JOB DESCRIPTION

Trust Registrar in
Acute and Geriatric Medicine
About the Trust

We’ve modernised and grown with over £200m of investment in our

buildings and services over the last five years
We have reached the end of our five year major building and refurbishment programme. We are
delighted to say that over 94% of our services are now delivered from new or newly refurbished
buildings that are less than six years old.

As well as modernising, we have continued to grow. We treat more patients and employ more staff
than ever before. Over 3,000 staff work at the hospital and well over 2,000 patients use our services
every day. It has been a period of major transformation and we are delighted with the progress we
have achieved.

Our vision and 2018/19 objectives

Our vision is to provide outstanding care for local people.

The board has agreed three key objectives for 2018/19 to deliver this vision. Our objectives are:

 Excellent outcomes for patients

 Excellent experience for patients and staff
 Excellent value for money

North Middlesex University Hospital NHS Trust is a single site, medium-sized hospital, located in
Edmonton, north London. It is the local acute hospital for the boroughs of Enfield and Haringey,
which have a combined population of approximately 590,000, of whom we serve about 300,000. We
provide high quality care across a full range of secondary care services and some specialist tertiary
services, reflecting the needs of the local population.

The hospital has been on its present site for over 100 years and was established as an NHS trust by
statute in December 1990. Most of the trust’s services are provided on the North Middlesex
University Hospital site, although some clinics and services are based in the community and at
partner hospitals. We provide services in collaboration with a range of partners, including local GPs,
acute, mental health and community health service providers.

We are a founder member of University College London Partners, working to improve clinical
outcomes for our patients. We also work closely with a number of universities to provide training for
doctors, nurses and other healthcare professionals as part of both undergraduate and postgraduate
programmes.

We are a major local employer with a headcount of 3,250 staff in March 2017, over 60% of whom
live locally in Enfield and Haringey. In 2016/17 we had a total annual income of £276 million.

Key figures 2016/17

 A&E attendances 167,021

 Outpatient attendances 376,348
 Admissions 83,804
 Operations / procedures 39,913
 Babies born 5,047

Future Development

In September 2017, the NMUH Trust Board decided that we will join the Royal Free London (RFL)
group as its first clinical partner.

This is an exciting development and the culmination of nearly two years of close working between
the two organisations.

As a clinical partner, the North Middlesex Hospital will continue to work alongside the RFL to ensure
there are consistent approaches to designing and delivering care based on evidence and best
practice – nationally and internationally.

Clinicians from both trusts are now coming together in Clinical Practice Groups (CPGs), sharing their
expertise to help transform the standards of care for our patients and local communities. CPGs will
embed continued Quality Improvement in the routine work of every department and every clinician.
Working for one of the RFLG hospitals will mean that you will have access to the best QI methods and
teams to understand and continually improve your own work.

The Royal Free London is one of four trusts across the NHS chosen to develop a group model,
enabling the Trust to share services and resources more effectively across hospitals to improve the
experience of patients and staff.

The Royal Free London group was formally stood up in June 2017, when new leadership teams at
Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital began their work. They have a
common vision: to make the RFL Group the best place to work and be treated in the NHS and to
become the best hospital group in Europe.

NMUH will continue to have its own separate board.

Trust Values and Expected Behaviours

At North Middlesex University Hospital we provide great care to our patients. As colleagues we are
enthusiastic about being the local hospital of choice and this rubs off on our patients. But the way we
do things is also important, and by demonstrating the values and behaviours chosen by staff and
patients , we can make North Mid an even better place to work and receive care.

Our values are:-.

 Caring
 Helpful
 Open and Honest
 Teamwork

These values are extremely important to us and we expect everyone who works at the Trust in any
capacity to share and uphold these values. Further information on the Trust’s values is available on
our website.

Management Structure

The Executive team are

Chief Executive Maria Kane

Medical Director Dr Whicher Whicher
Director of Nursing Deborah Wheeler
Director of Finance David Stacey
Chief Operating Officer Dr Andrew Heeps
Director of Strategic Development Richard Gourlay
Director of Human Resources Mark Vaughan

The operational structure comprises 3 Clinical Divisions

Division 1 Medicine & Urgent Care Services

Division 2 Surgical Services
Division 3 Women’s, Children’s, Cancer and Clinical Support Services

Each Division has a Divisional Clinical Director, Divisional Director of Operations and Divisional Head
of Nursing. This team is supported by Clinical Directors, Matrons, Service Managers, Service Leads
and Clinical Leads.

The Departments
Acute Medicine Department
The Acute Medicine department is made up of 3 co-located acute care areas:
 Acute Medicine Unit / Short Stay Ward (AMU)
 Acute Assessment Unit (AAU)
 Ambulatory Emergency Care (AEC)

The AMU is a 38-bedded purpose-built short stay ward located on the ground floor of the new
hospital. Of the 38 beds, 11 are side rooms including 4 negative pressure isolation rooms for
infection control purposes. Adjacent to this is the AAU which provides 18 beds/trolleys for the rapid
assessment and treatment of medically admitted patients, including direct access for medically
expected patients / GP referrals. During a recent reconfiguration we were able to relocate the AEC to
the same clinical area to create a single clinical area for all acute medicine.
The primary role of the acute medicine department is to provide early assessment, diagnosis,
stabilisation, and treatment of acute medical and care of the elderly patients who are admitted to
the hospital. The development of our ambulatory emergency care services also now allows for the
prevention of avoidable admissions and management of patients along ambulatory care pathways.
All acute medical and care of the elderly patients admitted to the North Middlesex will spend the
initial period of their assessment and admission on the AAU/AMU under the care of the acute
medicine consultant or the acute care of the elderly physician. Patients on the AMU are divided
between the AMU and Acute Elderly Care teams on the basis of age, whilst all those on AAU are
under the AAU consultant. Specialty in-reach is provided by all medical specialties and also acute
oncology via the morning handover meeting.
There are typically 35-50 acute medical patients admitted every 24 hours with an additional 40
patients per day managed through AEC.
The Emergency department continues to provide emergency triage, assessment and treatment,
including resuscitation, for patients presenting to the hospital, but an increasing number of expected
medical emergency admissions come to the AAU directly to avoid unnecessary delays and duplication
as a result of assessment within A&E.
GP referred patients and those referred on from A&E are transferred directly to the AAU or AEC for
review by the medical team. All patients are reviewed by a consultant and a decision made whether
they are likely to be discharged within 12 hours (stay on AAU), remain for up to 48 hours (move to
AMU short stay ward) or if they should be transferred to a speciality bed on the medical or elderly
care wards.

Staffing in Acute Medicine

Consultants:
Dr David Stanton (Consultant in acute medicine and specialty lead)
Dr Helen Ward (Consultant in acute medicine)
Dr Muhammad Esakji (Consultant in acute medicine and critical care)
Dr Roger Rear (0.5 Cardiology and 0.5 acute medicine)
Dr Anukul Garg (0.75 Endocrinology and diabetes, and 0.25 acute medicine)
Dr Salman Sajid (0.75 Nephrology and 0.25 acute medicine)
Dr Chris Valerio (Respiratory and acute medicine)
Dr Zaheer Mangera (Respiratory and acute medicine)
Dr Girish Rayanagoudar (Endocrinology and acute medicine)
Dr Ravi Menon

Acute medicine is supported by the Acute Elderly Care team (7 consultants) and a wider faculty of
specialty physicians who participate in the weekend and evening AMU rota.

Other Staff on the AMU/AAU:

3 x StR (1 x Rheumatology, 2 x Trust Grade; with 1x Acute Medicine from Feb 2019) – as the other
Acute reg will be on COE??
3 x FY2/SHO
5 x FY1
2 x Physicians’ assistants

Care of the Elderly Department

The Department of Medicine for the Elderly at North Middlesex University Hospital NHS Trust is
forward thinking and innovative, delivering high quality care. The Dept of Medicine for the Elderly
aims to enhance the clinical care for older people, by treating acute medical conditions from the
outset, emphasising rehabilitation and ensuring patient autonomy.

Staffing in Care of the Elderly

Consultants:
Dr Maurice Cohen (Divisional Director, Consultant Geriatrician)
Dr Richard Robson (Specialty lead for Geriatric Medicine, Clinical Lead for Dementia)
Dr Polia Naydenova (Consultant Geriatrician)
Dr Nick Rollitt (Consultant Orthogeriatrician)
Dr Mark Horowitz (Consultant Geriatrician)
Dr Sumathi Ragavan (Consultant Orthogeriatrician)
Dr Mike Aziz (Consultant Geriatrician)
Dr Nina Ballah (Consultant Geriatrician)

Junior Medical Staff:

6 Geriatric SpRs
6 Core Medical Trainees
6 GPVTS Trainees
5 FY2 Doctors
1 Trust SHO
5 FY1 Doctors

About the Posts

These posts offer the opportunity to work in a busy, thriving Acute Medical department caring for a
varied patient population with a wide range of acute and chronic medical problems. The jobs are
primarily based in AAU/AMU, where post holders will be expected to support daily consultant-led
ward rounds. The role involves close liaison with other medical specialties to facilitate decision
making and patient flow. Post holders are expected to support junior members of staff, perform and
supervise procedures and take a leadership role in multidisciplinary handover meetings.

Post holders will also have the opportunity to play a role in Ambulatory Care, facilitating acute
investigation and management whilst avoiding unnecessary admission. There is also the chance to
work on the short stay ward looking after patients with a wide range of general medical problems
who require admission for greater than 48 hours.

Post holders will have the opportunity to work closely with the Acute Care of the Elderly team,
reviewing patients with complex frailty needs and either facilitating early discharge via Occupational
and Physiotherapy, or admitting to a specialist COE bed if required. There may be an opportunity to
gain more Elderly Care experience on one of the specialist wards/clinics.

In addition, the roles involve general medical on calls as part of the General Internal Medicine
registrar rota, admitting patients from ED and managing acutely unwell patients on the ward. This
includes weekends and nights, and is approximately 1 in 4 weekends. There are 2 registrars on call at
any one time.

These posts does not have educational approval from the postgraduate dean and will not be
recognised for training, however support is provided for career development and the post holder will
have a Clinical and Educational supervisor to facilitate this. Attendance at local and regional training
days is strongly encouraged and supported.

Departmental Teaching
There is a weekly medical “grand round" on the NMH site. The department holds its own Academic
meeting weekly, which vary between outside speakers, internal teaching and radiology meetings.

We encourage post holders to develop quality improvement projects, audits and research projects
during their rotation. Previous post holders have gone on to present posters at National meetings.
Participation in undergraduate teaching is also encouraged.

Annual Leave
Annual leave must be coordinated with your colleagues, consultant and approved by the educational
lead and rota coordinator. The post allows for 27 days annual leave. Leave requests must be
submitted at least 6 weeks in advance.
They will be permitted 10 days study leave per year and equivalent budget allocation of similar grade
trainees in deanery approved posts.

Trust Standards
Equal, Diversity and Inclusion
The Trust is committed to fair and transparent recruitment and selection procedures and to
providing a workplace where all staff are treated with respect and feel included. It is the aim of the
Trust to ensure that no job applicant or employee receives less favourable treatment because of age,
disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race,
religion or belief, sex, or sexual orientation.

Health & Safety

Employees must be aware of the responsibilities placed on them under the Health & Safety at Work
Act 1974 to maintain a safe environment for both staff, patients and visitors, to observe obligations
under organisational and departmental Health & Safety policies, maintaining awareness of safe
practices and assessment of risk.

Data Protection and Caldicott

To obtain, process and use information (held on computer and manual filing systems) in affair and
lawful way. To hold person identifiable information for specific registered purposes and not to use,
disclose or transfer person identifiable information in any way that is incompatible with the law and
Caldicott requirements. To disclose person identifiable information only to authorised persons or
organisations as instructed. Email must not be used to transmit person identifiable information
between Trust and other premises without advice concerning additional document protection.
Customer Care
The aim of the hospital is to provide patients and clients with the best possible care and services. In
order to meet this aim, all our staff are required at all times to put the patient and client first and do
their utmost to meet their requests and needs courteously and efficiently. In order that staff
understand the principles of customer care and the effects on their particular post and service, full
training will be given.

Infection Control
All healthcare workers have an overriding duty of care to patients and are expected to comply fully
with best practice standards. You have a responsibility to comply with Trust policies for personal and
patient safety and for prevention of healthcare associated infection (HCAI); this includes a
requirement for rigorous and consistent compliance with Trust policies for hand hygiene, use of
personal protective equipment and safe disposal of sharps. Knowledge, skills and behaviour in the
workplace should reflect this; at annual appraisal you will be asked about application of practice
measures known to be effective in reducing HCAI.

Smoking Policy
The Trust provides a smoke free work environment.

Confidentiality
Under no circumstances, either during or after the end of your employment (however it is
terminated), may you divulge any unauthorised person confidential information relating to the Trust.
This includes but is not limited to, information covering patients, individual staff records, industrial
relations, financial affairs, contract terms and prices or business forecasts.

Clinical Governance
Staff are expected to provide patients with timely and effective care. Treatment and direct / indirect
support must be based on best practice. Everyone is responsible for this and his/her job in the Trust
is important in achieving this.

Rehabilitation of Offenders Act

This post is exempt from the Rehabilitation of Offenders Act 1974. Should you be offered the post it
will be subject to a criminal check from the Criminal Records Bureau before the appointment is
confirmed. This will include details of cautions, reprimands, final warnings, as well as convictions.

Safeguarding Vulnerable People

It is a basic human right of every child and adult to be protected from harm and NHS Trusts have a
fundamental part to play in this. We expect all our staff to recognise signs of vulnerability and to
report and act on any concerns in line with policy and guidance contained in 'Working Together -
Every Child Matters' and 'No Secrets - guidance on developing multi-agency policies and procedures
to protect vulnerable adults from abuse' on which our Trust Polices are based.

Specification Essential
Qualifications
Knowledge and Skills
Maintaining Clinical Competence
Teaching and Research
Communication, relationships and
work colleagues
Person Specification
Desirable
- MBBS or equivalent
- Eligible for full GMC registration and licence to practice
- Full MRCP or equivalent
- Competent in basic procedures, physical examination,
history taking, infection control
- Able to prioritise clinical need
- Understands current clinical issues in general medicine
- Aware of own limitations, consults senior colleagues
appropriately and knows when to ask for help
- Understands the principles of patient confidentiality and
data protection
- Understands the need for and appreciates the role of audit
in clinical practice
- Understands the principles of clinical governance – ensures
patients are not put at risk
- Keeps professional knowledge and skills up to date
- Potential to benefit from the training available
- Able to contribute to teaching and learning of others in the
clinical setting
- Understanding of the basic principles of research
- Able to communicate clearly in written and spoken English
e.g. able to write legible records
- Able to discuss treatment options with patients in a way
they can understand
- Able to establish good working relations with patients and
carers and multi-disciplinary colleagues
- Working towards a post graduate
qualification
- Knowledge of UK health systems and
practices including the relationship between
primary and secondary care and inter
professional relationships
- Knowledge of current issues in the NHS
- Computer literate
- Understands the importance and impact of
information systems in health care
- Has participated in clinical audit
- Experience in oncology or haematology
- Demonstrates a critical and enquiring
approach to knowledge acquisition
- Understands the purpose and process of
basic professional training
- Understands the responsibilities of being an
employee of the NHS