MORECAMBE BAY HOSPITALS NHS TRUST
JOB DESCRIPTION
CONSULTANT IN ACCIDENT AND EMERGENCY

FULL-TIME: Eleven Sessions (standard NHS contract)
BASE: The Royal Lancaster Infirmary
THE POST: Clinical duties at the Royal Lancaster Infirmary and the Westmorland General Hospital

INTRODUCTION

These are new posts that will increase the complement of A&E Consultants based at the Royal Lancaster Infirmary from 2 to 4. The posts offers candidates the unique opportunity to contribute to the further development of the service. Flexible working patterns are seen as essential to the ability of the Department to provide an optimal emergency service responsive to a changing N.H.S.

THE LOCATION

The posts are based in the attractive historic city of Lancaster. There is a vibrant cultural life in the city, in part the result of being a university city. There are increasing academic links between the Trust and the university. Road and rail communications to rest of England, Scotland and Wales are good and there is a regular ferry to the Isle of Man. Manchester is one hour's drive away and London three hours by train.

There is a large choice of local primary schools with very good OFSTED reports. There are excellent secondary schools, including a choice of state schools ranked amongst the best in the country, and private schools.

A vast range of outdoor pursuits are available including close proximity to the Lake District, Forest of Bowland, Pennines, and activities on rivers and sea. The city is well served with sporting facilities, clubs and opportunities, including a new swimming pool, tartan athletic track, and a range of facilities including all weather pitches and indoor facilities provided by the local authority, university, local colleges and schools.

Visit the North West: http://englandsnorthwest.com/explore_the_region/

MORECAMBE BAY HOSPITALS NHS TRUST

The Morecambe Bay Hospitals NHS Trust was established on 1st April 1998 following the merger of the Furness Hospitals NHS Trust, Westmorland Hospitals NHS Trust and the Lancaster Acute Hospitals NHS Trust. The new Trust provides an extensive range of acute, emergency and continuing care to a population of 350,000 in South Cumbria and North Lancashire.

A joint initiative between the Morecambe Bay Hospitals NHS Trust and the Universities of Lancaster and Liverpool to develop a course for 4th and 5th year students has been agreed. A total of 100 students will be based at our Trust from 2004/2005.

Royal Lancaster Infirmary

This 495 bedded hospital has all major specialties on site, including Coronary Care, Intensive Care and a 24 hour CT scan service. The Centenary Building opened in 1996 provided new Surgical, ITU and theatre facilities, so that all specialities are on the same hospital site. A new MR and spiral CT was commissioned in summer 2001 adjacent to the A&E department. The Day Surgical Unit is in the older building and a new Out-Patient Department was opened in May 1998.

Westmorland General Hospital

This hospital was opened in 1991 on the southern outskirts of Kendal to serve a population of approximately 97,000. The area covers a wide rural district from Langdale in the North, Grange-over-Sands in the West and Dent and Sedbergh to the East. (see later section on facilities at W.G.H.)

Furness General Hospital

This 419 bedded District General Hospital opened in 1984 and serves a population of approximately 110,000 based in the Furness peninsula and is situated on a green field site on the edge of Barrow in Furness.

Regional Services

The specialties of Neurosurgery and Plastic surgery are based at the Royal Preston Hospital (23 miles away), although out-patient sessions are held locally. Emergency Cardio-thoracic Surgery is based at Blackpool Victoria Hospital.

THE ACCIDENT DEPARTMENT

The Accident Department at the Royal Lancaster Infirmary sees 38,000 new patients a year with a seasonal variation.

This Centenary Building which opened in January 1996 includes a purpose built Accident and Emergency department. In addition to the usual facilities it has an overhead X-ray gantry in the Resuscitation Room and a designated eye room with slit lamp. There is no short stay ward.

NEW PATIENTS ATTENDING R.L.I. A&E

The department is equipped to receive patients who are critically injured from the South Lakes area as well as the Lancaster District. There is 24hr Reception cover.

There are 3 stretcher bays in the resuscitation room and 10 cubicles in the main A&E area. There is one A&E theatre used for suturing and sedative procedures. There is a designated decontamination room.

There is a separate waiting area for children and a designated children's treatment room.

There are two Review Clinics per week held in the adjacent orthopaedic out patient department. Daily Dressing Clinics in A&E are staffed by the department.

Equipment in the department includes:

• 5 Propaq Monitors (incl. Pulse Oximetry, E.C.G. & non-invasive B.P.)
• 2 Propaq monitors with end tidal CO2,
• 1 Propaq monitor with invasive B.P. monitoring
• 1 Transpac Ventilator
• 2 defibrillators including external pacing facility
• Carbon Monoxide breathalyser
• Wall mounted ophthalmoscopes and auroscopes in cubicles
• There is a Modem/Computer link via the NHS net to the Edinburgh Poisons Unit.

Computerised A&E System

The department was a pilot site for the Regional ACT Medisys Unix Computer Software (now Isoft) which has been operational since July 1992. The development of this system has improved the capability to audit both nursing and medical activity. The medium term plan is to develop an Electronic Patient Record System.

PERFORMANCE INDICATORS FOR ROYAL LANCASTER INFIRMARY

Initial Assessment by a nurse is performed within 15 minutes in 94% of new patients and over 50% of new patients are seen by a doctor within 30 minutes.

A National A&E performance target is that “By March 2004 no one is to wait more than 4 hours in an A&E department from arrival to admission to a bed in the hospital transfer elsewhere or discharge. The average length of waiting time in the department (arrival to discharge) should fall to 75 minutes.” In 2002 51% of our patients were discharged within 75 mins.

PERCENTAGE OF PATIENTS DISCHARGED WITHIN 75 MINUTES OF ARRIVAL

PERCENTAGE OF PATIENTS DISCHARGED OR ADMITTED WITHIN 4 HOURS OF ARRIVAL

The Audit Commission Report on Accident and Emergency October 2001 No.2 provides comparative performance for all A&E departments across the U.K.. Internet:
www.audit-commission.gov.uk

The A&E department at the Royal Lancaster Infirmary compares favourably with other sites.
http://www.doh.gov.uk/performanceratings/2002/d_102.html

CLINICAL AUDIT & STANDARDS

The Clinical Effectiveness Committee of the BAEM has drafted a set of clinical standards based on good practice and supported by various Royal college recommendations as well as documents such as National service Frameworks. The department is auditing certain ‘sentinel’ diagnoses and then comparing performance against both National and local standards.

Many of the above issues need some clarification, but these results form the basis for on-going audit, monitoring & teaching. Further explanation & discussion can be found in the A&E ‘Annual report’.

As well as co-operating in Regional Audit studies the department is also involved in the UK TARN trauma study.

KETAMINE

The department has led the U.K. in the use of Ketamine in sedation of children prior to suturing. Two research papers have been published and a series of 500 cases was presented at the 9th International A&E Conference in Edinburgh June 2002 and at the Faculty Meeting in November 2002. More information about ketamine is to be found on our Web Site.

The procedure is only performed by middle grade doctors and Consultants.

TEACHING

There are 12 formal all day Wednesday teaching sessions for the S.H.O.s during the first 3 months of each 6 mth cycle. Thus this is equal to one session a week over the whole 6 month post. SHOs from Barrow and Lancaster attend these sessions.

S.H.O.s are encouraged to attend the Regional A&E induction weekend course at Bolton and the Soft Tissue Injury Course at Oldham.

Nursing Staff are taught to suture, cannulate and plaster in the department and there are daily afternoon teaching sessions.

There is a departmental book and video library. CD Roms are accessed via the departmental computer.

The A&E department of the Royal Lancaster Infirmary has been approved by the University of Manchester for the teaching of medical students in their 3rd and 4th years whilst doing Special Study Modules. In 2003/4 the department will instead have a regular attachment of 5 final year Liverpool medical students. These attachments will last 8 weeks throughout their final year.

There is a very active Education Centre with library adjacent to the Royal Lancaster Infirmary where regular meetings are held. A new Education Centre will be opened in Autumn 2003.

MANAGEMENT

An A&E Directorate structure was introduced in October 2002.

The A&E departments have responsibility for separate A&E budgets.

Clinical Director A&E - Dr.Ray McGlone
Directorate Manager - Ms.Cathy Tite
Lead Nurse - Vacant

There is a weekly Thursday morning departmental meeting and a monthly Thursday across Bay Directorate meeting held at Kendal.

STAFFING

MEDICAL STAFF INCLUDE -

Consultant Dr.R.McGlone – Lead Clinician
Consultant Dr.R.Odes (locum)
Consultant New Post
Consultant New Post
Staff Grade Dr.S.Sivakumar
Staff Grade Vacant
1 SpR Manchester Rotation

-plus 3 additional clinical assistant sessions to cover teaching / audit on Wednesdays and Thursdays.

There is an arrangement in place for South African A&E Consultants to rotate to the Trust on a regular basis from the Johannesburg and Capetown areas.

6 Senior House Officers Band 2A (prospective cover).

Two S.H.O.s are on a G.P. vocational scheme and two on the Basic Surgical Training Scheme. One post a year (February) is on the Anaesthetic Regional Training Scheme.

MIDDLE GRADE COVER

The full rota is available on the website. The following shows the Middle Grade cover for evenings and weekends:

The Registrar works 1 in 4 weekends and the Staff Grades works 2 sessions each Saturday and Sunday on a 1 in 4 basis.

The establishment of a 4th A&E Consultant post is in preparation for the full Liverpool allocation of final year students in 2005 of up to six students in each group

NURSES

1 H Grade
2 G Grade
8 F Grade,
8.1 E Grade
11.49 D Grade

This Nursing compliment includes plaster nurses / technicians.

Total 32 W.T.E.

ADMINISTRATIVE SUPPORT

1 Full time Secretary,
1 Part-time Ward Clerk
9 (WTE) Receptionists (including 1 "Scale 4" Senior Receptionist).
Reception staff also have responsibility for orthopaedic out-patients.

(WTE = Whole Time Equivalents)

PARAMEDICS AND FLYING SQUAD

A new "Flying Squad" vehicle is stationed outside the department available to attend serious trauma, primarily for patients trapped in vehicles. The on-call A&E Consultant is the team leader of the Flying Squad.

Cumbria paramedics and local Lancashire crews have mobile phones and notify the department for stand by cases on a designated wall phone in A&E. Local Lancashire crews have the facility to transmit 12 lead E.C.G.s to the department.

Ambulance Paramedics from Cumbria attend the department regularly for training purposes.

All splints in the department are standardised with equipment on the Ambulances such as cervical collars, traction and vacuum splints. The A&E Consultants are on the Paramedic Advisory Committees for Lancashire and Cumbria.

MINOR INJURY UNIT - WESTMORLAND GENERAL HOSPITAL KENDAL

Westmorland General Hospital is part of the Morecambe Bay Hospitals NHS Trust and has close links with the other 2 hospitals in the Trust, namely the Royal Lancaster Infirmary 23 miles to the south and Furness General Hospital, Barrow 25 miles to the west. This unit sees 18,000 new patients a year.

It is a 236 bed hospital on the southern outskirts of Kendal which opened in 1991. It serves a resident population of approximately 97,000, in an area covering the South Lakes and parts of North Lancashire, North Cumbria and North Yorkshire.

The hospital has 50 beds for General Medicine, a 4 bed CCU, 54 Acute Geriatric beds and 34 beds for Rehabilitation. There are also beds covering General Surgery, Urology, Trauma and Orthopaedics, Obstetrics, Gynaecology and a 6 station Renal Dialysis Unit. Also situated on site are a 12 bed Day Case Unit covering Surgical Specialities and Endoscopy, 3 Day Hospitals (for the Elderly, Adult Mentally Ill and Elderly Mentally Ill), 3 Operating Theatres and an Emergency Room for Obstetrics. There are also 47 beds for the Acute Mentally Ill managed by The Bay Community Trust. N.H.S. DIRECT is based in the hospital.

A full range of support services including on site Pathology, Pharmacy, Clinical Investigation, Rehabilitation etc. are also available.

It has a first class Education Centre and unrivalled modern residential accommodation for junior medical staff.

The GP Co-operative is based on-site 2200-0800 hr within the Minor Injury Unit. It is based in the Out Patient department in the early evenings and at the weekend.

There is no 24 hr anaesthetic cover, no emergency surgery and no paediatric beds. In view of this the Cumbria Ambulance service is supplied with a protocol to limit the range of ambulance cases presenting to the unit. Hence Major Trauma is diverted to the main unit at Lancaster.

There is a review of the Minor Injury service in progress. The G.P. Co-op is likely to continue providing support to Nurse Practitioners overnight with a further restriction in the case mix of 999 ambulance cases attending.

The A&E Consultant will not have clinical liability for the service midnight to 0800 hr.

However the Primary Care Trust (PCT) have specified that there should be an increase in Consultant presence at the Unit primarily to provide further development and training for staff. It is envisaged that this commitment to WGH will rotate with other A&E Consultant colleagues on a yearly basis.

W.G.H. Minor Accident Unit

STAFFING

It is presently staffed by 4 full time staff grades (13 sessions). The rota allows for holiday entitlement and 10 study leave days per year. Two weekly Review Clinics are staffed by the Associate Specialist in Orthopaedics. Between midnight and 0800 am the unit is staffed by a nurse practitioner with a GP on-call.

Nursing Staff Establishment 16.26 WTE:

• 6.8 Nurse Practitioners
• 10.54 Nurses and support workers
• 1 Receptionist

PERFORMANCE INDICATORS FOR WESTMORLAND GENERAL HOSPITAL:

PERCENTAGE OF PATIENTS DISCHARGED WITHIN 75MINS OF ARRIVAL

The department was computerised from 1997.

PERCENTAGE OF PATIENTS DISCHARGED OR ADMITTED WITHIN 4 HOURS OF ARRIVAL

THE POST

The successful applicant would be expected to help maintain standards within the Department and provide guidance for the junior medical staff.

Consultants are expected to see new patients alongside the S.H.O.s and Nurse Practitioners when scheduled to work in the department on fixed sessions.

The successful candidate would be expected to perform administrative tasks e.g. checking positive X-rays results on patients with no follow up arranged, checking all blood, biochemistry and MSU results on discharged patients and assist in liaison with groups such as General Practitioners and the Ambulance Service.

He/she would be expected to assist with the teaching of the nurses, medical students and the junior medical staff. There is a departmental meeting in Lancaster every Thursday at 0900 hr.

The appointment will be for 11 sessions (Full time 6 fixed sessions and 5 flexible sessions), including two flexible sessions in recognition of the requirement for flexible cover and ‘out of hours’ intensity) as outlined below.

The on-call (1 in 4 cover) will consist of the following duties:

1. Trauma Team Leader
2. Available for Flying Squad (only when requested by the Ambulance Service via the A&E department). Average 1 call a month.
3. To respond appropriately to request for assistance from A&E staff.
4. Reciprocal telephone advice for the units at Lancaster, Barrow and Kendal.
5. Major Incident

The Consultant will be expected, once all 4 Consultants are in post, to work in the department every 1 in 4 weekends, for 5 hours each day (flexible hours) and 1 in 4 weekday evenings 1720-2200 hr. All Consultants and Staff Grades will be doing these anti-social shop-floor duties worked at a premium rate of 1.5. Weekends with no Consultant Sat/Sun presence on the shop-floor will either have a Staff Grade or Registrar or equivalent on duty.

• Review Clinic marked * and Fixed sessions are marked in bold type. Sessional time off in lieu of working time regulations should be taken during flexible sessions and recorded by the Human Resources department.
• Any clinic sessions at WGH will be covered by Consultant line “C” when “A” is on holiday.
• To ensure equity the lines on the rota will rotate between staff on an annual basis

The rota will be reviewed at the end of 6 months by the Directorate.

When working flexible sessions (not including teaching / formal meetings) Consultants are expected to help on shop-floor if the waiting time exceeds 2 hours (Excluding Category Blue patients). If one refers to the graphs for waiting times one can see that prolonged waiting times are the exception on both hospital sites. However if this extra clinical work consistently exceeds one session on a weekly basis then the practice will be reviewed at Directorate level. The normal Trust Consultant contract is for 7 fixed sessions whereas this contract is for 6.

The funding body for this post (PCT) are expecting an increase in Consultant New Patient episodes and junior doctor supervised episodes.

Consultants will have 2 sessions off for on-call (11 session Consultant Contract). The Consultants will not be obliged to cover any other "shop-floor" weekend or evening sessions (i.e. replacing S.H.O. or middle grades on the rota) , however if he or she does then payment will be as agreed with the Medical Advisory Committee. The latter must be confirmed beforehand by the Chief Executive or Medical Director.

Annual Holidays are equal to 30 working days and Bank Holidays. Holidays should normally be agreed with colleagues and booked 6 weeks in advance. If a Consultant covers a colleague’s clinical duties on a day when he/she would be OFF they are entitled to a day off in lieu (to be recorded by Human Resources). Saturday and Sunday clinical fixed sessions cannot be taken as holiday, but instead must be swapped with colleagues. Lieu days should be taken within 2 months of accrual.

Consultant’s covering a Bank Holiday will spend one fixed clinical session in A&E on the R.L.I. site. He / she will be entitled to a day off in lieu.

DUTIES AT WESTMORLAND GENERAL HOSPITAL

The Directorate provides three Consultant sessions to supervise the Accident and Emergency services (Minor Injuries - EMAU) based at Westmorland General Hospital, Kendal. The successful candidate will provide this cover.

Duties 1 fixed session and 2 flexible to include –

• Development of Nurse Practitioner role in Unit
• X-ray digital link development / audit between 3 sites RLI / WGH / FGH
• Teaching of Nursing and Medical staff in hospital
• Lead on Audit at WGH EMAU
• On-going development of Departmental Manual (using clinical protocols as agreed by Consultant colleagues in Trust)
• Development of thrombolysis at EMAU
• Appraisal of Staff Grades
• Representation on the Cumbria Paramedic Steering Group. Involvement in paramedic training / assessment as organised by Cumbria Ambulance Service.
• Liaison for non-accidental injuries in children.
• Liaison with local GP Co-operative
• One clinical session Monday morning is fixed, however if the waiting time exceeds 2 hours the Consultant is expected to help seeing new patients when on flexible sessions.

There is no fixed sessional time for travelling. The successful candidate will be entitled to a Trust Lease Car if requested, in view of the weekly mileage from the Base Hospital at Lancaster.

The successful candidate accepts that he/she will occasionally be asked to perform duties at short notice if a crisis occurs.

COMMITTEE WORK

The appointee will be a member of the Medical Advisory Committee.

OTHER CONDITIONS OF SERVICE

1. There is an appendix to these particulars which gives general details applicable to all Consultant posts
2. The appointee will be required to live within ten road miles – or 30 minutes- of the base hospital (Royal Lancaster Infirmary), unless prior agreement is given in writing by the Medical Director.
3. Opportunities for clinical research exist at most hospitals. A great many projects are undertaken without the need for additional resources, but if funds are required for the purchase of special equipment of for temporary assistance with staff, financial support may be obtained locally, or, alternatively, applications for research grants may be made to the Trust through the clinical research advisory committee for short-term projects not exceeding three years.
4. Annual Leave
   A practitioner appointed to the grade is entitled to 6 weeks leave (pro rata).
5. Study Leave
   Subject to the Terms and Conditions of Service, the recommended standard is 30 days, including off-duty days within the leave period, in any period of three years (pro-rata). Continuing postgraduate education is encouraged.
6. Satisfactory heath screening assessment by the Occupational Health Department.
7. Satisfactory screening for criminal convictions.

VISITS

Arrangements to visit the hospital may be made with:

The Secretary
Accident & Emergency Department
Royal Lancaster Infirmary
Ashton Road
Lancaster
LA1 4RP
Tel: 01524-583004/2

To discuss the Job Description further please contact the Clinical Director, Dr.Ray McGlone on 01524 583516 or BT Bleep 07693 941009

The Chief Executive Mr Ian Cumming and the Medical Director Dr.David Telford are also contactable via 01539 795366

Visit our Web Site on:
http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm

PROTECTION OF CHILDREN ACT: DISCLOSURE OF CRIMINAL BACKGROUND OF THOSE WITH ACCESS TO CHILDREN

Candidates are requested to note that any person recommended for appointment in connection with this post will be required to give permission, in writing, for an appropriate check to be carried out.

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