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THE SHREWSBURY AND TELFORD HOSPITAL NHS TRUST

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JOB DESCRIPTION

October 2019

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INTRODUCTION A full-time Consultant Physician in Renal and General Medicine is required for the Shrewsbury and Telford Hospital NHS Trust. The Department of Renal Medicine provides a service to the County of Shropshire and Mid-Wales. It currently consists of seven physicians based at the Royal Shrewsbury Hospital, Shrewsbury and the Princess Royal Hospital, Telford. THE AREA Shropshire is the largest inland County in England, in the most western part of the West Midlands Region, and is a beautiful, predominantly rural County – it has the lowest population density of any English County – with some dramatic landscapes. Shrewsbury, the County Town, with attractive medieval and 18

th century streets and buildings has a population of 90,000. The M54 motorway,

which starts just outside Shrewsbury, provides quick access to the national motorway network. Intercity trains to London and Birmingham are available at Wolverhampton, 45 minutes from Shrewsbury. Housing standards are high in the County both in Town and Country with good local state and private schools THE POST This is a new post. The successful candidate will be expected to take part in the Royal Shrewsbury and Princess Royal Hospital Acute Medical take rota, manage General Medical and Nephrology in patients, and support the outpatient and dialysis unit patient caseload at both hospitals. SUMMARY OF POST

Title: Consultant Physician and Nephrologist

Location: Shrewsbury and Telford Hospital NHS Trust

New or Replacement Post: New

Prime responsibility: To support and maintain a Consultant led service in the provision of

Medical and Renal Services, and undertake on-call Medical duties

in collaboration with Consultant Physician colleagues

Accountable to: Medical Director

Reports to: Clinical Care Group Medical Director for Unscheduled Care

Works with: Consultants and staff of SaTH

Key tasks: Deliver high quality Renal and Medical Services

Be responsible for patients on the Renal Ward, Dialysis Units and

Renal Out Patients

Take part in the on-call Consultant Physician rota – 1:13/14

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Nephrology commitments: The department works across both the Royal Shrewsbury and Princess Royal Hospitals with the majority of renal services and staff currently based at The Royal Shrewsbury Hospital. The department is working to provide a high quality, accessible and equitable service across the two acute Hospitals.

Dr Kevin Eardley (Care group Medical Director for Unscheduled Care)

Dr Johann Nicholas (Clinical Lead for Renal Services)

Dr Ramaswamy Diwakar

Dr Suresh Ramadoss

Dr Sunita Nair (part-time Wednesday-Friday)

Dr. Sourabh Chand

Dr Stephen Davies

The new Consultant will support the services based at both Hospitals. In addition to managing Nephrology inpatients and supporting the dialysis units at both Hospitals you will also have up to 3 renal clinics per week. The usual clinic templates include an average of 2 new and 10 review patients per clinic. The Renal Department: The renal inpatient beds are situated on a 34 bed multifunctional ward – Ward 28N. There are 14 beds of predominantly renal patients and 20 beds of general medical patients who are looked after by 2 renal Consultants with 2 junior doctor teams. Whilst covering the wards (1:2.3) you do Consultant ward rounds on a Monday, Wednesday and Friday morning and ‘board rounds’ Monday – Friday morning for 45 minutes. There is a Friday 4:00pm handover to the weekend covering Consultant. All renal Consultants have equal access to junior doctors. The Renal SpR has commitments to medical patients and participates in the Medical on calls. We have 2 Speciality Doctors who will support the renal wards depending on the staffing levels of junior Doctors. The Haemodialysis unit at The Royal Shrewsbury Hospital provides chronic haemodialysis for over 110 patients (24 stations). On Monday, Wednesday and Friday there are three dialysis shifts whilst on Tuesday Thursday and Saturday there isn’t a twilight shift. The renal unit also provides haemodialysis for approximately 50 patients per year with acute kidney injury. On-line haemodiafiltration as well as acetate-free biofiltration dialysis techniques are used. A 20-station satellite haemodialysis unit at the Princess Royal Hospital currently provides dialysis for 90 patients with plans to increase to 98 patients shortly. The satellite haemodialysis unit at Ludlow currently caters for 10 patients on Monday, Wednesday and Friday morning and afternoon shift. A business case has been approved to open the unit for 10 additional patients on Tuesday, Thursday and Saturday. This additional capacity is planned to open January 2020. The majority of our renal transplants are performed at the Queen Elizabeth Hospital, Birmingham with whom there are close links. Patients return for post-transplant care at three months. There are currently around 170 renal transplant recipients under our care. Our combined renal- pancreas transplants are usually done at University Hospital, Cardiff. Additional support for the renal service includes a nurse Operational Manager, modality sister, renal anaemia coordinator, home haemodialysis sister, vascular access sister, pre-end stage dialysis sister, renal transplant sister, and 2 dieticians. At RSH site we also have a West Midlands Renal SpR, 2 Specialty Doctors, an IMT3, CT2, CT1, FY1,a GPVTS trainee, a FY3 and a physician associate. Weekly multi-disciplinary meetings, a monthly Renal Forum, monthly histopathology meeting and fortnightly Educational meetings also take place. There are fortnightly dedicated surgical day-case access lists provided by the three Vascular Surgeons who have demonstrated a clear commitment and interest in

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Vascular access Surgery. They have also developed a database which helps streamline patient care and audit. Three Consultant Radiologists provide renal radiological services including vascular access surveillance, MR angiography and renal artery stenting. The Peritoneal Dialysis unit is based on ward 28N and is managed by an enthusiastic PD nursing team who care for 60 peritoneal dialysis patients. The number of PD patients has nearly doubled in the last 3 years and is expected to continue to increase. Our peritonitis rates have traditionally been low. Approximately 70% of patients receive APD. Acute PD and assisted APD are also provided depending on clinical need. We provide a medical PD insertion service for patients who are deemed suitable. A business case has been accepted by Specialised Commissioning and local CCGs for approval to expand our home therapies team. The Home Haemodialysis program has an excellent record and continues to flourish and expand. It is headed by 3 Senior Nurses and 1 HHD sister. Currently 30 of our patients receive their dialysis at home. This number is expected to increase to 35 in the next few months. We were one of the first units in West Midlands to use NxStage machines for HHD and currently we have 24 patients using this system. We also support nocturnal home dialysis. The transplant listing team (including the transplantation sister, transplant link nurses and 2 dedicated transplant lead consultants) have ensured that we actively partake in the transplant first programme and are working hard to increase our live donor transplant rates as well as our pre-emptive transplant rates. The renal department has led the development of AKI services at SaTH. AKI patient information leaflet and GP information documents have been produced and well received. The renal department has worked with the biochemistry department in developing AKI e-alerts both in-house at SaTH and to Shropshire, Telford and Wrekin CCG GPs. The renal department provides regular education sessions for junior doctor, nursing staff and using the role of undergraduate tutors to medical students posted to SaTH from Keele University. Renal commitments at the Princess Royal Hospital: The medical bed base allocated to renal at the Princess Royal Hospital includes a 14 bed base at ward 7 along with outliers in ward 14. This is supported by a team of junior doctors including 2 recently appointed renal speciality doctors (SHO level), an FY2 and an IMT3. In addition we provide a daily renal referral and AKI outreach service. Renal referrals are seen within 24 hours Monday – Friday 9:00-17:00. Renal patients who do not need dialysis are frequently managed at the Princess Royal Hospital with regular assessments by renal physicians. Patients requiring acute dialysis admitted to The Princess Royal are transferred to the Royal Shrewsbury for their continued inpatient care. The Princess Royal satellite unit is supported by 3 of the existing renal Consultants in addition to acute input from 2 other consultants. The post holder will be responsible for the overall renal Management of the patients dialysing on the twilight shift of Monday, Wednesday and Friday. This number is expected to increase to 18 from 15 in due course. There is opportunity for the candidate to lead changes at the dialysis unit at PRH working with the haemodialysis nursing leads. The travel time to The Princess Royal is considered in allocation of PAs. In addition the satellite haemodialysis unit at Ludlow ,which currently caters for 10 patients ,is expected to increase capacity to provide dialysis for 10 additional patients. It is expected that the appointee will take responsibility for these additional patients. General Medicine commitment: The post holder will be contributing to a 1 in 13/14 on call rota. During the week this necessitates an evening session of senior review of newly admitted medical patients in AMU and A&E (4:00pm to

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8:00pm) and performing a PTWR at 08:00 on overnight Medical admissions. Whilst post take the consultant may be expected to support the AMU consultants till 1300 h. The average daily number of unselected medical admissions received at each Hospital is approximately 35 to 40. You will also equitably contribute to the Friday and weekend rota. When on call on Friday the Consultant performs senior review duties in AMU and A&E Friday afternoon and evening, and performs a PTWR starting 08:00 on the Saturday morning. When on call for Saturday and Sunday, in addition to being available for telephone advice over these two days, you are expected to perform a PTWR Saturday afternoon/early evening (17:00-20:00), and Sunday morning (08:00 – 14:00) and afternoon (17:00-20:00). On Monday morning you would perform a further WR of those patients remaining on AMU and some of the patients moved out of AMU on the Monday morning. Following a weekend on call for Medicine, Consultant Physicians do take time off in lieu within the subsequent week. The medical Consultant on call is available out of hours for advice and may need to return to the Hospital in cases of emergency.

A. Royal Shrewsbury Hospital The Acute Medical Unit has 25 beds and is supported by an excellent nursing team who are well led. The Clinical Decisions Unit (CDU) is co-located with AMU and has 12 beds. The rapid turnover of these patients is supported by the Acute Physicians, diagnostics and in reach from Nurse Specialists and specialty Consultants. The Ambulatory Care Unit is currently located next to diagnostics and is integrated with Primary Care Ambulatory Care services, including those for the elderly. This integrated service is particularly effective in ensuring rapid access to services that support the safe management of patients in the community. There is scope to manage many more patients than now through ambulatory care services and the appointment of more Acute Physicians is an integral part of the plan to achieve this objective. There are 5 juniors supporting the running of the medical on call, AMU and CDU during the day. Overnight there are 3 juniors and a Nurse Practitioner. B. Princess Royal Hospital The Acute Medical Unit has 25 beds and is supported by an excellent nursing team who are well led. The Short Stay Unit is located in a separate area (Ward 7) and has 12 beds. The Ambulatory Care Unit is co-located with AMU and run solely by GPs between 0900-2100 h SaTH. It is however well supported by Primary Care liaison Nurses who support the safe management of patients in the Community. There are 5 Juniors supporting the running of the AMU and SSU during the day (1 x FY1/FY2, 1 x FY2, 2 x CMT, 1 x SpR). Overnight there are 3 Juniors (1 x FY1/FY2, 1 x CMT, 1 x SpR) and a Nurse Practitioner.

Acute medicine at both Hospitals is well supported by colleagues delivering specialty services. Stroke thrombolysis is provided 24/7 at PRH and supported by a stroke consultant on call team. Primary coronary artery intervention is provided by New Cross Hospital, Wolverhampton or University Hospital North Staffordshire but Cardiologists within SaTH support management of acute cardiological disorders. The gastroenterologists are also available 24/7 as part of the bleed rota for patients who may require urgent endoscopic intervention for GI bleed. Critical care services are supported by an outreach team facilitating best practice for the critically ill patient and supporting access to Critical Care Services. We utilise an IT system, Vital Pac, which supports paperless recording of patient medical observations. This facility has proved invaluable in helping Clinicians identify and react to the deteriorating patient, as well as support compliance with assessments such as VTE

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prophylaxis assessments. The trust is actively engaged in the future fit process and it is expected that over the next few years reconfiguration of services across the 2 sites (RSH and PRH) is expected to occur. SaTH working closely with the Virginia Mason Institute is working towards incorporating up to date lean techniques in the provision of health care at SaTH. These will provide a unique opportunity to develop and remodel renal services in this region.

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Proposed Weekly Job Plan

Day Activity Location/Venue PA

Monday AM

Renal/Medical Ward rounds (1:2)

RSH/PRH

0.5 PA

Admin (1:2) 0.5 PA

Monday PM

Renal Clinic (1:2) RSH 0.5 PA

Tuesday AM

Renal Clinic (1:2) PRH 0.5 PA

Telford Dialysis Unit (1:2)

PRH 0.5 PA

Tuesday PM

SPA RSH

1 SPA

Wednesday AM

Renal/Medical Ward rounds (1:3.35)

RSH 0.5 PA

Telford Dialysis Unit (1:2)

PRH 0.5 PA

Wednesday PM

Weekly Medical Grand Rounds/Research

/Teaching/ Supervision RSH 0.75 SPA

Procedure list (1:4)

RSH 0.25 PA

Thursday AM

Renal Clinic RSH 0.5 PA

Thursday PM

SPA RSH 0. 5 SPA

Renal Forum (1:4) RSH 0.25 SPA

Renal histology meetings - monthly

RSH 0.125 PA

Renal/Medical Ward

Rounds (1:3.35) RSH 0.25 PA

Friday AM Renal referrals/Low

Clearance Work PRH 0.5 PA

Friday PM

Handover RSH 0.125PA

Admin 0.5 PA

Referrals 0.25 PA

On call

1 in 14 on call rota (1700-2000 during

weekdays, 0800-1400 and 1700-2000 during Saturday and Sundays

when on call)

RSH 1.5 PA

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Out of Hour

phone call rota

(category B)

1 in 7 on call for phone calls

2%

Total PA 10 + 2%

supplement

DCC 7.5

SPA 2.5

Renal out of hours service: Currently we provide a 7 day out of hour’s renal telephone advice service for both Hospitals which includes weekends. This provides cover for renal patients from the dialysis units, renal and medical wards and also patients newly presenting with AKI during the medical takes. For patients who require dialysis out of hours, either the medical registrar or the ITU team provide the vascular access and on-call renal nurses perform dialysis on the acute unit at the Royal Shrewsbury Hospital with renal Consultant advice as required. We are currently assessing work force plans and requirements to allow the provision of a full 7 day renal consultant service for the Trust across both sites which are accepted to be a high clinical priority. Changes to existing job plans and working practices will need to be agreed by all renal consultants subject to these discussions and developments agreed. All out of hours renal work will be shared equally amongst the nephrologists and additional supplements for this service will be provided as appropriate. The renal on calls and medical on calls are covered separately; during the week of renal telephone on call advice, acute medical take duties are reallocated internally between renal colleagues by mutual agreement. Travel time to PRH is included in the PA allocation. Direct Clinical Care 7.5 PA on average per week (Clinical activity, clinically related activity, predictable and unpredictable emergency work) Supporting Professional Activities 2.5 PA on average per week (Includes CPD, audit, teaching, research , mandatory training and revalidation) Total Programmed Activities: 10 PA’s

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Office and Secretarial support: You will have office space, access to IT equipment and appropriate secretarial support (0.5 WTE per consultant). Teaching and training: A significant contribution will be expected of you to the educational commitments of the unit. This will include teaching at postgraduate levels. You will have clinical supervisor responsibility for juniors working in renal and general medicine. Clinical Audit and CME/CPD: Clinical Audit is a contractual requirement within the Trust and you will be expected to attend and participate in the clinical Governance meetings. The Trust supports appropriate CPD as per the requirements of the Royal Collage of Physicians. You will be obliged to take part in the administration of CME and to accrue the number of CME credits determined by the Royal College of Physicians, as required. We have a fully staffed Audit office at both Hospitals with well-organised team members. Research It is usual for the Trust to be participating in many research projects at any time. Every effort would be made to accommodate a particular research interest of the successful applicant, particularly if trainee members of the department could be incorporated in the methodological and practical stages.

APPRAISAL, REVALIDATION AND MENTORSHIP The successful applicant will undergo annual appraisal allowing jointly agreed development needs to be fed into their job plan. A formal review of the job plan will be performed at least annually. Appropriate educational and training needs will be supported by the Trust in, as agreed with the LNC (for example, the approval and funding of study leave). An annual job plan review at individual and departmental level is being introduced. The successful applicant will be expected to participate in this exercise. You will need to register SaTH as your designated body via the GMC to ensure that you are set up on the Equiniti revalidation system; this should be completed as soon as possible upon commencing employment with the Trust. Once you have registered SaTH as your designated body, you will need to complete the RMS Personal Information Form found on the Trusts intranet page so that we can set up your Equniti account. Please refer to the Medical Practitioners page on the Trusts intranet for more information. Mentorship will be provided by the Clinical Lead in the first year of appointment and after this the post holder may identify another Consultant colleague for this role. Accommodation The Trust has residential accommodation for medical staff. Other Facilities There is an active Doctors mess run by the Junior Doctors Mess Committee which organise social events, parties, outings etc. There are on-site fitness centres (a membership fee is payable) available to all members of staff. Staff Benefits There are a number of staff benefit schemes which attract tax reductions if joined. This includes a discount on the staff car parking charge for full-time Consultant staff, staff gym membership, on-site crèche/childcare provision and access to NHS Discounts schemes. Terms and conditions of service

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The appointment is full-time / part-time and the successful candidate will be appointed on the Terms & Conditions Consultants (England) 2003. The salary scale is based on the Consultant scale MC72: Salary Scale: £76,001- £102,465 per annum for 10 Programmed Activities (as of April 2016) The post is based on the recognition of 10 Programmed Activities (but there is scope for negotiating other PA work). The post holder:

will be in possession of a recognised medical / dental qualification and full registration with the General Medical Council and continue to hold a licence to practice

Is advised to be a member of a recognised medical defence society or be suitably insured. Trust insurance does not cover work undertaken outside the Trust other than caring for patients and work of the Trust

will be expected to make sure that there are adequate arrangements for hospital staff involved in patient care to be able to contact him/her when necessary

will be expected to reside within 30 minutes or 10 miles by road of the base hospital whilst on-call

Will not be permitted to commence employment until a full medical examination has been completed with a satisfactory result or the Occupational Health Physician has satisfied himself that a full examination is not necessary. The completion of a satisfactory health questionnaire is a condition of employment

will not be permitted to commence employment until full clearance has been received from the Criminal Records Bureau

The Trust operates a no smoking policy. The Trust values its diverse workforce and is committed to taking all necessary steps to ensure that individuals are treated equally and fairly and to taking positive action to promote equal opportunities. Visiting the Trust Appointments to visit the Trust should be arranged with: Dr Johann Nicholas (Lead Consultant Nephrologist and Physician), or Dr Kevin Eardley (Care Group Medical Director for Unscheduled Care) Please telephone RSH switchboard on 01743 261000

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STATEMENTS Health & Safety As an employee of the Trust you have a responsibility to:

take reasonable care of your own Health and Safety and that of any other person who may be affected by your acts or omissions at work; and

co-operate with the Trust in ensuring that statutory regulations, codes of practice, local policies and departmental health and safety rules are adhered to; and

Not intentionally or recklessly interfere with or misuse anything provided in the interests of health and safety.

Infection Prevention and Control The prevention and management of acquired infection is a key priority for the Trust. Any breach of infection control policies is a serious matter which may result in disciplinary action. As an employee of the Trust you have a responsibility to:

ensure that your work methods are compliant with the Trust’s agreed policies and procedures and do not endanger other people or yourself; and

be aware of infection prevention and control policies, practices and guidelines appropriate for your duties and you must follow these at all times to maintain a safe environment for patients, visitors and staff; and

maintain an up to date knowledge of infection prevention and control, policies, practices and procedures through attendance at annual mandatory updates and ongoing continuing professional development; and

Challenge poor infection prevention and control practices of others and to report any breaches, using appropriate Trust mechanisms (e.g. incident reporting policy).

Information Governance The Trust is committed to compliance with Information Governance standards to ensure that all information is handled legally, securely, efficiently and effectively. You are required to comply with the Trust’s Information Governance policies and standards. Failure to do so may result in action being taken in accordance with the Trust’s Disciplinary Procedure.

Confidentiality and Security - Your attention is drawn to the confidential nature of information collected within the NHS. Whilst you are employed by the Trust you will come into contact with confidential information and data relating to the work of the Trust, its patients or employees. You are bound by your conditions of service to respect the confidentiality of any information you may come into contact with which identifies patients, employees or other Trust personnel, or business information of the Trust. You also have a duty to ensure that all confidential information is held securely at all times, both on and off site.

Disclosure of Information - The unauthorised use or disclosure of information relating to the

Trust’s activities or affairs, the treatment of patients or the personal details of an employee, will normally be considered a serious disciplinary offence which could result in dismissal. Upon leaving the Trust’s employment and at any time thereafter you must not take advantage of or disclose confidential information that you learnt in the course of your employment. Unauthorised disclosure of any of this information may be deemed as a criminal offence. If you are found to have permitted the unauthorised disclosure of any such information, you and the Trust may face legal action.

Information Quality and Records Management - You must ensure that all information

handled by you is accurate and kept up-to-date and you must comply with the Trust’s recording, monitoring, validation and improvement schemes and processes.

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Professional Standards and Performance Review As an employee of the Trust you have a responsibility to:

participate in statutory and mandatory training as appropriate for the post; and maintain consistently high personal and professional standards and act in accordance with

the relevant professional code of conduct; and take responsibility for the maintenance and improvement of personal and professional

competence and to encourage that of colleagues and subordinates; and Participate in the Trust’s appraisal processes including identifying performance standards for

the post, personal objective setting and the creation of a personal development plan in line with the KSF outline for the post.

Safeguarding Children and Vulnerable Adults

We all have a personal and a professional responsibility within the Trust to identify and report abuse. This may be known, suspected, witnessed or have raised concerns. Early recognition is vital to ensuring the patient is safeguarded; other people (children and vulnerable adults) may be at risk. The Trust’s procedures must be implemented, working in partnership with the relevant authorities. The Sharing of Information no matter how small is of prime importance in safeguarding children, young people and vulnerable adults.

As an employee of the Trust you have a responsibility to ensure that: o You are familiar with and adhere to the Trusts Safeguarding Children procedures and

guidelines. o You attend safeguarding awareness training and undertake any additional training in

relation to safeguarding relevant to your role. Social Responsibility The Trust is committed to behaving responsibly in the way we manage transport, procurement, our facilities, employment, skills and our engagement with the local community so that we can make a positive contribution to society. As an employee of the Trust you have a responsibility to take measures to support our contribution and to reduce the environmental impact of our activities relating to energy and water usage, transport and waste.

THE SHREWSBURY & TELFORD HOSPITAL NHS TRUST

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PERSON SPECIFICATION

POST: CONSULTANT PHYSICIAN IN NEPHROLOGY AND GENERAL MEDICINE REF:

Requirements Essential Desirable

Qualifications MBChB or equivalent

MRCP or equivalent

Completion of higher training

Eligible for entry onto the Specialist Register in Renal Medicine and GIM, or within 6 months of obtaining CCT at time of interview,

CESR or European Community Rights

MD/PhD

On the specialist register or be within 6 months of obtaining CCT at the time of interview

Clinical Experience Broad based training and wide experience of acute & general medicine, and nephrology

A special interest within nephrology

Experience and expertise in performing native and transplant renal biopsies

Experience and expertise in placing central venous catheters

Experience and expertise in placing peritoneal dialysis catheters

Clinical Audit Understanding of the principles of clinical governance and clinical risk. Understanding and experience of audit

Previous broader experience of clinical governance, clinical risk management and associated areas

Teaching Experience Wide experience of, and strong commitment to, undergraduate and postgraduate teaching

Evidence of ability to organise training/teaching events

Management and Administrative Experience

Understanding of NHS organisation and management, and of DoH guidance and policies relevant to the provision of acute medical and nephrology services

A commitment to participate in the management of acute medical services

Formal management course with previous management experience especially of change management

Research Experience Knowledge of research methodology and clinical trials

Interest in or previous experience of service development research including successful delivery of research objectives

Publications in peer-reviewed journals

Other attributes Good communication and

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interpersonal skills

Experience of, and ability to, work within a multi-disciplinary team

Flexibility to respond to the varying needs of a busy department

THE SHREWSBURY & TELFORD HOSPITAL NHS TRUST Completed by: Dr Johann Nicholas, Consultant Physician and Nephrologist Created: October 2019