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					VTS job description Nov 2005.          1
Royal Liverpool Hospital
Acute and Geriatric medicine
THE ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITAL


Job Description – SHO in Acute Medicine/ Geriatric Medicine (GPVTS)

The Hospital
The Royal Liverpool University Hospital was opened in 1978. It is a major teaching hospital in
the Mersey Region for the University of Liverpool and is adjacent to the University Campus. It
became a self-governing Trust within the NHS in April 1991 and subsequently amalgamated
with Broadgreen Hospital NHS Trust to form the Royal Liverpool and Broadgreen University
Hospitals Trust in 1995. Many of the speciality departments, in addition to offering a service to
the local community, offer a service of tertiary referral for the Mersey Region and beyond. There
are close ties with the faculty of Medicine of the University of Liverpool. Most of the Faculty’s
Clinical Departments are housed at the RLUH complex. The hospital has special strengths in
medical and surgical gastroenterology, renal transplantation, nephrology, surgical oncology and
haematology. Because of the strength of neighbouring stand-alone units in paediatrics and
Women’s services, there is no direct provision of these at the Royal. The Women’s Hospital is
situated about a mile away from the RLUH campus, and the laboratory services to the Women’s
Hospital are provided from RLUH laboratories. Close links exist with the Children’s Hospital,
and some specialised paediatric services, such as endocrinology are provided from the RLUH
laboratories. The hospital does not provide services in cardiothoracic surgery, neurosurgery or
plastic surgery, all of which are concentrated in regional units in nearby hospitals.


The Medical Directorate
The Medical Directorate is the largest single clinical directorate within the Trust. It currently has
around 325 designated beds and an annual revenue budget of approximately £14 million. All
major medical subspecialties are represented within the directorate, with the exception of
neurology, which is provided by the Regional Neurological Centre based at University Hospital
Aintree.

The Acute Medical Unit
The AMU has undergone significant development in the last year and is now amongst the
biggest and most dynamic in the country. A new area of the AMU was opened in January 2001
and provides a state of the art, purpose built working environment. Acute Emergency Medical
Admissions are preferentially handled on the Acute Medical Unit (AMU), which is situated
adjacent to the Accident and Emergency Unit at the Royal Liverpool Hospital. This unit deals
with patients representing over 90% of the

Directorate’s total acute admissions, whether admitted via the A&E department or through GP
referral. The AMU currently has 46 beds (including 6 assessment trolleys). Approximately 60%
of all admissions to AMU are discharged to home directly from the unit. The median stay on
AMU for all patients is in the region of 22 hours.

There is a Heart Emergency Centre adjacent to the AMU, which opened in November 2002,
which is supervised by Cardiologists, with input from the AMU team. In addition, part of this
VTS job description Nov 2005.          2
Royal Liverpool Hospital
Acute and Geriatric medicine
scheme involves the eventual utilisation of part of the ground floor ward as an expanded
Coronary Care Unit.

A dedicated admitting team drawn from one of the six medical firms manages emergency
medical admissions, averaging 60 per 24 hours. This team consists of 3 Specialist Registrars, 2
Senior House Officers and 2 Pre-registration House Officers. A full shift system ensures that a
fresh team of House Physicians, SHO’s and SpR’s take over responsibilities for the acute take
from 11.30pm until 9am the next morning. The admitting team is supported by 2 Senior Nurse
Practitioners who carry out initial clerking and assessment of patients and initiate and interpret
investigations. The AMU consultants supervise the 2 Senior Nurse Practitioners. An expanding
physicians assistant service is under development on the AMU, specially trained health care
assistants cannulate and send blood on emergency patients. Senior input to the acute take is
provided by the admitting team of the day through 2 Consultant ward rounds by the Consultant
Physician of the day. These occupy 2 formal sessions and have designated teaching time allotted
to them. The 3 SPRs review patients admitted by the juniors on a continual basis and feed back
learning points and management suggestions. A speciality triage system is in operation in which
patients are allocated wherever possible to the appropriate speciality firm on transfer from the
AMU.

The Directorate of Rehabilitation and Acute Medical Services for the Elderly
(RAMSE/Geriatric medicine)
This is a busy Directorate with beds on both the Royal Liverpool Hospital site and the
Broadgreen Hospital site. On the BGH site the 96 acute care beds for the elderly are in four
wards based in the Alexandra wing nucleus. The Directorate is strengthening links with
Intermediate Care, which is well developed in Liverpool. The Directorate is very active locally
within the Local Implementation Team for the National Service Framework for older people
both managerially and clinically. There are active Postgraduate Centres and library facilities on
both sites with regular educational meetings planned throughout the academic year.

Special Interests of the RAMSE Directorate
All consultants see a wide variety of general geriatric problems. Some of the consultants have a
specialist interest and expertise in the sub-specialities of geriatric medicine. There are interests in
stroke medicine, Parkinson’s disease, vascular rehabilitation, orthogeriatric liaison and falls
represented within our Directorate currently. We have a number of specialist nurses within the
Directorate including a stroke nurse, and a nurse with expertise in the management of
Parkinson’s disease.
VTS job description Nov 2005.         3
Royal Liverpool Hospital
Acute and Geriatric medicine
The Post

Title:        SHO/VTS in Acute Medicine/Geriatric Medicine; 3 months in each post
The post holders will spend 3 months in each of AMU and RAMSE. Two post holders will be
initially appointed and will rotate after 3months.

Clinical Duties- AMU
The consultants in the unit are Dr P Burnham, Dr I Osman, Dr T Kennedy, Prof T Walley, Dr A
Diak and Dr S Almond. The rest of the AMU medical team includes a staff grade physician, 1
GP VTS trainee, 4 Foundation Year 2 SHOs, a Critical Care rotation SHO a PRHO and two
Nurse Practitioners. The post holder will work weekdays and a 1:8 On Call Committment. With
the continual development of the unit, there is the possibility of changes to this pattern. All the
patients in the unit after the post-take round at 09:00 are under the responsibility of the AMU
team. The post holder will be expected to assist the AMU consultants to look after those patients,
under normal circumstances the post holder will be directly responsible for no more than 15
patients at any time. A typical working day includes 5 main areas of activity:
1.      Ward round with the AMU consultant in the morning. All patients are seen each morning
        by either the consultant or an experienced staff grade. The trainees accompany the senior
        doctor and initiate the investigations and procedures resulting from the review of patients.
        Trainees are expected to act on investigation results where necessary and to facilitate
        discharge in liaison with the senior medical and nursing staff where appropriate.
2.      Duties in the afternoon on the AMU are very varied and include attending to seriously ill
        patients, carrying out procedures, seeing newly arrived patients on the ward and
        administrative work. Helping with the supervision and training of the PRHOs and
        medical students is also part of this job. The AMU rotates two senior students who are
        post finals during term time and to an extent they become integrated into clinical
        activities and provide very practical help. The post holder is encouraged to consult senior
        colleagues in all complicated or difficult cases. A consultant physician in acute medicine
        is available in the unit from 09:00 until 20:30.
3.      In addition, with an expanded cohort of junior staff that the present posts will offer, some
        supervised experience of admitting acutely ill general medical patients will be available.
        It is envisaged that this will be of the order of 2 sessions per week but this could be
        varied according to the wishes of the trainee. These sessions will be based in the
        assessment area of the AMU. Patients referred directly from primary care settings (GP
        surgeries/visits, walk in centres, minor injury units) are assessed and managed. This work
        is done under close supervision of the AMU consultant and the on call consultant
        physician. In addition, advice is available from the three SPRs. It is expected that during
        the 3-month attachment, the post holder will become familiar with the management of the
        full range of acute medical problems.
4.      There will be out patient experience available. Again, this would be flexible and is likely
        to occupy 2 sessions per week. Any of the major medical specialities (e.g. chest,
        gastroenterology, cardiology) could be accommodated for outpatient experience and
        every effort would be made by the Trust to offer the trainees a choice of their out patient
        sessions. In addition, the AMU has 2 general medicine out patient clinics per week,
        seeing both new and follow up patients; the trainees would be encouraged to attend these.
VTS job description Nov 2005.         4
Royal Liverpool Hospital
Acute and Geriatric medicine
5.      Taking on of administrative work is encouraged and expected. In addition to
        administration relating to clinical work such as producing out patient correspondence and
        discharge summaries, the AMU has an active audit programme; the trainees are
        encouraged to participate in this.

Clinical Duties- RAMSE
The post holder will work on Ward 2Y an acute geriatric ward at the Royal Liverpool Hospital
site for Drs Scott and Loharuka. There will be duties on both the Acute Stroke Unit (ASU),
which is based on ward 2Y, and for general geriatric patients on the same ward. The Acute
Stroke Unit currently has 15 beds and the remainder of ward 2Y has 18 acute geriatric beds.

There are 2 other SHOs and a nurse clinician and a Specialist Registrar in Geriatric Medicine
also providing junior medical cover for ward 2Y. The SHOs and nurse clinician must co-
ordinate their leave requirements with Mrs Devida Broadbent (Ext 3422) as no more than 2 of
these 4 individuals will be allowed to be off the ward at the same time.

Nursing staff and therapy support to the ward are well established and highly skilled in the
management of stroke patients and geriatric patients. There is a stroke specialist nurse who
supports all areas of the stroke service.

The post holder will also be expected to attend the Stroke Review Clinic once weekly. This
clinic is based in the Elderly Health Unit at the Broadgreen site and will allow the post holder to
gain expertise in stroke rehabilitation and stroke secondary prevention. Further experience in
stroke rehabilitation will be possible if this would be beneficial to the post holder.

The post holder will work an On Call Commitment.


Training:
1. AMU
The AMU is unique as far as secondary care settings are concerned in that there is a consultant
presence on the unit at least 9am to 5pm (presently, 70% of the time there is a consultant 9am
until 9pm) Monday to Friday. These consultants are on the “shop floor” and are available for
advise/supervision.

From the primary care point of view, because the work of the AMU interfaces so closely with
that of GPs these posts will provide a valuable insight into this interface from the secondary care
perspective.

These jobs offer excellent experience in management of acute medical conditions. There is a
wealth of patients with good physical signs as well as plenty of interesting X-rays, ECGs and
Pathology reports. It is expected that during the attachment, the trainees will become more
comfortable with the management of unselected acutely ill general medicine patients.

Training in different medical procedures is also available. These include lumbar puncture, CVP
lines, pleural aspiration and tube insertion, ascites aspiration and sigmoidoscopy.
VTS job description Nov 2005.            5
Royal Liverpool Hospital
Acute and Geriatric medicine

2. RAMSE
In addition to the management of patients with acute stroke and acutely ill elderly patients, this
part of the rotation will allow trainees to develop an understanding of social aspects of medicine
in the modern NHS and the interface between secondary and intermediate care.

Ward 2Y is focused on not only on the management of the acute stroke patients and acutely ill
elderly patients but also the prevention of complications and assessing patients for their
rehabilitation potential and rapid movement to an appropriate destination. The trainees in their
attachment should experience the diagnosis and treatment of all commonly presenting types of
stroke.

The RAMSE Directorate is using innovative approaches to improve the provision of intermediate
care in the city and to strengthen the interface between primary, secondary and intermediate care.
The trainee will acquire insight into this rapidly developing area of the NHS.

Continuing Education
One session per week should be devoted to continuing medical education; in addition the
GPVTS session will be attended during 1 weekly session. The post holder will have access to the
Grand Round and the Department of Medicine lunchtime clinical case conference. In addition
there are weekly formal AMU seminars and RAMSE has a strong educational and audit
programme, again with weekly seminars. The trainees are expected to attend all these activities.
Study leave to be taken subject to the Terms and Conditions of Service.

Job Plan
1. AMU
The proposed job plan is set out below. It is subject to slight variation to take account of annual
leave. Please see above for an explanation of clinical duties. The job plan shows how the post
holder will integrate with the other SHOs on the AMU.

         Mon                    Tues           Wed             Thurs            Fri
SHO      Am        Pm           Am      Pm     Am      Pm      Am       Pm      Am        Pm
1        WR        Ward         OPD     Take   WR      Ward    OPD      VTS     Admin     Study
2        WR        Ward         Admin   OPD    Study   Take    WR       VTS     OPD       Take
3        Admin     Take         WR      Ward   WR      Study   OPD      VTS     WR        Ward
4        OPD       Admin        WR      Ward   OPD     Ward    Study    VTS     WR        Take

WR= Ward Round
Ward= Ward Work
OPD= Out Patients
Take= Medical Take Work
Admin= Letters/ Discharge Summaries
Study= Personal Study, Teaching, Audit, Research
VTS job description Nov 2005.         6
Royal Liverpool Hospital
Acute and Geriatric medicine
2. RAMSE
                      AM                                        PM
Monday                Ward round ASU                            Ward work
Tuesday               Ward round and Case Conference ASU        Ward work
Wednesday             Ward round ASU (Specialist Registrar)     Ward work
Thursday              Stroke review clinic                      Ward work
Friday                Ward round and case conference ASU        Ward work

Additionally the following hospital education sessions should be attended:
Tuesday 12:30-13:30- case presentations in medicine
Thursday 12:30-13:30- medical SHO teaching
Friday 09:00-10:00- Grand Round


Further information about Liverpool
The North West Regional Health Authority was formed by the amalgamation of the Mersey,
North Western and part of the Northern Regional Health Authorities and has a population of 6.6
million. Merseyside consists of 5 Metropolitan Boroughs, the largest being the City of Liverpool.

Liverpool is a dynamic city. It has experienced a major revival over the past few years and
Merseysiders enjoy a superb quality of life. Liverpool is unusually compact and travel both into
and around the city is fairly stress free.

The county abounds with fine architecture, lively cultural pursuits and outstanding sport.
Tourism has become a major industry and 20 million people visited the city last year, attracted
by both the natural and man-made assets. The University of Liverpool and Liverpool John Moors
University are now the focal points for much of the inner city vitality.

Merseyside’s theatres, museums and collections are now amongst its strongest assets. The city is
alive with numerous artistic enterprises including independent theatre groups, authors, dance
groups, poets, photography sculpture and street art. The Walker Art Gallery contains a collection
that equals any in the provinces and the Tate Gallery opened in 1988 on Liverpool’s waterfront
in the refurbished Albert Dock. The Philharmonic Orchestra is nationally acclaimed and there is
a full range of musical activities of all types.

There are both Anglican and Roman Catholic Cathedrals and facilities for worship of every other
faith in the city. There are excellent schools for both sexes, including a variety of denominational
schools in the private and state sectors.

There is very good housing in pleasant suburbs near the sea and in rural areas at costs less than
the national average. Two international airports, at Liverpool and Manchester are within a short
drive. There are excellent train services and motorway links to all parts of the country. Liverpool
enjoys particularly easy access to the national parks of North Wales, the Peak District and the
Lake District and to varied countryside’s of the Wirral, Lancashire and North Wales.

				
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