Clinical Fellow

Job description

Job responsibilities

Cognitive deficits are a core feature of psychotic disorders, account for much of the impaired functioning associated with these conditions, and are not responsive to existing treatments. Indeed, some psychiatric treatments worsen cognitive symptoms in people with psychosis. Cognitive impairment has a major impact on long term prognosis and leads to poor functional outcomes e.g., unemployment and an inability to live independently. In addition to the direct effects of psychotic illness, cognitive symptoms arise secondary to several reversible causes. These include the anticholinergic properties of many medications used to treat psychosis, refractory positive symptoms, untreated affective symptoms, sleep disturbance, and substance misuse. Furthermore, weight gain and broader metabolic dysfunction is associated with poor cognitive health and is frequently observed in people with psychosis. Metabolic dysfunction leading to cardiovascular disease is the key contributor to premature mortality seen in people with psychotic disorders. Current services do not adequately address either cognitive deficits or metabolic disease risk in people with psychosis. Current barriers to cognitive and metabolic care delivery in people with psychosis include clinician time-pressure, inexperience of clinicians in appropriate assessment/management approaches, and absence of multidisciplinary support.A new holistic service, TUNE-UP, has been developed to address these challenges. The TUNE-UP clinic will provide comprehensive, state of the art assessment and management of individuals with cognitive symptoms and/or metabolic disturbance. The service operates a shared care arrangement with clinical teams, providing assessment and treatment. However, overall responsibility for clinical care of patients stays with referrers. The post-holder will participate in developing new aspects of the service, evaluating the service, related clinical research projects (with an honorary position held at The Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London), and journal clubs. The post-holder will be supported and supervised both clinically and academically by Dr Toby Pillinger.

The TUNE-UP service will:

Provide comprehensive and state-of-the-art clinical assessment, including the use of structured clinical and cognitive assessments.

Provide a holistic assessment of both body and mind, with a focus on cognition, weight-gain, and metabolic disturbance.

Where appropriate, rationalise psychiatric medication and facilitate initiation of clozapine for eligible patients.

Monitor response to treatments and provide additional advice where adequate response is not observed.

Work closely with existing community mental health teams, primary care, and secondary care physical health services.

Key Responsibilities:

Responsibilities will be commensurate with competencies as established through external and internal training, including GCP and research study specific training.

To perform clinical and cognitive assessments and produce clinical management plans.

To develop and evaluate a novel service for people with psychosis and cognitive symptoms and/or metabolic disturbance.

To contribute to the successful completion of experimental medicine studies in individuals with psychotic disorders.

Manage own academic research and administrative activities and contribute to the administrative activities of the group.

Collaborate in the preparation of research publications and contribute ideas for new research projects.

Present papers at conferences or public meetings.

Supervise students and research assistants

1. Providing medical input to for patients attending TUNE-UP. This includes:

Comprehensive clinical assessment including the use of structured interviews, standardise scales, cognitive assessments, physical examinations, assessment of adherence.

Production of clinical reports and maintenance of clinical databases.

Explaining treatment options to patients and carers.

Where appropriate, leading community clozapine initiations (registration with monitoring agencies, prescribing, side effect review and management, monitoring response).

Communicating with GPs, CMHTs, and secondary physical health services.

Assessing capacity and ability to consent.

2. Development and evaluation a novel service

Developing service protocols

Collecting and analysing data pertaining to the costs and effectiveness of the service

Visiting CMHTs to describe the service and seek referrals

3. Working as a sub-investigator on clinical studies of cardiometabolic disease and its treatment in people with psychosis.

Taking consent

Psychiatric and physical examination

Accompanying patients for investigations

Data recording

4. This post does not carry its own on-call responsibilities. However, the post-holder may conduct core/specialty trainee on-call shifts for South London and Maudsley NHS Foundation Trust.

Person Specification

A/I

Essential

• GMC registered to practice in UK by time of appointment
• Minimum of 2 years postgraduate medical training
• Experience of working professionally with people with psychotic disorders
• Excellent communication and team working skills

Desirable

• Post MRCPsych membership
• Evidence of participation in research and QI projects
• Clinical experience within both medical and psychiatry clinical settings

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

South London and Maudsley NHS Foundation Trust

Address

Maudsley Hospital

Denmark Hill, London, SE5 8AZ

London

SE5 8AZ

Employer's website

https://www.slam.nhs.uk/ (Opens in a new tab)