PRE-REGISTRATION HOUSE OFFICER

ESSEX RIVERS HEALTHCARE TRUST

MEDICINE

CARE OF THE ELDERLY

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COLCHESTER GENERAL HOSPITAL

ESSEX RIVERS HEALTHCARE TRUST

ORIGINS AND COMPOSITION OF THE TRUST

Essex Rivers Healthcare NHS Trust (ERH) was established as a second wave NHS Trust on 1st April 1992. It comprises the former Acute and Community Units of the North East Essex Health Authority. On 1st April 1992 the other two Units of that Health Authority, i.e., the Mental Handicap and Mental Health Units were established as the New Possibilities and North East Essex Mental Health Services NHS Trusts respectively. On 1st April 1993 the North East Essex Health Authority merged with the Mid Essex and West Essex Health Authorities to form the North Essex Health Authority with headquarters based in Witham, a small town midway between Colchester and Chelmsford and the former headquarters of the Essex Area Health Authority

There are four main towns: the Roman town of Colchester, England's oldest recorded town; Clacton on Sea, a seaside resort on the Tendring peninsula; Halstead, a small market town, Harwich, a major port serving Holland, Germany and Scandinavia.

Colchester can be reached from London in 90 minutes by road. The journey by train from Liverpool Street Station takes 50 minutes to Colchester and a further 20 minutes to Clacton on Sea.

The district has a population of approximately 334,000, with a high proportion of elderly people concentrated in the coastal region. Both the total population and proportion of elderly people are increasing.

THE HOSPITALS

Colchester General Hospital (CGH) – 611 Beds

(Telephone 01206 747474)

Colchester General Hospital was originally a modified nucleus design opened in 1984 with the intention that further matching phases would be added. The nucleus design was however abandoned but several developments have taken place on the site since 1984 as part of the Trust’s centralisation policy and more developments are planned.

Elmstead Day Services Unit opened in May 1993 as a dedicated day unit and was subsequently expanded and consists of three operating theatres, two endoscopy suites, Haematology Day Unit and thirty five beds. The endoscopy suites are equipped for both upper GI Endoscopy and Colonoscopy as well as ERCP examinations.

In January 1997 a new block, Constable Wing, was opened allowing the old Colchester Maternity Hospital to close. Constable Wing consists of the Obstetrics and Gynaecology Departments, additional wards and the Dennis Dunn Orthopaedic Unit which partly replaced the orthopaedic services provided at Black Notley Hospital when that hospital closed in March 1998.

Gainsborough Wing has recently been opened and accommodates Care of the Elderly Wards, Neurology, Rheumatology and Rehabilitation, including a state of the art hydrotherapy pool.

Planning for Phase V, which includes Cancer Services, The Breast Unit and other services currently provided at the Essex County Hospital, has begun which will complete the centralisation of services on the Colchester General Hospital site. Currently, therefore, the specialties and departments contained within the Colchester General Hospital site are:

Accident & Emergency

Out-patients

Acute Geriatrics

General Medicine & Thoracic Medicine

General Surgery

Urology

ITU

Paediatrics

Pain Relief

Plastic Surgery

Ear, Nose and Throat Surgery

Orthopaedics and Traumatology

Haematology and Blood Transfusion

Radiology, including CAT scanner, Angiography and Duplex scanning

Head Injury & Neurological Rehabilitation

Rehabilitation including a Day Hospital

Rheumatology

Gynaecology

Obstetrics

Special Care Baby Unit

Oral Surgery

Breast Surgery

Mortuary

There is a six bed Intensive Therapy Unit and a four bed high dependency unit. This is run by the Anaesthetic Department, although care of patients is shared with the clinician involved. In addition plans are being prepared for the establishment of a High Dependency Unit. There is a separate Coronary Care Unit and there are plans to relocate this to a larger site within CGH now that the new Gainsborough Wing has been completed. The X-ray Department has digital subtraction angiography, as well as conventional angiography, a spiral CT Scanner and ultrasound including duplex scanning. An MRI Scanner is due to be installed in the near future.

There are currently eleven operating theatres, three in Elmstead Day Unit, four in Constable Wing and four in the main CGH block, near the Intensive Care Unit and the surgical wards. There are plans to convert the nearby Rowhedge Ward into more theatre capacity to allow a CEPOD theatre to be available all the time for emergencies.

Colchester is a Breast Screening Centre and will continue as a Cancer Treatment Centre following agreement between the Trust, the Health Authority and the regions involved.

Other facilities on the CGH site include a physiotherapy department with gymnasium and a fortnightly amputee limb fitting clinic, occupational therapy, pharmacy and CSSD. There are also the staff restaurant, snack bar and hospital shop and car parking facilities for staff and visitors.

Essex County Hospital (ECH) – 56 Beds

(Telephone 01206 747474)

Opened as a voluntary hospital (the Essex and Colchester Hospital) in 1820, it

was the main acute hospital until the opening of CGH. ECH houses a sub Regional centre for radiotherapy. It has a busy out-patient department.

Departments and Specialties located within Essex County Hospital are:

Breast Unit and Screening Centre

ENT Out-patients Department

Medical Physics Department/Nuclear Medicine

Audiology Department

Out-patients Department

Radiotherapy

Dermatology

Cytogenetic Laboratory

Ophthalmology In-patients

Genito-Urinary Medicine

Plastic Surgery Out-patients

Pain Relief

Essex County Hospital maintains some support services, i.e. pharmacy, X-ray, physiotherapy and occupational therapy. The occupational health department is also based there.

Clacton and District Hospital

(Telephone 01206 747474)

118 beds, including 56 Acute Care of the Elderly beds, 25 bed Rehabilitation ward. Busy Out-patient department, 1 GP ward and GP Maternity Unit, accommodates wards for the NE Mental Health Services Trust as well, and a small 9.00 am to 5.00 pm Casualty Department.

Harwich Hospital

(Telephone 01255 201200)

This houses 37 GP beds with a small Casualty Department and active

Out-patient Department.

Halstead Hospital

(Telephone 01787 291010)

There are 20 GP beds within a new ward block opened in May 1993 and an

Out-patient Department

Severalls Hospital

Recently closed as a N E Essex Mental Health Trust facility but still housing

(and for the immediate future):

Clinical Biochemistry

Histopathology

Cytopathology

ESSEX RIVERS HEALTHCARE

MEDICAL STAFFING (MEDICINE AND CARE OF THE ELDERLY)

· Consultants, General Medicine 9

· Consultants, Care of the Elderly 5

· Consultants, Clinical Haematology 2

· Consultants, Rheumatology / Rehabilitation 3

· Medical Specialist Registrars 4

· Specialist Registrar, Care of the Elderly 1

· Senior SHO, Care of the Elderly 1

· Medical SHOs 5 + 1 Floater

· SHO Rheumatology 1

· SHOs, Care of the Elderly 5 + 2 at Clacton Hospital

· Staff Grade, Care of the Elderly 1

· Pre-Registration HPs currently 8 increasing to 10

The specialities embraced by the consultants in General Medicine comprise:-

· Thoracic Medicine

· Cardiology

· Gastroenterology

· Endocrinology

· Diabetes

· Nephrology

The Medical outpatient facilities for Neurology and Rheumatology have recently been relocated to the new Gainsborough Wing at Colchester General Hospital. Rheumatology beds have also transferred to the new building.

Other Staff: Specialist nursing staff in Diabetes, Respiratory Medicine, TB, Haematology plus a Resuscitation Training Officer and Cardiac Rehabilitation Co‑ordinator.

SERVICE COMMITMENT

Medicine and Care of the Elderly

On-Call Duties at Colchester General Hospital

In order to meet the requirements of a 56 hours week and to try to improve continuity of care and workload, the on-call rota has recently been restructured to form a "team based" approach to acute admissions. There are 5 teams each led by 2 Consultant Physicians and 1 COTE Physician. Your team comprises of:

Team X

· 1 Registrar

· 2 SHOs (Medicine / Care of the Elderly)

· 2 Pre-Registration House Officers (1 Medicine/1Care of the Elderly)

The House Officer will work with one pair of general physicians for three months and then rotate to work with the Care of the Elderly physicians for a second three months (or vice versa).

The allocation of named consultants will be notified at appointment.

Each team will be on-take 1:5. The Registrar manages the on-call team so that there is an even distribution of work.

When on-take the team is responsible for all acute medical admissions and performing relevant emergency procedures.

The SHOs in the on-call team work alternately ‘on-call’ for 24 hours (with protected sleep) or on a full shift from 2100 – 1100 hours the next day. Thus, the ‘on-call’ team, (Reg, 1 SHO,1 PRHO and Trust Doctor) get protected sleep as the night calls are taken by the other SHO. In exceptional circumstances the Registrar or other SHO may be called to help the night SHO. PRHOs should expect a full night’s sleep.

Patients over 75 years of age are admitted by the take team and subsequently managed by the appropriate Care of the Elderly Consultant and his / her SHO. The hospital has a paramedic service between 2300 and 0700 hours so that routine tasks (IV cannulae, urinary catheters) are not the responsibility of medical staff.

On the morning following a 24 hour on-call there will be a consultant ward round to review new admissions. If the ward round takes place on a Saturday or Sunday, the PRHO is expected to attend this.

The House Officer is expected to ensure that he/she has handed over fully to his/her partner teams PRHO before going off duty for one half day per week. Bleeps MUST be handed to the person before leaving.

ADMISSIONS POLICY

The responsibility for identifying available beds rests broadly with the Administrator / On-Call Manager but the responsibility for allocating patients and agreeing which bed to use rests with the on-call doctor.

Day to day duties include:

· Being responsible for the continuity of care of your consultants teams in-patients

· Clerking and examining all of your teams consultants admissions from 0900 to 1700 hours when not off duty.

· Attending your teams consultants twice weekly ward rounds.

· Ensuring that a written short discharge note, including diagnosis and medication, is given to patients (or relatives) on discharge from hospital.

GENERAL TRAINING SPECIFICATION

An Induction Course is held on the first day of taking up the post when, if this is your first appointment since qualification, you will also shadow your predecessor. Attendance is compulsory. This will deal with:-

· Geographic Orientation

· Cardiopulmonary Resuscitation

· Interdepartmental Relationships

· Appraisal of Management Protocols

In the first 2 weeks of appointment, there will be a compulsory attendance at a 3‑hour session on cardiopulmonary resuscitation.

There are regular weekly lunchtime tutorials for all House Officers covering a wide range of clinical and related topics. A sandwich lunch is provided at these meetings. The House Officer should ask his/her SHO to provide cover ("hold the bleep") or hand bleeps in to the Postgraduate administrative staff during this 90 minute period in order to facilitate the House Officer's attendance at the tutorials.

The House Physician will be given the opportunity to participate in the firm's Clinical Case and Journal Club Presentations.

Clinical experience will be obtained over the full spectrum of acute medicine when first on-all. The PRHO willhave the opportunity to work with other health care workers on the wards especially when doing the 3 months Care of the Elderly slot.

Clinical audit is an ongoing and integral part of the department. There is one half day each month set aside for audit activities.

COUNSELLING

The incumbent's pastoral and professional supervisor will be your initialy supervising consultant, but where conflict might arise the Clinical Tutor will take his place or, when appropriate, nominate a non-medical counsellor. All PRHOs also have a named Senior Nurse from their clinical area, who acts as a nurse mentor.

POSTGRADUATE FACILITIES

The Postgraduate Centre is situated in a dedicated building 3 minutes walking distance from the Hospital. It has a library, a private study room, 4 seminar rooms, a bar, and a lecture theatre able to accommodate 100 people.

Director of Education and Training - Dr Tony Elston

Administrator - Mrs Penny West

College Tutor - Dr T Rudra

Librarian - Mrs Sarah Stock

Medical Personnel Manager - Mrs Christine Bassett

Services offered:

· Access to a wide range of general and specialist journals and standard textbooks.

· Regular postgraduate meetings for hospital doctors and GPs.

· One hour tutorials for HP / HSs on a wide spectrum of emergency topics and management skills.

· Clinical case presentations in lecture theatre.

· Journal Club in seminar rooms, (Thurs lunchtimes).

Library Hours:

Colchester General Hospital - Monday -Friday 9.00 am - 5.00 pm

Postgraduate Medical Centre - Monday 9.00 am to 5.00 pm

Tuesday 9.00am - 7.00 pm

Wednesday 9.00 am - 7.00 pm

Thursday 9.00 am - 7.00 pm

Friday 9.00 am - 5.00 pm

Literature searches using computer (Medline and Cinahl on CD-Rom).

LEAVE ARRANGEMENTS

Annual leave should be planned immediately upon taking up the post. Leave will not normally be granted during the first and last week of appointment. Six weeks notice of leave must be given (leave requested without this notice may be refused). No more than two House Physicians may be away on leave at any one time except under exceptional circumstances. PRHOs may not take leave at the same time as their partner teams pre-registration house officer. Leave may not be taken to include a planned weekend on-call. Leave is to be approved by Consultant and Clinical Director.

ACCOMMODATION

Accommodation will be provided within one mile of the hospital.

An on-call room is available in the hospital. This is situated close to the junior doctors' mess, which has facilities for the making of hot beverages and snacks. Meals are taken in the hospital restaurant.

The Postholder should be prepared to perform duties in occasional emergencies and unforeseen circumstances. Commitments arising in such circumstances are however, exceptional, and the postholder will not be required to undertake work of this kind for prolonged periods or on a regular basis. All efforts will be made to ensure that work of this kind does not result in continuous hours of duty which exceed the New Deal continuous hours of duty limits.

MAIN CONDITIONS OF SERVICE

(a) This post is covered by the Whitley Council Agreements for Hospital Medical and Dental Staff.

(b) This is a whole time appointment.

CONDITIONS OF APPOINTMENT

(i) Particular Qualifications / Experience Required

On appointment as a House Officer, a Medical Practitioner must be registered or provisionally registered with the General Medical Council. Posts will normally be held for six months.

(ii) Medical Examination

It is necessary for you to complete a Health Questionnaire if this is your first appointment within this District.

DETAILS OF ARRANGEMENTS FOR APPLICANTS VISITING HOSPITAL AND MEETING EXISTING MEMBERS OF STAFF:

Should you wish to visit the hospital, initially contact Medical Personnel who will arrange for you to be put through to the appropriate consultant's secretary.

Telephone: Colchester (01206) 742148

HOURS OF DUTY

40 hours per week basic plus Band 2A

Total actual hours worked on average in one week is within the junior doctors' New Deal 56 hour perimeter.

newprhoBand2a

Dec 00