Nhs lothian Edinburgh chp rehabilitation Medicine Base: Astley Ainslie Hospital Fixed Term (6 months 4/2/15 – 43/8/15) las in Rehabilitation Medicine at the Astley Ainslie Hospital, Edinburgh



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NHS Lothian
Edinburgh CHP
Rehabilitation Medicine
Base: Astley Ainslie Hospital
Fixed Term (6 months 4/2/15 – 43/8/15) LAS in Rehabilitation Medicine

at the Astley Ainslie Hospital, Edinburgh



  1. Outline of the post

Applications are invited for the above post, which is available from February 2015 for a period of 6 months. This post would suit a potential/future trainee in General Practice/Core Medical Training or Rehabilitation Medicine looking to expand their clinical experience.





  1. NHS Lothian

NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental health and hospital services. Tim Davison is Chief Executive and Dr David Farquharson is Medical Director.


The NHS Board determines strategy, allocates resources and provides governance across the health system. Services are delivered by Lothian University hospitals division, the Royal Edinburgh hospital and Associated mental health services, 4 community health (and social care) partnerships (CH(C)Ps) in City of Edinburgh, West Lothian, East Lothian and Midlothian, and a Public Health directorate.
NHS Lothian serves a population of 850,000.


    1. University Hospitals Division

The University Hospitals Division provides a full range of secondary and tertiary clinical services to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The Division is one of the major research and teaching centres in the United Kingdom.


Hospitals included in the Division are:
The Royal Infirmary of Edinburgh

The Western General Hospital

The Royal Hospital for Sick Children, Edinburgh

St Johns Hospital

Royal Victoria Hospital

Liberton Hospital

The Princess Alexandra Eye Pavilion.
The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres, and is equipped with modern theatre and critical care equipment and monitoring. Within the main building is a dedicated, multidisciplinary, 5 theatre day surgery complex. The hospital provides for most specialities and is the centre for:


  • General surgery with a focus on the upper GI tract

  • Vascular surgery

  • Hepato-biliary and Transplant medicine and surgery

  • Cardiac and Thoracic surgery

  • Elective and trauma Orthopaedics surgery

  • Neonatology

  • Obstetrics & Gynaecology

  • Cardiology

  • Renal Medicine

  • Sleep Medicine

  • Regional major Accident and Emergency centre.

There is a Combined Assessment Unit that takes unselected GP or direct emergency referrals, and from A&E. CAU includes the Dept of Liaison Psychiatry and the Scottish Poisons Bureau and Treatment Centre. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM and PET scanning will be available in 2008). There is a full range of lecture theatres, a library and AV facilities.


The Western General Hospital (WGH) has 600 beds and 5 operating theatres and is equipped with modern theatre and critical care equipment and monitoring. The Anne Ferguson building was completed in 2001. The hospital provides for most specialties and is the centre for:


  • Neurology, Neurosurgery and neuropathology

  • UK CJD unit

  • Colorectal Surgery

  • Urology and Scottish Lithotriptor Centre

  • Breast Surgery and Breast screening

  • Gastro-Intestinal disease

  • Rheumatology

  • Infectious Diseases

  • Haematology Oncology

  • Medical Oncology

  • Radiation Oncology (including 6 LINACs)

  • Dermatology (Inpatient)

  • Medicine of the Elderly and Stroke Medicine

There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance medical cases on a zoned basis within the city, and a nurse led Minor Injuries Unit. There is no trauma unit at this hospital. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM).There is a full range of lecture theatres, a library and AV facilities.


St John’s Hospital opened in 1989 and is located in the centre of Livingston; a new town about 30 minutes drive west from Edinburgh. The hospital provides for most common specialties but does not have emergency general surgery or orthopaedic trauma operating. The hospital has a paediatric ward and is the centre for:


  • General Medicine with specialists in Cardiology, Diabetes & Endocrinology, Gastroenterology, Respiratory Medicine and Care of the Elderly

  • Obstetrics & Gynaecology

  • Child Health including Paediatrics and community child health

  • The regional Burns and Plastic Surgery unit for SE Scotland

  • Oral and Maxillofacial Surgery

  • ENT

  • Critical Care (ITU, HDU and CCU)

  • Accident and Emergency

  • General Surgery

  • Orthopaedics

  • Anaesthetics

  • Mental Health including ICCU and ICPU

Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH being developed as a major elective centre for the region. Lothian’s ENT service was relocated to SJH to create an integrated head and neck unit with OMFS and Plastic Surgery.


Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, Ultrasound and NM).
The hospital has been accredited full teaching hospital status by the University of Edinburgh. There is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and specialist services for children. The hospital is situated in a residential area close to the centre of Edinburgh and is approximately 3 miles from the site of the New Royal Infirmary and the co-located University of Edinburgh Medical School and 3 miles from the Western General Hospital. The RHSC is the main paediatric teaching hospital for the South-East of Scotland providing general and specialised services on a local, regional and national basis. It acts as the local paediatric referral centre for the children of Edinburgh and surrounding areas, and as a tertiary referral centre for intensive care patients; gastroenterology, hepatology & nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal surgery; plastic surgery; orthopaedic surgery; urological surgery and aspects of general surgery.
Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8 bedded Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3 bedded Neonatal Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full range of audio-visual equipment.

All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy services. The local radiology department provides on site Magnetic Resonance Imaging, CT Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry, haematology, pathology and neuropathology services.


The RHSC reprovision project is well under-way with plans to build a state-of-the-art children’s hospital on the current Royal Infirmary site. The aim is to transfer of the current RHSC services in 2015.
Community Healthcare Partnerships
The four established Lothian Community Health (and Social Care) Partnerships serve the population of Edinburgh, Midlothian, East Lothian and West Lothian.
Hospitals in the CH(C)Ps include:
The Astley Ainslie Hospital in Edinburgh

Rosslynlee Hospital in Midlothian

Herdmanflat Hospital

Roodlands Hospital in East Lothian.


The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian Councils bringing together those responsible for planning, managing and providing community-based health services for the population of Edinburgh and the Lothians.
There are 7,500 members of staff. In addition, there are approximately 1,000 independent contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A population of 850,000 people is served across health board area. The range of services care of the elderly, medical rehabilitation, community mental health, substance misuse and learning disability, district nursing and health visiting, family planning, well woman, , comprehensive dental care and those provided by Professions Allied to Medicine, such as physiotherapy, pharmacies and optometrists. Specialist services provided include brain injury rehabilitation, bio-engineering and prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and Family Psychiatric Services.


      1. Royal Edinburgh hospital and Associated Services

The Royal Edinburgh and Associated Services provides a range of Mental Health services to the population of Lothian and other Boards within Scotland.


The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the following range of specialities:-


  • Acute Mental Health

  • Rehabilitation

  • Psychiatric Emergency Team 24/7

  • Outpatients

  • Assessment Phychiatry of Old Age

  • Forensic Medium Security Unit

  • Inpatient facilities for under 18s

  • Psychotherapy Service

  • Psychology Services

  • Services for Eating Disorders

  • Day Hospitals – Psychiatry of Old Age

There are an additional 46 bed and 1 day hospitals for Psychiatry of Old Age in the north of the city at the Royal Victoria Hospital.


The hospital is currently housed in a mix of accommodation ranging from 19th century to present. There is a major project now in place to take forward a reprovisioning programme in line with the strategic vision with the “Delivery for Mental Health” Scottish Executive 2006.


    1. Department of Public Health Medicine

The aim is to improve the health of the people of Lothian in collaboration with many other partners. Using our range of knowledge, experience and networking capability, our distinctive contributions are:




  • the promotion of specific measures to monitor and improve health;




  • the collation and interpretation of health related information.

The following objectives have been agreed as the basis for the Department’s work plans:


1. To monitor the health status and health needs of people in Lothian;
2 To promote improvements in the health of Lothian people directly, and by providing information and advice to the public on health matters;
3. To assist Lothian NHS Board to fulfil its statutory obligations;
4. To contribute to strategic changes within the NHS in Lothian by providing information on clinical effectiveness;
5. To facilitate improvements in health and health care services directly, and through ‘managed clinical networks’ and wider alliances;
6. To contribute on a 24 hour basis to the control and prevention of communicable diseases and environmental hazards;


  1. To maintain commitments to teaching, training, professional development, audit and research.

To enable efficient management of the Department: there are at present four groups in the Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health Information.




  1. University of Edinburgh

The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research university, graded within the top six multi-faculty British Universities in the last national research assessment exercise (90 percent of its academic staff were in units rated 4, 5 or 5*). It has 3,000 academic staff, over 16,000 undergraduate and over 4,000 postgraduate students and an annual expenditure of over £261M for teaching and research. The University is organised into 3 Colleges: Humanities and Social Science, Medicine and Veterinary Medicine, Science and Engineering.




  1. NHS Library and Postgraduate Facilities

There are excellent facilities on all sites.




  1. The Department

The Rehabilitation Directorate is within the management structure of NHS Lothian’s Edinburgh Community Health Partnership (ECHP)




In-Patient Services
The in-patient facilities are as follows:


  1. Charles Bell Pavilion2 Wards - 40 neurorehabilitation beds (Dr Alasdair FitzGerald and Alyson Nelson) including patients with brain injury and those with acute disabling neurological conditions requiring inpatient rehabilitation. The unit has close links with the Dept of Clinical Neurosciences.




  1. Sutherland Ward - 13 beds (Consultant: Dr L Hutton) concerned with amputee rehabilitation. Close links exist between this service and vascular/orthopaedic surgery services as well as with prosthetics and bioengineering.




  1. Mears Ward - 13 beds (Consultant: Vacancy) provides rehabilitation principally for young male patients recovering from the consequences of stroke. The unit provides stroke rehabilitation primarily for patients under 65 and has close links with the acute stroke units in Lothian.




  1. East Pavilion – 18 beds (Consultant: Dr S Donald) provides a service for patients with complex, physically disability secondary to neuroprogressive disorders.



  1. Additionally the directorate manages the Robert Fergusson Unit a 20 bedded unit at the Royal Edinburgh Hospital for acquired brain injured patients with complex behavioural and cognitive issues.


Out-Patient Services & Community Services
1. Out-patient Clinics: All five Rehabilitation Medicine consultants hold clinics in the Cunningham Unit at the Astley Ainslie Hospital.


  1. Out-patient services: The four consultants with inpatients on this site also have outpatient services for follow-up of patients discharged from the ward and for new outpatients identified through clinics.




  1. Cardiac Rehabilitation services for Lothian are based on the site providing a number of programmes on-site and others in community locations




  1. A chronic pain management service is also based on the site.




  1. Community Services: The consultant responsible for the Lanfine service is the primary medical representative for community services for complex chronic neurological conditions. Medical input is also provided to the social work day centres in the city. There are a number of community teams serving neurological patients in the various Lothian sectors.




  1. Mobility & Rehabilitation Engineering: The South East Mobility & Rehabilitation Technology (SMART) Centre within the AAH contains a regional wheelchair centre; national driving assessment centre; a Disabled Living Centre; and provides special seating and bioengineering including prosthetic services.


Numbers and Grades of Other Medical Staff in the Department
4 Specialist Registrars in Rehabilitation Medicine

5 GPST1/2 (including this post)

1 CMTST1

4 GPFY (weekend day shifts)

1 Specialty Doctor

Names of Consultant & Other Senior Members of the Department
Dr I Todd (appointed 1995), Clinical Lead and Consultant in Rehabilitation Medicine (with special duties in Cardiac Rehabilitation
Dr S Donald (appointed 1997), Consultant in Rehabilitation Medicine (Community)
Dr L Hutton (appointed 2005), Consultant in Rehabilitation Medicine

(with special responsibility for Amputee and Mobility Services).


Dr Alasdair FitzGerald (appointed 2010), Consultant in Rehabilitation Medicine (with special duties in Brain Injury and neurorehabilitation)

Dr Alyson Nelson (appointed 2013), Consultant in Rehabilitation Medicine (with special duties in Brain Injury and neurorehabilitation)
Dr Lisa Barrett (appointed 2014), Consultant in Rehabilitation Medicine (with special duties in stroke and general rehabilitation)
6. Details of the Post
The rota is a full shift rota. While on call the doctor is required to live in and is first on call for the whole hospital. The current rota is normally shared with 5 GPSTs, 1 CMTST, 4 GPFY2s (weekend day shifts only) and 1 ST3/4 during the first two years of their specialist training programme. A second (and sometimes third) on-call duty rota operates with the Consultants in Rehabilitation Medicine and the Specialist Registrars/ST 5/6 (during the 3rd and 4th years of their training).

The post provides experience in the management of disability following illness or trauma. Rehabilitation is principally a multi-professional team activity and you will have the opportunity to work with several teams during your appointment. You will gain insight into the expertise of several other health professions such as occupational, physio and speech and language therapists, clinical psychologists and social workers, as well as rehabilitation nurses. The fact that most patients are in the hospital for weeks rather than days allows you to be involved in their management and observe their progress in more depth and over a longer period than in many other GPST posts.


Clinics in rehabilitation serve two main purposes: to assess new patients for out patient therapy and rehabilitation, and to review patients. GPSTs do not have set duties in out patients but are expected to attend clinics to gain further understanding of and experience in rehabilitation. This will require you to organise cross-cover for ward duties to release you to attend. Whilst in post we would recommend you attend at least four out patient clinics. Your educational supervisor will discuss this with you. Visits to the Disabled Living centre and Mobility Services are also recommended during your time in post.
Supervision
Dr FitzGerald is the consultant with responsibility for training and will allocate a RM consultant to act as designated tutor to each doctor at AAH. The tutor will devise an individual training plan with you within 2 weeks of your taking up post.
This tutor will also review your educational progress at 2-3 and at the end of your 4 month appointment. If this does not take place you should contact Dr FitzGerald without hesitation.
Formal Teaching
There are two formal teaching sessions each week during term time.
The multidisciplinary meetings on a Wednesday pm once a month include case studies and audit topics, as well as outside speakers on various topics relevant to rehabilitation.
The teaching seminars are for all STs and Specialist Registrars. These are aimed to cover the specialist curriculum but are flexible enough to cover requested topics within this broad theme.
In addition to the above the middle grade medical staff, in collaboration with some senior therapy/psychology staff, will provide an introductory course in rehabilitation to GP and CMT STs to cover some of the principal themes/concepts of Rehabilitation Medicine.
All doctors will be expected to become familiar with the Trak Patient Management System and to enter clinical details and details of treatment according to the requirements of the System. At all times doctors will be expected to maintain adequate notes in a legible and concise manner.
7. Contact Details
Dr I Todd, Clinical Lead, Rehabilitation Medicine

or Dr A FitzGerald, Consultant in Rehabilitation Medicine

Astley Ainslie Hospital, Edinburgh. EH9 2HL

Tel: 0131 537 9039 Email: yvonne.jones@nhslothian.scot.nhs.uk


8. Person Specification


REQUIREMENTS

ESSENTIAL

DESIRABLE

Qualifications/Training


GMC Registration

MBChB or equivalent

ELS/ALS Certificate



Experience/Knowledge


Previous experience in General Practice/hospital medicine at post GMC registration level.


or
Evidence of achievement of Foundation Competencies.
or
Evidence of equivalent experience/skills as above

Previous experience in Rehabilitation Medicine



Motivation


Keen to develop Rehabilitation Medicine skills within multidisciplinary teams and to deliver high quality care to patients within the service.





Personal Attributes


Common sense, the ability to organise and motivate yourself.


Able to communicate well, complement the existing multidisciplinary team and have verbal and written communication skills necessary to carry out duties safely and effectively
Displays honesty, integrity, awareness of confidentiality and ethical issues

Ability to manage and cope under pressure


Audit

Understanding of audit and how it affects clinical practice

Evidence of completed audit activity


Research

Understanding of research principles and how it affects clinical practice

Relevant publications in peer reviewed journals.






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