Consultant in Respiratory and General Medicine | Homerton Healthcare NHS Foundation Trust

Homerton Healthcare NHS Foundation Trust is appointing a Consultant in Respiratory and General Medicine. This is a replacement post to fill an existing vacancy in order to meet the demand of the increasing inpatient and outpatient referrals, particularly in sleep studies, the growing demand for 2-week wait, and inpatient care, that includes the provision of a respiratory support unit and CPAP.

The post is focused on the delivery of high-quality patient service in areas of Respiratory Medicine and General Medicine. In addition, the post also involves inpatient respiratory care, including NIV and is shared with three other respiratory physicians.

The post is offered on a full-time basis of 10 programmed activities with GIM on-call commitments. There will be 8.0 PAs of direct clinical care and 2.0 PA's allocated for supporting professional activities. As a senior employee of the Trust you will work in close co-operation with and support other clinical, medical, professional and managerial colleagues in providing high quality, safe health care to patients.

Integral to these responsibilities is the following:

· The provision of a first-class service

· Effective leadership to all staff engaged in the specialty

· Active involvement in undergraduate and post graduate teaching and training

· Undertaking all work in accordance with trust policies and procedures including the Code of Behaviour

· Conducting clinical practice in accordance with contractual requirements and within the parameters of Homerton's business plans

· Contribute to the management of the clinical service and service development

Clinical Responsibilities

The successful candidate will be expected to provide specialist expertise in Respiratory Medicine. In addition, the post holder will take part in acute medical on-take as part of the on-call medical rota.

The post primarily focuses on inpatient respiratory care on Lamb ward and other wards, including the provision of NIV, and inpatient respiratory consultations. The post-holder will be expected to deliver outpatient clinics, seeing those patients referred mainly for the sleep studies and general thoracic. Other clinics could include cough, lung cancer and asthma. These clinics are expected to complement the existing respiratory services, which include asthma, COPD, sleep and ventilation, and lung cancer. The post-holder will be expected to support colleagues in the department with ongoing management of patients on the cancer pathway.

Homerton Healthcare NHS Foundation Trust (HH) is an acute hospital located in the east London Borough of Hackney. The current Chairman is Sir John Gieve, and the Chief Executive is Ms Basirat Sadiq.

Homerton became one of the first ten NHS foundation trusts in the country in April 2004. This allows the Trust to secure certain freedoms to facilitate innovation in the way services are developed and provided. As well as our Trust Board, we also have a Council of Governors comprised of governors representing the local community.

In 2011 the Trust integrated with City & Hackney Community Health Services thereby providing it with an opportunity to develop new service models and pathways that cross traditional organisational boundaries.

Employing over 3000 people, the hospital has approximately 500 beds and manages a 50-bed nursing home, Mary Seacole Nursing Home, in Shoreditch, East London. In 2022, the Trust saw over 300,000 people in outpatient clinics, and over 126,000 people were treated in the accident and emergency department. The Trust also had contact with over 280,00 patients and clients within the community, often in their own homes.

The Trust has a turnover in the region of £220 million, performs consistently well against national performance targets, and has an ambitious objective to increase its income to £300 million over the next few years.

1. Respiratory Medicine

The Respiratory Department sees approximately over 3000 new patients a year and we aim to offer an appointment within four weeks of referral.

The lung function laboratory is led by Rama Gorrela, Chief Physiologist who is supported by two full-time technicians. In addition to standard lung function, there is a full Allergy service and a growing sleep service. The department has over 3000 patients on CPAP and receives referrals from other catchment areas as well. Having had one of the highest incidences of tuberculosis in the UK, the current rate is 27 per 100,000, below the London average. The prevalence of sarcoidosis is ~25 per 100,000 due to the large Afro-Caribbean, West African and white population groups.

Bronchoscopies have a dedicated endoscopy facility. Endoscopic and endobronchial ultrasound for mediastinal lymph node sampling is used with referrals received from across NE London. The Lung Cancer service is supported by a Lung CNS, an Acute Oncology Nurse and a team of Palliative Care Nurses.

Inpatient respiratory care is delivered via Lamb Ward which is a 28-bed unit dedicated to the care of respiratory and general medicine patients. TThe post holder is expected to work with three other colleagues in providing the service and be involved in the management of respiratory cases on other wards.

There is a weekly departmental meeting which includes case presentations, journal club and mortality review.

The department for the medical management of tuberculosis for NE London is located at the Homerton University Hospital, the allergy service is accredited by the Royal College of Physicians and the specialty also delivers active and highly regarded TB community services. There is an integrated respiratory service (ACERS) working across primary and secondary care, looking after patients with COPD, asthma, bronchiectasis and interstitial lung disease and also cardiac failure. There are also specialist nurses for Allergy, Asthma and Lung Cancer. There are ongoing post Covid-19 follow-up, interstital lung disease, TB and cough clinics and the post holder is expected to be involved in providing this service.

2. General Medicine

The Hospital has 237 beds in total, including an acute care unit, dedicated stroke unit, integrated acute and rehabilitation elderly care unit and the Regional Neurological Rehabilitation Unit (RNRU). There is a 12 bedded ITU/HDU, with a critical care outreach team.

The Accident and Emergency Department was newly built in 2000 and has over 110,000 attendances per year. All acute admissions (excluding paediatrics and gynaecology) are admitted to a 34 bedded Acute Care Unit (ACU) for prompt investigation and treatment with an expected stay of 24-48 hours before either discharge or transfer to specialty-based wards.

Respiratory problems account for 20% of all acute admissions and non-invasive ventilation can take place on Lamb Ward, ACU and ITU.

Acute Medicine is provided by General Physicians with interests in Gastroenterology, Endocrinology, Elderly Care, Respiratory Medicine and Rheumatology. On the "take" day the Consultant of the day provides leadership on the Acute Care Unit from 8am-8pm and is responsible for all admission during a 24-hour period. At weekends the Consultant is responsible for all admission during the period and for being physically present on the ACU up to 12 hours each day.

Clinical support services are characterised by excellent liaison with clinicians. A full range of biochemical, haematological and microbiological investigations are provided on site and a consultant microbiologist is always available for advice, seeing patients if necessary. Histopathology is sent to the Royal London hospital but there are clinicopathological meetings at which cases can be discussed. The radiology department provides the usual range of investigations including spiral CT and MRI.

The Same Day Emergency Care unit (SDEC) provides delivers emergency hospital care without admission to an acute inpatient bed. Ongoing treatment or investigation that would otherwise have required admission is delivered either by scheduling return visits to the ambulatory service or by management on the same day. This is facilitated by early senior decision-making and utilising robust evidence-based management strategies for common ambulatory care conditions ensuring safe, consistent, and efficient practice without acute admission. There is also the opportunity to discharge a subset of patients from inpatient beds into the ambulatory care service once they are well enough to do so, but before they would otherwise have been discharged. The post holder is expected have a scheduled session in managing respiratory cases, particular pleural procedures.

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