Consultant Physician Care of the Elderly and General Medicine in the Community

Consultant Physician Care of the Elderly and General Medicine in the Community Two posts Clinical Lead of Adult Medicine for West Kent Locality Research Lead for Kent Community Health NHS Trust

Overview Kent Community Health NHS Trust (KCHT) has established a consultant-led Enhanced Rapid Response Service, which is funded by West Kent Clinical Commissioning Group. This innovative approach has enabled a significant shift in the complexity of care that can be appropriately managed in the community across all care settings. The Enhanced Rapid Response Service provides care 24-hours-a-day, seven days-a-week, including access to community hospitals. If successfully appointed to one of the two newly created posts, you will have the opportunity to develop and grow the scope of the service, alongside clinical managers. This expanding medical department is embedded in, and supported by, a multi-disciplinary working environment. To be successful you will need to be a consultant in care of the elderly medicine and able to demonstrate effective multidisciplinary team working. Experience of community working would be an advantage. Although these are full-time posts, applicants wishing to work part-time will be considered, including those within four months of obtaining their CCT (NEED TO SPELL OUT WHAT THIS IS). For candidates expressing interest and with appropriate experience, the Trust would like to nominate one of the new appointees as clinical lead of adult medicine for west Kent locality and the other as research lead for the Trust. Vision Our vision is to be the provider of choice by delivering excellent care and improving the health of our communities. We aim to achieve the best outcomes for our patients and to deliver care as close to home and support patients independence for as long as possible. We will strive to provide all community services at the highest calibre and build on our established rehabilitation strengths. We will demonstrate progress by delivering against our business objectives and strategic goals: To prevent people from dying prematurely by improving the health of the population through universal targeted services. To enhanced the quality of life for people with long-term conditions by providing integrated services to enable them to manage their condition and maintain their health. To help people recover from periods of ill health or following injury through the provision of responsive community services. To ensure that people have a positive experience of care and improved health outcomes by delivering excellent healthcare. To ensure people receive safe care through best practice. Our vision for this exciting service is that we will achieve real change in the way patients are cared for, keeping people in their own homes for as long as possible and that Kent Community Health NHS Trust can lead this by working closely with our partners and become the lead provider for services across Kent. Values and behaviours KCHT has a set of values and behaviours to improve the experience for our patients and our staff and this has been developed into a Values into Action framework. This means that the successful candidates are expected to, at all times, behave in a way that demonstrates commitment to delivering thoughtful patient care and continuous improvement: Caring with compassion. Listening, responding and empowering. Leading through partnerships. Learning, sharing and innovating. Striving for excellence. 2 3

Who we are Kent Community Health NHS Trust provides wideranging NHS care for people, in their community, in a range of settings including people s own homes; nursing homes; health clinics; community hospitals; minor injury units; a walk-in centre and in mobile units. KCHT is one of the largest NHS community health providers in England, serving a population of about 1.4 million. It employs 5,500 staff, including community nurses, physiotherapists, dietitians and many other healthcare professionals. It was formed on 1 April 2011 from the merger of Eastern and Coastal Kent Community Services NHS Trust and West Kent Community Health. It spans Kent and provides services in East Sussex and London. It has an annual budget of 215million. KCHT has 283 beds in community settings across Kent. In west Kent, there are 80 beds in four community hospitals. There are a further 22 beds at Maidstone and Tunbridge Wells NHS Trust s site in Maidstone, for rehabilitation, which are managed by KCHT. Management arrangements Kent Community Health NHS Trust is managed via a structure of corporate directorates and two operational directorates adults and children. These roles sit in the adults operational directorate, which has four localities: West Kent; Dartford, Gravesham and Swanley and Swale; South Kent Coast and Ashford, Canterbury and Coastal and Thanet. Each locality is led by a community services director. The head of service for operations provides operational leadership. Each service is managed by a matron. These roles sit within the Enhanced Rapid Response Service. West Kent Clinical Commissioning Group (CCG) commissions all services in the west Kent locality. 4 5

National direction Role description These two new consultant posts will support development of the Enhanced Rapid Response Service (ERRS) for west Kent. National direction was set out in the Health and Social Care Act 2012. This is translated operationally into NHS Operating Framework. Much direction is determined at a local CCG level. Key challenges have arisen, particularly centred on quality, safety, productivity and whole systems issues, focused around: the Francis Report productivity challenge to save 20 billion by 2014 Quality, Innovation, Productivity and Prevention (QIPP) management of long-term conditions and increasing need of elderly frail people. In addition, there are specific directives which outline the need to reduce hospital admissions and reduce stress on accident and emergency services. This is a newly expanded and highly innovative KCHT service, following significant investment by West Kent Clinical Commissioning Group. The Enhanced Rapid Response Service comprises a wide ranging multi-disciplinary team, with consultants and specialty doctor medical grades, enhanced nursing roles, paramedic practitioners and allied health professionals providing a high level of skill and care management in the community. The ERRS enables patients with increasing complexity to be cared for and remain in a community setting. The service is expected to manage patients with conditions such as those in the following list, which is by no means exhaustive, and to keep them at home: cellulitis not responding to oral antibiotics and needing IV antibiotics UTIs without sepsis, but causing other morbidities like falls or acute confusion patients fit for discharge but needed IV antibiotics respiratory problems, such as COPD and asthma exacerbation acute heart failure (mild to moderate) 6 7 falls dementia crisis acute confusion gastroenteritis with mild to moderate dehydration hypoglycaemia in patients on insulin frail elderly with acute loss of self independence or mobility due to any minor illness acute urinary retention palliative or end of life care with acute deterioration individual experiencing a sudden level of reduced mobility and ability to self-care individual recovering from injury or surgery patients with high-level tube feeding needs beyond the scope of the regular community nursing team. To enable this, the ERRS has access to an expanding array of near patient testing, together with the ability to administer home IV drugs acutely. However, it will be more than simply a hospital replicated in the home through integrated multi-disciplinary, multi-agency working across long-term conditions, including patients with dementia and increasing frailty and through development of comprehensive anticipatory care plans. You will join an expanding medical team, including the Trust s Medical Director Dr Peter Maskell and Dr Bruce Pollington. You will mainly work in west Kent. The consultant team sits managerially in the Enhanced Rapid Response Service and is professionally managed by Dr Peter Maskell. The roles will be linked to the consultant team at Maidstone and Tunbridge Wells NHS Trust to support professional development and networking.

The investment by the clinical commissioning group and KCHT reflects the shared goal to improve services for older people by providing access to specialised geriatric medical expertise in the community. This is an increasing resource that will develop in time and, as early additions to the team, you will help develop the future vision for medical input into community services. Working in the community, you will be part of a multi-disciplinary team and will provide expert medical advice to: community care doctors modern matron enhanced nurse practitioners community nurses intermediate care teams GPs. You will see patients and support staff to enable comprehensive geriatric assessment and improve the care of frail older people wherever they live in west Kent. The goal is to identify, prevent and manage complex health problems nearer to patients or in patients own homes, reducing unnecessary emergency admissions and helping with an early return to the community from hospital. The Enhanced Rapid Response Service aims to provide comprehensive geriatric assessment for frail elderly people in the community, linked to four community hospitals. It has operational bases in Coxheath and Tonbridge, where daily multi-disciplinary meetings are held. There are 80 beds in the four community hospitals at Sevenoaks, Edenbridge, Tonbridge and Hawkhurst. They act as community rehabilitation and as step-up beds for the Enhanced Rapid Response Service. You will be responsible for patients transferred in to the community hospitals by the Enhanced Rapid Response Service. Specialty doctors from the Trust, from the neighbouring acute trust and via direct arrangements with local GP surgeries support this. There will be ward rounds to support these arrangements. Patients transferred into the community hospitals, under the Enhanced Rapid Response Service, are discussed at the daily multi-disciplinary meeting in Tonbridge or at Coxheath. Job plan and timetable You will have a range of responsibilities. The following job plan reflects our best assessment of what the final plan will be, based on 10 PAs. Any consultant who is unable, for personal reasons, to work fulltime will be eligible to be considered for the post on a part-time basis with the Trust, in consultation with consultant colleagues. The job plan will be devised to allow the successful candidate to pursue sub-specialty, for example in the acute setting and/or to participate in acute on-call as part of a stroke or general medicine on-call arrangement. These working arrangements will be negotiated between trusts. Community-based sub-specialty activities are also encouraged, such as falls or frailty/dementia service. In a 10 PAs job plan all consultants receive 1.5 SPAs to include activities supporting professional development and to meet the requirements of revalidation. Study leave is additional to these SPAs. Additionally, within the 10 PAs job plan it is envisaged that one successful candidate would receive a further one SPA as research lead for the Trust and the other candidate, depending upon experience, would receive a further one SPA as clinical lead of adult medicine for west Kent. As the service model develops and the scope of activities are embedded as part of the job planning process, there may be flexibility between DPA/ SPAs for educational activities for a range of staff in the community. This will be agreed, as necessary, on a year-to-year basis. 8 9

Draft job plan In this context, community ward rounds will include community hospitals and patients on the community virtual ward, for example at home and in care homes. The term sub-specialty has been used to reflect time for activities which may include post take ward round with the acute trust if this is agreed, in ether general medicine, care of the elderly or a sub-specialty, such as stroke service. Equally it may reflect community-based activities, such as falls prevention. The following job plans are indicative only. This represents 10 PAs in total. 7.5 DCC to include 2.5 PAs, which comprises ½ PA for clinical admin, three x ½ PAs for MDMs and associated administration and ½ PA for family meetings. 1.5 SPA to support professional development and revalidation activities. 1.0 SPA for additional duties of either clinical or research lead and will include time for supervision of medical staff, leadership and teaching. Monday Tuesday Wednesday Thursday Friday AM Community ward round Sub-specialty activity SPA Sub-specialty activity Community ward round PM MDM and community ward round ½ clinical admin ½ SPA MDM and family meetings Additional SPA for clinical or research lead MDM and community ward round 10 11

Duties You will be expected to fulfil the following duties with the agreed job plan: On-call Acute take on-call activities are not a requirement of this post, however for candidates wishing to continue with such activities, this may be arranged with the acute trust to compliment the role and may be reflected in the sub-specialty sessions of the job plan. The Enhanced Rapid Response Service is supported overnight and at weekends by a consultant phone advice service. This rota is arranged with the acute trust and is by separate arrangement. It is likely that the successful candidates will join this rota with a frequency of 1:10-12. Generic clinical responsibilities Management of patients admitted under his/her care, together with consultant colleagues to ensure a comprehensive urgent service. Provision of reciprocal cover for periods of leave for domiciliary and community wards. The proper functioning of the clinical service. Management responsibilities Supervision of specialist grade doctors. Leadership for the service provision alongside managers. Administration. Teaching responsibilities Involvement and participation in teaching medical staff and other clinical staff, as required. Support development of career grade structure. Research, governance and audit Supportive of research. Actively involved in all aspects of clinical governance and audit with support from the Trust s Performance Team. Continuous professional development The Trust supports the requirements for continuing professional development as laid down by the Royal College of Physicians and is committed to providing time and financial support for these activities. Other duties as agreed with line management. 12 13

Administrative support Office accommodation and administrative support will be provided by the Trust, as will a PC/laptop with email and internet access. All consultants are required to regularly check their email. Mentoring A range of mentoring options are available within the Trust and externally. Revalidation The Trust has the required arrangements in place, as laid down by the Royal College of Physicians, to make sure that all doctors have an annual appraisal with a trained appraiser and supports doctors going through the revalidation process. A consultant may be allowed professional or study leave for approved post-graduate purposes, in line with national terms and conditions. This is subject to the need to maintain NHS services. Professional or study leave will normally be granted to the maximum extent consistent with maintaining essential services in accordance with recommended standards. The recommended standard for consultants is leave with pay and expenses up to a maximum of 30 days, including off-duty days falling within the period of leave, in any period of three years for professional purposes in the UK. Where leave with pay is granted, the consultant must not do any other paid work during the leave period without the employing organisation s prior permission. Workload figures The Enhanced Rapid Response Service is receiving in the range of 65 to 110 new referrals each week. Non-consultant grade staff The posts are supported by a team of specialty doctors working across the care settings. In the Trust, this stands at 4.2 WTE, which will be shared between the two posts. Professional standards The community services director is managerially responsible for all activity and personnel in the locality in which the consultant works. The modern matron/head of service is responsible for the Enhanced Rapid Response Service. The medical director has overall responsibility for the professional performance of consultants employed by Kent Community Health NHS Trust. 14 15

Conditions of service The successful candidates will be contracted to Kent Community Health NHS Trust. These appointments will be on the terms and conditions of the new consultant contract. Those appointed will be expected to adhere to local Trust policies and procedures and to take note of the standing orders and financial instructions of the Trust. In particular, where the consultant manages employees, they will be expected to observe the employment and human resources policies and procedures of the Trust. Successful candidates must attend all mandatory training in line with trust policy All employees, who have responsibility for other staff need, to make sure that individual performance is reviewed and a personal development plan is jointly agreed. Managers and supervisors will work jointly with their staff to make sure all developmental actions that are agreed in the review take place and are evaluated during the following year. Travel The successful candidates will need to be able to demonstrate that they can travel between locations across the locality. 16 17

Residence Because of on-call commitments, the successful candidates will be expected to be contactable by phone and be able to travel as required by the role in a timely manner. This will be agreed upon on a case-bycase basis. Health and safety The Trust recognises its duties under Health and Safety at Work legislation to make sure, as far as reasonably practicable, the health, safety and welfare of all of its employees. In addition, the business of the Trust is carried out to make sure patients, their relatives, contractors, voluntary workers, visitors and members of the public having access to Trust premises and facilities, are not exposed to risks to their health and safety. All medical and dental staff under contract to the Trust are expected to be familiar with and adhere to its health and safety policies. All accidents must be reported and you must submit a completed accident/incident form. You must support accident prevention by reporting potential hazards. A copy of the Trust s health and safety policy will be available to the successful candidates. These include the requirement that all medical staff provide evidence that they are not carriers of Hepatitis B before their appointment and will accept immunisation, if not already immune. 18 19

Rehabilitation of offenders act Because of the nature of the work for which you are applying, these posts are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are not entitled to withhold information about convictions which, for other purposes, are spent under the provision of the Act. 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 completely confidential and will only be considered in relation to an application for positions to which the order applies. If, once employed, an employee receives a conviction they are required to inform the Trust. Protection of children Following a report by the Home Office, the government accepted its recommendation regarding the disclosure of criminal convictions of those with access to children. For all consultant posts a check will be made with the Criminal Records Bureau as to whether you have criminal records before the appointment can be confirmed. A child is defined as someone under the age of 18, but this may be interpreted flexibly in relation to vulnerable adults, for example someone with a learning disability. Visiting before interview Candidates are encouraged to make arrangements to visit the Trust and should contact these consultants: Dr Peter Maskell, Medical Director peter.maskell@kentcht.nhs.uk Dr Bruce Pollington, Community Lead for the ERRS bruce.pollington@kentcht.nhs.uk 20 21

PERSON SPECIFICATION Attainments Essential for the post Desirable for the post Professional registration Full registration with the GMC. Eligible to be included on the specialist register. Within six months of achieving CCT at the time of interview in geriatric medicine. Candidates with alternative routes to entry on to the register are encouraged to apply. Professional qualifications/ development Clinical skills/experience Management skills Personal skills and qualities Teaching, audit and research Practical requirements MRCP. Wide experience of acute and general medicine. Wide experience of geriatric medicine and its sub-specialties, including the care of inpatients and outpatients. Experience of managing patients in the community. Able to communicate effectively and appropriately with patients, their families and other health professionals. Able to work in a team. Able to develop, present and put into practice coherent ideas for service improvement. Able to delegate appropriately. Able to work flexibly in a changing health service. Trained to teach and support students and junior staff effectively. Evidence of understanding of clinical audit. Evidence of participation in research. Ability to travel across west Kent and has access to a vehicle. Clean current driving licence. MSc, MD or other higher degree. Specific training in community geriatrics and experience of working in community setting would be a distinct advantage. Specific training in falls. Ability and desire to take on responsibility within the speciality to develop a specific area or clinical management. 22 23

Excellent care, healthy communities