UNIVERSITY HOSPITALS OF LEICESTERNHS TRUST

TITLE OF POST: ACUTE CARE COMMON STEM SPECIALTY TRAINEE

University Hospitals of Leicester NHS Trust, Northampton General Hospital NHS Trust and Kettering General Hospital NHS Trust

University Hospitals of Leicester NHS Trust is the lead trust for recruitment to this post.

Job Description-University Hospitals of Leicester NHS Trust

The post is aimed at developing common competencies for a trainee with an interest in an acute medical specialty i.e. Acute Medicine, Emergency Medicine or Anaesthesia.

At the end of these posts, the ACCS trainee will be able to compete for posts in their chosen specialty at ST3 level.

Continuation in post is subject to satisfactory assessments and appraisals and achievement of competencies by the successful applicant.

The post consists of:-

6 months Anaesthesia 6 months Critical Care Medicine.6 months Acute Medicine.6 months Emergency Medicine.

The successful applicant will be expected to indicate their preferred future parent specialty at the time of application i.e. Anaesthesia, Acute Medicine or Emergency Medicine.

There will be regular appraisals and assessments during the post. Failure to make satisfactory progress may result in termination of contract.

All appointments are made to the Leicester groups of hospitals, which are the Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital.

The trainee will be based mainly at the Leicester Royal Infirmary but may be required to work as allocated to any of the above hospitals.

Remuneration will be at the ST1 level and band according to the relevant rota worked. Applicants should note there is no banding payment at the Leicester Royal Infirmary as there is no on-call commitment.

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Basic Specialist Trainee in Anaesthesia - 6 monthsClinical - Dr B T Ayorinde/Dr B Cagney

Trainees with no previous anaesthetic experience will work for three months under the direct supervision of a Consultant or until such time as they have achieved their initial test of competencies and assessments. Failure to achieve the required level will delay progression. Persistent failure will lead to a performance review.

Trainees will be introduced to daytime emergency work and will be accompanied by a consultant throughout the first 3 months. The degree of supervision after passing the initial competency test will depend on the level of competence of the trainee and the complexity of the case.

Preoperative assessment of all elective cases on your allocated list is mandatory at all the Leicester hospitals.

Competencies

The trainee will be expected to gain competencies in pre-operative assessment, basic airway management, fluid management, acute pain management and management of the immediate post-surgical patient in the Post-Anaesthesia Care Unit (PACU). It is also expected that by the end of the post, the trainee should be able to administer an anaesthetic to ASA I and II patients.

A training folder with full details of the required competencies, appraisals and assessments will be issued at the commencement of duty.

Teaching/Audit

There will be a regular post-graduate teaching programme for which the trainee will be released from clinical commitments. There are regular bi-monthly audit meetings in the department. The trainee will be expected to participate in audit and complete one audit project during the post.

Administration

This will take place in the anaesthetic department at the Leicester Royal Infirmary. All enquiries should be directed to Ms Elaine Sheppard. Telephone: 01162587235.

Basic Specialist Trainee in Critical Care Medicine - 6 monthsClinical Supervisor- Dr J Parker/Dr JMC Greiff

Prior to commencing this attachment the successful applicant will be given a CD with the relevant information regarding the Intensive Care Unit at Leicester Royal infirmary. It contains all the basic information required re:core skills and competencies required. A formal induction will be given together

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with a test on the information contained in the CD. Competency assessment, an education plan and appraisal will form part of this attachment. It is expected that the trainee will obtain competencies relevant to a six month attachment at ST1 level as set out by the Intercollegiate Board of Intensive Care Medicine.

Skills

Genericarterial and central venous accessinsertion of thoracic draininsertion of oro- or naso- gastric tube

Specificrecognition of the critically ill patientinsertion of transvenous pacemakerinsertion of oesophageal Doppler probeultrasound visualisation of main veinspercutaneous tracheostomyfibreoptic bronchoscopic clearance of sputumperitoneal lavageset up ventilator for adult suffering from severe ARDSassist in prone positioning patientassist in weaning patient from IPPV via assist/CPAP

Attitudes and behaviour

An awareness of the importance of communication skills and interpersonal relationships will be expected Obtaining consent / assent for procedures in the critical care unitBreaking bad newsRequesting post mortem investigationExplaining need for unexpected / early dischargeIntroducing the concept of organ donation

Workplace training objectives:

There will be variation in the experience and degree of competence that individual trainees will achieve in this initial period of ICM training. However, for example, they should be able to admit and manage a patient who has undergone major emergency for instance in vascular surgery or to admit and organise the early management of a patient suffering from severe respiratory failure complicated by acute renal failure.

The post will be based at the adult Intensive Care Unit at the LRI which has 15 beds.

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Teaching/Audit

There will be a regular post-graduate teaching programme for which the trainee will be released from clinical commitments. This includes regular tutorials on the ICU. There is a weekly journal club which takes place on Tuesday afternoons in the anaesthetic department.

There are regular bi-monthly audit meetings in the department. The trainee will be expected to participate in audit and complete one audit project during the post.

Administration

This will take place in the anaesthetic department at the Leicester Royal Infirmary. All enquiries should be directed to Mrs. Sarah Turner, Anaesthetic Secretary. Telephone: 01162586174.

Basic Specialist Trainee in Emergency Medicine - 6 monthsClinical Supervisor- Dr P Mukerjee

The post will be based at the Emergency Department at the LRI, which incorporates:

6 Resuscitation bays 22 Trolley bays Majors area 3 Ambulance assessment bays Minors with 10 cubicles 2 see and treat rooms Fully functioning separate Pediatric E D 16 bed Emergency decisions unit

The Leicester Royal Infirmary has the only Emergency Department serving the county of Leicestershire and is the busiest in the country, treating over 135,000 patients a year. One quarter of whom are paediatric. We also operate a pre-hospital 'flying squad’.

Competencies

The trainee will be expected to gain competencies in line with the College of Emergency Medicines curriculum for the MCEM examination

Teaching/Audit

An induction course consisting the fundamentals of emergency care is delivered daily for two hours a day during the first three weeks. Thereafter teaching is provided by regular lunchtime meetings. Appointees will have full access to the departmental library in our purpose built seminar room.

Participation in audit is expected of all appointees

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Administration

The standard working week will be on a full shift system. The duties will be those normally expected in a busy Emergency Department, and closely supervised by the Middle Grades and Consultants. The department benefits from 24-hour middle grade cover.

These appointments are confined to The Leicester Royal Infirmary, but may occasionally involve visits to any of the Wards and departments including Intensive Care.

5 days of study leave is incorporated in the base rota. Further study leave will be granted on a case-by-case basis.

Annual leave is allocated in advance and any special requests need to be notified to the department well in advance. Subsequently periods of leave may be swapped by mutual consent. Leave is not permitted during the induction period.

Basic Specialist Trainee in Acute Medicine - 6 monthsClinical Supervisor- Professor B Williams or a Member of the Consultant Core Team

The post will be based on the Acute Medical Unit at the LRI, which is a dedicated and progressive unit that provides comprehensive experience in the assessment and clinical management of Acute Medical Emergencies.

During the six months attachment to the AMU, the trainee will work based on AMU as part of a clinical team comprising of Foundation Doctors, Specialist Registrars and Consultants and will participate in the on call rota with direct supervision being provided by members of the Consultant AMU team.

Duties will include; assessment of patients, clerking, day-to-day care of Adult Emergency medical admissions and ward rounds.

Competencies

The trainee will be expected to gain competencies in procedures relevant to the assessment and clinical management of acute medical emergencies consistent with the competency level previously associated with SHO years 2 to 3.

A training folder with details of the required competencies and expectations will be issued upon commencement of post and a Consultant mentor from the AMU core team will be allocated for formal appraisal during the post.

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Teaching/Audit

There is an active post-graduate teaching programme in Leicester for trainees to which the trainee can apply to attend and would be released from clinical commitments if cover is available.

There is a regular AMU Case Presentation meeting, which takes place on Monday’s and a weekly journal club, which takes place on Thursday’s.

The trainee will be expected to participate in an AMU-based audit project whilst working on the unit.

Administration

Administration duties will include discharge summaries, and other duties as and when required

About University Hospitals of Leicester NHS Trust

University Hospitals of Leicester NHS Trust comprises of three acute hospitals based in Leicester:-

Glenfield Hospital, Leicester General Hospital and Leicester Royal Infirmary.

The three hospitals joined together to form the Trust on 1st April 2000 to meet the increasing demands for providing better healthcare. The Trust is one of the largest acute teaching hospitals in the United Kingdom, with nearly 10,000 staff and an annual operating income of over £400 million.

The importance of working with patients and the public is paramount to the strategy of continuing to improve healthcare services. The Pathway project is a major PFI scheme costing over £400 million and is due to be completed in 2010.

Glenfield Hospital is situated about three miles north west of Leicester city centre. The hospital has around 520 beds and over 2100 staff providing a range of in-patient, day case and outpatient services within the specialty groupings of Orthopaedics, Critical Care and Theatres, Cardiac Services and Integrated Medicine.

Within Cardiac Services the Rapid Access Chest Pain Clinic, providing specialist cardiological assessment for suspected cardiac pain, has been awarded ‘Beacon Site’ status by the National Health Service (NHS).

Leicester General Hospital is situated approximately three miles east of Leicester city centre and offers a range of in-patient, day case and outpatient services across the specialties of Medicine, Nephrology, Obstetrics and

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Gynaecology, Surgery, Anaesthesia and Clinical Support Services. Leicester General Hospital has approximately 680 beds and over 2700 staff.

Leicester Royal Infirmary is located close to Leicester city centre. The hospital has over 1100 beds and over 5300 staff and provides the only Accident & Emergency service. The main specialty groupings at the hospital are Medical, Obstetrics and Gynaecology, Surgery, Children’s Hospital, Clinical Diagnostic Services, Cancer Services, Theatres and Critical Care and A & E / Orthopaedic Trauma.

The Hearing Services Department (Surgical Directorate) at Leicester Royal Infirmary has been awarded two Charter Marks in 1996 and 1999, for delivering excellence in public service.

Clinical

University Hospitals of Leicester NHS Trust is one of the largest acute teaching hospitals in the NHS and the largest provider of acute healthcare in Leicestershire, with close relationships with the University of Leicester and DeMontfort University. A number of specialties have a national and international reputation for their ability to provide specialised or unique clinical services. Clinical research has won recognition for contributions to advances in clinical knowledge and practice.

Investment into the state of the art clinical equipment and major initiatives to improve quality of service ensure that services are more accessible and convenient to patients.

further information can be obtained via our website at: www.uhl-tr.nhs.uk

University of Leicester, School of Medicine

Dean designate: Professor David Wynford-Thomas, MB BCh, PhD, DSc, FRCPath, FMedSci (from 1 October 2008)

As part of the School of Medicine’s commitment to the maintaining and improving on its existing high standards of research and teaching, it carried out an extensive and successful restructuring process in 2003. The five substantial academic departments are defined primarily by their research interests and span the traditional clinical subject areas. They are Cancer Studies and Molecular Medicine (Head: Professor W P Steward); Cardiovascular Sciences (Head: Professor N J Samani); Health Sciences (Head: Professor R H Baker); Infection, Immunity and Inflammation (Head: Professor P W Andrew); and Medical and Social Care Education (Head: Professor S Petersen).

These Departments bring considerable intellectual resources to bear on a range of vital medical challenges and reflect the priorities of the National Health Service. They provide a stimulating environment for research and

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study at all levels, and offer a wide range of opportunities for professional training and development.

In addition to the departments there are clinical divisions, which bring together clinical academics from cognate clinical specialties, and whose role is to co-ordinate links with NHS colleagues, the Royal Colleges and postgraduate medical education.

Conditions of Service

These are in accordance with the Terms and Conditions of Service of Hospital Medical and Dental Staff (England and Wales). This is a whole-time appointment.

The successful candidate as part of the East Midlands (South) Training Programme will be contracted by the individual Trusts at which he/she will work. As a consequence he/she is expected to be aware of local policies and procedures and take note of the standing orders and financial instructions of those authorities.

Annual Leave

The annual leave entitlement for this post is five weeks per annum and will be calculated pro-rata.

Study Leave

Study Leave is granted in accordance with the recommended allowance subject to the maintenance of the service and to prior approval by the Director of Postgraduate Education at the appropriate administrative trust.

Study leave is defined as leave taken to attend a formal course of study designed to further the employees career and to enable the employee to obtain his/her professional qualification or gain necessary expertise in order to carry out his/her job. Where ever possible employees should attend courses organised within Trent Region.

Salary

The StR (CT) salary scale is at present £28,976 per annum progressing by annual increments to a maximum of £38,336 per annum, in accordance with the current nationally agreed salary scale.

As this post does not have a specific set rotation, in line with the NHS Employers Interpretation of pay protection the postholder will receive confirmation of the terms and conditions of service (including banding supplement), only after a specific post has been allocated to the post holder. The banding supplement payable to the postholder will be the pay band applicable to the rota at the time when a specific

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post is allocated. Pay protection will not be applied from date of appointment.

Accommodation

The University Hospitals of Leicester NHS Trust is extremely short of married accommodation, and this cannot be guaranteed. Please contact the Accommodation Officer for further information.

Maintaining Medical Excellence

The Trust is committed to providing safe and effective care for patients. To ensure this, there is an agreed procedure for medical staff that enables them to report quickly and confidentially, concerns about the conduct, performance or health of medical colleagues (Chief Medical Officer, December 1996). All medical staff, practising in the Trust, should ensure that they are familiar with the procedure.

CRB Clearance

This post requires a enhanced disclosure by enhanced criminal records certificates as this post is regulated by the Protection of Children Act 1999, The Criminal Justice Courts Act 2000 and / or the Care Standards Act 2000 and such other authority committed by statute.

Failure to disclose details if you are currently / or in the future are the subject of police investigation / proceedings which could result in a conviction, caution or bind over order is a disciplinary matter, and may result in dismissal.

Notice Period

The notice period for StR (CT) is one months notice on either side.

Removal Expenses

Hospitals on the East Midlands (South) Rotation operate their own policies for the re-imbursement of relocation expenses.

You should not commit yourself to any expenditure in connection with relocation before first obtaining advice and approval from the medical staffing department at your administering Hospital. Otherwise you may incur costs which you are unable to reclaim.

Medical Examination/Clearance

The appointment is subject to medical fitness and the appointee may be required to undergo a medical examination and chest x-ray.

Potential applicants should be aware of the Department of Health and GMC/GDC requirements with regard to HIV/AIDs and Hepatitis viruses.

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Health and Safety

The University Hospitals of Leicester NHS Trust recognises its duties under the Health and Safety at Work Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare at work of all its employees and, in addition, the business of the Trust shall be conducted so as to ensure that patients, their relatives, contractors, voluntary workers, visitors and members of the public having access to hospital premises and facilities are not exposed to risk to their health and safety.

The duties of this post may require the postholder to carry out exposure prone invasive procedures on patients of The University Hospitals of Leicester NHS Trust. In order to protect its patients from acquiring blood borne viral infections from staff it is required that the following conditions be met before appointment to the post is made:

1. The candidate must provide documentary evidence to the Occupational Health Service as part of pre-employment screening of immunity to Hepatitis B infection, either by immunisation or natural immunity. If the candidate is non-immune The University Hospitals of Leicester NHS Trust will require a blood test to be carried out for Hepatitis B antigen before appointment. The duties of this post are such that no Hepatitis B antigen positive candidate could be appointed.

2. Any appointee who is not immune to Hepatitis B, but is currently carrying out exposure prone invasive procedures, accepts that regular checks on Hepatitis B markers may need to be carried out by the Occupational Health Service appointed by The University Hospitals of Leicester NHS Trust.

The tests can be arranged, if the candidate agrees, in confidence through a local consultant microbiologist or the Occupational Health physician. All costs for testing will be borne by The University Hospitals of Leicester NHS Trust.

Infection Control

The prevention of hospital acquired infection is a vital concern for the Trust. Infections harm patients. Infections also harm the Trust. The post holder is required to ensure, as an employee, that his/her work methods do not endanger other people or themselves.

All staff must be aware of infection prevention and control policies and guidelines, and follow them at all times. Any breach of infection control policies is a serious matter and may result in disciplinary action.

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ACCS Rotation Northampton

Northampton General Hospital has one of the longest established ACCS rotations in the country. A critical care rotation was established which comprised EM, AM, Anaesthetics & ITU in a two year rotation in 2002; this was later converted into the ACCS training rotation. Trainees who have undertaken this rotation have all enjoyed their time at the hospital, developed excellent clinical skills, independent decision making and have secured the training posts of their choice at the end of their time here. The area and hospital

Northampton General Hospital NHS Trust serves a population of 350,000 in the area of Northampton and South Northamptonshire. This is one of the largest district general hospitals in the country. It occupies a large site in the centre of the town. There is an excellent recreation centre at the hospital for the use of staff. Facilities include a swimming pool, squash and badminton courts and other leisure amenities. The standard of staff accommodation in the hospital is good.

The Emergency Department

In the last twelve months the Department dealt with approximately 68,000 new attendances, children comprise approximately a quarter of total new attendances. Daily consultant review clinics are held. Staffing comprises 4 Consultants, 9 middle grade Doctors and 9 Junior doctors. The 9 middle grade Doctors provide 24 hour cover in the department. All doctors’ work a Band 1a rota. There is a highly motivated & skilled team of nurses and Emergency Nurse Practitioners (ENP).

An excellent weekly teaching programme takes place both for junior and middle grade doctors. Audit, teaching and presentations are encouraged from all doctors. The department is a happy place to work and juniors generally feel well supported.

Doctors in training from ACCS rotations & Emergency Medicine Specialist Registrars have much to gain from this department. Independent but supported decision making and practical procedures are encouraged. Senior trainees are given the opportunity to be involved in management activities and also have weekly timetabled non-clinical shifts, which include teaching in review clinics and time for personal study. Ultrasound Training started in 2008.

Anaesthetics and ITU

The ACCS anaesthetic/ITU year is split into 6 months general anaesthetics and 6 months ITU. The department is fully geared to training both ACCS and anaesthetic trainees. An initial 3 month fully supervised period is followed by gaining basic competencies. Once competent, the trainee will have the opportunity to become involved in the on call rota and do their own theatre

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lists (obviously supervised when appropriate). Teaching is usually 1:1 with a consultant plus a weekly departmental teaching programme. On ITU, the trainee will be involved in daily ITU ward rounds, cover the hospital cardiac arrest and trauma teams and have some involvement with the outreach team carrying out-patient assessments on the ward with a view to critical care support. There is ample opportunity to gain experience in central and arterial line insertion as well as many other core critical care skills.

Acute Medicine ACCS trainees spend their 6 month medical post split between working on the Emergency Admissions Unit and specialist acute firms. Trainees also work as part of the night team with training opportunities to raise their skills in the management of all acute medical emergencies. The Emergency Admission Unit has 28 beds with a 6-bed assessment bay for GP admissions. Links with the adjacent A&E help to streamline patient management. 

There is a well established Coronary Care Unit on the 28 bed cardiac ward. Elective angiography has been performed at Northampton for many years with the interventional work done at Oxford or Harefield. The opening of the new interventional cardiology unit at NGH will allow in- house Percutaneous Coronary Intervention (PCI) from summer 2008. A Rapid Access chest pain unit and chest pain nurses in A&E facilitate rapid assessment of cardiac patients and there are links with a nurse and pharmacist run heart failure team. There is ample opportunity for trainees to gain a wide range of experience in the management of cardiac patients with excellent training opportunities.Regular medical teaching takes place on Wednesday afternoons; the afternoon starts with a clinical meeting followed by a formal lecture for the next hour. There is then membership coaching at the level appropriate to the needs of the trainee. Attendance is expected at this meeting and presentations from trainees are an integral part of the clinical meeting. In addition there are fortnightly cardiology meetings run by the consultants and Specialist Registrars. There is also a regular MRCP Part I Teaching course and clinical teaching directed towards the clinical part of Part II occurs after the formal part of the academic afternoon. There is a good pass rate for PACES with 7 consultants who are active PACES examiners and the examination is held regularly at NGH.

Conditions of Service (please refer to pages 8&9)

University Hospitals of Leicester NHS Trust is the lead trust for recruitment to this post and will carry out all pre-employment checks

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ACCS Rotation Kettering

This post is an expansion to the ACCS rotation and will commence in August 2009.

Kettering General Hospital

Kettering General Hospital NHS Trust comprises some 591 beds and provides a comprehensive range of acute and midwifery services to the 260,000 people in the Kettering area. In addition, the Trust is responsible for the management of community midwifery services and provides a full range of acute outpatients clinics at peripheral hospital sites in Corby, Wellingborough and Rushden.

Kettering is located in a mainly rural area but, with the opening of the new A1/M1 link road, it has made Kettering increasingly attractive for light industry and distribution services. The industry is distributed between Kettering, Corby, Wellingborough and Rushden. With the new link road, Kettering lies within easy reach of several large towns, namely Leicester, Northampton, Cambridge and Peterborough.

The area provides schools of a good standard and there are ample leisure facilities within the Kettering area including a local golf course, squash club and a leisure centre.

TEAM CHART

Consultants: Dr J Luthman, Assoc Medical

Director Dr J C BurnellDr J FreemanDr E HadawayDr R N Moony

Dr J F Szafranski (Clinical Director)Dr L Twohey Dr R DravidDr L HollosDr A Bilolikar Dr S AgarwalDr N RobertsDr K SiddiquiDr D BlandDr A KoczorDr P WattDr N Dunk (College Tutor)Dr A Swami

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Associate Specialist: Dr K Shanmugadas

8 Staff Grades

6 Specialist Trainees (ST3)

9 Specialist Trainees (ST1&2)

1 FY2

STUDY/TRAINING

There are excellent library and postgraduate facilities on site and the librarian is able to borrow books extensively from outside sources as well as obtain access by computer searches of the medical literature. Audio-visual aids are available.

Anaesthetic tutorials and departmental meetings are held weekly. The hospital is recognised for basic specialist training. Trainees are expected to study for higher examinations.

Conditions of Service (please refer to pages 8&9)

University Hospitals of Leicester NHS Trust is the lead trust for recruitment to this post and will carry out all pre-employment checks

Common Stem JD December 2008

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