JOB DESCRIPTION
ST4-6 in General Adult Psychiatry (City Community Assessment & Treatment Service
[CATS] and Ward A43)
Introduction:
The employing organisation is Nottinghamshire NHS Healthcare Trust.
The post will be based at ward A43 (female ward), Queen’s Medical Centre and Highbury
Hospital for the CATS service.
Clinical and educational supervisors:
The clinical supervisors are Dr Bal Powar (on ward A43) and Dr Graham Worwood (for the
ACAT team). Both Dr Powar and Worwood have completed clinical supervisors training and are
in good standing with regards to CPD with the college. There are cross cover arrangements in
place so when either Dr Powar or Dr Worwood is away clinical supervision will continue.
Dr Powar and Dr Worwood will take turn every year to provide educational supervision of this
post and this will be confirmed before the trainee starts.
The service setting:
Ward A43
A42 and A43 are two psychiatric admissions wards intended to provide inpatient care for
CATS/EIP patients (i.e. those patients who have been within General Adult services for less
than 2-3 years). A42 takes male admissions and A43 female admissions, around 15-20
admissions to each ward per month. There is input from the EIP Service, CAT Service, Crisis
Team, Dual Diagnosis and psychology to the ward.
The ward team is comprised of nursing and occupational therapy staff. Community staff attend
regularly for reviews with patients. There is joint work across interfaces with colleagues based in
other directorates and organisations. Liaison with medical colleagues is good, being based on
the same site. Multi-disciplinary working is key to the success of the ward and the trainee will
gain experience in this. There is an emphasis on including carers in the assessment and
support process as well as ascertaining their needs.
ACAT Team
Nottingham City ACAT team receives all community referrals for working age adults between 18
and 65 to the secondary mental health services in the Nottingham City via the Single Point of
Access (SPA). It provides advice to primary care, assessment, provision of treatment for
various new onset psychiatric disorders for up to 1 year. It also helps to signpost referrals to
other services both within and outside the Trust. Within the team, we provide various treatments
including medication management, psychosocial interventions based on cognitive behavioural
therapy (CBT) and interpersonal therapy (IPT) principles. The team base is at the Laurel suite
at Highbury Hospital and the clinical service is mainly at the Highbury Hospital outpatient
department. As a community service, the trainee will also be expected to provide domiciliary
visits where appropriate.
The ACAT 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.
Professional relationships
Ward A43
Dr Powar will be working on A43 ward for 4.5 sessions a week. Dr Worwood (Consultant
Psychiatrist) is the lead Consultant for the Acute Care Network and works within the ACAT
service. This will make up the community component of the post. Dr Mepham (Associate
Specialist) and Dr Powar together cover ward A43. Dr Mepham will also support the postholder
in his/her work.
Annie Clarke is the ward manager. There is a CT trainee on A43. There are also 1 F1 and 2
F2’s working across wards A42 and A43.
ACAT Team
Dr Worwood works with the ACAT team for 7.5 sessions per week. He is also a lead consultant
within the Acute Care Network, and there may be opportunities to shadow him in his managerial
role. Dr Heather Flambert (Lead Clinician for City Community Services) also provides
consultant input to the ACAT team.
In the ACAT team, Chris Snowden is the team manager. At present, there are 2 GPVTS
trainees, 2 Foundation year 2 trainees, 1 CT1 trainee providing medical input to the team. Dr
Flambert also has a higher trainee under her supervision. The team has a full time clinical
psychologist, one occupational therapist, eight full or part time social workers, two secondary
care Gateway workers (CPNs), a non-medical independent prescriber (CPN) in addition to a
band 7 and four full or part time band 6 CPNs.
Core clinical work & roles and responsibilities of the trainee:
The trainees clinical work will have a dual focus on ward A43 and the ACAT team. The focus of
the trainee’s ward experience will be with Dr Powar on the ward A43 (4 sessions).
In addition to the above the trainee will also have the opportunity to obtain further clinical
experience working in the Nottingham city ACAT team for two days per week (also 4 sessions).
Ward sessions:
The A43 female ward provides an opportunity to assess and manage a great diversity of acute
psychiatric presentations. There is a rich diversity of acute psychiatric cases presenting for the
1st time to the service, alongside those with severe and enduring mental illness. The post will
provide a substantial grounding in the assessment and management of psychiatric
emergencies.
The trainee will be expected to contribute to the assessment and management of acutely unwell
patients with a particular focus on patients with more complex presentations/risks and will also
be able to manage selected cases with greater autonomy commensurate with their level of
training.
The trainee will also contribute to the MDT meetings on the ward at times providing clinical
leadership and consultation to the team and chairing MDT meetings.
There will additionally be the opportunity to become involved in mental health act work including
community, inpatient and section 136 assessments and preparation for/attendance at mental
health review tribunals. The Cassidy (136 suite) is based on the Queens Medical site between
wards A42 and A43. The suite currently receives an average of one 136 patient per day. The
Trainee would be expected to form part of a rota to cover the suite Monday – Friday 9-5pm for
patients not currently under the care of other parts of the psychiatric service. The rota is
currently 1 in 6 but we anticipate that this should become 1 in 7 next year. It is likely that the
trainee would be able to complete around 2 to 3 Mental Health Act assessments in the suite per
month.
Community sessions:
During the ACAT sessions, the trainee will conduct outpatient assessments that require medical
input that is urgent/emergency, and follow-up to new patients referred to the community team.
There is also the opportunity to follow up patients discharged from A43 who subsequently enter
the ACAT service. The trainee will also conduct assessments where appropriate with a member
of the multidisciplinary team.
The team uses the New Ways of Working model and there is a robust clinical supervision
structure within the team in which the trainees will be expected to participate as a senior
clinician and to provide support and leadership to the team at this level with the consultant’s
supervision. The trainee will also have opportunity to provide clinical leadership during the
weekly SPA referral meetings and to manage the process of referral into and the pathway
through secondary mental health service. There will also be plenty of opportunities to provide
liaison consultation to primary care, as well as to other secondary services and non statutory
services. There is a daily ACAT MDT meeting, where all referrals are discussed and care for
patients planned. This will be an excellent opportunity for the postholder to gain experience of
MDT working.
Others:
As there is considerable consultants’ input into both services, the trainee will necessarily work
closely with their clinical supervisors. This will facilitate substantial opportunity to identify
learning needs, to work on these and to provide an appropriate level of autonomy for the
trainee.
The trainee will have a role in supporting/ training of junior staff both on the ward and in the
community. The trainee will also be expected to become involved in both informal and formal
teaching for junior doctors and medical students for which there is considerable opportunity
within the post.
Both parts of the post will provide considerable experience in liaising with and working on
interfaces with other services and making key decisions about access to care.
In addition, there are regular cross team audit and clinical governance meetings held across the
City Adult Mental Health Service and the trainee has plenty of opportunity to participate an audit
and to improve service.
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
under the Mental Health Act.
Academic opportunities
There is a weekly local case conference/journal club meeting based at the Queens Medical
centre site and a trust wide postgraduate meeting weekly during term time. The trainee will
have chance to be involved in chairing these meetings and support junior trainee in presenting
at the meeting.
Other opportunities
There will also opportunity to develop management skills and experience which is essential to
work as a consultant in the changing climate of the NHS. Adult Mental Health service in
Nottingham City has major reconfiguration in the recent years and both ward A43 and City
ACAT team is a relatively new service arrangement. There is opportunity for service
development under the guidance especially in linking between inpatient and also community
services. In addition to the management experience to the multidisciplinary team and to junior
medical staff, relevant service development projects can be identified and taken on by the
trainee according to their level.
Supervision arrangement
One hour each week is set aside for educational supervision. This is in addition to ongoing
clinical supervision which occurs throughout the week and is facilitated by a close working
relationship between trainee and supervisor. Learning objectives will be created for each trainee
when they commence the post linked to the core curriculum and individual educational needs.
The training needs and progress will also be regularly reviewed during educational supervision.
Curriculum mapping
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 senior reviews of newly admitted inpatients on ward A43. In the
community, the trainee will be expected to see more complex presentations as a senior
clinician. These assessments and treatments will be mainly carried out in the out patient
setting, but sometimes at home or GP surgeries. This will include a very broad range of
psychiatric presentations from a wide variety of social and cultural backgrounds. They will
develop and implement management plans for patients they see in conjunction with the multidisciplinary teams on the ward and in the community.
The trainee will support other members of both teams, including more junior trainees, providing
ad hoc clinical supervision and consultation.
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.
The trainee will assess and manage people with a variety of presentations. They will be
expected to make a list of differential diagnoses 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 inpatient setting.
In the ACAT team, through managing and providing medical leadership to the multidisciplinary
SPA referral meetings the trainees will work across both primary and secondary care interface.
They will also develop decision making skills regarding access to psychiatric services and
pathways into and through different 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. In addition, members of the ACAT team liaise regularly with
other psychiatric specialties including the Nottingham Psychotherapy Unit, Nottinghamshire
Personality Disorder and Development Network, Nottingham Eating Disorder service, Early
Intervention of Psychosis team and tertiary ADHD service. There will be opportunity to develop
joint working with these services where appropriate.
Working on ward A43 also necessarily includes working with multiple psychiatric interfaces and
with primary care. The trainee will develop experience in working across these interfaces and
will also accrue particular experience and understanding of the interface between general
medical specialties and psychiatry from their ward work. The trainee will take key decisions
about access to care including when to admit and discharge patients.
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.
The trainee will gain exposure to many new psychiatric presentations and will develop
considerable experience in the psycho-social and biological investigation of these.
They will regularly initiate physical treatments through both the ward and the ACAT team and
will learn to assess the impact of these treatments. With the ACAT team, they will have
opportunity to deliver psychological treatments including CBT under the supervision.
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 minimize 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 accrue substantial experience in the assessment and management of the full
range of risks in both the inpatient setting and in the community. They will additionally learn to
manage risk across the interface between the ward and the community teams (including the
crisis resolution and home treatment team).
The trainee will be involved in, and at times lead on, the emergency management of acutely
disturbed patients on the ward and acute crises in the community. They will also develop skill in
advanced planning for emergency situations and crises.
The trainee will regularly work within the framework of both the mental health and mental
capacity acts especially in the ward environment. They will have the opportunity to complete
multiple mental health act assessments and to attend mental health review tribunals.
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
psychotherapeutic techniques in everyday treatment, including biological and socio-cultural
interventions. Within the CATS team, they will be able to access supervision provided by a
clinical psychologist, and other members of the team or the Nottingham Psychotherapy Unit.
Intended learning outcome 6
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 have substantial contact with patients with severe and enduring illness who are
currently acutely unwell through their role on the ward and in the community team. This latter
aspect will aid trainees to be able to develop longer term professional, therapeutic relationships
with patients.
Intended learning outcome 7
To demonstrate the ability to work effectively with colleagues, including team working
The trainee will work within multi-disciplinary inpatient and community teams. They will provide
clinical leadership on cases they are involved with and consultation to team members.
The trainee will learn about team functioning, the roles and contributions of different team
members and the likely sources of conflict and disagreement within the teams. They will learn
how to utilise the full team and motivate staff involved supporting the best quality patient care.
New Ways of Working is integral to the ACAT team with the more senior members of the team
seeing more complex presentations and providing supervision to others. The trainee will be
expected to work autonomously while discussing difficult and risky patients within the structures
provided and provide clinical leadership to the team.
Intended learning outcome 8
Develop appropriate leadership skills
The trainee will have the opportunity to act as a clinical leader within the service and will also be
able to supervise the work of more junior medical staff including foundation trainees. There may
also be the possibility of assisting Dr Worwood in managerial related work in his role as a
clinical lead.
Intended learning outcome 9
Demonstrate the knowledge, skills and behaviours to manage time and problems
effectively
The trainee will be expected to provide timely and clear written communication for colleagues.
They will be able to provide reports for mental health review tribunals and would be given the
opportunity to provide other legal reports if these are requested. Trainees will have the
opportunity to attend afew selected number of tribunals in place of the consultant, to gain
experience in this aspect of inpatient work. Dr Powar will provide support and guidance on this
prior to any attendance.
Intended learning outcome 10
Develop the ability to conduct and complete audit in clinical practice
The trainee will have considerable opportunity to be involved in audit. This will be supported by
the local acute care audit programme, as well as the city wide audit and clinical governance
meeting.
Dr Powar can assist in the development of an appropriate inpatient audit on A43.
Intended learning outcome 11
Develop an understanding of the implementation of clinical governance
The trainee will be involved in clinical governance with involvement in risk management issues.
They will also develop the skills of reporting and taking appropriate action following serious
untoward incidents.
Intended learning outcome 12
Develop the ability to teach, assess and appraise
The trainee will teach medical students attached to the teams and will be able to appraise junior
medical staff. The trainee will also be involved in the ACAT team monthly training and
development meeting.
Intended learning outcome 13
To ensure that the doctor acts in a professional manner at all times
The trainee will be required to work within the boundaries of medical confidentiality. In particular
they will learn how and when to disclose information to third parties without consent and how to
share information across services. This will form a regular part of their risk management of
cases especially within the ward and in the community.
Trainee’s Timetable
MONDAY
AM
ACAT Duty
Urgent/emergency
assessments
10-12 ACAT MDT
12.30 – 1.30
CC/JC
PM 2-5 acat
ASSESSMENTS
TUESDAY WEDNESDAY THURSDAY
FRIDAY
CATS
Referral
Meeting/
outpatient
assessment
09:00-11:00
Ward Work and
admin on A43
Special
Interest/Research
time
Ward reviews A43
Ward Reviews
A43
Special
Interest/Research
Time
Educational
Supervision (2-3pm)*
Primary care
liaison
(12:0013:00)
CATS
outpatient
follow-ups
including
admin time
Ward Reviews A43
(Highbury
Hospital)
The Trainee’s timetable can also be negotiated to suit the individual training
needs of the postholder.
Dr Bal Powar’s timetable
MONDAY
TUESDAY
WEDNESDAY
THURSDAY FRIDAY
MDT review
and ward
MDT review
and ward
SPA
Management
Teaching
Crisis Team
MDT review and
Ward
Crisis Team
SPA
Management
teaching
Crisis Team/Ward
Work
Crisis Team
Educational
Supervision for higher
trainee (2-3pm)*
AM
PM
Ward Work
Dr Graham Worwood’s timetable
MONDAY
AM
ACAT Duty
Urgent/emergency
assessments
TUESDAY
WEDNESDAY THURSDAY
FRIDAY
Routine OPA
acat
Spa
Management
Teaching
ACAT Duty
Urgent/emergency
assessments
CAT follow up
clinic
10-1 ACAT MDT
PM
1-5 acat
ASSESSMENTS
10-1 ACAT MDT
Clinical admin
1/2 SPA
As above
CAT follow
ups/liaison
1-5 acat
ASSESSMENTS
* Educational Supervision – will alternate between Dr Worwood and Dr Powar each
year