Job responsibilities
DUTIES OF POST
Clinical
The job is based in the Princess of Wales Hospital, which is an acute general hospital. The successful candidate will be working in a team, with Acute Clinical Nurse practitioners, overseen by the lead Consultant and responsible for looking after acute frail elderly patients, who have been admitted to the Acute Care of the Elderly Unit (ACE) via ED or the Acute Medical Admissions Unit.
There will be opportunity to undertake outpatient clinics with support from Consultants.
The post holder will join a team of 5 Care of the Elderly Consultants and one Associate Specialist responsible for the provision of Care of the Elderly services based at Princess of Wales Hospital.
You will provide a clinical service as a part of Care of the Elderly (COTE) Team, which will include the responsibility for the prevention, diagnosis and treatment of illness. There is opportunity to develop your clinical skills with support from COTE Consultants.
The Care of the Elderly services in Princess of Wales Hospital include the Acute Frailty Service, 3 Care of the Elderly inpatient wards, Day Hospital, Movement Disorder Service and Stroke Services.
Example Job Plan:
Mon
Tues
Wed
Thurs
Fri
AM
ACE Unit
ACE Unit
ACE Unit
ACE Unit
ACE Unit
PM
Clinic Admin
SPA
Clinic
SPA
ACE Unit
Acute Frailty Service
A model geared towards early identification of frail older people in urgent-care settings, formulation of plans for holistic management of their issues with a comprehensive geriatric assessment, sign posting their unscheduled care pathway to the appropriate wards/back to community. With specialty/Community Resource Team (see below) liaison, with patient-centered plans focused on the objectives of reduced acute care reliance (including hospital length of stay) and preserving/optimising functional independence- preferably in patients usual places of residence. Each of the five geriatricians provide one front-end session per week to the Emergency Department and Medical Admissions Unit to achieve the above objectives, working closely with Advanced nurse practitoner/Nurse Practitioners team and Therapy services. Other rapid follow-up arrangements (in out-patient/day hospital settings and virtual follow up via telephone/ Attendance Anywhere (wherever appropriate) supplements continued senior input to oversee patients journey to recovery. While the ethos of the service remains the same, the Acute Frailty Service model is flexible to react to availability of resources with the changing times with exciting plans for the further development of an Acute Frailty Ward at the front-end- which the post-holder will have the opportunity to play a hands on interactive role in its development.
Community Resource Team
The Care of the Elderly consultants work very closely with the Community Resource Team based at Trem y Mor providing 5 consultant sessions a week.
Consultants within the Care of the Elderly Directorate in Princess of Wales Hospital are involved in providing support and clinical leadership for the Community Resource Team in the locality. The Acute Clinical Team (one arm of the larger Community Resource Team) deliver a Comprehensive Geriatric Assessment based model of care for managing frail patients with an acute illness in the community. The multi-disciplinary team consists of advanced clinical practitioners, nurses, therapists and health care assistants. Involvement of Consultant Geriatricians from secondary care enables better inter-team working between community and secondary care services, and continuity of care for our frail population. There are currently daily consultant sessions provided (Monday-Friday) to support and clinically lead the service.
The broad functions of the Acute Clinical Team are to support primary care to maintain patients in their own homes, avoiding hospital admission where appropriate. In addition, it is available to support early discharge from secondary care. With the ongoing development of front-end frailty services in Princess of Wales Hospital, we envisage that the team will develop further its ability to support and facilitate timely step down from secondary to community care of our frail patients.
2.2 Consultants and senior staff in the specialty
Name
Main Base
Role
Interests
Dr Ashok David
PWH
Consultant Physician and Clinical Director - Care of the Elderly/Acute Medicine/Stroke
Interface Geriatrics
Dr Anthony James
PWH
Consultant Physician - Care of the Elderly
Orthogeriatrics
Dr Gwilym McMillan
PWH
Consultant Physician Care of the Elderly
Interface Geriatrics
Dr Pranoy Barua
PWH
Consultant Physician Care of the Elderly
Interface Geriatrics
Dr Lauren Evans
PWH
Consultant Physician - Care of the Elderly
Geriatrics/Parkinson Disease
Dr Sandip Raha
PWH
Associate Specialist Care of the Elderly
Parkinsons Disease
2.3 Other medical staff in the specialty
2 Specialist Registrars
4 Core Training Doctors
2 ST1 (GP Trainee Doctors)
1 Foundation Programme 1 Doctors
2 Advanced Nurse Practitioners COTE
6 Specialist Nurse Practitioners COTE
1 Specialist Nurse Practitioner Parkinson Disease Service
There are plans to recruit additional middle grade doctors to support the development of Care of the Elderly services.
2.4 Other relevant staff and members of the multi-disciplinary team
Advanced Nurse practitioner / Nurse Practitioner general COTE medicine.
The Advanced Nurse Practitioner / Nurse Practitioner team consists of nurses whose have or are training to develop extended clinical assessment, diagnostic and therapeutic skills through masters level education in Advanced Practice. This level of education incorporates a qualification to independently prescribe all medications within the context of their specialty. The band 7 to 8a roles work in an autonomous fashion with COTE consultant input as required.
The band 6 Trainee is linked with a band 7 NP and ward based consultant in order to develop the required skills and advanced practice level of working.
The 8a lead ANP role is responsible for team management and service development alongside the COTE consultants. The ANP/NP has a vast knowledge in the specialty of care of elderly Comprehensive Geriatric Assessment, which includes clinical care management of acute and chronic conditions, complex discharge planning, Advanced Care Planning and palliative care.
Advanced Nurse practitioner / Nurse Practitioner Parkinson Disease Service
The Parkinsons disease nurse specialist is a key part of the movement disorder team. The current staff member is very experienced in the role and works as an autonomous practitioner (band 8a). They support the consultants and manage their own caseload of patients. They assesses and reviews patients in community nurse-led clinics, in their own homes, both as in-patients and in out-patients department. They manage all the patients who require advanced therapy for Parkinsons such as apomorphine or Dudoopa. They manages the patients from diagnosis through to palliative care, including advance care planning. They also manages the patients with Parkinsons disease dementia including memory drug prescriptions.
They are involved in research and education and runs the Parkinsons disease nurse module via Swansea University.
There is an electronic database for all the movement disorder patients.
You will be required to adhere to the principles of good medical practice laid down in the guidance of Good Medical Practice issued by the General Medical Council.
You will be required to participate in the Cwm Taf Morgannwg University Health Boards risk management process and in clinical audit and other clinical governance activities within the department, the Clinical Service Group and Cwm Taf Morgannwg University Health Board. Adherence to Caldicott Principles is mandatory. The post holder will be positively encouraged to participate in research and development in line with Cwm Taf Morgannwg University Health Boards Commissioner and NHS priorities.
Travelling as necessary between hospitals/clinics may be required to undertake such duties.
Teaching
The COTE Department has a high clinical teaching workload in both postgraduate and undergraduate spheres which the post holder would be expected to contribute towards.
Opportunity exists for further developing education and teaching skills at the clinical skills centre at the Royal Glamorgan hospital.
Audit
The Medical Clinical Service Group identifies 4 afternoons per year for presentation of audit work. Clinical commitments for these afternoons are cancelled, and attendance is expected for senior and junior staff. This has resulted in high quality audit and review within the Clinical Service Group. The Successful candidate will be expected to take part in the department audit activities.
Continuous Professional Development
There are weekly speciality meetings, weekly medical Clinical Service Group clinical meetings, and weekly Grand rounds at which attendance is expected.
The Cwm Taf Morgannwg University Health Boards actively supports all trainees to achieve their CPD targets as agreed at annual appraisal.
