Dorothy House Hospice Care (Bath and surrounding area) Job Description Consultant in Palliative Medicine (10.5 PA s less than full time will be considered) March 2018
Consultant in Palliative Medicine at Dorothy House Hospice Care Commencing: Salary: Reports to: Accountable to: Responsible for: Essential: Contract held by: Hours of work: 1/6/18 or ASAP 76,761-103,490 pro-rata (according to level of experience) Medical Director Medical Director Provision of specialist medical care to patients living within the Dorothy House catchment area. On Specialist Register for Palliative Medicine (or within 6 months of completion of CCST) Dorothy House Hospice Care (DHHC) 10 Programmed Activities (PAs) per week Plus 0.5 PA for on-call commitments (and 3% supplement). Less than full time will be considered. Background Information Since its inception as a charity in 1976, DHHC has focussed on the provision of palliative care services within the community it serves, working alongside GPs and District Nurses, to support patients and their families. It also has a close relationship with the hospital palliative care team at the Royal United Hospital (RUH) NHS Foundation Trust, Bath. DHHC is the specialist palliative care provider for a population of 500,000 and has an NHS Contract with two Clinical Commissioning Groups (Wiltshire and Somerset) and a sub-contract with Virgin Care, Prime Provider for Community Health and Social Care Services in Bath and North East Somerset. The main district general hospital for our area is the Royal United Hospitals (RUH) NHS Foundation Trust, Bath (which currently has 732 beds). There are 6 community hospitals within the hospice catchment area. The hospice provides clinical services from its base in Winsley, which opened in 1995, where there is a purpose built 10 bedded Inpatient Unit (IPU), Outpatient wing, Day Patient Unit (DPU), Education centre, and office accommodation, A Live Well centre is under development. The hospice also runs two community Outreach Centres where the Community Nurse Specialist and Lymphoedema teams are based. Patient and carer groups are run from here, and also much of the lighter touch pilot work. This lighter touch work aims to increase engagement with, patients with a non-cancer life limiting illness, and those at an earlier stage of their illness than they have traditionally accessed our services. Outreach centres are at: Trowbridge, Wiltshire which opened in June 2012 Peasedown St John, Bath and North East Somerset which opened in April 2013
DHHC employs over 440 staff [TN1](including bank staff) and has more than 1000 volunteers helping with care and our charity shops. Our full range of specialist palliative care services are offered to patients, and their families and carers across all settings including in-patient, day patient, outpatient, and in the community. The multi-disciplinary team includes doctors, nurses, physiotherapists, occupational therapists, lymphoedema therapists, dietician, complementary therapists, creative and diversional therapists, Multi-disciplinary Team Assistants, chaplains, social workers, counsellors, children and young people s workers, and trained and supported volunteers who provide a companion service. The hospice runs an active bereavement service for those whose family member was under our care. Key Current Working Relationships: Permanent Medical Staff: Consultants Dr Patricia Needham (Medical Director) 10PA s Dr Emma Frampton (Clinical Lead) 8PA s Dr Rebecca Bhatia 6PA s (on maternity leave until December 2018.) Dr Anitia Brigham Acting up Consultant covering maternity leave until end December 2018) Associate Specialist Dr Simon Brooks 10 PA s Speciality Doctors Dr Cally Todd 6 PA s Dr Heidi Leeder 6 PA s Rotational Training Posts: GPST1 doctor on 3 month full time placement. Post rotates with Oncology department and the Pain Team, at the RUH. Overview of Post: The Job Description is ideally for a 10.5 PA post but those wishing to work less than full time will be considered. It is a new post aimed at increasing the ability of the senior medical team to deliver the support required for the implementation of the new 7 year Dorothy House Strategy. Responsibilities The post holder will be expected to work as part of the senior medical team as the hospice expands its delivery of services and influence in accord with our strategy. Aside from contributing to clinical work in all settings within the medical team, it is envisaged that other responsibilities could include: Co-ordination of medical attachments/visitors medical students; GP Trainees and ad hoc others such as Care of the elderly/oncology trainees Contributing to the research agenda Developing partnership working with General practitioners and Nursing Homes Contributing to the delivery and development of a variety of educational activities Medical representation on internal governance and working groups established to develop service provision
Currently each of the members of the senior medical team, takes a lead for either: the Hospital Team, the In Patient Unit, or 1 or 2 of the 3 Community Teams, alongside other areas of designated responsibilities e.g. Clinical Audit and Quality improvement; driving the development of the Outcomes Assessment and Complexity Collaborative providing cross cover when required. Dorothy House Hospice Care There were 1954 patient referrals to the hospice care services in 2016-17, and 554 client referrals. All patients are currently referred with the approval of their GP although the referral may come from a variety of sources. 21% of referrals were for patients with a non-malignant disease. The In Patient Unit (IPU) has beds for ten patients. In 2016-17 we admitted 236 patients, with an average length of stay of 11.1 days. 29% were transferred from an acute hospital. 43% of those admitted were discharged. There is a 24-hour palliative care Advice Line providing advice and support for health professionals, families and carers. During office hours these are taken by the Contact Centre, Out of normal working hours by the nursing staff on the IPU, and are referred on to the covering doctor as required. In 2016-17, the service received an average of 133 calls per month. The Day Patient Unit (DPU) - on 3 days of the week this unit runs as a specialist unit with full access to the MDT. An additional day is run for those patients who do not require full MDT support. Up to 11 patients are supported each day. A review of day patient services was completed in 2016 and plans are well underway to develop and improve co-ordination of ambulatory Live well services. Community support services include: Dorothy House Nurse Specialists (DHNSs) (18 wte[tn2]) who are currently based as two teams in the Outreach centres. Our strategic direction is to develop local place based multi-professional teams who will deliver services in partnership with others (both statutory and voluntary) across four geographic areas. A well-developed Hospice at Home service which is co-ordinated by RNs and employs experienced nursing assistants to provide night cover, up to 24-hour care at home for the last two weeks of life, and limited respite care. An RN currently co-ordinates care 8am-7pm Monday-Friday and 10am-4pm at weekends and bank holidays. In 2016-17 this service delivered 22,076 hours of home care. DHHC is currently involved in projects with all 3 CCGs and the acute hospital extending the reach and potential of this service via an Enhanced Discharge Service; extended CHC funding and potentially introducing further skill mix within the team. A Bereavement and Children s service is run within the Family Support Team. The Education, Learning and Research department is very active and organises an extensive programme of education for all levels of health and social care staff, including Link Nursing Home and Residential Home schemes. It is a focus for development within our strategy as we look to develop a national and International reputation for Education and Research. Discussions are underway with Bath University and the University for the West of England in relation to establishing a Faculty. Following a 12 month project our Contact Centre is to be developed and our new Clinical Coordination Centre (functioning as a Single Point of Access for new and existing patients and their families) is to be implemented in April. Multi-disciplinary meetings to support this team currently take place 3 times a week. It is anticipated that this will ultimately become a 24/7
service and will work closely with the newly commissioned Out of Hours and 111 service in Wiltshire and BaNES. Dorothy House is currently at an exciting point in its history with a budget for 2018-19 of expansion, development and change. Amongst these changes will be the addition to the medical team of 2 new Advanced Nurse Practitioner posts providing 1 st on call cover and the development of plans to provide a 7 day service across all disciplines, including routine admissions to the IPU at weekends. Medical Services: In the hospice, the medical team are responsible for the care of in-patients and also provide medical advice and support for DPU patients, Outpatients, the 24-hour Advice Line and all the other services provided by DHHC. The Consultants and Associate Specialist provide medical support to the community DHNS teams by providing weekly caseload reviews and domiciliary visits. 3 Community Coordination Centre multi-disciplinary team meetings also occur each week for the triage of referrals and the discussion of ongoing complex patients and their families. A senior doctor is allocated each day to respond to calls for advice from the community (GPs, DHNS s, District nurses) between 9 and 5, and one to respond to urgent requests for IPU admissions. There is a strong educational component to the medical service. Medical students from the University of Bristol currently attend the hospice twice a week from September to December each year. The palliative care education programme for Bath GPVTS doctors in the Health Education South West Severn deanery has been running for many years. This includes education sessions for ST1s and 2s, and a programme for ST3s who come to the hospice for week-long placements preceded by an annual study day. We have also arranged placements for Specialty trainees working at the RUH in Care of the Elderly, Oncology, and Haematology. We also offer educational events for GPs, both as part of the regular Bath General Practice Education and Research Trust (BGPERT) programme, and as one off events at practices if requested. The Medical Team actively support the Education department in the provision of a range of bespoke education events and programmes. We have also provided End of Life education workshops to GP Trainers, and Educational and Clinical Supervisors at the RUH, and training days to Specialty trainees and F2s working within the Severn Deanery. Royal United Hospital, Bath The RUH Palliative Care Team is currently situated in zone A of the hospital, close to the Oncology department and Pain clinic. The Team consists of the Lead Nurse Palliative and End of Life Care (Helen Meehan); Dorothy House senior doctors (hold honorary contracts with the Trust), 5 clinical nurse specialists (3 wte), and a palliative care administrator (0.6wte). There are close links with the Pain clinic and the Oncology department (regular meetings with both), and links with hospital Nurse Specialists. Weekly attendance at the Gynaecology MDT and support for ward MDT/white board meetings. There are currently 5 sessions of consultant support to the RUH Palliative Care Team a week. The Palliative Care Team works in an advisory capacity providing information, palliative care expertise and support to patients, carers, and staff for patients with life-threatening illnesses throughout the RUH. The Medical Assessment Unit and Oncology wards are visited every day. The team promotes awareness and expertise in palliative care and end of life care through training and quality improvement initiatives. There is a regular programme of education for junior doctors, nurses and therapists across the trust. The team supports the ward ambassadors for end of life care who act as link nurses in promoting best practice in end of life care on the wards.
The team continues to lead on the Conversation Project initiative to support earlier recognition of patients with end of life care needs and compassionate conversations to support advance care planning. The team developed Priorities for Care' documentation to support patient centred care in the last days of life and continues to evaluate this through audit. The team is available Monday to Friday from 8.30am-4.30pm. Advice during out of hours is currently provided through the Dorothy House 24-hour Advice Line, although the team will be introducing a 7 day service of the nurse specialists later this year. There is daily communication and mutual support between the team and liaison with all the services at Dorothy House. The same clinical database, SystmOne is used by both DHHC and the Palliative Care Team. There are no designated palliative care beds in the RUH. Resources Available a) Administrative Support/Office Accommodation There is a full time administrative support to the medical team provided by 2 Medical Secretaries who each work 3 days per week and a full time PA to the Medical Director. Office accommodation, will be provided at Winsley. Computer links and workstations are also available at both Outreach centres. b) IT Competent IT skills are required. SystmOne is the clinical database used. Sharing of medical records between all SystmOne users (many GPs; Community services; and the RUH SPCT; etc.) is encouraged. All areas within the hospice, including the IPU, are essentially paperless. The results of all investigations performed locally can be accessed within the patients SystmOne record. Microsoft Office products are used within DHHC. Remote IT access is available. c) Diagnostic Facilities Full diagnostic services are available at the RUH including ultrasound, CT and MRI scans, and laboratory services. These services are readily available to all hospice patients d) Academic Facilities There is a palliative care library at Dorothy House. There is an active Post-Graduate Medical Centre on the RUH site with library facilities in the Education centre. There is a wide range of audio-visual equipment available at both sites. Medical Grand Rounds are held weekly at the RUH which include input from all fields of medicine, including palliative care. There is potential support for research at both sites. e) Peer Support We are a supportive team who work closely together. Regular supervision on a 1:1 basis is offered by a trained external supervisor. External mentor support will be arranged if requested. There are regular meetings between Palliative Care professionals both in the Bristol area and in the Wessex and South West regions.
Duties of the Post 1. Clinical Duties a) DHHC The post-holder and the three other consultants have responsibility for the medical management of hospice in-patients and, with the other doctors, provide specialist advice for DPU patients and outpatients at the hospice and two Outreach centres. The post-holder will also provide specialist advice to GPs for patients in the community offering domiciliary visits when needed, jointly with GPs where appropriate. There is a hospice commitment to increase these links further. The provision of 24-hour advice to external health care professionals on palliative care problems extends to patients who are not registered with the hospice. We are currently providing 2 nd on call phone advice to a neighbouring hospice (rarely utilised). On-call commitments currently involve predominantly telephone advice cover for in-patients and the Advice Line during out-of-hours one night a week, and a session at the hospice on Saturday and Sunday mornings during weekends on call. The current weekend rota is a 1 in 6 as first on call cover and one week day night. We are currently trialling a later start time and later finish on an on-call week day. Current out of hours admission rates are low at 1-1.6 per month (w/e, Bank Holidays and after 5pm weekdays). There is an additional 1 in 15-20 weekend second on call cover when a Speciality Doctor is first on call. The post holder will be expected to cover for colleagues absent on leave. On call commitments will change as we involve the Advanced Nurse Practitioners, extend to 7 day admissions and consultants provide less first on call cover. It is envisaged that the successful candidate will become responsible for the medical leadership within the Bath and North East Somerset (BaNES) area supporting the development of the multi-professional team working within this area, and forging strengthened links, and identifying new opportunities for working with, primary care colleagues. b) RUH As a part of the senior medical team the post holder will support the work of the Hospital Palliative Care team (initially this is most likely to be to cover periods of leave) undertaking medical consultations giving specialist advice on patients promoting good standards of palliative care amongst all clinical staff at the RUH providing palliative care education and support to junior medical staff developing working relationships with consultant colleagues e.g. respiratory, neurology, cardiac, care of the elderly, etc. liaising, as appropriate, with senior management in the hospital to achieve relevant aims, particularly in reducing unnecessary admissions or diverting admitted patients who would be better being cared for or dying elsewhere. The team have a lead role in promoting the achievement of the End of Life Care strategy in the hospital. 2. Research Working with the Medical Director a key component of this post will be the development of, and participation in, research activity. Developing collaborative projects. 3. Management Duties The post holder will be expected to participate in the medical contribution to management within the specialist palliative care service provided by DHHC. There will be opportunity for
other managerial and strategic responsibility at local and regional level according to agreement within the team to represent the team/the wider service. 4. Teaching The post holder will be expected to take an active part in developing the education offer of DHHC in close liaison with the Medical Director and the Head of Education. This will include participating in: the DHHC education programme BGPERT events the teaching of medical students and GP Specialty Trainees whilst on placement with the hospice teaching Specialist Trainees on placements at the hospice the teaching of junior medical staff and nurses at the RUH when covering leave. 5. Clinical Governance There is a Clinical Governance group which monitors all aspects of clinical governance in the services provided by DHHC. We have an active programme for Significant Event Analysis and supporting staff in reporting concerns. 6. Audit and Quality Improvement There is a regular Clinical Audit and Quality Improvement group and a very active programme in place. The post holder will be encouraged to participate in clinical audits and quality improvement initiatives. We are currently supporting the roll out of elements of OACC (Outcomes Assessment Complexity Collaborative) into the community following their successful introduction into DPU and IPU. 7. Professional Development The post holders Responsible Officer for Revalidation will be Dr Needham. Annual appraisals will take place with an Appraiser accessed through the RUH. An annual Personal Development Review with the Medical Director will feed into this. Job Plans are generally reviewed annually, but will be reviewed more frequently initially. CPD - DHHC is committed to ensuring support is given to the continuing medical education and professional development of medical staff. The post holder will be entitled to 30 days study leave within a 3-year period (pro rata part-time posts). The post holder will be expected to be registered for CPD at the Royal College of Physicians, keeping themselves up to date and taking part in the available meetings. 8. Networks There are a number of different networks operating locally, regionally and nationally. Medical staff are expected to involve themselves with these as appropriate. 9. Timetable (provisional and negotiable) and Job Plan Proposed Timetable This is given as an example of a 10.5 PA Job Plan and can be modified for those wishing to work less than full time. There is an understanding that the 4 consultants and Associate Specialist will regularly review and modify their work patterns in order to ensure continuity of care, responsiveness to need as a result of changing population requirements and service developments, and the responsibility to ensure medical support for care provision across all
care settings (inpatient unit, community and acute hospital). There is generally flexibility within the team to adjust this timetable to suit the appointee and colleagues. This provisional job plan will be agreed prior to commencement, and reviewed after 2 months with the Medical Director. A further review will occur prior to Dr Bhatia s return from maternity leave in December and following a review of progress with implementing the ANP role. am Monday SPA Visit Primary Care colleagues/op s/dvs Cover RUH session if leave Contact Centre MDT pm Tuesday Wednesday Community Team Case Load Review Community Contact Doctor IPU Handover IPU Contact Doctor Cover RUH session if leave 1.30-2.30pm senior medical team meeting Community Contact Doctor IPU Contact Doctor Cover RUH session if leave Thursday SPA OP s/dv s Friday IPU Handover IPU Contact Doctor Cover RUH session if leave IPU Contact Doctor Research/Education development Cover RUH session if leave Plus: Cover clinical responsibilities IPU/DPU; domiciliary visits; Hospital sessions, including on call, in colleagues absence Participate in education provision 1in 6 first on call weekend cover* 0.5 additional PA s*; 1 regular weekday on-call. 2nd on call approx. 1 in 15 20* to Specialty Doctor/Advanced Nurse Practitioner *This to be reviewed October 2018
Job Plan Direct Clinical Care In Patient Unit: Management of in-patients (10 beds) Triaging of admissions and discharges Community: Weekly discussion of patient caseload with members of Community Nurse Specialist teams Outpatient consultations (including DPU as required) Domiciliary consultations Attendance at a weekly CCC team MDT meeting Royal United Hospital: patient consultations advisory to SPCT and other Nurse Specialists PAs/week 3 2 0.5 Support and clinical advice to other Health Care Professionals 1.5 Weekend ward rounds I in 6 0.5 Total Clinical PAs 7.5 Supporting and Additional PAs Research Internal working groups Teaching Audit and Quality Improvement CPD Total Supporting and Additional PAs 3 Total Programmed Activities 10.5 On-call Availability Supplement Agreed rota*: 1 in 4 first on call weekday; 1 in 6 first on call weekends. 1 in 15-20 second on call weekends Agreed category: B On-call supplement:3% *to be reviewed October 2018
10. Conditions of Service a) The appointment is subject to the current National NHS Consultant Contract Terms and Conditions (England) 2003 b) Commences 1/6/18 or asap c) The post is for 10.5 PA s (negotiable) d) It is essential that the post holder shall be a member of a medical defence union. e) The post holder must be, and remain, a fully registered medical practitioner with General medical Council with a licence to practise and inclusion on the Specialist Register (for Palliative Medicine) f) The post holder will adhere to the Policies and Procedures of Dorothy House Hospice Care in the work for Dorothy House. g) Dorothy House Hospice Care is a charity offering care to patients free of charge. Private practice in the course of Dorothy House duties is therefore not undertaken. h) Medical examinations/screening. At any stage of your employment you may be required to undergo a medical examination to confirm your fitness to undertake your duties. The appointment is subject to medical screening. Satisfactory Hepatitis B status is necessary you will be asked to either undergo the immunisation process or produce written evidence of satisfactory status. Vaccinations and immunisations may be obtained by contacting the Occupational Health Department at St Margaret s Surgery. [TN3] i) Annual Leave. 6 weeks per 12 months pro-rata, to be approved by the Medical Director. j) Health & Safety The post holder will be expected to comply with appropriate Health and Safety Policies. Dorothy House Hospice Care operates a no smoking policy for staff on its premises and grounds. k) Residence The post holder will be required to live no more than 60 minutes travelling time from Winsley l) The post is pensionable within the NHS Pension Scheme unless the appointee opts out of the scheme or is ineligible to join. m) This post is subject to Enhanced Disclosure and Barring screening. n) The post holder undertakes exceptionally to perform additional duties in the case of emergencies and unforeseen circumstances, as necessary for the continuity of patient care. o) The appointee is entitled to receive 3 months notice of termination of employment and is required to give Dorothy House Hospice Care 3 months notice. 11. Details for Visiting Candidates are welcome to discuss the post further and to visit DHHC by contacting Drs Needham, or Frampton through the medical secretaries on 01225 722988 and medsec@dorothyhouse-hospice.org.uk
Person Specification - Consultant in Palliative Medicine Criteria Essential Desirable Qualifications and Experience MRCGP, MRCP or equivalent On Specialist Register for Palliative Medicine, or within 6 months of, completing CCST in Palliative medicine Experience within inpatient, community and hospital teams Full registration with GMC with license to practice MD or PhD in subject related to Palliative Care Evidence of areas of special interest Personal Skills Good interpersonal, written and verbal communication skills. Ability to motivate and inspire a multi-disciplinary team and work sensitively within teams and across organisations Ability to work independently Ability to organise and prioritise workload and to delegate responsibility and supervise staff Flexibility and adaptability in working with other members of the team Enthusiasm for this speciality Desire to develop innovative ways of delivering patient care Advanced Communication Skills course Evidence of creativity in problem solving Evidence of insight into own areas of strengths and weaknesses
Audit Governance An understanding of the benefits and challenges of continuous improvement Evidence of participation in audit and quality improvement projects Commitment to CPD and requirements of Clinical Governance Teaching, Research and Publications Teaching experience An enthusiasm for participation in the teaching of health professionals Experience in research Educational Qualification Completion of Train the Trainers course Evidence of publications and presentations Management Knowledge of contemporary management issues Leadership skills ability to take responsibility, demonstrate leadership and make decisions Completion of Management course Active involvement in management General Requirements Basic computer and IT skills Ability to fulfil all the duties of the post Car driver Lives within 60 minutes of Winsley Commitment to the ethos of Dorothy House Probity