NHS Lothian
Lothian University Hospitals Division
Directorate of Medicine & Associated Services
Hospital Base: Royal Infirmary of Edinburgh
CONSULTANT IN EMERGENCY MEDICINE
1.
Outline of the post
This is 1 Full Time (10 sessions) Consultant in Emergency Medicine posts based within the
Department of Emergency Medicine, Royal Infirmary of Edinburgh. This post is expected to
include a post-appointment negotiable amount of job planned time at one of the other sites in
NHS Lothian. These posts are both supporting the continued development of the Emergency
Medicine service within NHS Lothian.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental
health and hospital services. Mr 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.
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
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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
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 Emergency Department.
There is a Combined Assessment Unit which takes unselected GP or direct emergency
referals, 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
will be available in 2008). 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:
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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:
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General Medicine with specialists in Cardiology, Diabetes & Endocrinology,
Gastroenterology, Respiratory Medicine and Care of the Elderly
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Obstetrics & Gynaecology
Child Health including Paediatrics and community child health
The supraregional Burns and Plastic Surgery unit.
Oral and Maxillofacial Surgery
ENT
Critical Care (ITU, HDU and CCU)
Emergency Medicine
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 the ED. 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:
The Astley Ainslie Hospital in Edinburgh
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Rosslynlee Hospital in Midlothian
Herdmanflat Hospital &
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:
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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
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.
2.4 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;
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 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.
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.
It has established several major interdisciplinary research Centres:
i. MRC Centre for Inflammation Research (Director, Professor John Iredale)
ii. Centre for Cardiovascular Science (Director, Professor Brian Walker) incorporating the
BHF Centre of Research Excellence (Director, Professor John Mullins)
iii. Centre for Reproductive Biology (Director, Professor Phillipa Saunders) and MRC Human
Reproductive Sciences Unit (Director, Professor Robert Millar) including the Tommy’s
Centre (Director, Professor Jane Norman).
iv. MRC Centre for Regenerative Medicine (Director, Professor Sir Ian Wilmut)
v. Centre for Molecular Medicine (Director, Professor David Porteous)
vi. Centre for Cancer Research (Director, Professor David Harrison)
vii. Centre for Population Health Sciences (Director, Professor Harry Campbell)
viii. MRC Human Genetics Unit (Director, Professor Nick Hastie)
These Centres are predominantly based at two sites: the Queen’s Medical Research Institute at
the Royal Infirmary, and the Institute of Genetics and Molecular Medicine at the Western
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General Hospital. The co-location of basic science and clinical groups within state-of-the-art
infrastructure and technology provides an excellent and exciting opportunity to conduct
translational research at the highest level.
This academic power base is supported by clinical research infrastructure that includes:
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Wellcome Trust Clinical Research Facility
Clinical Research Imaging Centre
Edinburgh Clinical Trials Unit (UKCRN Registered) and Health Services Research Unit
Scottish Brain Imaging Research Centre
Experimental Cancer Medicine Centre
Academic and Clinical Central Office for Research and Development
NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
5.
Departmental Information
ROYAL INFIRMARY OF EDINBURGH
The Emergency Department at RIE currently assesses 111,000 new patients per year with a
high acuity case mix. It serves as a tertiary receiving centre for Lothian and Border regions.
The Department houses 2 resuscitation rooms with integral x-ray facilities, 17 High
Dependency/Immediate Care trolley cubicles and 15 Examination/Minor Injury and Illness
cubicles. There is a separate x-ray facility within this area. The Anaesthetic room is utilised for
manipulations and other techniques, which require anaesthetic/resuscitative support. There is
one patient/relative waiting area, 2 distressed/bereaved relatives rooms, Consultant, Senior
Nursing and secretarial office accommodation. In addition to a viewing room and staff room,
there is an office for trainee medical staff and a spacious teaching facility for both
undergraduate and postgraduate teaching.
A helicopter pad is on site. For the past two decades the Department has run an out-of-hospital
resuscitation service – MEDIC ONE – which has experience of over 3000 call-outs to trauma
and medical emergencies. MEDIC ONE also forms the focus for major incident medical team
deployment in Lothian and Borders.
The Department has direct radio communication with the Ambulance Service and direct
telephone communication with the Lothian and Borders Police Force, in addition to hosting its
own internal radio system utilised within the Department and MEDIC ONE.
There is ready access to state of the art equipment and monitoring, departmental USS and
adjacent CT and USS.
The average daily attendance is approximately 300 patients per day made up of 10-15
resuscitation cases and 120 High Dependency/Immediate Care Trolley Room patients. The
remainder constitute the minor injury and illness population. There are approximately 75-100
in-patient admissions per day, 50% of whom will be acute medical, 20% surgery, 20%
orthopaedic and the other specialties making up the balance.
A combined Medical and
Surgical Assessment Unit adjacent to the Emergency Department receives direct GP referred
cases.
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Staff
Consultants based at RIE:
Dr David Steedman
Prof Alasdair Gray
College Professor of Research
Dr David Caesar
Clinical Director for Emergency Medicine
Dr Sara Robinson
Clinical Lead Emergency Medicine RIE
Dr Matt Reed
Dr Marie-Clare Harris
Dr Angela Oglesby
Dr Emma-Beth Wilson
Dr Gareth Clegg
Dr Janet Skinner
Dr Randal McRoberts
Dr Simon Leigh-Smith
Dr Dean Kerslake
Dr Craig Walker
Dr Shirin Brady
Dr Krishna Murthy
Dr Jon Carter
Dr Richard Lyon
Dr Edward James
18 of these consultants are currently on the on call rota and provide weekend cover
Supporting Medical Staff
8 FY2s,
6 GPSTs
7 ST4+/SpR
8 ST1s
2 Trauma Fellows
Nursing Staff
1 Band 8 Departmental Nurse Manager
4.5 Band 7 Charge Nurses
85 band 5/6 Nurses
10.5 Nurse Practitioners
18.5 Clinical Support Workers
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Administrative Support
2 Personal Assistants
1 Data/Information Manager
17.7 WTE Reception/Secretarial Staff
ROYAL HOSPITAL FOR SICK CHILDREN
The Paediatric Emergency Department at the RHSC provides an Emergency Service to most
of Edinburgh, Mid and East Lothian, as well as tertiary receiving from the Lothians and
beyond. On site specialties include both trauma and non-trauma Orthopaedics, General,
Plastic and Neurological Surgery, Anaesthetics and Paediatric Intensive Care
Medicine/Retrieval, Paediatric Medicine and sub-specialties including Cardiology.
The
Paediatric Emergency Department sees 28,700 new patients per year with 4,000 returning for
review.
Medical Staffing
Consultants
Dr Paul Leonard (Professional Lead)
Dr Dylan Broomfield
Dr Angela Oglesby
Dr Jen Browning
Dr Alastair Kidd
Dr Lindsay Reid
Dr Gregor Campbell-Hewson
In addition there is one Associate Specialist, one SpR on the South East of Scotland Training
Programme, one Clinical Research Fellow, 3 WTE Staff Grades as well as 8 SHOs. There
are 3 WTE Emergency Nurse Practitioners.
ST JOHN’S HOSPITAL, LIVINGSTON
The Department manages approximately 39,000 new patients with a total attendance of
about 46,000 (15.6% return rate). 1:4 patients is a child under the age of 16 years. Overall,
around 60% of all new patients present with injury, 17% with medical illness and 8% with a
surgical problem. Over 2,000 patients require immediate treatment and resuscitation; almost
1:5 new patients (19.%) are admitted. The relatively high per cent of returns is due to the
fact that the Department runs a daily Review Clinic where most patients with minor fractures
are followed up.
The Department has undergone a recent £2.8 million rebuilding and expansion programme.
The rebuilt Department has a spacious, fully equipped Resuscitation Room with 2 adult and
one children’s bay served by an overhead digital x-ray gantry. There are 10 adult treatment
bays including one for cardiac emergencies, one for psychiatric and one for eye and ENT
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examinations. There is a separate children’s waiting area and 2 children’s treatment rooms.
There is an x-ray room within the Emergency Department and the hospital has completely
transferred to a digitally-based PACS radiology system. There is a relatives room with
adjacent viewing room.
Patient waiting and reception areas have been expanded and
improved in the re-build and there is a dedicated room for Emergency Nurse Practitioners.
Office space has been greatly enhanced, as have facilities for staff refreshment and teaching.
There is now an observation facility run and supervised by the Emergency Service.
Medical Staffing:
Consultants: Dr Martin McKechnie (8 PAs) (Professional Lead)
Dr Peter Freeland (6PAs)
Dr Jane Fothergill (7PAs)
Dr Randal McRoberts (6PAs)
Dr Paul Leonard (4PAs)
Dr Stephen Lynch (7PAs)
Dr Alastair Kidd (2PAs)
Dr Andy Stevenson (8Pas)
Dr Alexis Leal (8Pas)
Dr Jasmine Ng (7Pas)
Dr Rebecca Cranfield (7Pas)
Dr Doug Murray (7Pas)
Dr Jon Wraight (8Pas) (joint with toxicology RIE)
Supporting Medical Staff:
Dr Beth Threlfall (Associate Specialist)
1-2 ST4+/SpR based at St John’s for one year as part of the South East of
Scotland Training Programme
10 FY2/GPST/CT1-3
6.
Details of the Post
Consultant in Emergency Medicine works with the Band 7 ED nurse and the Primary Care
Physician to provide Emergency Medical expertise in the delivery of care plans for the Lothian
High Demand Service, on a consultative basis. Work constitutes direct clinical care rather
than supporting professional activity.
7.
Research and Development
The Emergency Department at the Royal Infirmary of Edinburgh has a distinguished track
record of research in Emergency Medicine and is coordinated through a regional research
group (EMeRGE). For the past 30 years, the Department has been renowned as a leading
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Centre for innovative research ideas and their application. The work is recognised by the
publication of over one dozen major text books and several hundred original research papers
have been produced by medical and nursing staff.
The Department has a world-wide
reputation particularly of research into pre-hospital care, cardiac arrest, cardio-pulmonary
resuscitation, major trauma and lung injury. The pivotal role of the Emergency Department
for patients with critical illness and injuries means that many other clinical specialties have
conducted collaborative research over the last 10 years; this has reaped enormous rewards.
There are strong links with the University of Edinburgh Departments of Cardiology,
Respiratory Medicine, The Raine Institute and with Heriot-Watt and Napier Universities.
Individuals within the Department have been closely involved in attracting major funding for
clinical and laboratory studies and the recognition of this work has been marked by
prestigious prizes and awards nationally and internationally. The Unit fosters a clinical and
academic environment where any member of staff, irrespective of background, can be
involved in the exciting and challenging nature of research in its application to improve patient
care.
8.
Teaching
Emergency Medicine is a fertile training ground for young doctors and in recognition of this
opportunity 8 FY2 trainees rotate through the unit every 4 months from August 2006. The
Emergency Medicine Consultant will contribute, via working with the Band 7 ED nurse and
the Primary Care Practitioner, to teaching and training of junior medical and nursing staff, and
students of medicine and nursing.
9.
Job Plan
Name:
Specialty:
Principal Place of Work:
Contract:
Full Time / Part Time / Honorary
Programmed Activities: 10
EPAs:
Availability Supplement:
None / Level 1 / Level 2
at 5%
Managerially accountable to: Clinical Director EM.
10.
Contact Details
Dr David Caesar, Clinical Director Emergency Medicine RIE & SJH.
Emergency Department,
Royal Infirmary of Edinburgh,
Little France,
EDINBURGH
EH16 4SA
Dave.caesar@luht.scot.nhs.uk
Tel: 0131 242 1338
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11.
Person Specification
REQUIREMENTS
Qualifications and
Experience
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ESSENTIAL
GMC registered medical
practitioner
Be on, or be eligible for
inclusion on within 6 months
of interview, the GMC
Specialist Register
Advanced training in
Emergency Medicine
FCEM or equivalent
Evidence of regular appraisal
Learning and continuous
professional development
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DESIRABLE
Additional post-graduate
qualifications, e.g. MD, PHD, DIMC
RCS Ed
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Level 1 USS training
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Accredited sub-specialty training
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Experience of working at Consultant
level
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Ability to re-design clinical
service or process
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Evidence of ability to take full
responsibility for independent
management of patients
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Academic
Achievements
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Evidence of research and
publications.
Teaching and
Audit
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Evidence of teaching qualification
or learning
Designing and effecting audit
programmes
Post-Specific
Experience
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Ability
Motivation
Team Working
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12.
Evidence of Audit or
Presentations
Evidence of formal and
informal teaching and training
of junior medical staff and
medical students, and
nursing staff.
 Evidence of Patient focused
care
 Effective and efficient use of
resources
 Values consistent with
Edinburgh Emergency
Medicine ethos
Evidence of teamwork with
colleagues in own and other
disciplines
Sense of humour
Able to organise time efficiently
and effectively
Clearly adds value to existing
team of consultants
Draft Advertisement
To be supplied
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Specialist interest in one of the
following: patient safety,
management & leadership,
telemedicine, frequent attender
management or medical
education.
Clear clinical and managerial
leadership skills
Evidence of development of
services for patients
Clear commitment to developing
future of emergency medicine
Able to motivate colleagues
Previous managerial training and
experience
Revised Medical and Dental HR December 2009
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