CONSULTANT IN EMERGENCY MEDICINE 2 POSTS 11.5 PA

JOB DESCRIPTION & BACKGROUND INFORMATION CONSULTANT IN EMERGENCY MEDICINE 2 POSTS 11.5 PA (Recruitment incentives may be available) based at the NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 1

INDEX Page The North Middlesex University Hospital NHS Trust 3 Introduction to the Department 5 Current Department Medical Staffing 5 Duties of the Post 7 Indicative Job Plan 7 Clinical Governance 9 Teaching 9 General Information /Conditions of Employment 10 Person Specification 13 2

THE NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST North Middlesex University Hospital NHS Trust is a single site, medium-sized hospital, located in Edmonton and is the local acute hospital for the boroughs of Enfield and Haringey. We provide high quality care across a full range of secondary care services and some specialist tertiary services that reflect the needs of the local population we serve. Over 3,000 staff work at the hospital and well over 2,000 patients use our services every day. After a period of major transformation, more than 90% of our clinical services are delivered from buildings that are either new or refurbished over the last 5 years. Implementation of the Barnet, Enfield and Haringey clinical strategy has resulted in a 20% increase in patient numbers, particularly in ED, paediatrics and maternity services. However, we also know there is still much to be done and we are determined to continue to improve the care we provide and our patients experience of our care. We are also changing the way we work together as a team. This year we have taken the opportunity to refocus our attention on our most important asset, our staff. We have established new staff values and are working hard to grow them. We have started to develop new staff training and learning opportunities, and we have created a range of exciting new events and activities for them. We know that by making the hospital an even better place to work, we can help our staff provide even better care for patients. Whatever your involvement with our hospital, thank you for taking the time to read our annual report and for your continued interest and support. The hospital has been on its present site for over 100 years and we were established as an NHS Trust in law by means of a statutory instrument in December 1990. We provide services in collaboration with a range of partners, including local GPs, acute, mental health and community health service providers. We are a founding member of University College London Partners, working to adapt academic and laboratory research to enable improved clinical outcomes for our patients. We also work closely with a number of universities to provide training for doctors, nurses and other healthcare professionals as part of both undergraduate and post-graduate programmes. Other key figures are: A&E attendances 178,863 Outpatient attendances 320,206 Admissions 74,543 Operations / procedures 36,065 Babies born 5,090 Approximate average daily patient numbers using the hospital s services are now as follows: 500 patients in A&E 450 inpatients on our wards 50 patients undergoing major or minor surgery 900 outpatients attending clinics 200 women attending maternity clinics 15 babies born in our maternity unit And in addition we provide approximately: 400 X-rays and radiology tests 500 blood tests. Income: 244m 3

Executive Officers of the Trust: Chief Executive Libby McManus Medical Director - Dr Catherine Cale Director of Nursing Deborah Wheeler Chief Operating Officer (Interim) - Eileen Doyle Director of Strategic Development - Richard Gourlay Director of Finance David Stacey Director of Human Resources Helen Rushworth CBU 1 Management Team: Clinical Director - Dr Turan Huseyin (from 27 06 2016) CBU 1 and 2 Managing Director (Interim) Patricia Dunsmore CBU 1 Operational Manager Mark Claydon CBU 1 and 2 Head of Nursing - Anna Langthorne CBU 1 Deputy Head of Nursing Christine Kerr Matron for Emergency Medicine Gemma Davis 4

INTRODUCTION TO THE DEPARTMENT North Middlesex Emergency Department was visited and assessed by NHS England, Health Education England and the GMC, and had an in-depth inspection by CQC in September. By the end of 2016: The CQC gave a Good rating for Leadership and Caring. The department was assesses as being well led and the level of care patients received was good. The CQC recognised that many improvement programmes were underway and the department was much better in many areas when compared to earlier visits Health Education England provided praise for turning around the training experience received by juniors. The juniors would now recommend the ED for training to their fellow colleagues The Emergency Department at the North Middlesex University Hospital has an annual attendance of 180,000 new patients. There is a significant trauma workload; consequently there is an active Trauma Team. The department receives nearly 40% of its workload as ambulance borne. The brand new state of the art, purpose built air-conditioned unit comprises of a 6-bay resuscitation unit, 8 streaming rooms, a separate see and treat area, a 12-bay majors area, a 12-bay minor unit and a separate paediatric unit and waiting area. There is also a 48 bedded Acute Medical Unit in close proximity to the department. Current Department Medical Staff Consultants 14 Consultant Team Dr Turan Huseyin Dr Vijay Kumar Mr A Alkhamesi Mr D Sharma Dr C Pearce Mr K Alam Mr R Rajarajan (Locum) Dr Mashhood Ul Haque Qazi Dr Adrienn Fricska-Nagy Mr Arunachalam Sathyanandha (Honoury) Dr Sathiya Rajaraman (Locum) Dr Ashfaque Sorathia(Locum) Dr Andrea Annoni (Locum) Dr Gayle Hannah Special Interests Clinical Director Undergraduate Education Lead Major Incident / Rotas Trauma Lead / Ultrasound Governance and Safety Lead / Clinical Tutor Paediatric Resuscitation Pre-hospital/Trauma Newly appointed Risk management Audit Paediatric Consultant Trauma/Child protection Other Medical Staff: 1 Associate Specialist 2 Specialty Registrars (ST4-6) 16 Clinical Fellows/Specialty Doctors (Middle Grade, Registrar equivalent) 7 CT1 & CT2 (ACCS) (GPVTS) 12 FY2 10 Trust SHO 2 Clinical Assistant sessions 5

Key Nursing Staff (or AHP): Deputy Head of nursing 1.0 wte Band 8b Matrons 2.00 wte Band 8a ENP 10.00 wte Band 7 Practice & Development Practitioner 1.00 wte Band 7 Sisters 11.00 wte Band 7 Staff Nurses 21.00 wte Band 6 Staff Nurses 22.78 wte Band 5 Health Care Support Workers 5.24 wte Physician Assistants 2 wte Band 2 Non-Medical Staff (Support Staff) Reception and Bed Bureau: Senior Team Leader 1.00 wte Admin & Clerical 11.25 wte Data Quality Assistant 1.00 wte Department Secretarial Support 2.00 wte There is an emergency Radiography Department adjacent to the ED which is staffed 24 hours a day. There is a CT scanner available at all times with excellent consultant based radiology support. Full emergency laboratory facilities including a well-resourced point of care testing room are available. An Acute Assessment Unit (AAU) is located alongside the ED. Administration The Hospital Consultant body meets monthly as the Medical Staff Committee to discuss issues affecting the Medical Staff as a whole. All consultants are expected to participate in the management of their own department and the hospital as a whole, and will be encouraged to develop their management and leadership skills. There is a monthly consultant departmental meeting and CBU1 performance review meeting, quarterly audit, mortality and morbidity meetings chaired by the lead consultant. The post holder is expected to attend quarterly patient safety and quality (PSQ) meeting. Services & Facilities The Emergency Department at the North Middlesex University Hospital has an annual attendance of ~180,000 new patients. 27% of attendances are under the age of 16. The post holder will be required to play an active role in the development of all of our services. She/he will be required to work closely with their other colleagues in providing clinical cover for annual and other planned leave within the department. There is a significant trauma workload; consequently there is an active Trauma Team. The department receives nearly 40% of its workload as ambulance borne. The department has a philosophy of comprehensive patient care where the initial management of the patient is undertaken in the ED and the patient then handed over to in-patient teams. There is an excellent relationship with the in-patient teams with seamless referrals. The case mix has the highest acuity in the North East Thames region with preponderance towards medically unwell patients. Major Incident Plan There is close co-operation between the Ambulance, Fire, and Police in the area. The major incident plan is routinely updated. Ambulance Training The Emergency Department is served by London Ambulance Service. Paramedics from the services update their training in the department. 6

CONSULTANT DUTIES A formal job plan will be agreed between the appointee and their clinical manager in line with the Job Planning Guidelines in force in the Trust. Once agreed with the clinical manager, job plans are finally signed off by the Medical Director. An indicative job plan for this post is provided below which will normally be reassessed after 3 months of appointment to ensure it meets the needs of the service. The philosophy of this department is to provide a high quality service to all patients presenting to the Emergency Department. The North Middlesex University Hospital Trust wishes to ensure a consultant presence on the shop floor for as much as the time as resources reasonably allow. At present, we provide consultant presence from 8am to 11pm. The consultants will provide clinical leadership and supervision allowing proactive quality service provision and development, ensuring an efficient and low risk service to patients and a pleasant and integrated working environment. The aim is to provide a 14 person consultant rota, with additional support from paediatric, medical and surgical specialties as required. The hospital is currently engaged in system wide improvement programme Safer, Faster, Better which is aimed at improving flow throughout the hospital and patient care in the emergency department. The workstreams encompass the ED, inpatient flow and discharges and social care. Consultants are encouraged to develop a special interest, and support will be provided to develop this. Indicative Job Plan The Trust is committed to recruit to a 14 person rota. Until all consultants are in post, additional PAs will be offered to consultants or shifts will be filled by locums or offered to existing post holders to ensure good levels of cover for evenings and weekends. The department will have on site consultant cover from 8 am until 11pm each day. See end of Job Description for the schematic breakdown of the job plan (page 14) Direct Clinical Care (DCCs): Shop floor presence This job plan sets out to provide a physical consultant presence out in the clinical arena of the Emergency Department. Each consultant will ensure clinical leadership and support to the departmental and other specialty staff as well as taking on their own patient workload. They will maintain and improve quality of care delivered to patients and guarantee the efficiency of the department. There will be a consultant present on the shop floor from 0800 hours until 2300 hours Monday to Friday and from 0900 hours until 2300 hours Saturday and Sunday Clinical administration and shop floor back up each consultant requires clinical time to undertake clinical administration and to ensure a quality clinical service in times of need. Overall weekend frequency equals 1 in 7 therefore will attract 5% oncall allowance Number of weekend days worked in 52 weeks will be 15 (ie 7.5 weekends) Supporting Professional Activities (SPAs): Delivery of the highest quality service possible is the main priority of this department. This means integrating evidence based practice, research, audit and other aspects of clinical governance particularly the delivery of quality training and exceptional risk management. There are endless areas for service development and requirements for working with all health care professionals and specialties. In accordance with Trust Guidance (agreed with the LNC) each consultant has 1 SPA for CPD, appraisal and their own professional needs. Up to 1.5 additional SPAs are available for work which supports the department/trust and must be 7

agreed with the Clinical Director as part of the job planning process. All SPAs should be delivered on site unless specifically agreed in advance. On Call and Internal Cover: Each consultant will be expected to provide an on call commitment to the department. Whilst on call the consultant must remain contactable at all times and be prepared to give advice on clinical and managerial issues as required by the hospital staff. The consultants must always be prepared to return to the department whilst on call for pressing clinical issues in accordance with escalation policy. The request for a consultant to return to the department should only be made for clinical reasons and is in line with the College of Emergency Medicine recommendations. There will be continuous on call cover from 2200 hours to 0800 hours Monday to Friday (1600 hours to 0800 hours when evening shifts not worked due to leave) and from 1500 hours to 0800 hours Saturday and Sunday. Internal cover between the consultants will be provided for all clinical shifts between 0800 and 1600 hours and for all on call periods. The department must always be able to access the services of one of the emergency consultants. Total Hours, Monitoring and Future Working: Based on the above working pattern each new consultant post will attract 11.5 PAs per week and a band A supplement (5%). Each successful applicant will share an office with a fellow consultant and be supported by the secretarial pool based in the department. General Responsibilities as Consultant in Emergency Medicine The following is not an exhaustive or exclusive list of the duties of a consultant. The appointee is expected to: Provide senior clinician services to the Emergency Department as per job plan or as agreed within the Trust, and as required when on call. Provide clinical leadership to the department when undertaking clinical care, taking lead clinical responsibility as rostered on a day to day basis. Work with consultant colleagues and nursing staff to ensure efficient use of Trust s resources and contribute actively to clinical governance in the department and to development of quality enhancement projects in the unit. Show flexibility and undertake different appropriate clinical tasks within allocated DCC sessions after discussion with the clinical manager, as the need arises. Actively participate in the Unit s Teaching Programme and undertake supervision, teaching and training of medical trainees and other multi-professional staff, in line with guidance from the relevant Royal Colleges or specialty bodies. Actively participate in clinical guidelines development, audit and CPD. Clinical Governance This appointee is expected to contribute actively to improving clinical governance in our department. The GMC s Good Medical Practice guidelines form the basis of the responsibilities and standards expected of the Trust s consultants. All newly appointed consultants will be issued with an Induction Programme, all aspects of which are mandatory. Training is available for mandatory skills such as Diversity Awareness and Fire drills. It is a condition of employment that all staff have a responsibility for Infection Control. The appointee will therefore be expected to attend mandatory Infection Control courses on appointment and to participate actively in measures designed to reduce Health Care Associated Infections (HCAIs) under the Saving Lives programme. The appointee will be expected to fulfil the relevant Royal College s requirements for Continuing Medical Education (CME) or Continuing Professional Development (CPD) as a minimum. The Trust supports the 8

requirements for Continuing Medical Education as laid down by the Royal College of Physicians and is committed to providing time and financial support for these activities. The Trust considers the development of Clinical Guidelines and Protocols as the foundation of evidencebased medical practice. All consultants are therefore expected as part of their SPAs to regularly develop and update clinical guidelines within their specialty that meet NICE or other peer-body guidance, and to audit their practice according to such guidelines or protocol. There is a Consultant Lead for Clinical Guidelines and Audit across the Trust and a dedicated Clinical Services area on the Trust Intranet where clinical guidelines are uploaded by specialty. The Trust has an Audit and Clinical Effectiveness Manager and an IT Developer who both work with the Guidelines Lead to support consultants. Teaching The North Middlesex University Hospital has a reputation for teaching excellence in the region, helped by a rich variety of clinical cases. Formal teaching sessions are organised in various departments. These include weekly sessions for FY1, FY2 and CMT trainees as well as afternoon sessions for GPVTS. There is a weekly department academic meeting held jointly with the diabetes and endocrine team and a weekly medical grand round. Undergraduate Education As a University hospital of the University of London, the hospital has a substantial commitment to training of medical students from the University College London (UCL) Medical School, and is one of the two centres outside the teaching hospitals for UCL Final MBBS examinations. Many consultants are recognised teachers of UCL. Medical students of St. George s University International School of Medicine in Grenada also attend for varying periods in different specialties. GENERAL INFORMATION & CONDITIONS OF EMPLOYMENT The post is covered by those terms and conditions of service of Consultants 2003 (England) which are appropriate to the Trust. The Trust may, however, introduce future changes in standard terms and conditions of service after negotiation. All local policies and procedures apply. The appointment is super-annuable under National Health Service regulations, unless the successful candidate chooses to opt-out of the scheme. Employees of the Trust are expected to maintain a safe working environment and observe obligations under organisational and departmental Health & Safety Policies, maintaining awareness of safe practices and assessment of risk. Employees of the Trust are required and expected to acquaint themselves of all the Trust policies that are relevant to their area of work. The operative policies at any time are available on the Trust Intranet. 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. All medical staff practising in the Trust should ensure that they are familiar with the procedure and apply it. All Consultants have a continuing responsibility for the care of patients in their charge and for the proper functioning of their departments. They are required to undertake the administrative duties associated with the care of their patients and the running of their clinical departments. The Consultant will be expected to attend meetings of the appropriate department and Clinical Business Unit as required. All Consultants are expected to assume responsibility, both singly and corporately, for the management of junior medical staff. In particular, they are expected to be responsible for approving and monitoring junior staff rotas and junior staff locum arrangements, where appropriate. They are also expected to concern themselves with the professional development, both clinical and personal, of their trainees. 9

All consultants are required to participate in the Trust s annual appraisal and job plan review process. Job Plan Guidance has been produced following negotiation with the LNC to guide the process. Job Plans will list all NHS duties of the Consultant, the number of programmed activities and agreed supporting resources. Job Plans may only be changed with the agreement of the Trust. Consultants will be offered the opportunity to participate in a mentor programme to support their development. Where you intend to undertake private professional services other than such work carried out under the terms of this contract, whether for the NHS, for the Independent sector or for another party, the provisions in Schedule 6 of the Terms and Conditions apply. Reference should be made to the Code of Conduct for Private Practice which sets out standards of best practice governing the relationship between NHS work, private practice and fee-paying sessions. Candidates unable, for personal reasons, to work whole time are invited to apply and will be eligible to be considered for the post. If such a person is appointed, modification of the job content will be discussed on a personal basis in consultation with consultant colleagues, the Clinical Manager and the Clinical Director. All applicants to any post within the Trust are required to declare any involvement, either directly or indirectly, with any firm, company or organisation that has a contract with the Trust. Failure to do so may result in an application being rejected or if it is discovered, after appointment that such information has been withheld, then this may lead to dismissal. Reimbursement of removal and associated expenses will be subject to agreement and in line with the Trust s Removal Expenses Policy. A satisfactory medical examination is a condition of employment for medical and dental staff in the NHS. Therefore, the successful candidate may be required to undergo such an examination. The appointee will be expected to provide cover for annual and study leave of his/her consultant colleagues. A copy of the Terms and Conditions Consultants (England) 2003 is available from: www.doh.gov.uk/consultantframework Annual Leave Annual leave is given in accordance with the Terms and Conditions of Service and the Trust Policy relating to Medical and Dental Staff. Whole-time Consultants are entitled to six weeks and two days leave a year (32 working days) if within 7 years of service, or 6 weeks and 4 days (34 working days) after 7 completed years of service. Annual leave for part-time staff is pro rata this whole-time amount. Consultants are expected to plan their annual leave well in advance so that their absence is not detrimental to the service. They should give no less than 6 weeks notice of intention to take leave. Study Leave Study leave is given in accordance with the Terms and Conditions of Service relating to Medical and Dental Staff. Consultants are currently entitled to assistance with expenses associated with approved study leave. It is the current policy of the Trust to assist consultants with reasonable fees and expenses associated with approved continuing medical education (currently up to approx. 600 per annum). Consultants are expected to plan Study Leave in advance so that their absence is not detrimental to the service. Rehabilitation of Offenders Because of the nature of the work of this post, it is exempt from the Section 4(2) of the Rehabilitation of Offenders Act (1974) by virtue of the Rehabilitation of Offenders Act (Exemption Order 1975). Applicants are therefore not entitled to withhold information about convictions including those which for other purposes are spent under the provisions of the Act and in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the Trust. Any information given will be 10

completely confidential and will be considered only in relation to application for positions to which the order applies. Criminal Records Bureau Posts are offered subject to satisfactory DBS clearance. Confidentiality You are required to maintain confidentiality of any information concerning patients, which you have access to or may be given in the course of your work. Personal Conduct All staff within the Trust are expected to treat other members of hospital staff with courtesy and respect. The Trust s rules and policies including the disciplinary procedure apply to all staff without exception. The attention of consultant medical staff is drawn to the GMC document Good Medical Practice. The Trust will take this into account when considering the conduct of medical staff in relation to any incident. Health & Safety Policy Employees must be aware of the responsibilities placed on them under the Health & Safety at Work Act 1974, to ensure that the agreed safety procedures are carried out to maintain a safe environment for employees and visitors. Security It is the responsibility of all employees to work within the security policies and procedures of the Trust to protect the patients, staff and visitors and the property of the Trust. This duty applies to the specific work area of the individual and the Hospital in general. All staff are required to wear official identification badges. Data Protection This post has a confidential aspect. If you are required to obtain, process and/or use information held on a computer or word processor you should do it in a fair and lawful way. You should hold data only for the specific registered purpose and not use or disclose it in any way incompatible with such a purpose and ought to disclose data only to authorised persons or organisations as instructed. Breaches of confidence in relation to data will result in disciplinary action. Equal Opportunities It is the aim of the Trust to ensure that no job applicant or employee receives less than favourable treatment on grounds of sex, race, colour, nationality or national origins and is not placed at a disadvantage by conditions or requirements that cannot be shown to be justifiable. To this end the Trust has an equal opportunities policy and it is for each employee to contribute to its success. Method of Payment Payment of salary is made into bank account/building society account by direct bank system. Details of a bank account or building society account will be required on the first day at work. There are no facilities for any other form of payment. ADDITIONAL INFORMATION Situated in Edmonton, North London with a multi-cultural community, the area provides a wide range of facilities and is close to the heart of London. On-site we offer subsidised car parking and restaurant facilities. Central London is easily accessible, with Liverpool Street and Kings Cross approximately 30 minutes away by public transport. 11

Road Access and Public Transport Situated on the North Circular Road, the hospital is within very easy reach of the M25, M1, A1, A10 and A12. The hospital is situated close to the residential districts of North London including Enfield and Winchmore Hill, which all have an excellent environment and schools. Silver Street main line railway station is a 5-minute walk away, with services direct to Liverpool Street Station and Seven Sisters underground Station. VISITS FOR APPLICANTS Intending applicants are welcome to visit the hospitals (at their own expense). Please contact Dr Turan Huseyin,Clinical Director, Dr Cathy Cale, Medical director or Eileen Doyle, Director of Operations on 020 8887 3004. Short listed candidates are encouraged to visit the hospital before being interviewed by the Trust s Advisory Appointment Committee. 12

PERSON SPECIFICATION CLINICAL DIRECTOR/ CONSULTANT IN EMERGENCY MEDICINE Requirements Qualifications/ Training Relevant Experience Skills & Abilities Essential Desirable Method of Assessment MB ChB or equivalent Registerable medical degree Full GMC Registration CCT or within 6 months of obtaining CCT or CESR ALS, ATLS, APLS/PALS provider status FRCEM or equivalent Training and experience in UK Emergency Medicine Operational experience of a Clinical Decision Unit Ability to work as part of multi-disciplinary team Commitment to continuous professional development Ability to work in Multidisciplinary teams Instructor status in one of the life support courses Experience in service transformation Education Application form Application form/interview Application form/interview Knowledge Evidence of participation in audit Application form/interview Other requirements Excellent communication skills, both oral and written in English, and an ability to relate to staff and patients. Ability to stay calm under pressure. Team player Ability to support and motivate staff during periods of pressure Application form/interview 13

Schematic for 11.5 PA Job Plan Hrs Pa Days worked PA Tally Propsective (x(52/42)) Divide by 14 (1 in 14) DCC 5pm-7pm 2 0.50 5 2.50 3.10 0.22 Mon-Fri On call 1 in 14 commitment. The on call person will work weekday 7pm-11pm 4 1.33 5 6.67 8.25 0.59 shop-floor DCC 5pm-11pm and weekend 4pm-11pm. They would be Sat & Sun 4pm-11pm 7 2.33 2 4.67 5.78 0.41 expected to stay until the department is safe. This will be 2.14 PA 3hrs extra 11pm-2am 3 1.00 7 7.00 8.67 0.62 prospectively covered. The DCC allowance for on call includes 3 Total Pas 1.84 hours per night on call for late finishes/ unpredictable work. Add bonus on-call supplement 0.30 Total Pas 2.14 DCC 1 in 14 commitment for a 2nd consultant at the weekend to work a shopfloor DCC 9am-4pm. This would be prospectively covered by the team 0.41 PA Sat & Sun 9am-4pm 7 2.33 2 4.67 5.78 0.41 DCC 1 in 14 commitment for a 2nd consultant weekdays to work a shopfloor DCC 2pm-10pm. This would be prospectively covered by the 7pm-10pm 3 1 5 5.00 6.19 0.44 2pm-7pm 5 1.25 5 6.25 7.74 0.55 0.99 PA Mon-Fri Total Pas 0.99 DCC 1 PA per consultant for administration responsibilities 1.00 PA DCC Mon-Fri Shop floor DCC not prospectively covered by team (~16hrs per week) between 4.46 PA Mon-Fri 18 8am-7pm Allows two 8hr shifts per week and will allow third 8hr shift every 4 weeks SPA Includes 1 PA for revalidation purposes 2.5 PA Total 11.5 PA 14