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NHS WESTERN ISLES

AGENDA FOR CHANGE

JOB DESCRIPTION

1. JOB IDENTIFICATION

Job Title: Senior Podiatrist – Specialising in General Practice

Department(s): Podiatry Department

Job Holder Reference: CAJE 203

No of Job Holders:4

2.   PURPOSE

       As an autonomous Practitioner you will be required to provide a high quality specialist General Podiatry service incorporating the care and management of patients presenting with, for example, complications associated with Diabetes, Biomechanics and gait dysfunction, nail pathologies requiring surgical intervention, chronic disease management (Stroke, Vascular Disease, Arthropathy, Neurological disorders), wound management and care of the elderly.

       To assess diagnose and develop specialised individual care pathways for patients with complex medical/Podiatric needs

       To supervise and provide clinical support to colleagues, Podiatry Assistants and students as part of the services Clinical Governance Framework.

       To maintain and develop personal and clinical skills and to manage an appropriate clinical caseload.

       To actively promote foot health and education with other health care professionals, patients and carers.

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3. ORGANISATIONAL CHART

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Western IslesNHS Board

Specialist General

Band 6 1 WTE (18 mnth FTC)

Specialist General

Band 6 1 WTEVacant

Specialist General

Band 6 0.62 WTE Southern

Podiatry AssistantBand 4 1

WTE

ESPCare of ElderlyBand 7 1 WTE ( Vacant being

filled by 18 mnth

Podiatry AdministratorBand 4 1

ESP High Risk Limb

Band 7 1 WTE (Vacant now

developmental

Podiatry Head of ServiceBand 8a

Specialist GeneralBand 6 1

WTE

General Manager Community Health Services Division

ESP MusculoskeletalBand 7 1 WTE (Vacant now

developmental

Chief Operating Officer

Chief Executive

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4. MAIN DUTIES AND RESPONSIBILITIES OF THE POSTClinical

To manage own fully integrated specialist podiatric caseload. To maintain clinical skills and competence and to be professionally accountable for all aspects

of own work including the management of patients. As an autonomous specialist practitioner you will be responsible for assessment, diagnosis,

care planning, care management, and care delivery utilising the most appropriate assessment techniques, diagnostic tests and specialist equipment.

Responsible for delivering the most appropriate and effective treatment programmes for patients with complex/specialist medical/podiatric needs, formulating appropriate treatment plans including discharge and aftercare arrangements.

To provide appropriate care/management of patients presenting with foot ulceration in the community, undertaking joint management with highly Specialist Practitioner as and when indicated, liasing with the wider clinical team.

To participate in and/or provide clinical cover to hospital based Foot Ulcer Clinic managed by highly Specialist Practitioner.

To regularly undertake nail surgery sessions providing and/or managing post-operative care. To provide podiatry treatment to patients across the Western Isles on the basis of clinical need. To provide assessment and relevant care in a variety of clinical settings including hospitals,

health centres, GP surgeries, residential/nursing homes and patients homes (this will involve management of a complex caseload and extensive inter island travel)

To carry out specialist assessments including Pre-operative assessment, Diabetic assessments and Biomechanical assessments as appropriate.

To prescribe, manufacture (where appropriate) and fit orthotics, insoles, splints and footwear, including the use of specialist casting techniques.

To work within and assist the development of national and local policies and protocols To undertake and/or request further diagnostic tests where required e.g. Microbiological,

Biochemical, Radiological investigations To advise, supply and prescribe (subject to completion of recognised training) ‘prescription

only medicines’. To recognise conditions not of a podiatric nature or within scope of practice, which require or

would benefit from advice and/or intervention from other healthcare and social care staff, providing appropriate advice and onward referral.

To promptly refer patients to the appropriate disciplines and external agencies/organisations to support achievement of podiatric care plan and improved outcome for patient.

To practice safely and effectively, maintaining professional standards of treatment and conduct. Applying best clinical practice.

As an autonomous practitioner you will still be expected to seek professional advice and peer support as and when necessary.

To maintain accurate clinical records of all clinical interventions and collate workload statistics as required.

To keep up to date with clinical and non-clinical developments in Podiatry.

Professional

To maintain excellent working relationships using highly developed interpersonal skills to

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promote effective communication with other professional groups across the Community Health Service, Hospital Service and Public Health Service Divisions in order to ensure that Podiatric, Foot Health and mobility issues are understood and foot health and podiatric support is an integral part of all service provision.

To work with the Occupational Health Department to ensure that appropriate advice is provided to individual staff in relation to management and prevention of mobility, foot and lower limb problems.

To maintain up-to-date knowledge of professional issues and developments, including clinical and technological advances.

To work within the HCPC and Society of Chiropodists and Podiatrists Codes of Professional Conduct, Ethics and Clinical Standards.

To actively participate in Local/National Special interest groups and supporting the development ‘best practice’ and ‘evidence based practice’.

To work within the framework of clinical governance in order to maintain and improve patient care, quality and efficacy.

To liase with AHP’s, GP’s, Consultants and other Healthcare professionals as required.

Education and Research

To undertake regular audit to review personal working practices, clinical activity and effectiveness.

To demonstrate commitment to personal development and acquisition of further knowledge and skills.

To be responsible for own personal development plan, ensuring that they are compliant with Society of Chiropodists and Podiatrists / HCPC CPD requirements.

To demonstrate own professional development activities and the maintenance of expertise, knowledge and skills, including CPD, Personal Development Plans and personal portfolios.

To be actively involved in the design and implementation of audit programmes in order to evaluate aspects of the service and identify areas for development.

To participate in research projects within or out with the podiatry department and/or Health Board as required.

Organisational.

To manage an appropriate clinical caseload and provide cover for colleagues in periods of absence.

To actively participate and contribute in staff meetings and training days in support of clinical professional development and education.

To deliver presentations to a range of personnel, which may include members of the Health Board, senior managers, other health care professionals and the general public.

To co-ordinate, plan and deliver training programmes, health improvement and/or advisory sessions to other health care professionals and/or the general public.

To advise and assist Health Promotion staff in developing promotional material and presentations and to undertake health promotional role as and when required.

Communication

Use appropriate or advanced communication methods as required to ensure a clear communication channel is established. This will include obtaining and communicating

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diagnostic information, gaining informed consent and ensuring patients have both a clear understanding and are compliant with the proposed treatment program. Most patients present with complex conditions or multiple pathologies, and will frequently have emotional, physical and psychological conditions (deafness, dysphasia, depression, Alzheimer’s) that stand in the way of easy understanding, which require the expert use of verbal and non-verbal communication tools, negotiation, motivation, explanation and empathy.

To establish effective relationships with all patients and/or their carers, through the application of high level communication and interpersonal skills and use such skills to help patients to recognise and overcome barriers to change. In cases where there are significant barriers to understanding, the use of empathy, reassurance and analysis to uncover social/psychological factors which may affect compliance in order to facilitate long term / permanent lifestyle changes will be required.

To work in partnership with all members of the podiatry service and wider multi disciplinary team to support quality services and effective care management for patients.

Manage possible conflict with patients, where the news imparted may not be what the patient wishes to hear or anticipated e.g. diagnosis, poor prognosis, , long waiting times, compliance with treatment plans and discharge policy

To organise, provide and deliver specialised education and training to patients and other staff groups as required

To maintain a pleasant and professional approach when dealing with patients, carers, , colleagues, and members of the public.

To ensure consideration is given to lifestyle, gender and cultural background, involvement of patients, carers, family members and significant others.

Managerial

To implement changes where authorised and to propose further changes to the Head of Podiatry.

To carry out duties of a clinical supervisor taking staff and students on rotation and evaluating their performance, liaise with and provide feedback to the students, staff, Head of Podiatry and university staff, as appropriate.

To work with colleagues to establish clinical guidelines, protocols and standards to meet clinical governance targets and to establish evidence base practice.

To maintain full clinical records, provide statistical returns and information for activity monitoring and comply with general administrative procedures.

To monitor waiting lists and prioritise patients when needed. To ensure that clinics are maintained to the highest levels and stock levels are adequate and

equipment is kept in good working order and that faults are promptly reported.

5. SUPPORTING EVIDENCE

Physical Demands of the Job

To regularly perform intricate clinical and surgical procedures, for example, debridement of foot ulceration and nail surgery procedures, for intense periods of activity to improve or eradicate complex foot disorders.

To administer local anaesthetic using specific and intricate injection techniques at various anatomical sites in the foot and lower limb to secure appropriate anaesthesia as and when clinically indicated.

To use specialised Podiatric instruments and equipment for monitoring, measuring and treating complex foot, lower limb and mobility disorders.

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When treating patients in Nursing/ Residential homes and domiciliary setting you may be required to work for long periods of time in awkward and uncomfortable positions. This may be due to the environment in which treatment must be provided, for example, poor lighting, unpleasant odours, poor hygiene, limited physical space, awkward posture/position and lack of appropriate equipment. (Risk assessment should always be carried out and any risk highlighted)

You will be required to carry a substantial amount of equipment to rural clinics, Nursing/Residential homes and domiciliary visits.

You will be required to record clinical activity, complete electronic treatment records and book patients/appointments using the services computerised clinical management system, requiring well developed keyboard and Information Technology/computer skills, including the use of various software applications and computer peripherals.

You will be required to provide clinical services at a number of clinical locations throughout the Western Isles. This will involve regular and extensive driving and inter-island travel including prolonged ferry and plane journeys.

Systems and Equipment

IM &T skills – working knowledge of Word Processing, Spreadsheets, databases, multi-media presentations (e.g. PowerPoint), Intranet/Internet, Email, Tynedale (clinical management system – including e-referral, appointment scheduling, electronic patient/treatment record, report generation and integrated audit tool)

Clinical equipment: Manual and electronic patient records. Specialist handheld clinical/surgical instruments, high speed electronic drills,

including liquid spray and dust extraction technologies Electronic vascular assessment equipment for example the use of Doppler

vascular flow monitors to monitor the quality of blood flow and blood pressure in the ‘at risk’ limb or pre-operative assessment.

The use of electronic equipment such as Neurothesiometers for the monitoring of vibration and sensory loss in the ‘at risk’ limb.

The use of specialist tuning forks and monitoring devices such as monofilaments for the detection and mapping of sensory loss in the ‘at risk’ limb

The use of specialised measuring devices to assess mobility and gait and the range and quality of movement within the large and small joints of the lower limb and foot.

The use of digital still and video camera equipment and image manipulation software for complex gait assessment, clinical diagnosis and condition monitoring e.g. ulceration or surgical wound evaluation

Education/training/Health Improvement – multi-media equipment projectors/TV/Video/DVD, displays/poster board’s flipcharts, etc.

Telephone, photocopier, fax machine Risk management systems (Health Board and inter-departmental)

Mental Effort

You will be required to have a high level of concentration on a regular basis often prolonged so as to perform intricate clinical and surgical procedures including:

Administration of local anaesthetic within the lower limb, foot and digits. Surgical avulsion and ablation of sections or complete pathological toe nails.

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Wound/ulcer management such as the skilled debridement of necrotic and infected tissue

Mobility/Gait analysis and detailed biomechanical assessments of lower limb and foot

In-depth specialist diabetic assessments, including medical history, disease control, vascular, neurological and biomechanical examination and risk assessment.

You will be required at any time, during your working day,to respond to and treat emergency patients without prior notice; this may be as a result of a request from the Accident and Emergency department or the unscheduled attendance of a patient or member of the public.

Emotional Effort

You will frequently be required to manage wounds of an offensive nature due to the presence of infection and necrotic tissue that could be distressing to both the patient and clinician

You will be required to effectively manage situations where pain relief is not possible or difficult to achieve, which may require prolonged and/or intensive treatment with the possibility of a poor outcome and the failure to meet the expectations and desires of the patient and/or carer.

You will regularly need to deal with patients who are upset or abusive (due to pain, illness, bereavement or under the influence of drugs and/or alcohol) in a calm, empathetic, non-confrontational and professional manner.

You will regularly need to deal with situations of patient non compliance, who possibly due to a lack of understanding, conflicting priorities and/or differing perceived needs, which contradicts appropriate evidence-based, best and/or safe clinical practice.

Working Conditions

You will be required to manufacture orthotic devices, insoles and splints using grinding machines to shape and adjust thermoplastic materials, which can cause considerable noise and dust generation (you must comply with and correctly use the eye, respiratory and ear protection equipment provided).

During the manufacturing process and adjustment of orthotic devices, insoles and splints you will be exposed to hazardous fumes from the use of and contact with solvents and glues.

On a daily basis you will be exposed to nail dust as a result of using specialist electronic nail drills (you must comply with and correctly use the eye and respiratory protection equipment provided).

There will be a need to treat patients within Nursing/residential homes and in the patient’s own home environment where conditions are not necessarily conducive to clinical treatment.

You will be exposed to wounds of an offensive nature due to the presence of infection and necrotic tissue/gangrene.

You may on occasion be exposed to aggressive and abusive patients or carers. You will frequently be in the position where lone working will be required, for example working

in unattended/non-manned rural clinical locations and domiciliary visits. With the possible complication of none or limited ability to alert or summon assistance from other staff.

Exposure to hazardous chemicals, for example, Phenol. Phenol is an acid applied to the nail bed during nail surgery causing a chemical burn and destruction of the chemical structure in order to prevent nail re-growth. Phenol consists of an aromatic benzene ring and is known to have potentially carcinogenic (cancer-causing) fumes, therefore a careful and concentrated technique is required for its use and strict COSHH procedures for its appropriate storage and disposal are adhered to.

Alcohol sprays used to clean the foot or used as a skin antiseptic, and nail dust from filing nails can cause respiratory and ocular irritation, you must therefore comply with appropriate Health

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and Safety policies and correctly use the eye and respiratory protection equipment provided. You will be required to safely handle, operate and dispose of sharp instruments, including

scalpel blades, chisels and needles. You will be required to carry out risk assessment on a daily basis and report on any relevant

findings

6. STANDARD ELEMENTS

Confidentiality

Comply with Health Board policy on confidentiality, and the data protection acct 1998 as amended, relating to information held manually or on computerised systems.

Respect the confidentiality and privacy of patients and staff at all times. Implement the Health boards child protection policy.

Health and Safety:Assist in maintaining own and others’ health, safety and security.

Take all reasonable steps to manage and promote a safe and healthy working environment, which is free from discrimination.

Maintain constant awareness of health, welfare and safety issues affecting colleagues, patient’s visitors and self, reporting any accidents or faults in line with Health Board policy.

Fully participate in Health and safety training.

NHS Western Isles attaches the greatest importance to the health and safety of its employees. It is the Board policy to do all that is reasonable to prevent personal injury and hazard to health by protecting staff and others including the public from foreseeable hazards compatible with the provision of proper services to patients. The Board expects its entire staff to take reasonable care of their own health and safety and that of others who may be affected by their acts or omissions at work. More detailed information is given in departmental safety policies where appropriate.

Ensure own actions support equality, diversity and rights.

Adhere to Health Board policy at all time. Comply with Health Board standing orders, standing financial instructions, policies procedures

and guidelines. Treat those you come in contact with equitably and with respect. Recognise the need for aids or adaptations.

JOB DESCRIPTION AGREEMENT

I, (Print Name)…………………………………………………….. confirm that the job description(s) /person specification(s) attached have been discussed with me and are an accurate and up-to-date account of the duties and responsibilities and skills/qualifications required to

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undertake the post.

Job Holder’s Signature:

Head of Department Signature:

Date:

Date:

WESTERN ISLES NHS BOARD

PERSONAL SPECIFICATION

Job Description: Senior Podiatrist specialist in General Practice

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Department: Podiatry

Location: Western Isles Hospital

FACTOR ESSENTIAL DESIRABLE

EXPERIENCE Several years post graduate experience and registered with the HCPC

Autonomous, accountable practice within procedures and guidelines

Interdisciplinary and interagency working

Clinical governance and particularly audit and research

Experience of providing clinical supervision

Held previous post in NHS

Membership of professional body

QUALIFICATIONSTRAININGRESEARCH PUBLICATIONS

Diploma/Degree in Podiatry

Documented evidence of continuing CPD

Additional relevant post-grad study i.e. Post-grad certificate, diploma/ MSc

Management or leadership training

Teacher/trainers training

KNOWLEDGE AND SKILLS Specific knowledge of and practical skills in the management of Diabetes, RA, Biomechanics and gait analysis, nail surgery and wound management

IT literacy

Specialist knowledge of the use, analysis and interpretation of complex assessment tools

Skills in planning and co-ordinating assessment, goal setting, treatment and development of care packages

Skills in relevant multidisciplinary and multi-agency working

Good knowledge of relevant health and social care legislation and current practice/regulations, especially Equal Opportunities, Data Protection and Caldicott, Health and Safety/Moving and Handling and Disability Discrimination Act

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Ability to work single handed with individuals and groups

Understanding team dynamics

Understanding of the Code of Ethics and Professional Conduct (COT, 2000) and its application in practice

Knowledge of Health and Safety/Moving and Handling and risk management applied to practice

Effective oral and written communication skills congruent with high standards of Podiatry professional practice and particularly advocacy, negotiation, persuasion, conflict resolution, tact, sensitivity, empathy, reassurance

Good personal organisational skills to deliver casework and other service requirements on time

Ability to manage own workload and determine priorities

Ability to work under pressure

Ability to reflect and critically appraise own performance

DISPOSITION Positive, assertive, flexible adaptable and resilient

Commitment to client centred, non-discriminatory inclusive practice

Commitment to lifelong learning and effective use and dissemination of CPD

Commitment to the development

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of the service as one of excellent in remote and rural Podiatry practice, and the profession

Commitment to peer support, team and co-operative working

Willingness to explore and engage in innovative and creative solutions to meet casework and service needs appropriate to a remote, rural and island setting within legal, policy, budgetary and procedural requirements

Willingness to attend off-island training and development opportunities

OTHER Clean driving licence and access to vehicle insured for business use

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