JOB DESCRIPTION

Senior Clinical Fellow in Acute Medicine

Chairman: Adrian Belton Chief Executive: Mrs Louise Robson

 Senior Clinical Fellow in Acute Medicine
Introduction:
We are looking for a team playing individual to join our front door team as a Clinical Fellow.
The Acute Medicine team has a multidisciplinary ethos, working in ‘partnership’ with other key teams
to assess and manage patients presenting to the service according to evidence based principles. We
have strong relationships with the Emergency department, Specialist teams, radiology, GPs and
community services to facilitate admission avoidance. We also aim to achieve the standards set out
by the Royal College of Physicians and the Society for Acute medicine in terms of competent clinical
decision maker reviews within four hours and senior decision maker reviews within 14 hours.

We were chosen in July 2015 as one of four ‘specialist’ hospital sites in Manchester, following a
unanimous decision by the 12 Greater Manchester clinical commissioning groups (CCGs) as part of
the Healthier Together programme.

A programme of reform of unscheduled care in the Trust and across Greater Manchester is
underway which includes investment in and expansion of the medical specialties to complement the
recent rapid expansion of Acute Medicine; this will facilitate more robust in-reach to the AMU
streamlining the care of patients to the appropriate specialist on admission.

The acute medical unit is a brand new 59 bed ward co-located with the emergency department
and the ambulatory care unit.

Main duties of the post:

The main duties of this post are the assessment of patients, ordering and following up investigations,
completing documentation and working flexibly within the acute medical bed base: Acute Medical
Unit (AMU), Ambulatory Care Unit (ACU), Primary Care Referral Unit (PRCU) and the Emergency
Department (ED). There will be on-call duties (see below) and you will be required to work flexibly
from 08:00 to 22:00 seven days a week. The duties will be supported by junior clinical fellows (SHO).
With regards to commitments to Acute Medicine, the successful applicant will work as part of a team
of acute physicians in a semi-autonomous fashion as befits their experience and seniority.

The post-holder will participate in audit including the quarterly presentations and the bi-weekly
medical specialty meetings and undertake appropriate administrative duties. The departmental
strongly supports educational needs such as clinical courses, conferences etc. The current acute
physicians take personal interest to support training activities and career development.

It is also expected that the successful candidate will be competent in commonly performed medical
procedures such as lumbar puncture, seldinger chest drain and central line insertion, ascitic tap/drain
and pleural tap to a level where they can help colleagues in difficulty with cases.

This is post is banded at 1a with commitments in the form of twilight sessions (until midnight in acute
medicine). Please note that some changes in rota will be expected with time.

Acute Medical Units:

At present two wards, AMU 1 and 2, comprise the acute medical unit with a total of 60 beds. As
stated previously these are moving into a single, purpose built, brand new AMU in October 2016. The
consultants have either 8am or 9am starts on the two wards. The 8am start enables consultants to
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focus on unwell patients on the ward, or patients who could be discharged quickly… ‘The golden
hour’. Four consultants operate the morning post take ward rounds. The vast majority of patients are
consultant reviewed daily. Each consultant has the support of a junior doctor.

The acute medicine consultants have a physician of the day who co-ordinates the acute medical take
from 09:00 to 19:00, and is responsible for patients referred to the acute medical team who are in the
emergency department. The physician of the day is supported by another acute medicine consultant
based on AMU from 13:00 to 17:00. A separate acute medicine consultant is responsible for the ACU
and PCRU from 12:00 to 20:00.

There is no current requirement for overnight on-calls for this post; however, this may be required in
the future if the unscheduled care model changes in line with trust and service requirements.

Ambulatory Care Unit:

Our ACU is located in very close proximity to the emergency department and the AMU. It is staffed
from 09:00 to 22:00 with registrar and nursing presence. Consultant presence is till 20:00. The unit
will extend its opening hours over the coming Winter up until midnight. The ACU has a number of
trolleys and recliner chairs for assessment, a separate waiting room for patients and a procedure
room. ACU will manage patients with a variety of ambulatory emergency conditions and will also
review patients discharged from the AMU who need follow up within a few days. All GP referrals are
triaged by senior sisters, registrars or consultants on ACU and a decision is made as to whether they
fulfill the criteria for ACU or if they should be referred to the adjacent PCRU.

Primary Care Referral Unit:

This is an assessment bay with 6 trolleys located within the acute medical unit. This unit is designed
to take GP referrals who are unstable, non-ambulatory or likely to need an acute medical admission
based on the telephone triage done on ACU. This unit is open from 08:00 to midnight seven days a
week.

Emergency Department:

We are developing in-reach into the emergency department (ED) where support is provided by the
acute medicine consultants. The role provides support for early clinical decision making, the
management of acute medical emergencies, and the identification of patients suitable for early
discharge via the ambulatory care unit, or from the emergency department itself. This model is
currently being developed to expand the capacity to stream acute medical admissions to appropriate
pathways of care, and integrate the work of ED doctors, on-call medical doctors and AMU
consultants to provide patients with earlier access to a medical consultant review. The role of the
physician of the day incorporates these responsibilities. The number of patients attending ED per
month is circa 8300.

Consultant Weekend Cover:

Weekend cover is currently on the basis of a 1:8. The Consultant in Acute Medicine works from 8am
to 5pm on AMU on Saturday and Sunday. During this time he/she is also on call for issues arising
within the ED department or on the other acute medical areas until 5pm. The general medicine on
call Consultant supports the acute medicine consultant from 09:00 to 12:00 and then takes over the
on call from 17:00.

The acute medicine medical staff works as a team and the expectation is that members of the team
will work flexibly across ACU / AMU / PCRU and ED units dependent on the demand.

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Accreditation
Prospective candidates for this position shall have completed at least four years’ full-time
postgraduate training (or its equivalent gained on a part-time or flexible basis) at least two of which
will be in a specialty training programme in a relevant specialty or as a fixed term specialty trainee in
a relevant specialty; or shall have equivalent experience and competencies. ALS and valid GMC
registration is essential while MRCP is desirable.
It is expected that the new incumbent will complement the current clinical and academic interest of
the department.

Staff:

The Acute Medicine Team:

Consultants Role/ Special Interest

Dr Karl Bonnici Associate Medical Director for Urgent Care

Dr Chaminda Jayawarna Ambulatory Care Lead
Dr Stephen Bonny Trust appraiser
Dr Simon Hodgson Audit lead
Dr Heather Constable Clinical Director for Acute Medicine
Dr Suzy Collins Trust Mortality Lead
Dr Osahon Gbinigie Clinical Governance Lead

The team is supported by three other locum consultants in acute medicine

ST3+ x1 JCFs x8
ST1 ACCS x2 FY2 x1
Specialty Doctors x6 FY1 x1
ANP x3

The acute medicine consultant team is supported with the presence of a junior doctor, for each
consultant, on ward rounds on the acute medical units. The ambulatory care unit has a dedicated
registrar level doctor from 09:00 to 17:00 and from 14:00 to 22:00. There is also a twilight registrar on
the ambulatory care unit from 16:00 to 22:00 Monday to Friday.

Additionally, the acute on call team, from the general medical specialties, works alongside the Acute
Medicine Team, on the assessment and treatment of acute admissions during the day (09:00 to
21:00). This is part of a separate internal rota within the general medical specialties.

Departmental Meetings
There are regular department meetings to discuss day to day issues in running the unit. On
Wednesday afternoon, there is a teaching session for acute medicine with a sponsored lunch. There
is also a monthly radiology meeting for acute medicine and a 8 weekly junior doctor forum for the
acute medicine team.

Audit/Research
The department contributes regularly to the Audit activity within the hospital. The department has
published articles in journals regularly in the last few years and has numerous poster presentations at
both national and international meetings.

Education:
The unit consistently gets excellent feedback from medical students and junior doctors for our
teaching provision. The unit has third year and fifth year students attached to it for most of the year.
The consultants organise weekly dedicated teaching sessions for the students which the appointee
would be expected to participate in. In addition, we organise a weekly acute medicine meeting which
is well attended, and have a consultant led monthly rota for morbidity and mortality reviews.
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The post-holder will participate in audit and medical specialty meetings and undertake appropriate
administrative duties. You will be expected to support informal and formal staff teaching and learning
across the multidisciplinary team.

Continuing professional development:

The Trust has positive attitude towards and encourages participation of its doctors in continuing
professional development to which the Trust provides time and funding for this purpose. The
appointee is expected to participate in CPD and fulfil college requirements.

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.

The Trust is committed to ensuring that newly appointed staff are given appropriate support within
their role. This includes opportunities for the post holder to access appropriate clinical/peer
mentoring.

The appointee will be assigned an educational supervisor.

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 BACKGROUND INFORMATION FOR STOCKPORT NHS FOUNDATION TRUST

GEOGRAPHICAL BACKGROUND:

Stockport constitutes one of ten boroughs in Greater Manchester and its proximity to the Manchester
Medical School has enabled the development of close working relationships with various University
Departments.

The general environment in Stockport and the surrounding countryside is a pleasant one, with the
Cheshire Plain to the South West and the High Peak of Derbyshire to the South East and many
stately homes and parks. There are numerous desirable residential areas and excellent facilities for
all types of education. There are superb transport links including Manchester airport a short distance
away.

THE TRUST:
Stockport NHS Foundation Trust was established on 1st April 2004. We have over 17,000
Members. The Trust provides hospital and outpatient care in acute and community care for children
and adults across Stockport, the High Peak area of Derbyshire and community services to the
population of Tameside and Glossop. The catchment population of our hospital services is about
350,000. The catchment of our community services is about 550,000.

Since becoming a Foundation Trust in 2004 we have used our financial freedoms to improve facilities
for patients. The Trust has built a £25million Cardiology and Surgical Unit and the £10million first
phase of our Southern Sector Development. We have also built a new Paediatric Emergency
Department and completed a new extended Neonatal Unit. The Trust has also invested in additional
car parking facilities at a cost of £2million. We are currently building a purpose built Urgent Care
Centre due for completion in 2016.

The Trust employs nearly 5,800 staff. Our major hospital is Stepping Hill Hospital located on the A6
south of Stockport town centre. The Trust also provides hospital services at the Devonshire Centre
and The Meadows in Stockport, the Colbar Maternity Unit based 18 miles away in Buxton and The
Lakes and Shire Hill Hospital in Tameside and Glossop.

The way we work here is driven by our values:

 Quality & Safety: We deliver safe, high quality and compassionate care. Clean and safe
environment for better care.
 Communication: We treat our patients, their families and our staff with dignity and respect. We
communicate with everyone in a clear and open way.
 Service: We provide effective, efficient and innovative care. We work in partnership with others,
to deliver improved care, in the right place, at the right time.

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In March 2014 the Care Quality Commission (CQC) has again awarded the Trust the top band six
rating; which demonstrates they consider the Trust to have a low risk rating and to be delivering their
outcomes effectively.

Specialist Hospital Status:

We were chosen in July 2015 as one of four ‘specialist’ hospital sites in Manchester, following a
unanimous decision by the 12 Greater Manchester clinical commissioning groups (CCGs) as part of
the Healthier Together programme. Being a ‘specialist’ hospital will enhance our general surgery,
anaesthetics, critical care and emergency medicine for the benefit of people in Stockport, High Peak,
Cheshire and across Greater Manchester.

We are a designated A&E trauma unit and have a fully equipped critical care unit, with additional
beds already available. Our specialist hyper acute stroke centre is one of only three in Greater
Manchester. We will open our new £17 million medical and surgical centre in 2016 which will
significantly enhance surgical care.

The new standards for all four single services will mean: an additional 35 consultants recruited
across A&E and general surgery, a minimum of 12 hours of consultant cover in every A&E seven
days a week, and a consultant surgeon and anaesthetist present for all high risk general surgical
operations.

Integrated Care Business Group (Medicine):

The Integrated Care Business Group provides a range of hospital and community medical services
including acute and emergency medicine through the Emergency Department and acute medical
wards; Acute Medicine and front door geriatrics, regional hyper acute stroke services, General
Medical services including Cardiology, Chest Medicine, Gastroenterology, Diabetes and
Endocrinology, Dermatology, Clinical Haematology, Rheumatology, Nephrology, Neurology,
Rehabilitation, Sexual Health and HIV services and a comprehensive range of services for older
people including Day Hospital and Rehabilitation.

The majority of hospital services are delivered from the Stepping Hill site, with some inpatient beds
on the Cherry Tree site and outreach to Buxton Hospital is also provided.

The Business group manages the full range of nursing community services in Stockport and works
closely with primary care & social care.

Surgical & Critical Care Business Group:

The surgical specialties include genito-urinary, gynaecological, maxillofacial, general, ENT,

orthopaedic and ophthalmic surgery. Anaesthesia is provided for ECT in the Psychiatric Department.
A 24-hour pain relief service is provided for the busy Maternity Unit, which has 73 obstetric beds and
averages 3,500 deliveries per year.

There is a newly refurbished Critical Care Unit consisting of 6 ICU beds and 8 HDU beds. These
staffed beds are used flexibly to accommodate level 2 & level 3 patients as required.

The trust has a purpose built anaesthetic pre-assessment service run by nurse practitioners.

An emergency / CEPOD theatre and a trauma theatre is available for emergency work every
afternoon allowing increasing consultant input into emergency work thus reducing out of hours
emergency workload particularly after midnight.

There is a well-established Acute and Chronic Pain service with 3 chronic pain consultant’s, two
acute pain specialist nurses and two chronic pain specialist nurses; the service has a lead consultant.

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Child & Family Services Business Group:

The Children’s and Family Services Business Group comprises the specialties of Maternity Services,
Gynaecology, Children’s Services and Health visiting.

Maternity comprises a comprehensive range of maternity services to the women of Stockport and the
High Peak area of North Derbyshire and Gynaecological Surgery. The service works in partnership
with General Practitioners and the Health Authority and there is a small base in Buxton providing
Maternity services. Gynaecology comprises of infertility service; inpatients; outpatients; direct access
hysteroscopy; colposcopy; and access to Ward D5 and Short Stay Surgical Unit.

Children's services - we have a purpose built Children's unit housing 3 acute wards including medical
and surgical specialties, plus an assessment and observation unit and a 2 bedded HDU. On the
ground floor is an outpatient unit with a day case investigation suite and integrated CAMHS and
therapy services. Stockport has a unique paediatric model where community and acute services are
integrated so that a child only has one paediatrician, and we have an in house acute children's
community nursing team. We also have extensive community services including a child development
unit, a children's learning disability team and a respite provision off site for children with severe
physical and learning disabilities.

Neonatal unit - our unit was fully refurbished and extended in 2009 to provide a state of the art facility
with 16 cots providing intensive, high dependency and special care as part of the North West
Regional neonatal cot network. We also have excellent parent facilities including a Transitional care
unit and 3 fully equipped rooms for resident parents.

Diagnostic and Clinical Support Services Business Group:

The Diagnostic and Clinical Support Services Business Group provides Pharmacy, Physiotherapy,
Occupational Therapy, Speech and Language Therapy, Rehabilitation, Laboratory Medicine,
Radiology and Outpatients services. A number of outpatient clinics are supported by sessions taken
by external consultants in Thoracic Surgery, Neurology and Oncology. Therapy services are provided
both in hospital and community settings.

Radiology provides a comprehensive diagnostic and interventional service to the Trust and, local GP
and dental practices from bases at Stepping Hill and Cherry Tree Hospitals. The MR Scanning
service is provided in a new purpose built on site unit.

Tameside and Glossop Community Healthcare Business Group:

The Group provides a full range of community services to the population of Tameside and Glossop
and also manages two hospitals: The Lakes in Hyde, Tameside and Shire Hill in Glossop,
Derbyshire. They provide many innovative and award winning services for both adults and children
and while they work mainly with Tameside Hospital across the primary and secondary care interface
they are increasingly influencing the service provision in Stockport towards a more integrated
approach across the community.

The Clinical Directorates are supported by a number of non-clinical services:

Facilities Directorate – Risk Management, Controls Assurance, Security, Linen Services,

Telecommunications, the Hospital Sterilisation and Disinfection Unit, Catering, Receipt and
Distribution, General Office, Hospital Cashier, Administration Services, Car Parking Services,
Voluntary Services, Transport Services, Gardening Services, Residential Accommodation, Hotel
Services Quality Control, Portering and Postal Services and Estates.

Central Management Services - Human Resources, Information, Finance and Planning. Within the
Human Resources Department is a Medical Personnel function, which provides a comprehensive
service to all grades of Medical Staff.
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A purpose built multidisciplinary Education Centre opened on the main hospital site in 1994 and
accommodates the Postgraduate Centre, the Training and Development Centre, the University Of
Manchester School Of Nursing and the Education Centre Library.

The General Directorate Physicians and Specialties are:

Gastro 6 WTE
Diabetes /Endocrine 3 WTE
Cardiology 7 WTE
Chest 4 WTE
Dept. Medicine Older People including Stroke 8 WTE

Academic
The Trust has positive attitude towards and encourages participation of its consultants in continuing
professional development to which the Trust provides time and funding for this purpose. The
appointee is expected to participate in CPD and fulfil college requirements.

Teaching
The Hospital undertakes clinical teaching of medical undergraduates from Manchester and students
may visit the trust/Department on an ad hoc basis. This has helped to establish and maintain close
links with the Medical School.

The successful candidate will be expected to offer teaching to junior doctors, medical students and
other health professionals within the Trust. From time to time the appointee may be asked to teach
other professional groups.

The integrated Education Centre has greatly enhanced the postgraduate education facilities. Many
lunchtime meetings are held at present in which the appointee would be expected to take a full and
active part.

Quality and Audit

There is an active clinical audit department in the hospital with quarterly inter-departmental meetings
at which there is regular medical input. The department is also involved in its own internal audit and
more extensive inter-departmental audit is a regular ongoing exercise.

Research
In response to recent national and regional changes of the NHS Research and Development funding,
Stockport NHS Trust is currently developing an integrated R & D information and support
infrastructure.

It should be noted that a Research and Development fund exists within the Trust and that a Research
and Development Co-ordinator and Committee, chaired by a Consultant Epidemiologist exists to help
this with a research interest.

A willingness to take lead in implementing the findings of R & D in clinical practice is welcome and
the successful candidate will be expected to actively contribute to debate within the Department on
methods for enhancing the effectiveness of the services delivered.

The Trust supports the requirements for Continuing Medical Education as laid down by the Royal
College of Physicians and is committed to providing time and financial support for these activities.
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PERSON SPECIFICATION

ESSENTIAL FOR THE POST DESIRABLE FOR THE POST

1. Professional Qualifications
2. Training
3. Previous Work Experience
a) Experience Needed
Primary Medical Qualification Full MRCP
MBChB shall have completed
at least four years’ full-time
postgraduate training (or its
equivalent gained on a part-
time or flexible basis) at least
two of which will be in a
specialty training programme
in a relevant specialty or as a
fixed term specialty trainee in
a relevant specialty. graduate
training in the UK (or
equivalent) in acute medicine/
General Internal Medicine.
GMC Full registration
MRCP part 1
Experience in Acute Medicine
In date ALS course
A minimum of 12 months
experience of working in the
NHS.

A broad training which

demonstrates appropriate
b) Level of responsibility should experience in and a positive
be shown now attitude towards Acute
Medicine

Comprehensive patient
management

4. Research/Publications Evidence of relevant

5. Professional Interests
6. Personal Skills
a) Communication
publications, demonstrating
understanding of research
methodology and commitment
Membership of appropriate
professional society(ies)
A friendly, understanding and
caring personality.

b) Relationships Good networking skills

c) Supervision Good written and oral

communication skills
d) Leadership
e) Teamwork Ability to form good
professional relationships with
all departments

Experience of supervision of
junior medical staff and
relevant staff
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 ESSENTIAL FOR THE POST DESIRABLE FOR THE POST

Ability to lead

Energy and enthusiasm and

the ability to work under
pressure
7. Management Issues
a) Management Knowledge of the principles of
Clinical Governance
Regular attendance and Awareness of the managerial
b) Clinical Governance participation at audit meetings role of a doctor in the NHS
c) Audit
8. Circumstances
a) Residence Car owner, with full driving
b) Car owner/driver licence
9. Physical Requirements

a) General Health Satisfactory medical clearance

from the Trust’s Occupational
Health Physician
10. Other Requirements Authorised to live and work in
the United Kingdom

Arrangements of Visit

Arrangements to visit the hospital may be made by contacting:

Dr Suzy Collins
Clinical Director for Acute Medicine
Acute medicine department (AMU)
Stepping Hill Hospital
Poplar Grove
Hazel Grove
Stockport
SK2 7JE

Or email: debbie.leeson@stockport.nhs.uk

Tel: 0161 419 4036

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