma lists, and the day starts with a post-take clinical
and educational meeting.
All the consultants are involved in the provision of elective hand surgery. The
department receives 4000 new elective hand surgery out-patients referrals/annum,
which represents 42% of the total number of referrals to the plastic surgery
department. There are currently three Extended Scope Practitioner (ESP) clinics/
week (trigger finger, Dupuytrens and hand trauma), run under consultant
supervision. The full hand team, including physiotherapists and outpatient nurses,
meets on a weekly basis.
The hand service is supported by excellent musculoskeletal radiologists, with
whom there is a weekly radiology meeting.
The hand consultants are actively involved in teaching across disciplines and
grades within NHS Lothian and medical students within Edinburgh University.
Paediatric Hand Service
The paediatric hand service is largely based in the plastic surgery department at
the RHSC. The appointee will have responsibility for provision and development of
the regional congenital hand service, supported by interested orthopaedic
colleagues. The appointee will share the daily management of paediatric hand
trauma with the three other plastic surgery consultants at the RHSC. On-call
paediatric hand trauma is shared by all the plastic surgery consultants.
5.
Details of the Post
Main place of employment:
The post will be based at the St Johns’ site. However, it is a requirement of your employment
that you be prepared to work at any additional or different location owned or served by the
trust, either on an on-going or temporary basis according to the demands of the service.
Job Summary:
and day surgery to deliver a first-class service to our patients
ery .
standard of patient care
t of the service and to lead the
junior medical team
Duties and responsibilities:
Clinical:
The postholder will, together with colleagues, be responsible for the provision of services to
the NHS Lothian University Hospitals Trust to include:
(a) Diagnosis and treatment of patients of the trust in such hospitals, health centres or clinics
or other premises as required.
(b) Continuing clinical responsibility for the patients in your charge, allowing for all proper
delegation to, and training of, your staff.
c) On call- the post holder will be expected to contribute to the out of hours on call rota at
speciality trainee level
Training of junior staff:
The postholder will take responsibility for the training and direction of junior staff allocated to
him/her under aegis of the training plan that that postholder has agreed with their supervising
consultant.
Teaching:
The postholder will be expected to contribute as appropriate in the teaching of undergraduate
and postgraduate students.
Clinical Governance:
All medical and dental staff are expected to take part in clinical governance activity, including
clinical audit, clinical guideline and protocol development and clinical risk management. They
will be expected to produce evidence of their contribution in these areas and their audit of their
own clinical work as part of their appraisal.
Mutual Obligation to Monitor Hours:
There is a contractual obligation on employers to monitor working hours through robust local
monitoring arrangements supported by national guidance, and on individual doctors to cooperate with those monitoring arrangements.
European Working Time Directive (EWTD):
All posts and working patterns are under constant review in line with EWTD guidelines
Educational Programme:
This post is not formally accredited for training. However the postholder will be expected to
attend and contribute to educational activities e.g. departmental meetings, x-ray meetings,
pathology meetings, multidisciplinary meetings, journal clubs etc.
Appraisal:
All medical and dental staff are required to undertake appraisal.
Additional Information:
The post holder is required to follow Trust policies and procedures which are regularly
updated including:
Confidentiality / Data Protection / Freedom of Information
Post holders must maintain the confidentiality of information about patients, staff and other
health service business in accordance with the Data Protection Act of 1998. Post holders must
not, without prior permission, disclose any information regarding patients or staff. If any
member of staff has communicated any such information to an unauthorised person those
staff will be liable to dismissal.
Information Governance
All staff must comply with information governance requirements. These includes statutory
responsibilities (such as compliance with the Data Protection Act), following national guidance
(such as the NHS Confidentiality Code of Practice) and compliance with local policies and
procedures (such as the Trust's Confidentiality policy). Staff are responsible for any personal
information (belonging to staff or patients) that they access and must ensure it is stored,
processed and forwarded in a secure and appropriate manner.
Equal Opportunities
Post holders must at all times fulfil their responsibilities with regard to the Trust’s Equal
Opportunities Policy and equality laws.
Health and Safety
All post holders have a responsibility, under the Health and Safety at Work Act (1974) and
subsequently published regulations, to ensure that the Trust’s health and safety policies and
procedures are complied with to maintain a safe working environment for patients, visitors and
employees.
Infection Control
All post holders have a personal obligation to act to reduce healthcare-associated infections
(HCAIs). They must attend mandatory training in Infection Control and be compliant with all
measures required by the Trust to reduce HCAIs. All post holders must comply with Trust
infection screening and immunisation policies as well as be familiar with the Trust’s
Infection Control Policies, including those that apply to their duties, such as Hand
Decontamination Policy, Personal Protective Equipment Policy, safe procedures for using
aseptic techniques and safe disposal of sharps.
Risk Management
All post holders have a responsibility to report risks such as clinical and non-clinical accidents
or incidents promptly. They are expected to be familiar with the Trust’s use of risk
assessments to predict and control risk, as well as the incident reporting system for learning
from mistakes and near misses in order to improve services. Post holders must also attend
training identified by their manager, or stated by the Trust to be mandatory.
Flexible Working
As an organisation we are committed to developing our services in ways that best suit the
needs of our patients. This means that some staff groups will increasingly be asked to work a
more flexible shift pattern so that we can offer services in the evenings or at weekends.
Safeguarding children and vulnerable adults
Post holders have a general responsibility for safeguarding children and vulnerable adults in
the course of their daily duties and for ensuring that they are aware of the specific duties
relating to their role.
Sustainability
It is the responsibility of all staff to minimise the Trust’s environmental impact by recycling
wherever possible, switching off lights, computers monitors and equipment when not in use,
minimising water usage and reporting faults promptly.
Smoking Policy
The Trust is committed to providing a healthy and safe environment for staff, patients and
visitors. Staff are therefore not permitted to smoke on Trust property or in Trust vehicles
Review of this Job Description
This job description is intended as an outline of the general areas of activity and will be
amended in the light of the changing needs of the organisation. To be reviewed in conjunction
with the post holder.
Other:
The list of duties and responsibilities given above is not an exhaustive list and you may be
asked to undertake other duties in line with the overall purpose and nature of the post as may
be required from time to time.
This job description reflects core activities of a post at a particular time. The trust expects that
all staff will recognise this and adopt a flexible approach to work.
All staff are expected to contribute to the smooth running of their clinical service as required;
in particular, to comply with the policies and procedures, Standing Orders and Financial
Regulations of the trust.
Study Leave:
Study Leave will be granted at the discretion of the Clinical Lead.
Exposure Prone Invasive Procedures
The holder of this post may be required to undertake exposure prone invasive procedures
(EPPs). As this could potentially place patients at risk, candidates must show evidence of
immune status to Hepatitis B or agree to undergo the necessary procedures.
It should be noted that the offer of appointment is subject to confirmation that the successful
candidate is Hepatitis B immune. This is checked by the Occupational Health Service prior to
commencement of duty.
9. Contact Details
For an informal discussion please contact Mr Ken Stewart – Consultant Plastic Surgeon –
ken.stewart@nhslothian.scot.nhs.uk
10. Person Specification (see attached)
Applications are invited from individuals seeking specialist training in Plastic Surgery.. The
Plastic Surgery Department at NHS Lothian provides a wide range of expert services and we
are looking to appoint a senior fellow to our department. We are flexible in the nature of this
fellowship and it will be tailored to the clinical interest of the successful candidate.
Fellowships have particular emphasis on clinical exposure to multi-disciplinary management.
You will gain excellent training in both clinic and theatre, with the aim of training you to
assess, perform and manage a range of procedures. The fellowship is designed to allow
flexibility to tailor individual areas of interest. Fellows can gain specialist reconstructive training
in breast reconstruction or hand surgery in particular.
But other areas such as sarcoma/skin cancer reconstruction or ear reconstruction could be
considered. In addition, you will be expected to assist in the provision of the trauma service
and be part of the on call team
Due to the clinical demands of this post, it is ideally aimed at individuals who have completed
their FRCS (Plast), or who are post-accreditation and have already completed a fellowship.
Further information can be obtained from:
Mr Mark Butterworth Clinical Director – mark.butterworth@nhslothian.scot.nhs.uk
This post is exempt from the Rehabilitation of Offenders Act 1974 and this means that any
criminal conviction must be made known at the time of application.
Person Specification – Fellow in Plastic Surgery
ESSENTIAL
Qualifications and
Full GMC Registration and
Training:
hold a licence to practise
Clinical Experience:
Considerable experience in
plastic surgery, as
demonstrated by being
either a Year 5/6 Specialist
Registrar or equivalent
Specialist interest in
Cancer Reconstruction
Completion of a
microsurgical fellowship
Knowledge and Skills:
Ability to work as an
effective member of a
multidisciplinary team
Ability to communicate
clearly and appropriately
with patients and other
professionals
Ability to manage own and
other’s time effectively
Research:
Understanding of the
principles and applications
of clinical research
Teaching:
Management:
Other
Experience of
undergraduate teaching
and post graduate training
Ability to teach practical
clinical skills to Senior
House Officers and Trust
Doctors
Evidence of understanding
of the role of clinical
management
Evidence of understanding
of and adherence to the
principles of Good Medical
Practice set out by the
General Medical Council
Evidence of contribution to
effective clinical audit and
clinical risk management
DESIRABLE
FRCS (PLAST) or
equivalent
Previous experience in the
surgery and clinical care of
patients undergoing
microvascular plastic
surgery
Computer literate
Evidence of original
research
Clinical research and
publications
Teaching qualification
Management training or
qualification.
Evidence of leadership in
the development of clinical
skills
Experience in clinical
guideline development
Appraisal training