NWC2017.13 (Final) Job Description Consultant in General Adult Psychiatry (Central Locality) 10 PA CMHT post Substantive post 1
Greater Manchester Mental Health NHS Foundation Trust Background Greater Manchester Mental Health NHS Foundation Trust (GMMH) came into being on 1 st January 2017 as a new large organisation after the acquisition of Manchester Mental Health and Social Care Trust by the Greater Manchester West Mental Health NHS Foundation Trust (GMW). Prior to being awarded Foundation Trust status GMW was known as Bolton, Salford and Trafford Mental Health NHS Trust, which came into being in April 2003. Prior to this, those services had been managed within a mix of Community and Acute Trusts. The development of the Trust reflected the National and Regional expectation that mental health services were best managed and delivered through specialist mental health provider arrangements. In June 2016, GMW received a good rating from CQC. The GMW Trust achieved a fully integrated Health and Social Care Service across all three Local Authority areas for Adult, Older People and Substance Misuse Services. Since 2000, Manchester s secondary care mental health services were provided by a city-wide Mental Health Trust (Manchester Mental Health and Social Care Trust or MMHSCT). The Trust was co-terminous with the city of Manchester and provided services to a total population of half a million people. The Trust was established in 2001, and was one of only three in England which existed as an integrated Health and Social Care Trust, the others being Kent and Medway NHS Social Care Partnership Trust and Sheffield Health and Social Care Foundation Trust. Services were provided from three acute Trusts, North Manchester General Hospital, Manchester Royal Infirmary and University Hospital of South Manchester, as well as several smaller community bases. Services were commissioned jointly by the Manchester Clinical Commissioning Groups and the Local Authority (Manchester City Council). There were three GP commissioning groups for the city, with one of these (North CCG) providing a lead role in mental health. In April 2011, the Trust took over the provision of a range of primary care, prison health care and other community services for the city. The Trust was one of six key players in the Manchester Academic Health Sciences Centre and was the second most successful Trust in the UK for mental health Page 2 of 16
services research publications. It was also a leading provider of teaching and training in mental health at undergraduate and post-graduate level. The new Trust Greater Manchester Mental Health Foundation Trust (GMMH) therefore now provides a wide range of local services to Bolton, Salford, Trafford and the city of Manchester. In addition to its mainstream acute and community services, the Trust provides a range of innovative arts and rehabilitation services based around the principles of recovery, and is committed to models of partnership working with local voluntary and third sector organisations. The Trust also provides a number of specialist mental health services supporting all of Greater Manchester, the North West and beyond. These include Forensic Mental Health services, Substance Misuse services, Child and Adolescent Mental Health services, Mental Health and Deafness, Health and Justice providing a service into the prison estate in Greater Manchester and Lancashire, Specialist Psychological services providing services to veterans and supporting probation services, as well as perinatal services. The Trust has reconfigured its management structures into three directorates or networks managed jointly by an Operational Director and an Associate Medical Director supported by a senior leadership team. The management culture is that of a clinically led, operationally supported, academically informed management team. The three directorates are: Specialist Services; Bolton, Salford and Greater Manchester wide services; and Manchester, Trafford and Manchester city-wide services. Each Associate Medical Director is supported by a number of Lead Consultants. The current post supports North, South and Central Manchester Services as well as the Homeless Team and will come under the Manchester, Trafford and Citywide services Directorate. The City of Manchester (Fig 1) Manchester is a vibrant city with a wealth of nationally acclaimed museums, art galleries and theatres. The city is also known internationally for its music and sporting reputation, and for its shops, restaurants and lively night life. Page 3 of 16
Fig 1. City of Manchester There are many lifestyle options open to those living in the city, with city centre apartments, semi-urban areas with an arty student atmosphere and more developed suburbs with excellent schools and housing options. The city has an excellent transport network with motorways, rail and the International Manchester Airport linking it to many important cities and resorts. Road and rail links make it easy to get out into the fantastic surrounding countryside, with the National Parks of the Peak District, Lake District and Snowdonia all within easy reach. Cultural diversity Manchester is culturally diverse and we welcome applicants from a similarly diverse range of backgrounds to gradually shift the profile of our workforce to match the population we serve. There are localities across the city with large communities identifying themselves as of African, Caribbean, Chinese or Indian sub-continent ethnic groups as well as many smaller ethnic and national groups covering most of the main world religions. Page 4 of 16
As a result of this diversity there are thriving communities in many parts of the city with voluntary and community groups playing an active role in providing services. All consultants in the Trust will work with culturally diverse communities, but, in addition, development work with ethnic minorities and associated research programs may form part of job plans for some posts. Population information for Manchester While Manchester is a well-developed and thriving city, it does have areas of significant deprivation and there is considerable inequality within the city as a whole. In addition, there are relatively high levels of homelessness, drug and alcohol use and other social problems associated with the inner city. Traditionally the Mental Health Needs Index (or MINI) has been used to predict population need for mental health services, taking account of measures of deprivation. The national weighted capitation formula gives a total Mental Health Needs Index for Manchester of 1.69 (where the ratio for England as a whole equals 1.00). On this measure, Manchester PCT ranks as having the fifth highest level of mental health need in England, behind Islington, Liverpool, City and Hackney, and Knowsley. In 2015 population was 530,330. People aged 16-65 counted approximately 377,752 (slightly more men than women). Services in Manchester are currently commissioned jointly by the PCT (NHS Manchester) and the local authority (Manchester City Council). There are three GP commissioning groups for the city, with one of these providing a lead role in mental health. Links with academic psychiatry The Trust is one of six key players in the Manchester Academic Health Science Centre. This is a formal relationship between the University and the Greater Manchester Teaching Hospitals to produce innovations in health research. Manchester University has a large research programme with strong links to GMMH Trust. There are many research programmes of international importance and there is a commitment locally to using research to strengthen local services. Page 5 of 16
Teaching and training The Trust is also a leading provider of both undergraduate and post graduate training. Medical students are attached to the Trust throughout the year for clinical, research and special study modules and all consultants are expected to contribute to the undergraduate teaching program. The Trust has a higher than average number of psychiatry training posts both at core and higher training levels and most of the consultants are supported in acting as educational and/or clinical supervisors. The Trust currently hosts Health Education North West previously known as the NW School of Psychiatry and several of the key training posts across the Region are held by consultants working in the Trust. Community Services Review The Trust is currently completing a major review of community services in the city of Manchester footprint. The existing Consultant Team as well as managers and members are being consulted upon improvements to the existing offering. This work will be on-going throughout 2017 and beyond and it is hoped the successful applicant will be actively involved in the consultation and eventual delivery of the improved model. There are currently 6 sectors, the majority of which are of roughly equal population size once deprivation is taken into account. Central East Consultant Psychiatrist This post is with the Central East Community Area Team and the office base is in the Rawnsley Building on the Manchester Royal Infirmary site. The new Community Area teams are accessed by a City-Wide Gateway Service which acts as the single point of entry for all new referrals to the Trust. Gateway can refer directly to Consultant Outpatient clinics as well as the Community Team. Once in the Community Team patients are assessed as part of the Intake function then allocated to active Treatment, Rehabilitation and Recovery, Review Team or Assertive Outreach pathways. Team members will have a case mix of patients in all these streams The Community Consultant will have all of these care coordinated patients on their case load. In addition the Consultant will carry an outpatient caseload for which they will be Lead Professional. The Trust has recognised that Consultants caseloads need review and reduction to maximise the best use of the medical workforce within Community Services. There is an active on-going work stream working to reduce caseloads and clarifying the role of the Outpatient clinic within the Trust. The current post holder Page 6 of 16
has initiated a Nurse Practitioner led clinic as part of these working practice reforms. Assertive Outreach Services are provided by the Manchester Engagement Team (MET) which also incorporates services for homeless patients and is a city-wide specialist service. Separate teams providing Early Intervention in Psychosis are in operation across the city and currently provide care for up to three years for any patient aged from 15 to 35, with a new episode of psychosis. These teams include 1.5 WTE consultant posts, and 2 WTE staff grade posts. The service is commissioned with a different provider (Rotherham, Doncaster and South Humber NHS Trust) but this will become fully incorporated into the newly formed GMMH from 1 st April 2017. There will be no upper age limit within the new service specification going forward. Current Model of working for community consultants Consultant input will be organised around community based clinics, team meetings and consultation, and time for home visiting. Decisions about which patients are seen for initial assessment by medical staff will be taken following discussion with the CMHT at weekly referral meetings. Where patients are seen initially by medical staff, it is anticipated that they will either be offered assessment, short-term intervention and discharge to primary care, or will be taken on by the CMHT for longer-term input. Where patients are under the care of the CMHT, medical review will be included as part of a comprehensive care package and according to individual need. Consultants will support other team members in assessing patients, and advising on their management. Consultants will also contribute to the leadership of the teams they work with. It is expected that all consultants will be active participants in activities which improve the performance of the community service in terms of quality, effectiveness and efficiency. CMHT catchment populations The catchment populations for the reconfigured community teams were originally mapped according to a new Mental Health Needs Index constructed by the Manchester Health Intelligence team. Where possible the teams were constructed to have roughly equal levels of morbidity adjusted need and hence provision of medical time was planned to be roughly equivalent for each team. The two exceptions to this are the North Mersey team (lower levels of need and hence resource) and the North West team (higher levels of need). The current vacancy is a full-time post within the Central East team, which already has one WTE substantive consultant in post. The catchment area for this post includes the following electoral wards: Longsight, Ardwick, N and S Gorton and Levenshulme. Page 7 of 16
CMHT staffing The Central East CMHT is based at the Rawnsley Building on the MRI site and is co-located with medical staff and secretaries. The team has one WTE team manager, 1.5 WTE senior practitioner, and approximately 13 care co-ordinators from a range of professions. The staff mix is around 50% nursing, 35% social work and 15 % occupational therapy posts. In addition there are 4 non-qualified support workers and 1.5 WTE admin worker. The total caseload for the team is approximately 450, with each care co-ordinator having a caseload of approximately 30 patients. The CMHT patients will be split between the two consultants according to the patient s GP. The Trust is reviewing separate out-patient caseloads, with a likely increasing emphasis on teamworking and the use of care pathways but for now the post holder will initially be responsible for an additional out-patient only caseload of around 220 patients. The post holder currently also has responsibility for a number of patients under the Review Team - patients in long term stable residential settings. Clinical duties The postholder will be responsible for assessment of up to 5 new patients per week, either directly or through supervision of junior doctors. All referrals are discussed first in the CMHT referral and allocation meeting (attended by consultants) in order to prioritise those requiring a medical assessment. The postholder will offer a range of opportunities for seeing follow up patients, via direct clinics, home visits organised by community staff, and CPA reviews. It is anticipated that there will be a total of 6 PAs per week of planned direct patient contact, to include assessment of up to 5 new patients and a total of 25 follow ups. Patients who are stable and under the care of the CMHT are booked for yearly CPA review and are otherwise seen at the request of the care co-ordinator as needed. This will allow capacity for more urgent reviews as needed. The consultant will be supported by a dedicated medical secretary and will have their own office within the Rawnsley Building. The consultant will have their own PC with IT support and access to the Trust s library and educational facilities. This includes a weekly postgraduate training programme and journal club. Junior doctor time has being reconfigured within the service with a priority given towards in-patient work, however this post is supported by a Staff Grade Locum with 0.5wte dedicated to this post holder s clinical work and 0.5wte to the other 1.0 WTE Consultant Psychiatrist. The Trust has well functioning Crisis Resolution and Home Treatment teams with separate medical staffing at consultant and middle grade. There will be access to a Page 8 of 16
Specialty Trainee for the sector to support urgent and Mental Health Act assessments, in addition to the city-wide on call rota. Indicative timetable AM 0900-13.00 PM 1300-17.00 Monday Tuesday Wednesday Thursday Friday 1 DCC Outpatient clinic* 1 to 2 pm 0.25 SPA/DCC Supervision of Staff grade/ Assistant Practitioner 0.75 DCC Outpatient clinic** 1 DCC Outpatient clinic * 1 DCC Outpatient clinic* 3out of 4 weeks) Monthly 1 SPA 3 rd Tuesday monthly including Community Consultants meeting ie equivalent of 0.75 DCC and 0.25 SPA 0.75 SPA Teaching and travel 0.25 DCC Liaison with CMHT 0.25 DCC Liaison with CMHT 0.5 DCC MHA work/complex reviews 0.25 SPA CPD 1 DCC CMHT Liaison and Central East team MDT and team support 1 DCC Emergency work and Home visits 1 DCC Outpatient clinic* 1 SPA Audit/clinical Governance Service Improvemen t work/cpd *1 new patient, 4 FU patients and clinical admin **4 FU patients and clinical admin Consultants will also participate in an on call rota 1:20. Regular activities will be cancelled when on call (equivalent to 2 weeks per year). Leave 6 weeks A/L, 2 weeks S/L. This timetable gives 5 PAs of booked direct clinic contact three out of four weeks; 1PA for CMHT meetings and support; 1PA for emergency clinical work and 0.5 PA for MHA work and complex reviews. SPA time is 2.25 PAs weekly plus monthly 1 PA equalling 2.5 PAs. Page 9 of 16
Other Services for Adults of Working Age The Trust provides in-patient facilities on open acute wards and Psychiatric Intensive Care Units (PICUs). Consultant cover for the in-patient units is not included in the Community consultant responsibilities, other than occasional cover for annual leave by arrangement. The Trust also has a well-developed urgent care system, with nurse-led A and E liaison services, two consultants in liaison psychiatry (Central and North Manchester sites) and Crisis Resolution and Home Treatment Teams (CRHT) at all sites. The CRHTs have dedicated medical cover at junior doctor, middle grade and consultant level and will support community services in dealing with any urgent or emergency assessments. The Trust also has a short stay assessment ward (SAFIRE) at the North Manchester site with dedicated medical input. Separate teams providing Early Intervention in Psychosis are in operation across the city and will provide care for up to three years for any patient aged from 15 to 35, with a new episode of psychosis. These teams include 1.5 WTE consultant posts, and 2 WTE staff grade posts. The service is commissioned with a different provider (Rotherham, Doncaster and South Humber NHS Trust) but is well integrated with MMSCT including use of the same IT system. The medical staff within this service are directly employed by MMHSCT. Other care groups Within the Older Adult provision there are well-developed in-patient and community services across sites, and an active academic and research profile in old age psychiatry. There are 7 WTE consultant posts in old age psychiatry plus core and higher training posts. There is a separate on call rota for old age psychiatry. Page 10 of 16
Other city-wide services in Manchester Service Psychotherapy Primary care mental health Psychology Perinatal service Specialist Affective Disorder Clinic Eating disorder service Prison in-reach Dual diagnosis Learning disability services Child and Adolescent Forensic Rehabilitation Description 3 consultants plus other therapists, DBT programme for Personality Disorders Currently being integrated into single management structure with CMHTs Well-developed services across the Trust Regional in-patient facility at Laureate House Out-patient perinatal advice Tertiary referral centre with University expertise on difficult to treat mood disorders Nurse led out-patient service 0.5 WTE consultant, plus staff grade and nursing input Specialist nurse liaison and Consultation Service. Partnership arrangement for consultant sessions with Calderstones Trust In-patient and community services on site. Commissioned directly with Central Manchester Foundation Trust Close links with forensic services and court diversion 2.5 WTE consultants across sites, providing input to several units and one in-patient rehab ward Characteristics of current post 1. Type of post This is a full-time post in general adult psychiatry working within the Central East locality/cmht. 2. Salary scale All posts within GMMH are on national terms and conditions of service. The nationally-agreed salary range under the consultant contract is 75,249-101,451 plus up to 9 local Clinical Excellence Awards. The starting incremental point will be decided by agreement based on prior experience at consultant level. Experience in other countries or in locum posts will be taken into account if evidenced wherever possible. Page 11 of 16
3. Base hospital The base hospital is Manchester Royal Infirmary with office space, secretarial support and clinics based at the Rawnsley Building. 4. Principal duties These are specified by programmed activity for the post. Clinical governance is referred to as CPD and Audit in GMMH job descriptions. Additional Clinical Governance aspects may occur in other PAs, but this session is committed to these two specific aspects. All full-time job plans have at least one programmed activity allocated to this. Management is covered by the term management and administration in GMMH job descriptions as programmed time is allocated for a broad range of activities not restricted to formal management roles. This includes the term Liaison (with other agencies) in terms of planning and developing services, but liaison about particular cases and clinical administration (Mental Health Review Tribunals for example) are considered as part of clinical PAs. All posts have a minimum of half a programmed activity for management and administration functions, but the allocation will be greater for posts carrying substantial management roles Education and training is covered by the generic term teaching in GMMH job descriptions to draw a distinction between receiving education and training (covered under CPD). Some posts take on an active leadership role in education (Site Tutors, Associate Medical Director for Medical Education etc.) and for these posts the agreed number of programmed activities for education and training may be higher. This can take a variety of forms including formal lectures, seminars, critical appraisal PAs, problem-based learning, examination practice, examining, preparing teaching material, appraisal, etc. Most consultants with a trainee doctor will act as clinical supervisors and expected to provide clinical supervision as part of their DCC allocation. Where a consultant is an educational supervisor, they will be expected to provide educational supervision as part of Supporting Professional Activities Sub speciality work is defined in all job descriptions where appropriate, and there is at least one flexible clinical PA which can be used for service development or, by agreement, sub-speciality work. 5. Number of Programmed activities As stated above, the programmed activities commitments are defined in terms of 2.5 Supporting Professional Activities (SPAs) and 7.5 Clinical Professional Activities (Clinical PAs) for all whole time posts plus on-call. For part-time posts, Clinical PAs and SPAs are offered on a pro-rata basis. 6. Provision for leave Page 12 of 16
The postholder will be entitled to 32 days a year of annual leave increasing to 34 days after seven years service, plus bank holidays, and up to 10 days of study leave per year. Consultants are expected to provide prospective cover for colleagues leave by prior arrangement, usually one consultant colleague at a time with reciprocal arrangements. 7. On-call commitments For adults of working age, consultant on call is based on a city wide rota with an approximate frequency of 1 in 2 for full-time consultants. During the working week each on call period is for a full 24 hours, from 9am, apart from Fridays which are 9am to 5pm with a separate Consultant on 5pm Friday to 9 am Saturday. The weekend on call runs from 9am Saturday to 9am Monday. All on call periods are supported by a middle grade Section 12 doctor, who is expected to undertake the majority of face to face Mental Health Act work out of hours, and by a junior doctor on call at each in-patient site. 8. Management arrangements Line management for this post will be from the Lead Consultant for Central Community services currently Dr Rosemary Clarke and Operationally responsible to ACSI Directorate lead Ms. Ilsa Finigan. 9. Specific requirements There are no additional specific requirements for the post. Holding a valid, current driving licence is desirable, but it is not a requirement, allowing those with a visual, motor or other disability to apply for the post. Consultants can live at any distance from the base hospital by agreement but typical off-peak travelling time should be within approximately 30-40 minutes. 10. Approval of posts The substantive post was previously approved and agreed with the Chair of the Medical Staff Committee for the former MMHSCT and agreed with the Regional Advisor. Page 13 of 16
GENERAL INFORMATION Main Conditions of Service Salary and Terms and conditions of employment are as laid down in the National Agreements for Consultants in the NHS. The successful candidate will normally be required to live within 10 miles of their base. The appointee will be responsible to the Chief Executive, Ms Bev Humphries who is advised by the Acting Medical Director, Dr Margaret Campbell. Community Services currently lie within the Adult Community and Social Inclusion Care Group in the Manchester arm of the newly formed Greater Manchester Mental Health NHS Foundation Trust. The new Trust (GMMH) managerial structures are being implemented in the coming months but immediate line management of the post holder will come via the Lead Community Consultant, currently Dr Rosemary Clarke. The Trust is fully committed to the continuous professional development of all consultant staff, and to this end adequate study leave and funds will be made available to support the individual s professional development, as approved by their peer group. All Consultants are therefore required to register and participate in CPD. Consultants are expected to attain and maintain good standing with the Royal College regarding CPD. The Trust supports consultants taking on external duties for example work for the Royal College of Psychiatrists (with prior agreement from line manager) The Trust has a robust Clinical Governance Programme, which includes clinical audit. All Consultants are required to participate in this programme. All Consultants are expected to undergo annual appraisal and job planning. Job planning is usually conducted by the Lead Consultant, and appraisers are chosen from a Trust pool of suitably trained consultants. It is expected that a job review will take place within six months of the appointment of a successful candidate. The appointment is subject to satisfactory medical clearance. Trust Policies and Procedures All medical staff employed by the GMMH are expected to comply with national guidelines, statutory requirements and the Trust s policies and procedures. Availability of Post The post is available with immediate effect and on completion of all satisfactory pre-employment checks if successful following interview. Contact for more information and visits Further information may be available from NHS jobs using reference number: Page 14 of 16
For viewing please contact: Dr Rosemary Clarke, Lead Consultant: rosemary.clarke@mhsc.nhs.uk Ms Ilsa Finigan, Director Adult Community and Social Inclusion Ilsa.Finigan@mhsc.mhs.uk Dr Margaret Campbell Acting Medical Director Ilsa.Finigan@mhsc.mhs.uk Page 15 of 16
Personal Specification CRITERIA ESSENTIAL DESIRABLE CV/ Intervie w Qualifications Training & Experience Teaching, Audit and Research MBChB, MBBS or equivalent Full GMC registration Registration as Specialist with the GMC Registration as Approved Clinician or eligibility to become one Successful completion of higher specialist training in psychiatry or equivalent or within 3 months of completion. Current and relevant knowledge of the principles of General Psychiatry Registered for CPD. Experience of/commitment to undergraduate and postgraduate learning and teaching Ability to critically appraise published research Evidence of audit competence Ability to understand and interpret current evidence in general adult psychiatry and research experience To understand the need to safeguard children and vulnerable adults and to adhere to all principles in effective safeguarding MRCPsych or equivalent On the Specialist Register for General Adult Psychiatry Clinical Experience in a setting working in a multi-cultural, multiethnic setting Experience in management roles Must be in Good Standing for CPD Understand principles of teaching Publication of an audit project Published research Presentation at regional or national conferences CV CV CV CV/I/R CV/I/R CV/I CV Page 16 of 16