JD for Higher specialist trainee MK 2009

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JD for Higher specialist trainee MK 2009 Powered By Docstoc

                 Standing Way
                 Milton Keynes
                   MK6 5NG
                 01908 660033

      On call in Paediatrics/neonates



                                 July 2009

Job Title:
        Speciality Trainee in Community Paediatrics


        Community Paediatrics

Clinical Supervisor:
        Allocated as per modular training (Appendix II)

Educational Supervisor:
        Allocated through the school of paediatrics

Full Time/Part Time:
        Full time

1)      The Department of Child Health, Milton Keynes PCT Head Quarters for
        Community Paediatrics. The department is on the hospital campus site and
        within walking distance to the Child Development Centre, Specialist CAMHS,
        Postgraduate Centre, Walk In Clinic, as well as the Paediatric inpatient and
        outpatient facilities. The trainee will have suitable office accommodation,
        access to a personal computer and printer, as well as secretarial support.
2)      Milton Keynes Hospital Foundation Trust for Acute on-call

Work Pattern:
        Full shift

Banding Supplement:
        1B or 2B including prospective cover

Annual and Study Leave arrangements:
        Duties include cover for colleagues absence on annual or study leave.
        Adequate notice of permission for leave must be obtained from the
        responsible consultants in both Child Health and Paediatrics, giving at least
        six weeks notice. Annual leave entitlement will be 5 or 6 weeks dependent on
        point of salary.

       Both departments have a library and a wide range of books. The local Post
       Graduate Centre is well supplied with the relevant journals and books and
       runs an active programme of postgraduate training.

       This post is based on full shift rota that is fully compliant with the European
       working time directive

Duties of Post:
1. Clinical:

       The trainee will be offered structured induction, teaching and educational
       supervision programme.

       The weekday time will be spent in Community Paediatrics as outlined in the
       proposed timetable. Appendix I

       The trainee will be involved in seeing both new referrals and reviewing
       children presenting with a range of neurodevelopmental/behavioural/social

       The department has a weekly referrals meeting at which the weeks referrals
       are discussed and distributed. The meetings are chaired in rotation and the
       trainee will participate in these meetings. The trainee will have the
       opportunity to see children with a wide range of neurodevelopmental
       disorders, e.g. Down‟s Syndrome; physical disabilities such as cerebral palsy,
       Autistic Spectrum Disorders, as well as undertake medicals for Looked After
       Children, adoption and contribute to the assessment of Special Educational
       The clinics are held at venues which all have disabled access, and are
       appropriately equipped. The trainee will have access to a range of
       standardised developmental assessment tools, including the Griffiths
       developmental scales/schedule of Growing skills ,3Di computer based
       Interview and the ADOS

       By September 2009 we anticipate having a single entry assessment with a
       joint referrals meeting involving Therapists, Paediatricians, Child Development
       Centre coordinator and a Clinical Psychologist.

       The trainee will be expected to undertake both single and joint assessments
       depending on the nature of the presenting complaint. Following the
       assessment the trainee will contribute to multidisciplinary/agency discussions,
       planning team meetings and the formulation of care plans. Through this there
       will be opportunities to develop an understanding of the range of

benefits/support services (voluntary/statutory) available to the children and
their families.

The Neurodisability and neurodevelopmental training will be ongoing
throughout all the modules.

The trainee will have access to the full range of investigations and specialist
expertise including the opportunity to sit in the joint clinics by visiting
specialists. The trainee will manage a caseload of children of all ages with
developmental and disabling conditions over the two to three year period of
the post and through this, gain experience of direct clinic care in the breadth
of work undertaken by Community Paediatricians.

Assessments for children presenting with physical abuse are undertaken via
the Acute Hospital on-call rota which the trainee will contribute to. In addition
the trainee will on a fortnightly basis be on-call for the daytime rota
unless if the trainee has some pre-arranged safeguarding commitment. This
fortnightly session will be part of the job plan throughout the two year
training programme. Level 3 competences for safeguarding will be covered
through these dedicated sessions. The sessions will allow for attendance at a
range of meetings, e.g. „internal peer review, strategic meetings with
children‟s social care, adoption panel with medical advisor, child protection

Assessments for sexual abuse in children are undertaken by Dr Sheila Paul
the Forensic Medical Examiner and arrangements will be made for the
trainee to undertake joint examinations with Dr Sheila Paul. The trainee will
also have the opportunity to attend peer reviews for child sexual abuse.

Other components of the syllabus for the Higher Specialist Training in
Community Child Health as defined by the British Association for Community
Child Health (2001) as well as the Framework of Competences for level 3
training in community child health (2008) will be covered in a more in-depth
manner through modular training. The modules will be of six months duration
and a proposed plan for the distribution of the modules in the two years of
Community Paediatrics are outlined in Appendix II

During each modular period the trainee will have regular meetings with the
Clinical Supervisor with a view to identifying the training needs and looking at
ways of addressing them.

The trainee will be encouraged to undertake audits/projects/reviewing of
guidelines relevant to the module and be supported in these by the
respective clinical supervisor.

      The trainee will participate in the middle grade Acute on-call rota for general
      paediatrics and neonates. The rota is new deal compliant. It is a 1 in 11 on
      call rota. There are daily consultant led ward rounds and twice daily
      handovers both of which are factored in to the rota. The trainees are well
      supported by the consultants during the on call. Details of the on-call are
      outlined in Appendix III.

      Details of the ward capacity /neonatal unit are covered in the general

      Assessments for children presenting with physical abuse.

2. Teaching/Training/Research & Clinical Audit:

      Both Departments (Child Health and Paediatrics) have an active
      teaching/meeting programme and these are outlined briefly in the proposed
      job plan. The Child Health Department has joint meetings/teaching sessions
      with Paediatrics (Weekly), CAMHS team (two monthly) and with the
      Northamptonshire Joint Paediatric/Psychiatric Teams(twice yearly) .

      The trainee will also be expected to attend the twice yearly Oxfordshire
      Epilepsy Network Meetings. the regional and National BACD /BACCH
      Meetings, as well as the programme of training run by the Oxford School of

      The trainee will be encouraged to undertake an MSC course in Community
      Paediatrics and relevant courses outlined in the BACCH syllabus.

      Weekly meetings for Clinicians/GP's are held at the Post Graduate Centre.

      The trainee will provide teaching to medical students and trainees at level 1
      and 2, as well as providing cover for the junior trainees clinical work during
      some of their teaching sessions.

3. Administration/management:
      Maintenance of patient records and communication with GP‟s, therapists and
      a range of professionals involved in the child‟s care, as well as parents. This
      will include letters, phone calls and discharge summaries (for Acute on-call).
      Collection of statistical data relevant to clinical audit, quality assurance and
      service delivery work.

4. Clinical Governance:

      All trainees are expected to take an active role in departmental clinical
      governance activities including undertaking and presenting audit and
      guideline work and participating in critical incident and mortality and
      morbidity reviews.


Milton Keynes District:

      The Milton Keynes District includes the thriving new city of Milton Keynes
      which is being rapidly developed in a designated area of North
      Buckinghamshire. It lies mid-way between Northampton and Aylesbury and
      is close to the M1, traversed by the London/Glasgow Intercity rail link (fast
      train to Euston, currently 35 minutes) and the Grand Union Canal. The town
      lies in attractive countryside, with a wide variety of housing both new and
      old. There are a large number of schools both public and private in Milton
      Keynes and nearby Bedfordshire.

      Milton Keynes is not only famous for the concrete cows! The well known
      shopping and food centres have recently been radically extended, a new
      theatre complex with art gallery opened in October 1999 and the largest
      indoor, real snow, ski slope in Europe with sports village opened August
      2000. There is a Young Children‟s Theme Park, Gulliver‟s Land and extensive
      leisure and sports facilities including the National Hockey Stadium ,a new
      football stadium which is home to MK Dons, National Badminton Centre, a
      range of water sports, bowling, ice and roller skating, swimming pools, gyms,
      clubs, a multi screen cinema, and numerous restaurants, cafes and bars.

      Cleo Laine and Johnny Dankworth live in the area and run the Stables as a
      jazz music and entertainment venue in the grounds of their home. This has
      recently undergone redevelopment with a new auditorium and exciting

      The building of the city began in the early 1970's and will continue into this
      Millennium with the population rising by around 6-7,000 per year (please
      refer to table). The age structure is weighted towards a younger population
      but the proportion of people over the age of 65 is also rising.

       Age     Mid         year % of           Mid year projection % of          %
               projection  total               2010                              increase
               1999                            [thousands]

       0-14    46.4                 22         53.0                   21         14
       15-44   95.9                 46         109.3                  43         14
       45-64   45.2                 22         64.9                   25         44

         65-74    11.2                   5        16.2                     6         45
         75-84    7.0                    3        8.2                      3         17
         85+      2.3                    1        3.3                      1         43
         All      207.9                           254.9

Provision of Comprehensive Children’s Health Services:

        Children‟s Health Services are currently provided within two separate Trusts.
        Acute Paediatric services within the acute Trust, Community Child health and
        Child and Adolescent Psychiatry in the Primary Care Trust. Despite the
        existence of the two separate departments, the clinicians work in a very
        integrated way with shared responsibility. The acute Paediatricians provide
        input into Child Protection/Disability and several of the Community
        Paediatricians contribute to the on-call rota.

        Hospital Paediatric services include in-patient, out-patients, neonatal care and
        specialist community nursing. The Primary Care Trust encompasses the Child
        Health Department, Health Visiting, School Nursing, Child and Adolescent
        Psychiatry/Psychology Services and Child Development Centre. The Child and
        Adolescent Psychiatry Department consists of 3 Consultant Psychiatrists who
        are supported by a range of other professionals including Clinical
        Psychologists, Family Therapists, Psychotherapists, Nurse Specialists and an
        Art Therapist. There are excellent working relationships amongst all the
        providers across both Trusts.

        Milton Keynes is a unitary local authority with almost coterminous boundaries
        to the PCT offering us unique opportunities to develop our services together.
        This is done through Milton Keynes Child Health Services and newly formed
        Children‟s Trust.


Paediatricians with their special interests:

Child Health Department:

Dr Yogini Thakker            W/T                     Consultant Paediatrician
(Clinical Director)                                  Lead clinician - Paediatric Audiology and
                                                     Child Health promotion. Special Interest
                                                     Genetic Disorders
Dr Adeola Vaughan            W/T                     Consultant Paediatrician
                                                     Safeguarding and children in special
                                                     circumstances – Named doctor for child
                                                     protection; Looked after children and
                                                     adoption and fostering.
Dr Chinwe Osuchukwu          W/T                     Consultant Paediatrician – Lead Clinician for
                                                     childhood obesity and special schools. Special
                                                     interest - neurodisability

Dr Diane Gindner        Part time 6 PA‟s   Consultant Paediatrician
                                           Lead Clinician-Food allergy and Enuresis

Vacancy                 W/T                Staff Grade
                                           Looked after children/Enuresis and Patch
                                           Responsibility. Participates in Acute on-call

Dr Atta Jan             W/T                Associate Specialist – Lead Clinician for
                                           Allergy clinic
Dr Phil Latham          P/T                Consultant Paediatrician
                                           Designated Doctor for Children Protection
                                           Named Doctor for Child Death Review

Department of Paediatrics

Dr Abraham Oommen           W/T            Consultant Paediatrician
(Clinical Director)                        Respiratory Paediatrics/Cystic Fibrosis
Dr Prem Roy                 W/T            Consultant Paediatrician
                                           General and HIV
Dr Vanda Joss               Part time      Consultant Paediatrician
                                           Sickle cell Haemoglobinopathy
Dr Jasper Katumba           W/T            Lead Clinician for Neonatology
Dr Pravin Lakhani           W/T            Consultant Paediatrician
                                           Named Doctor for Child Protection
                                           Endocrinology & Diabetes
Dr V Ramanathan             W/T            Consultant Paediatrician
Dr James Bursell            W/T            Consultant Paediatrician
                                           Endocrinology & Diabetes
Dr Chi Abbatuan             W/T            Staff Grade

Dr Iqbal Hussein            W/T            Staff Grade (Hospital)

Dr Raef Al Aghbar           W/T            Staff Grade (Hospital)

Dr Anne Okundi              W/T            General Paediatrics/Neonates
Clinical Fellow

Dr Azaz Khalil              W/T            Speciality Doctor (Hospital)

Dr Mustafa Reyes            W/T            Speciality Doctor (Hospital)

3 Level 2 Trainees          W/T            General Paediatrics/Neonates

1st Tier – 10 doctors       W/T            General Paediatrics/Neonates

3 Neonatal Nurse              2.5WTE

Community Paediatrics Services:

(a)    The Community Paediatricians provide a secondary service for children
       referred from primary care, hospital and community health professionals,
       schools, local educational authority as well as social services where there are
       concerns about the child‟s development, physical wellbeing and its impact on
       accessing the curriculum.

       Children are seen for an assessment and follow-up in the setting that is most
       appropriate to their needs i.e. clinics, special schools and the Child
       Development Centre. The team provides the statutory support to the Local
       Authority in relation to children with special educational needs, pre-school
       children who are looked after and children being placed for adoption and

(b)    Well Children:

       A comprehensive programme of neonatal screening, pre-school surveillance
       and immunisation is implemented entirely by primary health care services.
       The programme is promoted, collated and supported by the Child Health

       Milton Keynes was in the first wave of pilot sites for the implementation of
       the Newborn Hearing Screening Programme, the project went live on 1 April
       2002 and has been very successful.

(c)    Special Needs:

       A purpose-built Child Development Centre allows a co-ordinated approach to
       pre-school children with disabilities by Medical Staff and by the professionals
       allied to medicine. Individual and group therapy for a variety of conditions
       takes place in the child development centre and in the community. Milton
       Keynes Early stimulation project (Portage) is run by the LA.

       A policy of integration of children with disabilities into mainstream schooling
       wherever possible is followed locally. There are currently a number of Special
       Schools, in Milton Keynes two for children with moderate learning difficulties,
       one for children with severe/profound learning difficulties, a school for
       children with severe social communication difficulties including autism and
       two for children with emotional and behavioural difficulties. Medical support
       and input from the professions allied to medicine is provided to these schools
       and for those children integrated into mainstream schooling.

(d)    Child Protection:

      Milton Keynes has an active Local Safeguarding Children Board. There are
      good, well established working links with all appropriate local agencies.
      There is a constructive and progressive approach to child protection locally
      and a considerable amount of senior medical time has been invested in this

      Medical examinations mainly for physical abuse are undertaken via the acute
      on-call rota and initial health assessments are undertaken for children in care
      by the community paediatricians. Assessments of children for possible sexual
      abuse are generally undertaken by a very experienced Forensic Medical

      Dr Latham is currently the designated doctor for child protection and Named
      Doctor for the Child Death Review and Dr‟s Vaughan and Lakhani are the
      Named Doctors for child protection. They are supported in these roles by a
      strong team of named nurses in both Trusts and a designated nurse across
      the PCT area.

(e)   Acute Paediatrics:

      In-Patient Facilities:

      The Department has a 22 bedded Paediatric Ward, Ward 5 with the newly
      built Milton Mouse Unit providing Day care and a paediatric assessment unit
      which comprises of a six-bedded day assessment unit, two bedded/day
      investigation area, waiting room, offices and a seminar room. Community
      and Palliative Care Nurses work between these two areas and within both the
      hospital and community settings.

(f)   Neonatal Services:

      The neonatal unit has 21 cots of which 2/3 are intensive care cots, the
      remaining high Dependancy. We hope to open a transitional care area since
      occupancy is very high. There are around 4,000 deliveries annually, but with
      population expansion, deliveries are increasing. A full intensive care service
      is undertaken including long term ventilation and associated support, cranial
      ultrasound, echocardiography with tele-medicine facilities.

      We have a progressive unit which works closely with the local tertiary centre
      at Oxford. The NNU has diagnostic ultrasound, three Draeger and one SLE
      ventilators (with oscillation) 5 BIPAP and 5 SIPAP machines. Our current
      practice is of early aggressive extubation to SIPAP which has dramatically
      reduced ventilator days (and complications). We also feed very aggressively
      both parenterally and enterally and have reduced average lengths of stay for
      under 30 weekers from 71 days to 41 days.

       In 2004-5 there were 454 level 1, 652 level 2 and 3,900 level 3 bed days.
       Early discharge is facilitated by a very experienced Community Neonatal
       Nursing team.

       2.5 wte neonatal sisters have joint duties within the unit and community,
       providing outreach support and facilitating supervised early discharge
       including oxygen dependent babies.

(g)    Outpatient Facilities:

       The purpose built outpatient building area provides standard facilities, with a
       dedicated area for Paediatrics. Clinics are also held at the Child development
       Centre and the Walk in Centre, both of which are on the hospital campus site.

Regular Clinics include:

       General                               -     All Acute Consultants
                                                   Special Care Baby Follow-up
                                             -     Dr Katumba
       Diabetes                                    Drs Lakhani/Bursell
       Asthma/Cystic Fibrosis                -     Dr Oommen + Asthma Nurse
       Allergy/Anaphylaxis                   -     Dr.Gindner /Dr Jan & Specialist
       Enuresis                              -     Nurse led with support from
                                                   Drs Gindner/Core Trainee
       Developmental paediatrics                   All Community Paediatricians
       Oncology                              -     Dr Ramanathan
       Haematology                           -     Dr Joss

Joint Clinics with visiting/local Specialists:

                             Specialist                    Base

       Cardiac               Dr S Adwani                   Oxford
       Endocrine             Dr F Ryan                     Oxford
       Genetics              Dr H Stewart                  Oxford
       Orthopaedics          Mr J Flynn                    Milton Keynes
                             Mr M Khalik                   Milton Keynes
       Neurology             Dr A McShane                  Oxford
       Paediatric Surgery    Miss K Lakhoo                 Oxford
       HIV                   Dr H Lyall                    St Mary‟s London
       Haematology           Dr G Hall                     Oxford

Nursing Staff/Primary Care Trust:

Each school has a named School Nurse. The core programme based on the Revised
Health for all Children (2006) is carried out by the school nurses, who are also
responsible for the delivery of the school-based immunisation programme. Health
Visitors based within the Primary Care Teams play an integral part in providing the

Child Health Promotion programme which too follows the recommendations of Health
for All Children.

Children with Complex Needs Service:

This is a MKPCT nurse led service that delivers assessment, care, case management
and arranges the provision of medical supplies to children with complex physical
needs in their homes, schools and other community settings.

There are two community paediatric matrons, a part time band six paediatric nurse
and a part time band 5 paediatric nurse, 8 carer‟s and a service administrator.

A senior nurse manages the service.

Administrative Support Staff, Child Health/Primary Care Trust:

The team is managed by Erika Lamb; the Child Health Department Manager. The
team is involved in collating and maintaining a data base on all the children of Milton

Teaching/Training/Research and Clinical Audit:


The Department of Clinical Effectiveness has good resources and provides regular
support in departmental audits; it is located within the Postgraduate Centre and the
Trust Clinical Governance Group.

Clinical Audit meetings are held regularly at the Postgraduate Centre and integrated
with other Directorates on a “rolling half day basis”.

College Tutor is Dr Ramanathan.

Postgraduate Facilities:

There is a thriving Postgraduate Centre with a library and computer on-line services
available. The Postgraduate Clinical Tutor is responsible for organising the
programme, and active participation of Consultants and General Practitioners is
strongly encouraged. There is an active Speciality Tutors Committee that meets
regularly. The Trust has also been closely linked with the Regional Postgraduate
Deans office in piloting new training programmes for Consultants and Junior staff.

                     Provisional timetable for Higher Specialist Trainee                                                    Appendix I

            Monday             Tuesday                      Wednesday                Thursday                           Friday
AM          CDC clinic         Special School               WIC clinic fortnightly   Neurology clinic 6 weekly.         Special module
                                                            Special module           Clinical Admin
Lunchtime   Contribute to      CPD with Level 2 trainees    CPD with Acute           Referrals meeting
            teaching           in Acute Trust or            team                     CPD meeting at Post Grad Centre
            programme for      Multidisciplinary planning                            or within department
            Level 1 trainees   team meetings/social
                               communication meetings
PM          Clinical Admin     Genetics Clinic Monthly      Special Module           Monthly Child Health Department    2-4pm Grand round on
                               Research/Audit                                        meeting                            Neonatal Unit
                                                                                                                        4-5pm Clinical admin
                                                                                     Monthly Joint Orthopaedic Clinic

                                                                                     2 monthly joint meeting
                                                                                     CAMHS/Therapists etc

                                                                                     remaining weeks research/audit

                                                                                                                 APPENDIX II

                          Proposed programme for 6 monthly modular training for the 2 years in Community Paediatrics

Clinical supervisor                       Special Modules – 6 monthly period            Responsible Consultant

Dr Thakker                                Special Senses -          Vision              Eye Department
                                                                    Hearing             Dr Thakker and Third tier

                                        Child Health Promotion
                                                - including screening programmes Dr Thakker

Dr Vaughan
                                          Safeguarding                                  Dr Vaughan (throughout the two year period)

                                          Behavioural paediatrics                       CAMHS

                                        Immunisation                           Dr Jan and PCT immunisation coordinator
Dr Osuchuwkuw                           Educational Medicine                   Dr Osuchukwu
                                                - including SEN

                                          Childhood Obesity                             Dr Osuchukwu

                                        Public Health                          Public Health Team

Dr Gindner                                Enuresis                                      Dr Gindner

                                          Food Allergy                                  Dr Gindner

                                          Management and IT Systems                     Dr Thakker & Erika Lamb

Registrar Paeds                                                                                  Appendix III

Trust                      Milton Keynes Hospital NHS Foundation Trust
Rota                       Copy of Paediatric Spr 1 in 11 31.07.08
Post                       Post 1
Grade                      Specialty registrar 4
Specialty                  Paediatrics

Rota Summary

Work Pattern               Full Shift
New Deal Compliant?        Yes
Supplement                 50% (2B)

Rota timetable:

Week        Mon            Tue             Wed                 Thu                     Fri             Sat                     Sun
                                                                                       9:00 -
        1   9:00 - 21:30   9:00 - 21:30    9:00 - 17:00        9:00 - 17:00            17:00
                                                                                       9:00 -
        2   9:00 - 17:00   9:00 - 17:00    9:00 - 21:30        9:00 - 21:30            17:00
                                                               00:00 - 9:30, 21:00 -   00:00 -
        3   9:00 - 17:00   9:00 - 17:00    21:00 - 24:00       24:00                   9:30
                                                                                       9:00 -
        4   9:00 - 17:00   9:00 - 17:00    9:00 - 17:00        9:00 - 17:00            17:00
                                                                                       21:00 -         00:00 - 9:30, 21:00 -   00:00 - 9:30, 21:00 -
        5   9:00 - 17:00   9:00 - 17:00    9:00 - 17:00        9:00 - 17:00            24:00           24:00                   24:00
        6   00:00 - 9:30   9:00 - 17:00    9:00 - 17:00        9:00 - 17:00
                                                                                       9:00 -
        7   9:00 - 17:00   9:00 - 17:00    9:00 - 21:30        9:00 - 21:30            17:00
                                                                                       9:00 -
        8   9:00 - 21:30   9:00 - 21:30    9:00 - 17:00        9:00 - 17:00            17:00
        9   9:00 - 17:00   9:00 - 17:00    9:00 - 17:00        9:00 - 17:00            9:00 -          9:00 - 21:30            9:00 - 21:30
                                                                            9:00 -
       10   9:00 - 17:00     9:00 - 17:00    9:00 - 17:00    9:00 - 17:00   17:00
                             00:00 - 9:30,                                  9:00 -
       11   21:00 - 24:00    21:00 - 24:00   00:00 - 9:30    9:00 - 17:00   17:00

Duty details:

Duty            Name                         Work Pattern                   Start     Finish        Duration
A               NWD                          NWD                            9:00      17:00         8:00
B               Late                         Full Shift                     9:00      21:30         12:30
C               Night                        Full Shift                     21:00     9:30          12:30

New Deal Rules                               Rota                           Maximum
Contracted hours                             49:26 (47:22)                  56:00
Actual hours                                 49:26 (47:22)                  56:00
Max consecutive days                                                12                         13
Max continuous duty length                   12:30                          14:00 / 14:00
62 and 48 hours off                          Yes


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