SPECIALITY TRAINING PROGRAMME IN FORENSIC PSYCHIATRY IN HEALTH EDUCATION WESSEX

SPECIALITY TRAINING PROGRAMME IN FORENSIC PSYCHIATRY IN HEALTH EDUCATION WESSEX This is a three year training programme in Forensic Psychiatry (ST4), aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to support training for a CCT in Forensic Psychiatry. Details of essential competences and qualifications are detailed in the HEE person specification for Forensic Psychiatry at ST4 which is available from http://specialtytraining.hee.nhs.uk This 3 year Higher Specialty Training programme in Forensic Psychiatry will allow the successful applicant to achieve the award of a Certificate of Completion of Training (CCT) in Forensic Psychiatry, subject to satisfactory progression. The programme is based in Health Education England - Wessex in the following hospitals: HOSPITAL Ravenswood House/ Woodhaven Southfield (Tatchbury Mount) Bluebird House (Tatchbury Mount) Broadmoor Hospital LOCATION Nr Wickham Southampton Southampton Crowthorne Health Education England - Wessex is a relatively small deanery with a defined geographical area which does lead to there being a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some specialties will require successful candidates to preference both commencing location and specialty. Future placements will be based, as normal, on individual training and educational needs. Please note that applications are to Health Education England - Wessex as a whole. This may mean that you may be allocated to any geographic location within Health Education England - Wessex depending on training needs. Health Education England - Wessex covers a geographical area from Basingstoke in North Hampshire to Dorchester in West Dorset and the Isle of Wight to the South; in addition some programmes rotate to Jersey and Chichester in West Sussex. This is a spread of approximately 65 miles North to South and 76 miles East to West. Health Education England - Wessex serves a population of around 2.8 million people. Rotation Information Health Education England - Wessex Forensic Psychiatry service is made up of four separate units. Ravenswood House Medium Secure Unit, which is situated near Wickham, Southfield Low Secure Unit, Woodhaven Hospital and Bluebird House Adolescent Forensic Unit, all of which are situated on the edge of the New Forest. In addition to these units, trainees may also be placed in community forensic services in Poole (Dorset). Trainees will also be expected to attend the following prisons during their training scheme: Winchester Prison and Isle of Wight prisons. The trainee will also be expected to visit NHS 1

hospitals in the catchment area of the Wessex Forensic Service, which includes Dorset, Hampshire and the Isle of Wight to undertake assessments. Occasionally they will be required to undertake assessments further afield: at the high secure hospitals or in out of area placements and prisons elsewhere. The trainee in Forensic Psychiatry will spend at two years in Ravenswood House and a further 6 to 12 months at Southfield. The High secure training lasts 6 weeks usually. However if a trainee wanted to spend longer at Broadmoor this could be negotiated with the Trainee Programme Director. The on call cover is not on the Forensic out of hours rota and is part of the Southern Health AMH rota. The ST4-6 on call is undertaken from home and is not therefore residential. If the Senior Trainee needs advice when on call, there is continuous consultancy cover as a final tier. The speciality trainee will be expected to continue to contribute to this on call rota whilst they are on attachment at Broadmoor. Study and Training The primary aim of all posts is the training programme developed and there is a region wide syllabus and minimum standards of education agreed by all Trusts within the rotation. Health Education England - Wessex is committed to developing postgraduate training programmes as laid down by GMC, Colleges and Faculties and by COPMED - the Postgraduate Deans Network. At local level college/specialty tutors work with the Programme Director and Directors of Medical Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend meetings with their nominated educational supervisor. All posts within the training programme are recognised for postgraduate training by the General Medical Council (GMC) in accordance with their standards for training. Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service. All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals but the list is aimed at covering the majority of duties: 1. Supervise, monitor and assist Core Trainees or Foundation Doctors in the day-today management of in-patients in posts. 2. Liaise between nurses, F1 and F2 Doctors, Core Trainees, patients, relatives and senior medical staff. 3. Attend and participate in ward rounds as timetabled 4. Attend outpatient clinics. 5. Take part in rostered emergency work. 6. Dictate discharge summaries. 7. Study for higher examination and maintain continued professional development. 8. Attend weekly educational and multidisciplinary sessions. 2

9. Undertake audit at various times throughout the rotations. 10. Teach medical students as directed. 11. Co-operate with members of the personnel department when monitoring hours of work and other personnel issues. 12. Attend induction in each hospital or new department 13. Comply with all local policies including dress code, annual and study leave Trust Generic/Specialty Information In addition to the aforementioned duties, Forensic Psychiatry trainees will also: Undertake risk assessments of patients in other hospital units. Undertake assessments for admission to Ravenswood House. Produce discharge summaries and reports, relating to CPA s, tribunals and assessments. Take part in Rota emergency out of hours work. Undertake a Section 12 approval course/approved clinician course. Undertake at least one audit per year. Health Education England - Wessex Forensic Psychiatry Service has embraced the recovery model. During placement at Ravenswood House and Southfields, the trainee will have a named Educational Supervisor who will usually be a Clinical Supervisor. Clinical care is delivered through multidisciplinary teams, with full complements of nursing, psychology, occupational therapy and social work members. The unit also provides cognitive behavioural therapy, dialectic behavioural therapy and psychodynamic therapy. Medical staffing at Ravenswood House and Southfield consist of: 7 Consultant Forensic Psychiatrists Up to Five ST4-6 trainees in Forensic Psychiatry One staff graded psychiatrist in forensic psychiatry Three CT3 psychiatrists In addition to this, Bluebird House has a further 2.5 Consultant Forensic Psychiatrists and 2 staff grade forensic psychiatrists. 3

Ravenswood House Ravenswood House has seventy-nine beds. It is an all male service. The current unit was opened in 1985, on the site of the Knowle Hospital. Ravenswood House provides services to the Wessex part of the deanery. This area has a population of approximately three million. The unit provides an inpatient service for the assessment and treatment of patients, presenting management difficulties in general psychiatric hospitals, patients from high secure hospitals and mentally disordered offenders in prison, as well as a consultative role to psychiatric services, the Probation Service, Social Services, prisons, courts and solicitors. The service has an active community forensic team. The placement at Ravenswood House will include the following: Member of one of the 4.5 multidisciplinary teams at Ravenswood House Outpatient assessment and treatment of offenders The assessment of patients in other hospitals Liaison with the Probation Service, with regular sessions with NOMS There are opportunities to do Community Forensic Psychiatry in Dorset Sample Work Programme: AM PM Monday Referrals/admissions meeting Education Programme Clinical and psychotherapy supervision groups Tuesday Assessments Assessments Wednesday CPA meetings and clinical team patient review Individual Consultant Supervision Ward Work/Assessments Thursday Ward Work Assessments Friday Special Interests/research Special Interests/research The post holder will have an office at Ravenswood House with networked pc facilities. Administrative support is provided by a Secretary to the Consultant to which the trainee is attached. 4

Southfield Southfield Low Secure Unit has twenty-two beds and is designed to rehabilitate patients of enduring mental illness who require conditions of low security. Medical staffing at Bluebird is as follows: 1.5 Consultant Psychiatrists 1 CT 1-3 Bluebird House Bluebird House has twenty beds. It is the supra-regional adolescent forensic service, covering the whole of the south of England, south of Birmingham and excluding London. Medical staffing at Bluebird House is as follows: 2.5 Consultant Forensic Psychiatrists 1 Staff Grade Psychiatrists The placement at Bluebird House is on a Special Interest basis and will include the following; Member of one of the three multidisciplinary teams at Bluebird House Assessments on patients referred to the service for admission Prison psychiatry experience at HM YOI Ashfield Inpatient assessment and treatment of young people aged 12 to 18 years The provision of psychiatric reports on young offenders for youth courts and criminal courts Liaison with the Youth Justice Board and Youth Offending Teams as well as the opportunity to attend Youth Courts Opportunity to participate in a number of therapeutic groups in Bluebird House, as well as forensic psychotherapy supervision Regular participation in weekly academic programme The post-holder will have a shared office at Bluebird House with networked PC facilities. Administrative support is provided by the secretary to consultant who supervises the post. Broadmoor Broadmoor Hospital is one of three High Security Hospitals in England and Wales provided under Section 4 of the National Health Service Act (1977). From 1 April 2001 this hospital has become part of the services provided by the West London Mental Health NHS Trust, following the merger of the former Ealing, Hammersmith and Fulham NHS Trust and Broadmoor Hospital Authority. Broadmoor Hospital provides treatment under conditions of high security for patients, who are regarded as posing a high degree of risk of absconding and who are presenting an immediate danger to the public. All patients are detained under the Mental Health Act (1983). Patients who suffer from learning disabilities and require 5

maximum security are usually admitted to Rampton Hospital, one of the other High Security Hospitals. The hospital is located in Crowthorne, Berkshire, close to the M3 and M4 motorways, with easy access into London and the southern counties. The hospital has approximately 280 male beds. The catchment areas of the hospital include South London, South East Region and South West Region. The treatment of patients on each ward, is coordinated through a multidisciplinary clinical team, coordinated and led by the Consultant Forensic Psychiatrist. The members of the team include Nurses, Psychologists, Occupational Therapists, Lecturers/Teachers and Social Workers. The views of all disciplines are valued and regarded as important contributions, in the formulation of appropriate treatment and care plans for the patients. The Care Programme approach, forms the core of the treatment adopted throughout the hospital Admission of patients to Broadmoor Hospital (as with all high security hospitals), require an assessment by either a Consultant Forensic Psychiatrist, a Consultant Psychiatrist with a Special Interest in Forensic Psychiatry, or a Consultant Psychiatrist employed by the hospital. Trainees also carry out assessments under the supervision of a Consultant. A multidisciplinary admissions panel make the final decision on admissions. Sample Work Programme: AM PM Monday Individual supervision with Ward work, Broadmoor Educational Supervisor, ward work Tuesday Ward Round Broadmoor Ward Work Broadmoor Wednesday Outside assessments and reports Broadmoor Outside assessments and reports Broadmoor Thursday Broadmoor Special Interest Broadmoor Special Interest Friday Ward work, Broadmoor Ward work, Broadmoor The post at Broadmoor Hospital is whole-time for 6 weeks. On call continues on the Southern Health AMH rota whilst at Broadmoor. Other Duties of the Post at Broadmoor Hospital include participation in the corporate function of the hospital including its committees demonstrating at all times a full commitment to the highest standards of medical and psychiatric practice, and promoting the highest standard of professional relationships, within the hospital and in relation to the professions generally in other psychiatric hospitals, prisons and the community. It is accepted that the resources available to Broadmoor Hospital and Southern Health Foundation NHS Trust are finite and that all changes in workload and developments requiring additional resources, must have prior agreement through the hospital s management arrangements. 6

The trainee will be provided with office space and appropriate secretarial support services. He/she will be expected to participate in the administrative duties, associated with the care of his/her patients and the running of the clinical service. To ensure that safe practices are recognised within the hospital, in accordance with the Health and Safety at Work Act and with the Hospital s security policy statements, as approved by the Managers. Teaching Ravenswood House Supervision will be provided both individually (one hour per week) and as a group in the academic programme. The trainee will have regular opportunities to teach Psychiatry Trainees, Medical Students and Nurses from Southampton School of Nursing. The Speciality Trainees will provide additional Clinical Supervision for Core Trainees in psychiatry. The trainee will be expected to participate in medical and clinical audit programmes at Ravenswood House. The Speciality Trainee will join with other senior Trainees at Ravenswood House, Woodhaven and Southfield, in taking a lead role for various regular management tasks. During their attachments, the trainee will have an opportunity to gain management experience with the Clinical Service Director. This is in addition to the one week Wessex Professional Programme and Leadership Programme. The Academic Programme includes peer review case conferences, journal clubs, medical/legal updates, occasional outside speakers and discussion sessions with a Forensic Psychotherapist. The trainee expected to participate in the academic programme. The Forensic Psychiatry Library at Ravenswood House is staffed three days per week, by a Clinical Librarian. The Trainee will be expected to undertake two sessions per week, of either research and/or special interest. The unit has links with the Academic Department of the University of Southampton. Study leave is granted in accordance with the Deanery/Trust Policy and is subject to the maintenance of the service. 7

Broadmoor The Trainee will receive one hour weekly non-clinical supervision from his/her Educational Supervisor. Clinical supervision will be provided through ward rounds, supervision of reports and day-to-day contact. Broadmoor Hospital is associated with other universities both in relation to training and research. The Hospital has an excellent education centre with a comprehensive library. Depending on the Trainee s interest and opportunities, he/she may wish to take advantage of working on the acute admission unit, the young person s unit with its emphasis on managing personality disorder, rehabilitation wards, the intensive care unit or other appropriate wards. Other clinical training will include experience in outside assessments and Mental Health Review Tribunals. There will also be opportunities for taking patients for individual and/or group psychotherapy, under the supervision of a Consultant Psychotherapist. The successful candidate will be expected to take part in the continuing professional development, which will be supported by appropriate study leave and expenses through Health Education England - Wessex. The hospital has an excellent educational centre with an unrivalled forensic psychiatry library. The Trainee will be expected to attend the quarterly training seminars at Broadmoor Hospital held on Fridays. He/she will also be part of ongoing medical audit within the hospital. Trainees also participate in the teaching and supervision of junior medical staff, as well as other disciplines as part of the multidisciplinary process of care. Main Conditions of Service The posts are whole-time and the appointments are subject to: 1. The Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales) 2. Satisfactory registration with the General Medical Council 3. Medical Fitness You 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 regards to HIV/AIDS and Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be required to provide, in advance of appointment, evidence of immunity or have a local blood test (as deemed necessary by the Occupational Health Department) 4. Right to work in the UK 5. Criminal Records Check/POCA check carried out by the Trust Medical HR department. 6. Pre-employment checks carried out by the Trust Medical HR department. 8

Hours The working hours for junior doctors in training are now 48-hours averaged over 26 weeks (six months). Doctors in training also have an individual right to opt-out if they choose to do so, but they cannot opt-out of rest break or leave requirements. However, the contracts for doctors in training make clear that overall hours must not exceed 56 hours in a week (New Deal Contract requirements) across all their employments and any locum work they do: http://www.nhsemployers.org/your-workforce/need-to-know/european-working-timedirective. Pay You should be paid monthly at the rates set out in the national terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service (England and Wales), the TCS, as amended from time to time. The pay scales are reviewed annually. Current rates of pay may be viewed at: http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/agenda-for-change-pay. Part-time posts will be paid pro-rata. Pay supplement Depending upon the working pattern and hours of duty you are contracted to undertake by the employer you should be paid a monthly additional pay supplement at the rates set out in paragraph 22 of the TCS. The current pay scales may be viewed at: http://www.nhsemployers.org/. The pay supplement is not reckonable for NHS pension purposes. The pay supplement will be determined by the employer and should be made clear in their offer of employment and subject to monitoring. Pension You will be entitled to join or continue as a member of the NHS Pension Scheme, subject to its terms and rules, which may be amended from time to time. Annual leave Your entitlement to annual leave will be five or six weeks per annum depending upon your previous service/incremental point, as set out in paragraphs 205 206 of the TCS. The TCS may be viewed at: http://www.nhsemployers.org/your-workforce/pay-andreward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars. Sick pay Entitlements are outlined in paragraphs 225-240 of the TCS. Notice 9

You will be required to give your employer and entitled to receive from them notice in accordance with paragraphs 195 196 of the TCS. Study leave The employer is expected to offer study leave in accordance with paragraphs 250 254 of the TCS. Local policy and procedure will be explained at your induction. Travel expenses The employer is expected to offer travel expenses in accordance with paragraphs 277 308 of the TCS for journeys incurred in performing your duties. Local policy and procedure will be explained at induction. Subsistence expenses The employer is expected to offer subsistence expenses in accordance with paragraph 311 of the TCS. Local policy and procedure will be explained at induction. Relocation expenses The employer will have a local policy for relocation expenses based on paragraphs 314 315 of the TCS and national guidance at: http://www.nhsemployers.org/your-workforce/payand-reward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars. You are advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure. In addition to local policy there is Deanery guidance which can be viewed on www.wessexdeanery.nhs.uk Pre-employment checks All NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements expected to be in line with national guidance at: http://www.nhsemployers.org/your-workforce/recruit/employment-checks. Professional registration It will be a requirement of employment that you have professional registration with the GMC for the duration of your employment. Health and safety All employers have a duty to protect their workers from harm. You will be advised by the employer of local policies and procedures intended to protect your health and safety and to comply with these. Disciplinary and grievance procedures The employer will have local policies and procedures for dealing with any disciplinary concerns or grievances you may have. They will advise you how to access these, not later than eight weeks after commencement of employment. 10

Educational supervisor The employer will confirm your supervisor on commencement. General information Health Education Wessex s management of Specialty Training programmes, including issues such as taking time out of programme and dealing with concerns or complaints, is available at www.wessexdeanery.nhs.uk and in the national Gold guide to Specialty Training at: http://specialtytraining.hee.nhs.uk/news/the-gold-guide/. 11