CONSULTANT GERIATRICIAN OLDER ADULT ASSESSMENT UNIT, ROYAL ALEXANDRA HOSPITAL

CLYDE SECTOR

INFORMATION PACK

REF: 44628D

CLOSING DATE: 18TH NOVEMBER 2016

www.nhsggc.org.uk/medicaljobs

SUMMARY INFORMATION RELATING TO THIS POSITION

POST: CONSULTANT GERIATRICIAN – OLDER ADULT ASSESSMENT UNIT

BASE: ROYAL ALEXANDRA HOSPITAL

We are delighted to advertise this new post based at the Royal Alexandra Hospital (RAH). We are looking for a motivated, enthusiastic colleague to lead our Older Adult Assessment Unit (OAAU).This award winning unit was initially a pilot project as part of the Renfrewshire Development Programme. The one year pilot was hugely successful and, as such, the OAAU is now a permanent facet of the Department of Medicine for the Elderly at the RAH. Our vision is to build on the current model with a view to widening the referral pathways to increase assessment numbers.

The main aim of the OAAU is to provide access to comprehensive geriatric assessment (CGA) at the front door. We have a dedicated unit, staffed by specialist nursing, medical and allied health professional (AHP) team. Extensive quantitative and qualitative analysis has shown that the unit leads to shorter length of stay for patients when compared to ‘usual care’ but, more importantly provides an excellent patient and carer experience. The development of the OAAU has had a positive ‘knock on’ effect across our wards leading to shorter waits for transfer to our general assessment and rehabilitation wards and fewer patients requiring interim transfer to other wards from the Acute Medical Unit (AMU).

There are currently four consultants providing input to the OAAU across the week. We would be looking for the successful candidate taking this post to take on a leadership role within the OAAU, supporting the whole team to develop the unit and maintain the standard of care. This would include ensuring relevant clinical governance priorities are addressed.

Applicants should have full GMC registration, a licence to practise, MRCP or equivalent and eligibility for inclusion on the Specialist Register. Those trained in the UK should have evidence of higher specialist training in General Internal Medicine and Geriatric Medicine leading to CCT or eligibility for specialist registration (CESR) or be within 6 months of confirmed entry from date of Interview. Non-UK applicants must demonstrate equivalent training.

NHS Greater Glasgow & Clyde

Stroke and Older Peoples Service – Clyde Sector

Consultant Geriatrician – Older Adult Assessment Unit

1. General InformationThe Royal Alexandra Hospital (RAH) is situated in Paisley and provides acute health care services to Renfrew District (pop 205,000). The Hospital is a 968 bed modern District General Hospital (DGH) which opened in 1986 and is one of the largest and busiest teaching DGHs in Scotland. In addition, the hospital is currently the base for provision of surgical, orthopaedic, ophthalmology, paediatric and also the majority of maternity services to the population north of the Clyde served by the Vale of Leven Hospital.

The hospital provides a wide range of District General Hospital specialties with excellent support facilities. The hospital has a first class modern radiology department and services. All departments participate in undergraduate teaching and there is an active postgraduate educational programme. The hospital enjoys an enviable reputation for undergraduate teaching and is highly popular with training grades. There is also a good medical library service.

2. Medicine for the Elderly and Stroke serviceThe Department of Medicine for the Elderly (DME) Service in the Royal Alexandra Hospital (RAH) delivers all its in-patient services on the hospital site. There are, however, close links with the Vale of Leven Service (VoL), particularly with an integrated stroke care pathway

Interface with General MedicineA daily visit to the Medical Admissions unit is undertaken to review patients identified at the post-receiving round by General Physicians using agreed criteria. Direct transfers from there to Medicine for the Elderly beds takes place dependent upon bed availability.

Regular liaison visits to medical wards are undertaken to ensure appropriate patients are transferred to Medicine for the Elderly beds later in the course of admission.

Patients are admitted to RAH from the VoL service according to agreed criteria - generally the more medically unstable patients and all stroke patients (except those needing thrombolysis who go to the Queen Elizabeth University Hospital, Glasgow).

The group of medical patients who remain in the VoL are cared for under the supervision of a ‘Physician of the week’ rotating from RAH. Medicine for the Elderly Consultants triage patients on a daily basis for transfer to their wards.

Trauma admissions are admitted to RAH and when appropriate older patients transferred directly back to Ward 15 in VoL for further orthogeriatric rehabilitation under the care of the Geriatrician.

Currently some Medicine for the Elderly patients admitted to RAH are not fit to return to VoL and are transferred to the Medicine for the Elderly service at RAH. Appropriate patients may be transferred directly from medical wards to VoL Medicine for the Elderly beds.

Stroke Service (patients of all ages)Beds for stroke patients (approx 25) are part of a 30 bedded Medicine for the Elderly ward. Work is ongoing to ensure direct admissions from A&E and early transfer to the Stroke Unit. There are approximately 399 admissions to the stoke unit per year. Thrombolysis for patients from the RAH catchment area is delivered by the South Glasgow Stroke Service and patients repatriated thereafter.

Rapid access TIA clinics are undertaken, with the number of clinics required to achieve national performance targets recently being agreed following review.

There is a neurology liaison service in Royal Alexandra Hospital and Inverclyde Royal Hospital and a new member of that team has a special interest in Stroke Medicine.

The Stroke service is represented on the Greater Glasgow & Clyde Stroke Managed Clinical Network.

Geriatric Orthopaedic ServiceThe orthogeriatic service is provided by 3 consultant, supported by a Staff Grade doctor. The team works to a target of reviewing patients within 72 hours of admission.There is both inpatient and community rehabilitation teams and links to care homes through the Gerontology Nurse Specialist with an interest in Orthogeriatrics.

There is a fast track service where patients with a Fractured Hip can be transferred directly to the Geriatric Orthopaedic Unit either in the Royal Alexandra hospital or Vale of Leven Hospital as appropriate according to certain criteria. There are also over 300 liaison visits per year. There is a weekly multidisciplinary team meeting in orthopaedics. The Department of Medicine for the Elderly is strongly supported by Orthopaedics and has 22 dedicated beds in ward 3 which provide orthogeriatric rehabilitation

Movement DisordersThe RAH service is provided by 2 consultants, supported by a one Parkinson’s Disease Nurse Specialist. There are 2 outpatient clinics per week and inpatients are cared for in ward 5 wherever possible/appropriate. The team provides liaison support to other specialities within the hospital and provides domiciallary visits, where possible, to our local nursing homes.

Day HospitalA 5 day services is provided, supported by a Specialty Doctor. The recent development of Community work and the introduction of rapid access clinic slots has been part of a review of the Day Hospital service as an alternative to admission to hospital with comprehensive geriatric assessment being lead by a Consultant Geriatrician.

Outpatient ClinicsSpecialist clinics are available, for Stroke, Movement Disorders and Falls.

Community Geriatric MedicineCommunity Geriatric Medicine was established in 2006 under the auspices of the Joint Planning Group. One geriatrician currently supports the Joint Planning Group. There are clinical links between geriatricians and the Gerontology Nurse Specialists, Parkinson’s Nurse Specialist, Rehab and Enablement Team and Interface Pharmacy. Further developments are proposed around this area.

Bed Numbers Ward 3 30 beds GORU (22) & Assessment/Rehabilitation (8)

Ward 4 30 beds Stroke + up to 5 geriatric patients

Ward 5 30 beds Assessment/ Rehabilitation

Ward 6 12 beds Older Peoples Assessment Unit

Ward 7 30 beds Assessment/ Rehabilitation

Ward 36 20 beds NHS Complex care

Currently there at are 354 admissions to Wards 3 and 890 admissions to 5 and 7 per year with an average length of stay of 13-14 days. The Older Adult Unit looks after 700-800 patients per year with average LOS of 3-4 days.

3. The Acute Medical Unit The Medical Unit at the Royal Alexandra Hospital has 209 beds. This includes an 18 bedded Coronary Care / Chest Pain Unit, a 30 bedded medical receiving ward and Medical Assessment Unit and evolving ambulatory care pathway. The medical unit provides an acute service in general medicine with clinics in general medicine, diabetes and endocrinology, gastroenterology, cardiology, asthma, respiratory medicine and haematology.

The Medical Unit at Inverclyde Royal consists of an Acute Medical Receiving Unit and three general medical wards totaling 116 beds and an 11 bedded Coronary Care Unit. The Medical Unit provides an acute service in general medicine with clinics in general medicine, diabetes & endocrinology, cardiology, rheumatology and respiratory medicine in addition to gastroenterology.

3.1 Medical Assessment and Acute Receiving

GP referred medical patients are triaged from the Emergency Department to the Medical Assessment Unit at Royal Alexandra Hospital Monday to Sunday 10am to 10pm. All patients are reviewed by a senior doctor of whom 50% are discharged home. Patients requiring admission can be admitted to the relevant specialty bed direct from MAU. A re-design of front door assessment is currently underway on the RAH site in order to provide early specialist review and support ambulatory pathways of care.

Acute medical admissions are admitted to the Acute Medical Unit (ward 2) at the RAH, which is staffed by one of the consultants on a rotating ‘Physician of the Week’ basis

Monday morning to Friday lunchtime and an Acute Care Physician. Patients are then triaged to the appropriate specialty wards if not for early discharge. Separate rotas are in place to cover weekend acute and continuing care.

3.2 Coronary Care Unit

Patients with acute myocardial infarction, acute coronary syndromes, arrhythmias or congestive cardiac failure at the RAH are admitted to the 12 bedded coronary care unit, staffed during the day by one of the consultant cardiologists on a rotational basis, supported by junior medical staff from the cardiology ward.

3.3 Medical High Dependency Unit (HDU)

The RAH has three medical HDU beds at present within the combined 12 bedded HDU, with scope to increase to four or more medical HDU beds if required.

3.4 Junior Doctors out-of-hours

A Hospital @ Night service started at the RAH in August 2006. This is part of ongoing work addressing the impact of modernising Medical Careers and implementing plans to support the delivery of high quality sustainable services.

THE POST

(a) Title: Consultant Physician in Medicine for the Elderly

(b) Relationships:

(I) Rehabilitation and Assessment DirectorateDirector: Mrs M FarrellChief of Medicine Dr Chris JonesGeneral Manager Mr J KennedyClincial Director Dr G SimpsonLead Clinician (Clyde) Dr J Murtagh

(ii) Names of Consultant members of the Department:

Consultant: Special Interest:Dr F. BoyceDr J. McManus

Stroke / Medicine for the ElderlyStroke / Medicine for the Elderly

Dr G. Simpson Movement Disorder / Medicine for the ElderlyDr S. Farid Stroke / Medicine for the ElderlyDr A. Macrae Falls and orthogeriatric medicineDr J. Murtagh Movement Disorder / Medicine for the ElderlyDr O. Lucie Community / Medicine for the ElderlyDr D. Mack Falls and orthogeriatric medicineDr K. Kanthi Vale of Leven/GORU/Falls/Syncope

(iii) Support Grades

Please completeSpecialty Doctors 2 = 17 sessions

FY2 5

GPST 3

CMT 1

ST3 1 – when allocated via Deanery

(c) Duties of the Post:

(i) The postholder will be expected to work with local managers and professional colleagues in the efficient running of the service. Subject to the provisions of the terms and conditions of Service, the postholder is expected to observe NHS Greater Glasgow and Clyde’s agreed policies and procedures, drawn up in consultation with the profession on clinical matters, and to follow the standing orders and financial instructions of the Health Board.

(ii) The postholder will be expected to ensure that there are adequate arrangements for hospital staff involved in the care of patients to be able to make contact with the postholder when necessary.

(iii) The postholder is required to comply with GG&C Health and Safety Policies.

(iii) Clinical

The post is open to candidates who wish to contribute to both the development of the Older Adult Assessment Unit and the wider Medicine for the Elderly Service. The clinical duties described will depend upon final agreement of the job plan. Needs-led acute receiving for older people in the Royal Alexandra Hospital. Weekend cover to receiving is provided by the on-call Consultant 1:8 This is on call for the service which includes input to medical receiving and covering the Rehabilitation and Assessment beds (Stroke and Medicine for the Elderly) Liaison and advice for appropriate older patients in medical wards. Care of assessment and rehabilitation patients in the Medicine for the Elderly beds Assessment and review of patients attending Day Hospital which provides open access to general practitioners and liaison with Community rehabilitation teams. The Consultant will be expected to share cover for absent colleagues on annual or study leave by prior arrangement and short-term, unplanned sick leave.

(iv) Supporting Professional Activities

As part of supporting Professional activity, full involvement in the Clinical Governance programme of the Directorate

Participation in Clinical Meetings and an audit programme

The appointee will be expected to participate in annual appraisal

Development of the Older Adult Assessment Unit model

With negotiation about total SPA time the following may be included:

The Consultant will be responsible, in conjunction with colleagues, for the clinical and educational supervision of trainee medical staff.

The Consultant would be expected to take part in the undergraduate teaching for students from University of Glasgow

The Consultant may be expected to contribute, by agreement with

Clinical Director, to internal and external Health Service committees

5. Proposed Weekly Programme

5.1 Job Plan

The proposed indicative weekly programme is shown in Section 4a. Activities with current fixed time commitments will be carried out as detailed in the work programme eg clinics. Other DCC and SPA activities are shown with indicative timings within the weekly programme and will be discussed with the appointee.

The job plan will be reviewed with the successful candidate no later than 3 months following appointment and where possible discussion may take place in advance of appointment. Job plan review thereafter will be no less frequent than annually.

The agreed job plan will include all the consultant’s professional duties and commitments, including agreed Supporting Professional Activity.

Opportunities may exist for Extra Programmed Activities to be undertaken subject to service requirements and in accordance with national terms and conditions of service.

5.2 Notes on the Programme

Patient Administration. This activity covers the management of individual patients including Out Patient administration, results reporting, letters/phone calls to patients, carers, GP’S and members

of the wider multidisciplinary team involved in the patients care. Office accommodation will be in the Royal Alexandra Hospital.

Ward Rounds: The time allocated is indicative and will be discussed with the appointee. Ward work will include teaching ward rounds as required.

Travel: Any travel allocation will be included within the Total Programmed Activities and will be determined by location at which Direct Clinical Care and Supporting Professional activities are carried out.

On call arrangements: The postholder will be part of the current Medicine for Elderly rota based at Royal Alexandra Hospital. This rota is a 1:8. Availability supplement is 5%.

A half programmed activity based on premium time per week has been included within the allocation of DCC to recognise the predictable and unpredictable hours of work associated with the provision of emergency cover.

Supporting Professional Activities:

A minimum of 1 SPA is included in the indicative job plan, which shall normally be sufficient to reflect activities such as CPD, audit, clinical governance, appraisal, revalidation, job planning, internal routine communication and management meetings. The precise allocation of SPA time and associate objectives will be agreed with the successful applicant and will be reviewed at annual job planning.It will be requested that SPAs are delivered at the normal place of work, unless there are mutual. advantages to it being performed elsewhere.

7. Summary of the Post

The appointee will provide consultant leadership in the Older Adult Assessment Unit and contribute to the management of patients both within the assessment/rehabilitation wards and outpatient setting.

7.1 Duties of the Post

Inpatient: OAAU based at the RAH Assessment rehabiliation ward beds

Outpatient: Day Hospital, based at Royal Alexandra Hospital.

7.2 Suggested job plan

This job plan is negotiable and will be agreed between the successful applicant and the Clinical Director. NHS Greater Glasgow & Clyde initially allocates all full time consultants 10 PAs made up of 9 PAs in Direct Clinical Care (DCC) and one core Supporting Professional Activities (SPA) for CPD, audit, clinical governance, appraisal, revalidation, job planning, internal routine communication and management meetings. The precise allocation of SPA time and associate objectives will be agreed with the successful applicant and will be reviewed at annual job planning. The appointee may be required to support clinical activity elsewhere across Greater Glasgow and Clyde.

Duty PAs

Older Adult Assessment Unit (including AMU liaison and DHE follow-up)

4.0

Ward Rounds/Relatives (x 2)MDT/ Admin

Outpatients

2.0 0.5 1.0 1.0

Out of Hours Work 0.5

Total DCC 9.0

SPA 1.0

TOTAL 10

Cover for study leave, holidays will be provided from within existing consultants.

7.3 On call duties

The postholder will be part of the current Medicine for Elderly rota based at Royal Alexandra Hospital. This rota is a 1:8. Availability supplement is 5%. Duties include review of new and unwell patients in wards 3-7 and liaison to AMU.

7.4 Support staffThere is secretarial support for the consultant appointments.

8. Postgraduate and Undergraduate TrainingBoth the Medicine for the Elderly and Medical units have a postgraduate programme which includes a weekly unit meeting, morbidity and mortality meetings and SHO tutorial sessions. There are weekly hospital postgraduate meetings during term time. Mr Andrew Renwick is the postgraduate tutor at RAH.

The Medical Units teach a number of medical students from Glasgow University. As part of the new curriculum teaching of years one to five is becoming established.

9. Further information

Candidates are strongly urged to make contact for further information and to arrange a visit

to the department:

Please contact:

Dr G Simpson Clinical Director, Older People / Stroke (Sec 0141 314 6190) Dr Janice Murtagh Lead Clinician, Older People and Stroke, RAH (Sec 0141 314 7444)

PERSON SPECIFICATION

ESSENTIAL DESIRABLE

QUALIFICATIONS Applicants should have full GMC registration, a licence to practise, MRCP or equivalent and eligibility for inclusion on the Specialist Register. Those trained in the UK should have evidence of higher specialist training in General Internal Medicine and Geriatric Medicine leading to CCT or eligibility for specialist registration (CESR) or be within 6 months of confirmed entry from date of Interview. Non-UK applicants must demonstrate equivalent training.

CLINICAL EXPERIENCE

Clinical training and experience equivalent to that required for gaining UK CCT in General Internal Medicine and Geriatric Medicine.Ability to offer expert clinical opinion on a range of geriatric problems.Ability to take full and independent responsibility for clinical care of patients.

Sub-specialty interest.

MANAGEMENT AND ADMINISTRATIVE EXPERIENCE

Demonstrate leadership qualities that will help them to support and develop the OAAU.Ability to organise and manage ward patients and outpatient priorities. Experience of audit management.Ability and willingness to work within NHS GG&C and NHS Scotland performance framework and access targets.Demonstrate an understanding of clinical governance as a concept, as well as the local priorities in this area.

Attendance at management course for clinicians.

TEACHING EXPERIENCE

Experience of supervising medical trainees.Ability to teach clinical skills.

Experience of MMC assessment tools.

OTHER ATTRIBUTES

Ability to work in a team.Good interpersonal skills.Caring attitude to patients.Ability to communicate effectively with patients, relatives, GPs, nursing staff and other relevant parties.Commitment to the requirements of clinical governance.

TERMS AND CONDITIONS OF SERVICE

The conditions of service are those laid down and amended from time to time by the Hospital and Medical & Dental Whitley Council.

TYPE OF CONTRACT Permanent

GRADE AND SALARY Consultant£ 77,529 - £ 104,525 per annum (pro rata)

New Entrants to the NHS will normally commence on the minimum point of the salary scale, (dependent on qualifications and experience). Salary is paid monthly by Bank Credit Transfer.

HOURS OF DUTY Full Time 40.00

SUPERANNUATION New entrants to NHS Greater Glasgow and Clyde who are aged sixteen but under seventy five will be enrolled automatically into membership of the NHS Pension Scheme.  Should you choose to "opt out" arrangements can be made to do this via: www.sppa.gov.uk

REMOVAL EXPENSES Assistance with removal and associated expenses may be given and would be discussed and agreed prior to appointment.

EXPENSES OF CANDIDATES FOR APPOINTMENT

Candidates who are requested to attend an interview will be given assistance with appropriate travelling expenses. Re-imbursement shall not normally be made to employees who withdraw their application or refuse an offer of appointment.

TOBACCO POLICY NHS Greater Glasgow and Clyde operate a No Smoking Policy in all premises and grounds.

DISCLOSURE SCOTLANDThis post is considered to be in the category of “Regulated Work” and therefore requires a Disclosure Scotland Protection of Vulnerable Groups Scheme (PVG) Membership.

CONFIRMATION OF ELIGIBILITY TO WORK IN THE UK

NHS Greater Glasgow and Clyde (NHSGGC) has a legal obligation to ensure that it’s employees, both EEA and non EEA nationals, are legally entitled to work in the United Kingdom. Before any person can commence employment within NHS GGC they will need to provide documentation to prove that they are eligible to work in the UK. Non EEA nationals will be required to show evidence that either Entry Clearance or Leave to Remain in the UK has been granted for the work which they are applying to do. Where an individual is subject to immigration control under no circumstances will they be allowed to commence until the right to work in the UK has been verified. ALL applicants regardless of nationality must complete and return the Confirmation of Eligibility to Work in the UK Statement with their completed application form. You will be required provide appropriate documentation prior to any appointment being made.

REHABILITATION OF OFFENDERS ACT 1974

The rehabilitation of Offenders act 1974 allows people who have been convicted of certain criminal offences to regard their convictions as “spent” after the lapse of a period of years. However, due to the nature of work for which you are applying this post is exempt from the provisions of Section 4 of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions Orders 1975 and 1986). Therefore, applicants are required to disclose information about convictions which for other purposes are “spent” under the provision of the act in the event of employment, failure to disclose such convictions could result in dismissal or disciplinary action by NHS Greater Glasgow and Clyde. Any information given will be completely confidential.

DISABLED APPLICANTS A disability or health problems does not preclude full consideration for the job and applications from people with disabilities are welcome. All information will be treated as confidential. NHS Greater Glasgow and Clyde guarantees to interview all applicants with disabilities who meet the minimum criteria for the post. You will note on our application form that we ask for relevant information with regard to your disability. This is simply to ensure that we can assist you, if you are called for interview, to have every opportunity to present your application in full. We may call you to discuss your needs in more detail if you are selected for interview.

GENERAL NHS Greater Glasgow and Clyde operates flexible staffing arrangements whereby all appointments are to a grade within a department. The duties of an officer may be varied from an initial set of duties to any other set, which are commensurate with the grade of the officer. The enhanced experience resulting from this is considered to be in the best interest of both NHS Greater Glasgow and Clyde and the individual.

EQUAL OPPORTUNITIES The postholder will undertake their duties in strict accordance with NHS Greater Glasgow and Clyde’s Equal Opportunities Policy.

NOTICE The employment is subject to three months’ notice on either side, subject to appeal against dismissal.

MEDICAL NEGLIGENCE In terms of NHS Circular 1989 (PCS) 32 dealing with Medical Negligence the Health Board does not require you to subscribe to a Medical Defence Organisation. Health Board indemnity will cover only Health Board responsibilities. It may, however, be in your interest to subscribe to a defence organisation in order to ensure you are covered for any work, which does not fall within the scope of the indemnity scheme.

FURTHER INFORMATION

For further information on NHS Greater Glasgow and Clyde, please visit our website on www.nhsggc.org.uk

View all our vacancies at: www.nhsggc.org.uk/medicaljobs

Register for Job Alerts at: www.medicaljobs.scot.nhs.uk

Applicants wishing further information about the post are invited to contact For further information or to arrange to visit the Department, please contact Dr Graeme Simpson on 0141 314 6190 or Dr. Janice Murtagh on 0141 314 7444 with whom visiting arrangements can also be made.

HOW TO APPLY

To apply for these posts please include your CV and names and addresses of 3 Referees, along with the following documents; (click on the hyperlinks to open)

Medical and Dental Application and Equal Opportunities Monitoring Form

Declaration Form Regarding Fitness to Practice

Immigration Questionnaire

Alternatively please visit www.nhsggc.org.uk/medicaljobs and click on the “How to Apply” tab to access application for and CV submission information.

NOMINATION OF REFEREES

It is Board policy that no person can act as a member of an Advisory Appointments Committee and be a referee for a candidate for that post. You should therefore check with your proposed referees whether there is likely to be any difficulty in this respect for we may otherwise have to invite you to submit another name or names

RETURN OF APPLICATIONS

Please return your application by email to nhsggcrecruitment@nhs.net or to the recruitment address below;

Medical and Dental Recruitment TeamNHS Greater Glasgow and ClydeWest Glasgow ACH (formerly Yorkhill) 2nd FloorDalnair Street, Yorkhill, G3 8SJ

CLOSING DATE

The closing date will be 18th November 2016

INTERVIEW DATE

The interview date will be 9th December 2016