Acute Medicine

Grade/Level
Trust Grade / ST3+

Location
North East London

Site
Homerton University Hospital

Website
www.homerton.nhs.uk

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 HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

CLINICAL FELLOW (CT 3 GRADE) IN ACUTE MEDICINE

1. Introduction

Homerton University Hospital NHS Foundation Trust (HUH) is an acute hospital located in the east London
Borough of Hackney. The current Chairman is Sir John Gieve and the Chief Executive is Ms Tracey Fletcher.

The hospital building opened in 1986, with Homerton Hospital Trust established in 1994. The hospital received
university status in 2001. We provide training for medical students from Queen Mary College, University of
London and nursing and allied health professions training for students from City University and the University of
East London.

Homerton became one of the first ten NHS foundation trusts in the country in April 2004. This allows the Trust to
secure certain freedoms to facilitate innovation in the way services are developed and provided. As well as our
Trust Board, we also have a Council of Governors comprised of governors representing the local community.

In 2011 the Trust integrated with City & Hackney Community Health Services thereby providing it with an
opportunity to develop new service models and pathways which cross traditional organisational boundaries.

Employing over 3000 people, the hospital has approximately 500 beds and also manages a 50 bed nursing
home, Mary Seacole Nursing Home, in Shoreditch, East London. In 2015/16, the Trust admitted over 50,000
people, saw over 250,000 people in outpatient clinics and nearly 120,000 people were treated in the accident
and emergency department.

The Trust has a turnover in the region of £220 million, performs consistently well against national performance
targets and has an ambitious objective to increase its income to £300 million over the next few years.

The hospital provides a full range of general acute services for the local population and a range of specialist
services for patients from further afield. These include perinatal (level 3 NICU) and fertility services, bariatric and
laparoscopic surgery, and stroke and neuro-rehabilitation. The hospital has three day surgery theatres and five
main operating theatres for all types of general surgery, trauma and orthopaedics, gynaecology, maxillo-facial,
urology, ENT and obstetrics. There is a 10-bedded combined adult intensive care / high dependency unit.

The Trust’s community services offer a full range of adult and children’s services and many of these are
delivered in conjunction with partner organisations within the local health and social care economy.

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2. Management Structure

Homerton’s Board of Directors has overall responsibility for the management and delivery of services. The
responsibility for clinical and operational management and leadership is delegated to the Clinical Board,
comprising of the executive directors, associate medical directors and divisional operations directors:

 Chief Executive - Ms Tracey Fletcher

 Director of Finance
 Chief Nurse/Director of Governance
 Medical Director
 Chief Operating Officer
 Associate Medical Director (SWSH)
 Associate Medical Director (CDSO)
 Associate Medical Director (IMRS)
 Divisional Operations Director IMRS
 Divisional Operations Director SWSH
 Divisional Operations Director CSDO
- Mr Phill Wells
- Ms Catherine Pelley
- Dr Deblina Dasgupta
- Mr Dylan Jones
- Dr Eleanor Wood
Mr Yinka Akinfenwa
- Dr Sue Rowe
- Dr Emma Rowland
- Mr Osian Powell
- Ms Mags Farley
- Mr Daniel Wood

3. Structure of Clinical Services

Clinical care is the responsibility of clinical and operational teams within the Trust’s three Divisions. Each
Division is headed by a Divisional Operations Director and an Associate Medical Director:

The Integrated Medicine & Rehabilitation Services Division (IMRS) includes the emergency department, medical
specialties, and adult community services.

The Surgery, Women’s and Sexual Health Division (SWSH) includes the surgical specialities, obstetrics and
gynaecology and acute and community sexual health services.

The Children’s Services, Diagnostics and Outpatients Division (CSDO) includes all acute and community
paediatric provision, radiology, pathology, pharmacy and outpatient services.

4. The Local Environment

Hackney has an ethnically diverse population with less than half (47%) of residents identifying themselves as
White British. Nearly a third of the population describes their ethnic origin as Black African (11%), Black
Caribbean (9%) or south Asian (9%). These Census categories disguise the complexity of the ethnic profile of
Hackney however. The size of the Charedi (Orthodox Jewish) community is estimated to be 15,400 or 7% of the
population for instance. This community is growing rapidly; over half (52%) of the Charedi population is under 20
years old.

There is also a large Turkish community and recently there has been an increase in people coming to the area
from the new member states of the EU, especially Poland. Hackney has one of the largest refugee and asylum
seeker populations in London, estimated to be between 16,000 and 20,000 people, and has the third highest
number of refugee children in maintained (state‐funded) schools.

Hackney has large Christian, Muslim and Jewish populations. The City is less diverse, though even here 31% of
the population does not identify as White British and 8% describe their ethnic origin as south Asian. The
population of the City is majority Christian

The population of Hackney is evenly divided in relation to sexes: 51% female vs. 49% male. The population of
the City is much older with only one in ten (10%) residents aged under 20. There are more men (54%) than
women (46%) in the City.

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5. Clinical Commissioning Group

The Trust has an excellent and long-standing relationship with its local GPs and works well with the newly
established City & Hackney Clinical Commissioning Group. Joint-working has led to a number of initiatives
across a range of specialities with a focus on improving the integration and quality of services. This work is
expected to continue and intensify over the next few years.

6. Strategic Priorities and Values

Since becoming a Foundation Trust in 2004, the Trust has maintained its reputation as a high performing
provider, delivering quality patient and service user care whilst also achieving compliance with key performance
and regulatory requirements.

In January 2014 the Trust launched a new organisation strategy, Achieving Together. This strategy sets out our
priorities, goals and values for going beyond our current high standards and establishing the Trust as one of
country’s foremost health providers with a reputation for quality, innovation and leading the way on service
integration.

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Our mission:
Safe, compassionate, effective care provided to our communities with a transparent, open approach.

Our Strategic Priorities:

Quality:
• Safe – Continuously strive to improve patient safety and provide harm free care.
• Effective – Provide services based on the latest evidence and clinical research.
• Positive patient experience – Ensure all patients have an excellent experience of our services through
providing person centred care that takes into account each patient’s or service user’s needs, concerns
and preferences.

Integration:
• Pathways – Ensure care pathways, across the health system, are designed around the needs of the
individual.
• Prevention – Focus on early intervention to improve health and wellbeing and reduce the cost of health
care provision.
• Partnership – Create seamless services in which organisational boundaries are not evident to the patient
or service user.

Growth:
• Scale – Ensure core services are of a sufficient scale for long term sustainability and effectiveness.
• Reputation – Develop a national reputation and profile for leading the way in the provision of high quality
and innovative health care services.
• Turnover – Establish an ability to respond to the financial and quality challenges facing health care
providers by increasing turnover to £400m by 2020.

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Our Values:
The Trust has developed four core Values which form a framework for how we deliver services and relate to one
another.

Over 1,500 members of staff, as well as our patients and service users participated in developing the values.
This gives them real strength and reinforces the importance that they form the foundation of all that we do.

Safe:
We will do everything we can to make our services as safe as possible and create a positive learning
environment.

We will do this by:

 being open and honest when we get things wrong, and doing all we can to correct and learn from our
mistakes
 listening to our staff, patients, service users and their carers and using their feedback to improve
services
 ensuring that we have the right staff with the right skills caring for each patient
 constantly monitoring standards of care and responding quickly if there are concerns

Personal:
We will provide care which addresses individual needs and focuses on our patients, service users, their families
and carers, and our staff

We will do this by:

 ensuring that relationships with patients and service users are founded on compassion, empathy and
kindness
 appreciating each person as an individual and addressing their specific needs
 actively listening to and involving patients and service users in decisions about their care
 providing continuity of care through good communication and teamwork

Respectful:
We will treat others as we would expect ourselves or our families to be treated

We will do this by:

 treating everyone with dignity and respect
 listening to others and valuing their contribution
 providing services that meet the diverse needs of our communities
 valuing and supporting the health and wellbeing of all our staff

Responsibility:
We will take responsibility for our actions and any problems that we come across – we will lead by example.

We will do this by:

 being open and transparent about our performance and setting challenging improvement targets
 think differently and look for new and innovative ways of working
 ensure our care is evidence based and follows best practice
do the right thing, even when it is difficult

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Job Title: Registrar in Acute Medicine

Grade: ST3+ or above, or equivalent experience

Division: Integrated Medicine and Rehabilitation Services (IMRS)

Reports to: The registrar will report directly to the Clinical Lead for Acute Care Medicine and be
responsible to the Divisional Associate Medicine Director.

The registrar will be responsible for contributing to one or more of the following activities within the Trust:

 Managing services
 Coordination of medical care
 Quality and service improvement
 Education and training
 Service re-design
 Workforce transformation

This may include the exploration of out-of-hours working or the safety of 7-day working.

Coordination of Medical Care

The registrar should, as a minimum, attend departmental and divisional management meetings to gain an
understanding of management and the wider social, political and economic influences on healthcare delivery.
Where possible and appropriate, they should attend trust board meetings. They should lead any sessions on
service development, improvement and transformation for which they have direct responsibility.

The registrar will be involved in overseeing the planning of service delivery in relation to junior medical staff
deployment. This may include planning and oversight of delegation of specific duties to non-medical staff. The
chief registrar must have insight into patterns of out-of-hours working, shift working, safe cover / medical staffing,
handover, hospital at night, communication and information technology systems.

An important function of the registrar will be to engage with junior medical staff within the Medical Division, to act
as a conduit between them and the senior physicians and senior clinical managers responsible for service
delivery.

The registrar will also engage with allied healthcare professionals and may explore innovative solutions to
medical workforce challenges.

Quality and service improvement

There will be opportunity for the registrar will work closely with senior management to initiate and lead a range of
strategic projects, including service re-design and the introduction of new services. The projects selected will be
tailored to the needs of the trust and individual’s interests. All such activities should have patient safety and the
delivery of high-quality, safe, compassionate care at their core.

Education and training

The appointee will contribute to the junior doctor educational programme. This may include designing teaching
programmes, overseeing the delivery and evaluation of teaching, and ensuring the quality of junior doctor
education in the Medical Division, particularly with respect to internal medicine. The Homerton University
Hospital NHS Foundation Trust has a large education and simulation department. The registrar will be given the
opportunity to complete the ‘train the trainers’ course’ and will lead on in situ simulation course on the acute care
unit.

Homerton University Hospital has a strong track record of providing high quality training for junior doctors.

The post holder will participate fully in undergraduate and postgraduate teaching programmes. Other training
opportunities can be arranged in a range of other specialities e.g. emergency medicine, ITU, anaesthetics,
geriatric medicine etc to help develop your specialist interests.

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Clinical Responsibilities:

The timetable will include on-call commitments (general medical rota). The clinical responsibilities undertake will
based on the acute care unit where they will oversee the day-to-day operations and will be expected to
contribute to the acute medical take as part of the medical rota.

The registrar will work closely with the Consultants and other staff on ACU; however will be the consistent senior
decision maker on the unit. Furthermore, you will be working with and liaising with on-call consultants this will
help ensure timely, well planned and efficient treatment and discharges occur. The successful candidate will be
expected to be flexible to cover other gaps in the rota in case of need.

The standard shift pattern for this post is 0900-1700 Monday to Friday. However, the postholder will be required
to be flexible and will be expected to work long days (0930-2200), evening shifts (1400-2200), night shifts (2130-
1000) and weekend shifts as required. The rota is European Work Time Directive compliant.

We will give the following notice for a shift outside of core hours (0800 - 1600)

Twilights/Nights – 24 hours
Weekend – 48 hours

Although the post holder will require being flexible in covering gaps in the rota no more than 10 weekend shifts
and/or 20 night shifts will be required in a 6 month period.

The post attracts a 50% payment supplement the flexibility in completing the anti-social hours.

Department of Acute Medicine

Services

The department aims to provide residents of Hackney with the highest standard of acute medical care. The
department offers following inpatient services:

1) A thirty five-bedded Acute Care Unit

2) Full range of medical investigations expected from a busy DGH

All emergency admissions are admitted to the Acute care Unit, which is staffed by a Multiprofessional large
Acute care Team who retains overall responsibility for the whole ward. The unit is busy and sees approximately
10,000 admissions per year. The Acute care Unit & the team has been functional since 2007 and incorporates
the Hospital at Night team. The unit has robust clinical governance systems to promote patient safety &
experience.

Staff

The Acute Care Department comprises of a clinical and non-clinical multi-disciplinary team consisting of Doctors,
Nurses, Therapists and ward clerks. This team works together to facilitate the highest standard of care for
patients, ensure an efficient throughput of patients and an effective discharge planning process.

The Homerton University Hospital Acute Care service operates this service by ensuring adequate staffing on the
ground by using a rota that is EWTD compliant.

Homerton University Hospital Trust was a leader in the development of Hospital at Night and now has
established this in the Acute Medicine Service.

24 hour cover is achieved with two ‘Acute Care’ Registrars on day shifts, and one ‘Acute Care’ SHO on day shift
accompanied by the staff on ‘Acute Care Unit’ rota. This will include:

Consultants

There are 16 Consultant Physicians partaking in an on-call rota covering 24 hours 7 days a week.

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Continuing Medical Education

The currently advertised post is not approved for training by the Postgraduate Dean; however it has the same
training and educational opportunities as those available to other ST3 post in the Trust
Continuing medical education (CME) is an integral part of the post. The appointee will be encouraged to ensure
that his full entitlement to CME/study leave is taken.
The post holder will be encouraged to participate in the following training opportunities:
 Acute medicine teaching program
 Medical Unit meeting
 CMT teaching program
You will work have the opportunity to work closely with consultants of all specialities with wide scope to learn and
enhance acute medical skills.
Further to this, training opportunities can be arranged according to specific interests including
emergency medicine or ITU. Any other interest areas or career development opportunities and activities
would also be supported. The Trust also has an active simulation teaching program which the post
holder will be encouraged to participate as well.
Educational supervision will be actively provided.

Main Conditions of Service – Terms and Conditions

The post is covered by the Homerton University Hospital NHS Foundation Trust’s terms and conditions of
service, which follow those of the national terms and conditions of hospital medical and dental staff (England and
Wales) (the ‘TCS’) and is subject to the National Health Service (Superannuation) regulations.

Duration of appointment
The appointment is for six months to one year in the first instance, unless previously terminated by one months’
notice on either side.

Salary scale
The salary for the post will be on the MN37 payscale in accordance with the NHS salary scales (£31,217 to
£49,086 per annum) plus London weighting allowance.

The post attracts a 50% payment supplement the flexibility in completing the anti-social hours.

Health clearance

All appointments are made subject to satisfactory occupational health clearance and the successful candidate
will be required to undergo occupational health screening prior to commencing work with patients.

Spent convictions

Because of the nature of the work, this post is exempt from the provision of section 4(2) of the rehabilitation of
offenders act, 1974, by virtue of the rehabilitation of offenders act, 1974 (exemption order 1975). Applicants are,
therefore, not entitled to withhold information about convictions including those which for other purposes are
“spent” under the act and, in the event of employment, any failure to disclose such convictions could result in
dismissal or disciplinary action by the Trust. Any information will be completely confidential and be considered
only in relation to an application for positions to which the order applies.

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 HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
DEPARTMENT OF ACUTE MEDICINE
DIRECTORATE OF GENERAL AND EMERGENCY MEDICINE
CLINICAL FELLOW (ST 3+ GRADE) IN ACUTE MEDICINE
PERSON SPECIFICATION
Essential criteria
Qualifications / training
 Full registration with General Medical Council
 Be fit to practice
 Should be ST3+ or above.
 Evidence of satisfactory / more than satisfactory progress
through training, including annual review of competence
progression (ARCP) outcomes
Clinical skills
 Competence in managing medical emergencies
 Evidence of clinical competencies in their medical specialty
appropriate for their stage in training
 An appropriate knowledge base, and ability to apply sound
clinical judgement to problems
 Ability to prioritise clinical need
 Ability to maximise safety and minimise risk
 Ability to work without supervision where appropriate
Research
 Understanding of research, including awareness of ethical
issues
 Understanding of research methodology
 Knowledge of evidence-based practice
Leadership and management
 Evidence of effective team working and leadership, supported
by multi-source feedback or workplace-based assessments
 Self-awareness, with knowledge of personal strengths and
weaknesses, impact and areas for development
 Interest in and knowledge of the importance of leadership and
management for clinicians
Quality / service improvement or audit
 Awareness of the RCP Future Hospital Programme and
understanding of the issues related to the implementation of
the Future Hospital Commission’s recommendations
 Understanding of clinical governance, including the basic
principles of audit, clinical risk management, evidence-based
practice, patient safety and quality improvement initiatives
 Evidence of active involvement in quality improvement, audit,
research or other activity that focuses on patient safety and
clinical improvement and innovation
 Interest in / knowledge of the delivery of safe, effective
healthcare services
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Desirable criteria
 Additional relevant degree (intercalated,
masters or doctorate)
 Evidence of skills in the management of
acute medical emergencies (eg ALERT,
IMPACT certification, ALS instructor)

 Evidence of involvement in a formal
research project
 Evidence of relevant academic
achievements, including publications /
presentations
 Evidence of involvement in local
management systems
 Evidence of effective leadership in and
outside medicine (eg evidence of leading
innovations or improvements)
 Understanding of leadership theory and
practice
 Understanding of NHS management and
resources
 Understanding of the local and national
context in which the trust operates,
including economic and political influences
 Evidence of a portfolio of audit / quality
improvement projects, including evidence
that the audit loop has been closed and
evidence of learning about the principles of
change management
 Evidence of publications / presentations /
prizes in quality improvement or audit
 Good knowledge of the UK healthcare
system, including education, research,
service provision, regulation, career
structures, medical politics and ethics
 Clear insight into issues facing UK
healthcare services