MORECAMBE BAY
HOSPITALS NHS TRUST
JOB DESCRIPTION
CONSULTANT IN ACCIDENT AND EMERGENCY
BASE The Royal Lancaster
Infirmary
Contract for 11 PA’s
( 8 clinical & 3 supporting activities)
The Post Clinical duties at the Royal Lancaster
Infirmary and the Westmorland General Hospital
INTRODUCTION
This new post will increase the
complement of A&E Consultants based at the Royal Lancaster Infirmary from 3
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 40,000 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.
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
1 Blood Gas Analyser
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.
A Web
Page for the department has been developed accessed via the BAEM site http://www.baem.org.uk/aedepartment.htm
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 achieved at Lancaster was that “By March 2004 more than 94% of
patients are to wait less 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 2003 45% of our patients were discharged within 75 mins.
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
More statistics are
available on our Web Site.
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.
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.
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.
In 2004/5 the department will
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 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 - Ms Sally Young
There is a weekly Thursday
morning departmental meeting and a monthly Thursday across Bay Directorate meeting
held at Kendal.
Yearly appraisal will be done by
the Clinical Director for A&E (Trust Appointment).
STAFFING
Medical Staff include -
Consultant Dr.R.McGlone – Clinical Director
Consultant South
African Rotation (locum)
Consultant Dr.S.Schneidman
Consultant New Post
Staff Grade Dr.S.Sivakumar
Staff Grade Dr.T.Fleet
1 SpR Manchester
Rotation
1 SpR Manchester
Rotation
-plus 3
additional GP clinical assistant sessions.
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)
& 1 Junior Clinical Fellow
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:
Monday till 0200 hr Staff
Grade
Tuesday till 0200 hr Registrar
Wednesday till 0200 hr Registrar
Thursday till 0200 hr Staff Grade
1 in 2 Fridays till 0300 hr Registrar
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 and assistants.
Total 32
W.T.E.
Administrative Support
1 Full time Secretary,
1 Part-time Ward Clerk and
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 19,000 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.
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:
n 6.8 Nurse
Practitioners
n 10.54 Nurses and support workers
n 1 Receptionist
Performance Indicators for Westmorland
General Hospital
The department was computerised
from 1997.
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 clinical 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 PA
sessions (8 Direct Clinical Care and 3 Supporting Activity sessions) as
outlined below. 2 sessions are allocated for unscheduled emergency patient
care. The Clinical Director and the lead for Medical Student Education will
have less clinical and more supporting activity PA’s allocated.
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 to
work in the department every 1 in 4 weekends, for 6 hours each day (flexible
hours) equals to one PA a week. Weekends
with no Consultant Sat/Sun presence on the shop-floor will either have a Staff
Grade or Registrar or equivalent on duty.
|
ROTA |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|||||
|
New Post “A” |
WGH |
WGH |
OFF |
OFF |
OFF |
RLI* |
SA* |
SA |
RLI |
SA |
|
Dr.McGlone “B” |
OFF |
OFF |
RLI |
RLI |
SA |
SA |
OFF |
RLI* |
SA* |
RLI |
|
Existing Post “C” |
OFF |
RLI* |
SA* |
SA |
RLI |
SA |
RLI |
RLI |
OFF |
OFF |
|
New Post “D” |
RLI |
RLI |
OFF |
RLI* |
OFF |
OFF |
RLI |
SA |
SA |
SA* |
· SA* = Supporting activity at home
· RLI* = Plus
one session into evening (1500-2200) followed by On-call
· To ensure equity the lines on
the rota will rotate between staff on an annual basis
The Job Plan and rota is
reviewed on an annual basis and will change as more Consultants join the
department.
The funding body for this post
(PCT) are expecting an increase in Consultant New Patient episodes
(a minimum of 1,000 p.a. for each
individual) and junior doctor supervised episodes.
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 32
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 two fixed clinical sessions (6 hrs) 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 2 sessions–
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 the WGH out of
hours GP PCT service
Time spent in travelling to WGH
is counted towards Direct Clinical Care – 30 minutes each way. 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 The
appointee will be a member of the Medical
WORK Advisory
Committee.
OTHER a). There is an appendix to these
particulars
CONDITIONS which gives general details applicable to
all Consultant posts
OF SERVICE
b). 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.
c). 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.
d). Annual Leave
A practitioner appointed to the
grade is entitled to 6 weeks leave or 32 working days plus lieu days (pro
rata).
e). 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). Up to 6 days are also allowed to teach on
advanced life support courses. Continuing postgraduate education is encouraged.
f). Satisfactory heath screening assessment by the Occupational Health
Department.
g) 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.baem.org.uk/aedepartment.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.