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									                                                                                            TB 46/08c


                                       1. SUMMARY SHEET
Post Reference Code
Post Title                  Consultant Anaesthetist with special interest in Paediatrics

Specialty                   Paediatric Anaesthesia
Directorate                 Surgery and Anaesthesia
Is this a New Post?                   Yes         Replacement Post?                        No
Replacing (name)                                  Last day of service

Number of BLT-funded PAs of outgoing
Is this post a joint appointment?                 No

Number of BLT-funded          10                  Number PAs funded          0
Programmed Activities                             from elsewhere
                                                  Please specify source
Has the Head of Institute at QMUL been consulted?            NA
Where relevant, has financial support from the medical       NA
school been agreed?
Budget Holder (Name)                                         Please enter budget code below
Wendy Cookson/Julie                                           AHC30       22020
Lamb                                                          0           0

Contractual Status:                 Whole time                      Part time

Expected Start Date
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                            2. STRATEGIC CONTEXT
1. Why is this post needed?
(How do you anticipate the new post holder’s speciality will affect the quantity
and/or quality of service activity?)

This is a much needed 10th Consultant Paediatric Anaesthesia post to support the
growing paediatric surgery departments and high dependency units at The Royal
London Hospital. A locum tenth post holder has been recruited for the past two years
to ensure the gap in capacity was resourced to ensure the provision of a safe and
effective paediatric service.
As a busy trauma centre, the hospital receives a large number of paediatric
emergency cases often requiring the specialist skills of a paediatric anaesthetist to
provide life support. The opening of a new 8 bed Paediatric critical care unit in
February 2007 means that critically ill children now remain at Barts and the London
for their care, with the paediatric anaesthetists required to provide support for this
unit, particularly in pain management.

In addition there has been an increase in activity in elective and emergency work and
critical care. The elective commissioned activity for 08/09 requiring consultant
anaesthetist cover is currently 4555 spells, with an additional 834 emergency spells.
Further developments in-year include, a planned increased in paediatric endoscopies
and an increased presence of anaesthetists in admission clinics. The current
substantive establishment of nine consultants, without locum cover, requires an extra
10.2 DCC sessions. This tenth post is required to manage the majority of this
shortfall, and is seen as a more cost effective way of managing the demand than with
locum staff. Until further developments are quantified, any shortfall will be managed

It is now essential for the post to become permanent to ensure the service is provided
by an established and committed team.

2. How does this post contribute to the Pathfinder Strategy?
Clinical Efficiency

There is a specialist training module in paediatric anaesthesia for MMC trainees years
3-7. With the introduction of MMC, the trainees will require more intensive input
from the Consultants to ensure that they meet all of the necessary competencies
within the agreed timeframe. Therefore Consultants will need to be doubled up with
trainees on all lists, which will not be possible within existing numbers.
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Consultant-led anaesthesia is vital in delivering improved theatre efficiency by
reducing patient cancellations and improving turnaround times between patients.

Recent feedback from trainees has criticised the number of cases where they have
been left alone to cover lists due to lack of available Consultants. This not only
impacts on their training, but also on service, as the anaesthetic time is increased due
to the trainees’ inexperience and overall throughput is thereby reduced. Where both a
Consultant and a trainee are assigned to a list, the time between patients in theatres is
much reduced, improving end efficiency.

Clinical Risk
It is vital that the paediatric surgery lists (all specialties) have specialist Consultant
Anaesthetist cover for them in order to maintain a safe service. Paediatric
Anaesthesia requires a specialist skill set and a separate on-call rota is in place to
deliver emergency care as required both in theatres and on the HDU. Consultants
must perform a minimum number of paediatric anaesthetics each year in order to
meet good practice guidelines (RCA), and without this additional post, the current
Consultant body is very stretched. The growth in Paediatric trauma and the
concentration of trauma patients on particular Orthopaedic and Maxfax lists
requires more consultant input

Clinical Quality
This post will provide additional teaching and training hours for junior anaesthetists
which will become even more important with the advent of MMC and the associated
increase in assessments and decrease in the experience of trainees. Moreover, the
reduction in working hours imposed by EWTD will mean that when the trainees are
in work, it is vital that Consultants are available to deliver training rather than asking
trainees to run lists alone.

The surgical lists for which this post holder will provide cover often have complex
patients undergoing high risk procedures. It is not suitable for trainees to be asked to
provide cover for these lists and without a Consultant present it would not be possible
to proceed with some cases.

3. Additional comments in support of the post:
Anaesthesia is a vital support speciality to assist the Trust in achieving challenging access targets.
   The proposed job plan includes sessions at both sites, and support for some adult lists.
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                                                 3. JOB PLAN
Proposed Job Plan: please enter details of all Programmed Activities – A Trust guide to Job
Planning has been published and can be requested. The Job Plan must be compliant under the EU
Working Time Directive
A: Timetable of programmed activities for direct clinical care/supporting professional activity
               Timing    Description            Frequenc      Location                    Number
                                                                           Care /                     DCC        SPA
                                                y                                         of PA’s
                                                                           l Activity
Monday am      0900 –    Paediatric Surgery -   Weekly        RLH          DCC            1.25
               1230      Orthopaedics
Monday pm      1330 –    Paediatric Surgery -   Weekly        RLH          DCC            1.25
               1700      ENT

Tuesday am     0830-     SPA                    Weekly        RLH          SPA
               1230                                                                                                   1

Tuesday pm     1330 –    Paediatric Surgery -   Weekly        RLH          DCC            1.00
               1700      DOPS                                                                            1

Wednesday      0900 –    Teaching
am             1230
Wednesday      1330 -
pm             1630
Thursday am    0830 -    Paediatric Surgery -   1:2           RLH          DCC            0.625
               1230      Specialty
Thursday pm    1330-     Paediatric Surgery -   1:2           RLH          DCC            0.625
               1730      Specialty

Friday am      0830 -    Paediatric Surgery -   1:8           RLH          DCC            1
               1300      Specialty
                                 Flexible       Weekly
Friday pm      1330-     Paediatric Surgery -   1:8           RLH          DCC            1
               1730      Specialty
                                 Flexible       Weekly
                                                              RLH          DCC

                                                                                                       8.75           2
                                                              TOTAL                                           10.75

B: Any other dcc/spa programmed activities not captured in table A. Please describe frequency, location and
average number of weekly PAs.

C: On-call commitment. Please describe the on-call commitment including rota, sites covered, average number of
PAs worked weekly.
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1 in 8 On-call on the Paediatric rota, (single nights and weekend) – 2 PA

D: External duties and additional NHS responsibilities. Please describe, including the nature of any commitments,
frequency, location, average number of programmed activities worked weekly, and for what organisation for Eds
              •   HDU cover for ventilated children.
              •   Resuscitation
              •   Paediatric pain issues
              •   Radiography as required
              •   Flexibility to accommodate paediatric rota and vacant session.

E: SUMMARY Total average number of programmed activities worked weekly
Direct clinical care
Supporting professional activity
External duties
Additional NHS responsibilities
Where total is ten PAs or less, is the       Possibly
consultant willing to offer one further
programmed activity to the NHS?

A copy of the job description must be attached to this document. It should include a
statement concerning the responsibilities of the post holder in the teaching and
training of Junior Doctors. A description should also be given of the role that the
post holder is expected to undertake in delivering the Trust’s research strategy and
maintaining a portfolio of quality research projects, and of on-call commitment.
                       4. NON PATIENT-RELATED REQUIREMENTS

Please describe how the post will specifically contribute to the Directorate’s Teaching
commitments, Research and Development Strategy or other non activity related

Training: The post holder will be expected to contribute to the regular paediatric teaching and training session as
indicated in the job plan.

Research: The post holder will have opportunity to do audit and original research in several sub-specialities of

Management: The post holder will be expected to participate in Consultants’ meetings.

Please identify activity related to School of Medicine and Dentistry


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                               5. COST IMPLICATIONS
This section must be completed or endorsed by the Directorate Finance
Manager. Please indicate below any additional facilities which will be
required by the new appointee.
Gross cost of appointment per annum:
There are no additional facilities required by this post, the post holder is
supporting a service already provided.

    Facilities             Additional         Estimated Cost          Source of
                          Requirement             (£000)             Funding (*)

Inpatient Beds        0                   0                       N/A

Theatre Sessions      0                   0                       N/A

Day Case Theatre 0                        0                       N/A

Outpatient Clinic


Other Facilities
Net cost of appointment per annum
         Facilities             Current        Required        Difference    Cost
Inpatient Beds
Theatre Sessions - Covered                                              0
Day Case Theatre Sessions
Outpatient Clinic Sessions                                              0            0
Office Accommodation                                                    0            0
Other Facilities
Total                                                                                0

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Income assumptions

   • Increased ability to manage complex patients within the paediatric critical care

Please indicate below any new or replacement equipment that will be required:

    Nature of       New / replacement       Estimated Cost          Source of
   Equipment                                                        Funding

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Please indicate below any changes to revenue budgets that will be required. Costs of
additional activity in diagnostics and patient services should be included. Where there is
any expectation there will be funding from another NHS or external body written
evidence of agreement to pay MUST be obtained before the appraisal is released.

   Nature of                 Details         Estimated Cost           Source of
    Change                                                            Funding

                                 6. INTERNAL IMPACT
Please specify impact the appointment will have on other clinical and support areas
including clinical support staff.
                                                                      YES    NO      N/A
Has the appointment been agreed with the Clinical Director and                       X
General Manager of Physics Imaging and Pathology
Has the appointment been agreed with the Clinical Director and        X
General Manager of Dental and Patient Services?
Are any other employers/organisations involved in this                       X
appointment? IF YES, written agreement to the post and their
share of funding must be obtained prior to internal approval

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                                   7. APPROVAL
The post must be approved by the General Manager and at his/her discretion, the
Directorate Board
Date Approved
Signature of General manager

Signature of Clinical Director
Signature of Head of Financial
Management (required for new and
significantly changed posts)

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                                                         8. APPENDIX 1
These tables need not be completed for the investment appraisal but they must be completed for all posts and included within the
job description itself to ensure the directorate has a comprehensive record of PA’s.
Current establishment – Senior Medical Staff
                                                                   # PAs for BLT                    # non-BLT PAs (inc      Total PAs
                                                   Clinical   Research   Teaching   Other   Total    # PAs   Organisation
       Name                          Speciality


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Activity forecast for the appropriate speciality/sub-speciality:

                                     Previous Year             Present Year        Next Year

                                        Out-turn                    Total          Projected        Projected
                                                             Activity (including   Out-turn     Activity (including
                                                              non-contracted )                   non-contracted)


       Day Care

       Total FCEs

       Outpatients - New

              - Follow-up


       Other Activity

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