Nottinghamshire Healthcare NHS Trust
ST4-6 Post in Perinatal Psychiatry
Base: Perinatal Psychiatry, QMC, Nottingham.
Trainer: Dr Neelam Sisodia
The Service
The Perinatal Psychiatry Service is a busy clinical team dealing with
approximately 100 new referrals per month from across the geographic
county of Nottinghamshire. It includes a tertiary care level Mother & Baby
Unit which is part of the East Midlands Managed Care Network accepting
patients from across the region. There is also a secondary care level Perinatal
Community Team based in Nottingham at the QMC and another based in
Sutton-in-Ashfield.
Professional relationships
Dr Sisodia is the Consultant to the in-patient Mother and Baby Unit and the
City and South of the County and Dr di Mambro, who works half time with the
Perinatal Psychiatry Service, as he is also a Clinical Teaching Fellow, is the
Consultant covering the community patients, largely in the North of the
County, but also for some City patients. Jointly the two consultants provide
medical cover for the whole county; the in-patient service is based on A45 at
the QMC and out-patient clinics are held at the QMC, Nottingham City
Hospital, Sutton-in-Ashfield and Worksop. Dr Sisodia and Dr di Mambro cover
each other for the purposes of annual and sick leave.
Mrs Judy Gardiner is the ward manager on A45. There is a core-trainee
(CT3) in the team. There are 4.5 WTE CPNs and 1.5 medical secretaries at
the QMC base, for City and South County, and 3.5 WTE CPNs, part-time
clinical psychologist for 2.5 sessions/week, and one secretary in the base at
Forest House, Mansfield, for N. Notts.
Job Summary
The trainee will work as an integral part of the multi-disciplinary team,
covering all aspects of Perinatal Psychiatry. This will comprise one clinic per
week, alongside other assessments on the Obstetric/Gynaecology Wards and
Mother & Baby Unit. The trainee will be involved in providing reactive
telephone liaison consultation to other services.
Liaison workload is
necessarily unpredictable and the trainee will need to be flexible and work
closely with the team to prioritise both referrals and resources.
The post provides an extremely broad range of clinical experience including
the assessment of well and unwell women throughout the perinatal period,
and supporting colleagues working with psychological difficulties surrounding
delivery.
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A weekly journal club/case conference is held at the QMC 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).
Clinical Supervision
Dr Sisodia provides most of the clinical supervision for this post, but Dr di
Mambro is also available to provide clinical supervision. At the beginning of
the post the trainer will discuss the level of clinical supervision required with
the trainee, but in any case there is a once weekly supervision session with Dr
Sisodia (there may be room for manoeuvre about times, but at present that
slot is on Tuesday afternoons).
Educational Supervision
The trainee will be expected to continue to see their Educational Supervisor
as planned.
Trainee Timetable
Monday
am
9:00 – 10:00 Admin
10:00 – 12:00
New Pt OPC - QMC
Tuesday
Wednesday
Thursday
Friday
WARD ROUND –
QMC
(Mother & Baby Unit)
Special Interest
9:00 – 12:30 – MDT
Referral / Allocation /
Supervision With
CPNs – DMH
Mini Ward Review –
QMC
(Mother & Baby Unit)
15:00 – 16:00
Supervision
Research
Obstetric Liaison
/ Home Visits
Admin / Audit
Journal Club/ Case
Conference
pm
14:00 – 16:00
Follow-up OPC QMC
Urgent Assessments
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Trainer timetable
am
Monday
Tuesday
9:00 – 10:00 Admin
10:00 – 12:00NOON
New patient clinic
QMC
WARD ROUND –
QMC
(Mother & Baby Unit)
ON CALL PPS
URGENTS
QMC / DMH
ON CALL PPS
URGENTS
2:00 – 3:00 ADMIN QMC
3:00 - 4:00
SUPERVISION OF
SpR
4:00 – 5:00
Supervision of SHO
ON CALL PPS
URGENTS
2:00 – 5:00 SPA –
QMC
ON CALL PPS
URGENTS
Journal Club/ Case
Conference
pm
13:40 – 17:00
FOLLOW-UP CLINIC
– QMC
Wednesday
POSTGRAD
MEETING
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Thursday
Friday
9:00 – 12:30 – MDT
REFERRAL /
ALLOCATION /
SUPERVISION WITH
CPNs – DMH
WARD REVIEW QMC
ON CALL PPS
URGENTS
13:30 – 17:00 (1ST &
3RD) Outpatient
Clinic – CHN
12:30 – 2:00 2ND
Business Mtg
12:30 – 2:00 4TH
Perinatal Clinical /
Audit
15:00 – 17:00 Urgent
Assessments (2nd
and 4th)
Admin / Obstetric
Liaision – QMC
ON CALL PPS
URGENTS
Duties and opportunities
The duties of the post, performance criteria and the learning opportunities
available are set out following the structure of the subspecialty curriculum for
Perinatal Psychiatry (Specialty Curriculum, November 2010), which in turn, is
based on the headings of the GMC’s Good Medical Practice.
Intended learning outcome 1
The trainee will be involved in the assessment of women pre-conceptually,
ante-natally and post-natally, and as such will experience the distinctive
features of illness in the perinatal period.
They will undertake new
assessments on outpatients, liaison referrals from obstetric and gynaecology
wards (primarily at the QMC and Nottingham City Hospital) and review
patients on the specialist regional Mother & Baby Unit (A45, QMC). This will
include the range of conditions affecting adults but also specifically the
assessment of patients who may be suffering normal psychological changes
in the perinatal period as well as those with mood disorders (including
puerperal psychosis), OCD and relapses of Schizophrenia. Assessments will
also consider parenting competence as affected by illness. In assessing the
need for treatment, the trainee will routinely consider the risks and benefits of
medication in pregnancy and breastfeeding and be able to relate this to the
development of the foetus/neonate. The trainee will also develop a general
understanding of the physical problems that may arise during pregnancy and
the puerperium through exposure, primarily on the Mother & Baby Unit.
They will also provide clinical supervision on an ad hoc basis to assessments
undertaken by the core trainee and nursing staff.
Intended learning outcome 2
The trainee will work across interfaces in Psychiatry, Primary Care,
Community Midwifery, Health Visiting, Childcare Social Services and
Obstetrics & Gynaecology. They will also liaise with services across area
boundaries such as liaising with services in Lincolnshire where less
specialised services are available. They will be expected to prioritise and
manage referrals and to work within the multidisciplinary team across the
County. There is an opportunity to further discuss cases at the weekly MDT
meeting.
The Service also works with well women who have a predictable risk of illness
post-natally, to try to prevent relapse; pathways are in place to facilitate this.
Intended learning outcome 3
Following assessment the trainee will develop appropriate management plans
including the appropriateness of further investigations, and bio-psycho-social
treatments. Where appropriate the trainee will utilize or advise on the use of
the Mental Capacity Act/Mental Health Act to facilitate this. The trainee will
utilise appropriate psychological approaches such as CBT and supportive
psychotherapy.
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The service works with women throughout pregnancy and the first postnatal
year. Consequently, when prescribing medication the trainee will need to
consider the pharmaco-kinetic and pharmaco-dynamic alterations occurring in
pregnancy and the early puerperium, as well as the impact on breastfeeding.
Intended learning outcome 4
Risk of suicide its relation to the perinatal period has been a significant driver
in the development of perinatal services through the influence of the
Confidential Enquiries into Maternal Deaths, NICE and SIGN guidelines.
Assessments of all women, including those currently well will involve
assessment of the risk of deliberate self-harm/suicide. They will liaise and
work with other teams, such as the crisis team, as appropriate to manage risk.
Through liaison referrals, outpatient referrals and inpatients on the Mother &
Baby Unit, the trainee will have experience of a variety of emergency
situations including managing patients who pose a risk of harm to themselves,
those at risk of exploitation/neglect and behavioural disturbance due to acute
medical disorders. They will be expected to use both pharmacological and
environmental means of managing risk.
Risk posed to others is especially important in perinatal psychiatry and the
trainee will be expected to assess the risk to children. They will work with
colleagues and other services (such as Childcare Social Services) to minimise
these risks.
Intended learning outcome 5
The trainee will undertake psychological therapies within their competence
and Health-in-Mind or the Psychotherapy Unit as appropriate. Supervision of
Cognitive-Behavioural cases can be sought.
Intended learning outcome 7
The trainee will follow-up patients in clinic and demonstrate the ability to
develop professional and therapeutic relationships with their patients. When
working with well women at risk of postnatal illness there is a need to remain
positive whilst engaging in preventative strategies at what is an emotional and
stressful life of life. They will manage complex mental health and capacity
assessments in the acute hospital including emergency situations such as
around delivery.
Intended learning outcome 8
The trainee will be expected to communicate effectively and sensitively and
bear in mind the particular issues for women with mental illness, including
their fears of stigma and the fear of consequences of sharing information
regarding their illness. This includes common fears that their children will be
removed by Social Services.
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Intended learning outcome 9
The trainee will routinely work with colleagues in General Practice,
Community Midwifery, Health Visiting, Childcare Social Services and
Obstetrics & Gynaecology. They will attend case conferences typically
arranged either on the Mother & Baby Unit or by Social Services. At times
there will be divergent views which will need managing. The trainee will bring
a specialist understanding of the mother’s mental illness and prognosis to
these meetings and relate it to the ability to parent.
Intended learning outcome 10
The trainee will be given the opportunity to act as a leader. Trainees with
representative roles in Trust management committees will be supported and
the department’s involvement in PQN (Perinatal Quality Network) provides the
trainee with the opportunity to be involved with peer audit and accreditation of
services and experience of how standards can drive development. The
Quality Network is now developing standards and audit of community teams.
They will experience a tertiary level service (the Mother & Baby Unit) and the
differences that this brings in terms of accepting patients across the region (as
part of the East Midlands Managed Care Network) and in Specialised
Commissioning as opposed to PCT/GP Consortia level commissioning.
The trainee will have the opportunity to have experience of the Managed Care
Network and understand the development of services on a regional/national
level.
Intended learning outcome 11
The trainee will be expected to produce timely and clear written
communication to colleagues, both within and without the service. This will
include legal reports where these are requested such as those under the
Children’s Act.
Intended learning outcome 12
The trainee will be involved in the audit process of the team and will have the
opportunity to develop their own topics and present them at the monthly
business meeting.
Intended learning outcome 13
The trainee will be involved in clinical governance. This will include
participation in the annual accreditation by the Perinatal Quality Network.
Intended learning outcome 15
The trainee will be involved in the monthly team development meeting, with
opportunities to teach colleagues. They will be allocated medical students for
task presentations and, in addition, be involved with the clinical exposure and
teaching of students in Perinatal Psychiatry. There are also opportunities to
be involved in the teaching of Midwifes and Health Visitors.
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Intended learning outcome 16
The team has been involved in research such as the national collaborative
BISMARC outcomes in perinatal psychiatry study. The Perinatal Section of
the Royal College of Psychiatrists is working to develop a national perinatal
research network and it is intended that Nottingham will be involved. Trainees
would be welcome to assist in future projects.
Intended learning outcome 17
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.
Dr N Sisodia / Dr AJ Cairns, December 2010.
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