Job Description

Specialty Doctor or Senior Clinical Fellow in

PSYCHIATRY

Full time – 40 hours /10 sessions per week

Based within the Mental Health Service, in different areas of

the Health Board, across Carmarthen, Aberystwyth and
Pembrokeshire

Job Reference: 100-MED-MHLD-

SPECIALITY CONTACT FOR ENQUIRIES ABOUT THIS POST

Dr Warren Lloyd
Tel  01267 674 130

Links to Additional Information

Hywel Dda Health Board Homepage http://www.hywelddahb.wales.nhs.uk/

Don't forget you can follow us on our social media channels via your own devices and
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Medical Recruitment, Hafan Derwen, St David’s Park, Jobswell Road, Carmarthen SA31 3BB

Tel  01267 239737 / Fax  01267 239860 / Email  Medical.Recruitment.HDD@Wales.nhs.uk

INTRODUCTION

We are looking to recruit to the vacant substantive 10 session posts

based across the Health Board Mental Health & Learning Disabilities
Directorate. You will join colleagues in a very dynamic and forward
looking Mental Health & Learning Disabilities Service and there will
be opportunities to develop special areas of interest within the MH &
LD Directorate.

The salary offered is on Specialty Doctor 10 sessions (plus additional

sessions) or Senior Clinical Fellow (plus Banding) pay scales
depending on experience. These posts are part of the first on-call
rota and attract additional sessions or appropriate banding for full
shift pattern rota of 1 in 8 or 1:6 cover.

Applicants must possess full registration with the GMC and should have completed at
least four years full time postgraduate training at least two of which will be in a specialty
training programme in a relevant specialty or as a FTSTA in a relevant specialty, or the
candidate should have equivalent experience and competencies.

Hywel Dda University Health Board provides services to the 3 counties of Ceredigion,
Pembrokeshire and Carmarthenshire which together cover a quarter of Wale. Hywel Dda
provides primary, secondary, community, mental health and learning disability services to
a population of around 389,000 people. It is predominantly rural in nature with areas of
outstanding beauty attracting National Park status. Llanelli on the south coast is the only
major industrial town in the area. Aberystwyth, Lampeter and Carmarthen are University
towns.

The Hospitals within the Health Board boasts beautiful coastal county with 60 miles of
beautiful, clean, coast & beaches. Low crime rate with friendly people and colleagues.
Any applicant who is unable, for personal reasons, to work full-time will be considered for
the post. If such a person is appointed, modification of the job content will be discussed
on a personal basis in consultation with colleagues/management.

Office accommodation, secretarial support and full IT facilities including access to intranet
and internet will be provided.

NHS Wales Core Principles

The NHS is about people, working with people, to care for people. NHS Wales values all
its staff – from Wales, the UK, EU and non-EU foreign nationals. As part of NHS Wales’
ongoing commitment to strengthen the values and behaviours of Health Boards and
Trusts, the following Core Principles have been developed which further help staff
respond better to the demands for its services:-

 We put our patients and users of our services first

 We seek to improve our care
 We focus on wellbeing and prevention
 We reflect on our experiences and learn
 We work in partnership and as a team
 We value all who work for the NHS

Specialty Doctor/Senior Clinical Fellow Reference: 100-MED-MHLD-111 Date: 18/08/2021

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These Core Principles describe how everyone within NHS Wales is expected to behave
and help us all to achieve the highest quality in everything we do.

Mental Health & Learning Disabilities Directorate

HDUHB is currently actively engaged in an innovative Mental Health Transformation

programme and a proactive member of the International Mental Health Collaborating
Network. In 2015 HDUHB established a new International Twinning Collaboration
Convention with Trieste Mental Health Service Department in Italy.

The International Twinning Collaboration has enabled the development of formal Action
Learning Sets, staff exchange programmes (that include the wider stakeholders, Service
Users and Carers), mentoring and support to each Service, including joint training,
seminars and conferences.

The Health Board provides Mental Health and Learning Disabilities services to people
across West Wales. In recent years Consultant Psychiatrists have re-organised along
“New ways of working” structures. Mental health services include conventional CMHT
and inpatient units, Assertive Outreach Teams, Crisis Resolution Teams and developing
Liaison Services. Within Wales the Health Board has a high profile in developing
psychological approaches with a specialist Personality Disorder Service, Early Onset
Psychosis and an Eating Disorder Community Service. Additionally there are Health
Board wide Substance Misuse and Community Forensic Services. Admission units are
based within District General Hospitals and specialist services in Hafan Derwen,
Carmarthen. Clinical services on the Hafan Derwen site include an Intensive Care Unit,
and a Low Secure Unit (Cwm Seren). The in-patient units for LD are situated alongside
Cwm Seren.

The Hafan Derwen site also provides office accommodation for Mental Health & Learning
Disability management across the Health Board area, a specialist Medical Education &
library facility.

The department is the only Health Board in Wales who run a 5 year CESR programme,
approved by the Welsh Deanery.

Details for Visiting

Those wishing to discuss the post informally in the first instance, or visit the department
are encouraged to contact:

Dr Warren Lloyd, Clinical Director & Associate Medical Director for Mental Health &
Learning Disabilities Service
Hywel Dda University Health Board
Canolfan Gwili, Glangwili Hospital, Carmarthen SA31 2AF
Tel: 01267 674130
Email: warren.lloyd@wales.nhs.uk

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 JOB DESCRIPTION

The Job Itself

Title: Specialty Doctor or Senior Clinical Fellow –

Psychiatry

Professionally responsible to: The Medical Director

Managerially accountable to: Consultant within the Team/ Associate Medical

Director for Mental Health & Learning Disabilities,
with ultimate accountability to the Chief Executive

Responsibility for Staff as Part of this Post: Junior medical staff (where applicable)

This appointment is Health Board wide, with your principal place of employment being
confirmed once appointed. Locations for posts are within Carmarthenshire,
Pembrokeshire and Ceredigion. This will be subject to change as the Health Board’s
clinical requirements are amended to meet the needs of the service/patients.

Other hospitals at which duties are performed: In view of the fact that the organisation is
currently undertaking a review of its services and the locations at which they are
undertaken, it is important to be aware that work patterns may change and the place(s)
of duties modified.

The Clinical Strategy of the Health Board is under constant development and the job
holder may be required to undertake different duties agreed at the time of appointment.

THE JOB ITSELF

Purpose of the Post and General Responsibilities

Hywel Dda has a population of in crica 389,686. The areas age and sex profile is similar to
that of Wales as a whole, but there are notable differences with relatively high numbers
of older people in rural Pembrokeshire and Ceredigion. The post holder will be joining a
team of consultant colleagues across the 3 counties covered by the Health Board.

The Speciality Doctor will be working closely with Multi-disciplinary colleagues who covers
the relevant clinical Service. We will try to accommodate your sub-specialty interests or
various rotations around all areas of Psychiatry to suit your needs.

Office accommodation is provided at all the sites with administrative support.

The design of the post is consistent with the New Ways of working documentation.

All Adult Mental Health Services across the Health Board use the electronic Care Pathway
system.

All clinical staff are accountable and responsible for their own clinical competence and
should limit their actions to those for which they are deemed competent. Clinical staff

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are also required to comply with the requirements of their professional organisation
regarding supervision.

As a senior employee of the Health Board the post holder will work in close co-operation
with, and support other clinical, medical professional and managerial colleagues in
providing high quality healthcare to the Health Board’s patients.

In-Patients/CRHT
Morlais ward is 10 bedded unit set in the grounds of Glangwili Hospital.
The CRHT base is located within Morlais Unit and members of the CRHT regularly
work on the ward and ward staff have been seconded to the CRHT fostering a close
working relationship. The consultant working with the general psychiatric admission
ward also works with the Crisis Resolution and Home Treatment (CRHT) team
which facilitates a coherent approach to service user needs when they are in
relapse/crisis and require intensive support or admission.The introduction of Facilitated
Early Discharge by the CRHT team has been successful in contributing to reducing the
length of admissions across the Health Board.

The population of Carmarthenshire has a large elderly population. The service is

moving towards an age blind service and admission to the inpatient units are
based on the needs of the patient. A fit older adult with functional illness would be
admitted to the acute ward and a younger person with a dementing disorder or
frail patient may be admitted to Bryngofal ward, Prince Philip Hospital. Patients
over the age of 18 are accepted. And only In exceptional circumstances younger
patients accepted. Under 18 age patients are admitted to the identified age
appropriate beds in Carmarthen, one such bed co-located on Morlais ward.
Crisis Resolution and Home Treatment team provides a service consistent with
models recommended in the National Service Framework. The team 'gate keep'
admissions to the inpatient unit and the consultant working with the CRHT also
covers the general psychiatric admission ward which facilitates a coherent approach
to service user needs when they are in relapse/crisis and require intensive support
or admission.

MHA referrals during daytime are the responsibility of the community teams and
CRHT attend where possible. The Speciality doctors from the community teams may
have sessional time to support the Acute care service during working hours and to
broaden their experience of liaison and acute care.

Liaison Service
The service is provided from the Morlais unit. The service will be further developed
with the aim of reducing acute medical and surgical bed occupancy and acute
attendances. The IP/CRHT service has a close relationship with the other specialist
teams.

Outpatient and Community Clinics

The post holder will not hold an outpatient caseload however outpatient clinics are
held In the 4 CMHT's. The Psychotherapy Department for Hywel Dda Health Board
has been successful in rolling out the IAPT programme and providing brief
interventions to the GP practices. This has made a significant reduction in the number
of GP referrals to secondary care and has facilitated progress in the New Ways of
working. The outpatient clinics are increasingly CTP reviews/ consultation. It Is
anticipated that the further introduction of IAPT services will potentially reduce the
total number of GP referrals coming to the team as this component of a 'stepped care'
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approach is implemented. The introduction of the Mental Health Measure has provided
for a Primary Care Mental Health service to be established. In Carmarthenshire there
is a system of Link working with GP Surgeries. The link workers are all CMHT
members and provide weekly sessions in GP surgeries.

Therapeutic Day Services

The TDS service provide brief therapeutic interventions on individual and group
sessions. There are satellite services in areas across the Health Board and further
development is expected under the current development plans.

Psychological Therapies
The psychology service provides high intensity psychological interventions CBT,
IPT, CAT and Schema Therapy. They provide assessments to the inpatient
service and CRHT as required. As already mentioned IAPT are well established
and low intensity psychological interventions are provided to GP practices in the
area.

Psychiatry of Old Age (POA)

POA service accepts referrals of those of 65 years or older. In general new referrals
for psychiatric input over the age of 65 years would go to the POA. The General
Adult service currently continue to look after those of its patients who reach this age
until such time as their needs i.e. physical frailty, multi system disorder make it
appropriate to negotiate transfer to the POA service. Patients with dementia under the
age of 65 will also be the responsibility of the POA service. The memory clinic is run
in conjunction with a local physician.

Learning Disability
The Carmarthenshire LO team accesses General Adult services and Inpatient beds
where a patients’ needs are best met by the General Adult service.
S-CAMHS
S-CAMH Services are located in the MHLD directorate and provide a service to
children up to 18 years.

Integral to the responsibilities of the post are the following requirements:-

To ensure the provision and delivery of a first class clinical service
To provide effective leadership to all staff engaged in the specialty
To sustain and develop teaching and research wherever appropriate
To undertake all work in accordance with the Health Board’s procedures and
operating policies
To conduct clinical practice in accordance with contractual requirements and within
the parameters of the Health Board’s service plans
To maintain the confidence of business plans and development strategies formulated
for the specialty or the Health Board
Participating in CPD including Audit
You are expected to maintain your professional development for Revalidation
A Teaching and Training Role for medical undergraduates and postgraduates
Educational Supervisor role to Junior and Middle Grade Medical Staff
To undertake regular multidisciplinary clinical audit and provide evidence based
medicine

Specific Responsibilities of the Post

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The post holder will be based one of our sites to be discussed and agreed with the
successful applicant. The post holder will have the opportunities to actively contribute to
the service developments across the MH&LD Directorate

The post holder will be responsible for the assessment and management of adult
community patients or inpatients and is expected to remain closely involved with the care
of those admitted to the associated wards. All these clinical activities will be supervised
by the Consultant.

The Service Manager & CMHS Team Manager will be responsible for ensuring that Health
Board policies and procedures for safe functioning of the service are followed, including
referral processes, assessment and adherence to the key performance indicators for the
service and the Mental Health measure. The post holder will be expected to work in close
co-operation with the locality Consultant, the n Service Manager and CMHS Team
Manager.

Clinical

 To provide clinical leadership and full participation in the multidisciplinary team

working of the CMHS / Inpatient Service.

 To contribute senior clinical input to the modernisation, development and ongoing

operational management of CMHS / Inpatient service provision

 To conduct clinical practice in accordance with contractual requirements within the

parameters of the Division’s and Health Board’s agreed objectives.

 To work within the framework of the Mental Health (Wales) Measure 2010

Teaching/Training (as agreed with AMD/Head of Service/MD)

 To provide conditions for improved training opportunities in line with national and
local recommendations arising out of MMC and related requirements

 To participate in the undergraduate teaching programme

 To assist and participate with the development of postgraduate training for F1s,
F2s, CTs, STs, SpRs, Speciality Doctors and other staff as appropriate

Management

You will be required to co-operate with your team in the efficient running of services and
are expected to share, in the medical contribution to management, training obligations
and modernisation of the service.

You will be required to work in close cooperation and liaison with colleagues both within
and outside of the organisation, as appropriate, in multi professional and multidisciplinary
team environments.

There is a requirement to work within the financial and other constraints decided upon by
the health board. Additional expenses of any kind must not be committed without the
approval of the appropriate manager/budget holder.
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Subject to the terms and conditions of service, the post-holder will be expected to
observe policies and procedures of the organisation, drawn up in consultation with the
professions, where they involve both clinical and non clinical matters.

The post-holder will be expected to comply with local and national employment and
Human Resources policies and procedures in the management of employees of the
organisation.

The post-holder will be required to ensure that arrangements are in place for the
organisation of medical staff and that they are allocated duties in accordance with the
work of the specialty and within the level of their competence.

Administrative

Maintaining a high standard of note-keeping. Communication with other staff.

Presentations at weekly and clinical case conferences, carrying out audits and
involvement in teaching junior staff and other professionals.

Audit (as agreed with Clinical Team Lead/Clinical Director/MD)

To promote evidence-based clinical practice

To undertake regular audit

Research Opportunities in Hywel Dda

The Health Board has University status with strong links to the Swansea & Cardiff
Universities to promote research & development and multi-professional teaching. We
recently appointed our first Chair in Respiratory Medicine into the Health Board, with
further appointments for the future, and we are the first Health Board in Wales to
appoint Bevan Commission Fellows. This initiative programme aims to engage and
capture the enthusiasm and commitment of our up and coming clinicians in Wales in
addressing Prudent Health Care.

HDUHB is committed to enhance local research and development and the successful
applicant would be strongly encouraged to develop a local research portfolio as part of
their core NHS responsibilities (Handbook to the NHS Constitution, January 2009) as it
improves patient outcomes (http://www.crncc.nihr.ac.uk/ppi/why_is_research_important)
and is a Welsh Government priority
(https://www.wales.nhs.uk/sites3/page.cfm?orgid=580&pid=59041).

The annual operating R&D Budget has increased by over 750% since 2008 and research
operates across all 4 hospital sites with increasing opportunities in Primary Care.
- Basic sciences: we have memoranda of understanding with Swansea and
Aberystwyth Universities, jointly funding post-doctoral researchers and co-
supervising MSc, MPhil and PhD students in e.g. sport science, rehabilitation,
medical engineering, psychology & qualitative research, management change,
biomarker discovery and most recently metabolomics

- Commercial Trials: with experienced research nurses dealing solely with

commercial companies working on your behalf and pharmacists dedicated only for

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 clinical trials, our clinicians are working increasingly with major companies. This is
not only in our established areas of strength such as diabetes and respiratory
medicine, but new studies have just opened with Consultants as Principal
Investigators in cardiology, lipid medicine, urology, rheumatology and
dermatology

- Portfolio trials: there are specialist researchers from the Health & Care Research
Wales and NIHR workforce recruiting patients into National and International trials
across all 4 hospital sites and increasingly in Primary Care. New funding and a
specialist R&D Manager will help any clinician act as a local Principle Investigator
or develop their own pathway to portfolio work.

We have an 8-room Clinical Research Facility in PPH, with state of the art facilities that
was opened in 2012 and new initiatives involve BioBanking, EU Lead for telemonitoring at
scale and new Clinical Research Fellowships. For more details, please contact the Director
of R&D and visit

Revalidation & Appraisal

□ The post holder will be expected to participate in annual appraisal and to maintain a
portfolio of supporting information to bring to appraisal as a basis for discussion. The
All Wales format for appraisal is the online Medical Appraisal and Revalidation System
(MARS),
□ You will be expected to maintain GMC Revalidation as and then required, and will be
supported through this process by the appointed Revalidation Manager. The
Responsible Officer for Hywel Dda Health Board is Medical Director.

Quality and Standards

To be familiar with and actively promote adherence to the regulatory framework
including NICE and National Service Framework Guidance and to actively promote
professional standards “The Duties of a Doctor”
To undertake all work in accordance with the Health Board’s procedures and
operating policies

Learning Organisation

To be participate with your Consultant in complaints and any medico legal claims in
your area of practice, management of serious incidents and responsibility for sharing
any organisational learning from these

Patient Experience

To monitor and respond to measures of patient experience

Patient Safety

To work actively to reduce unintended harm to patients

To contribute actively to the content areas of the 1000 Lives Campaign and any other
subsequent patient safety campaign
To adhere to the Health Board’s Clinical Incident Policy

The post holder has a general duty of care for their own health, safety and wellbeing and
that of work colleagues, visitors and patients within the hospital. This statutory duty is in

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addition to any specific risk management or clinical governance accountabilities
associated with the post.

Finally, the post holder is expected to:

Observe the rules, policies, procedures and standards of Hywel Dda Health Board
together with all relevant statutory and professional obligations
Observe and maintain strict confidentiality of personal information relating to patients
and staff
Be responsible, with management support, for their own personal development and
to actively contribute to the development of colleagues

Teaching, Audit and Research

Medical students are posted to the hospital from Cardiff and elsewhere and the post-
holder is responsible for a proportion of the instruction and for taking part in the
Postgraduate Tutorial Programme for Membership Training. Active participation in audit
and research is expected.

Study & Training

Adequate study leave would be granted for courses with expenses which would be of
benefit to the doctor and relevant to the speciality.

There is excellent medical library facilities at all our hospital sites with active postgraduate
medical programme. A GP Vocational Training Scheme exists within the hospital. Those
interested who are not on the regular scheme may attend meetings. There is an obligation
to attend a fixed teaching session which is equal to one session per week.

Main Conditions of Service

The post is covered by the Terms and Conditions of Service for Hospital Medical and Dental
Staff.

The successful candidate is required to be registered with the General Medical Council
throughout the duration of their employment and to carry out their duties in line with the
GMC booklet “Guide to Good Medical practice”. This is a whole-time appointment.

The post is full time 40 hours (10 sessions) per week Plus additional sessions subject to
annual job plan review.

Other Facilities

The hospital has modern residential accommodation. This will be available short-term
only to successful candidate depending on availability.

Continued Education

The Directorate has a good track record in supporting Clinical Fellows / Speciality Doctors
to further their careers with numerous opportunities to achieve Section 12 & Approved
Clinician status and successful CESR applications.

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The Directorate has excellent post Post Graduate activities to assist Junior Medical Staff
to obtain MRCPsych and subsequent Specialist training posts. This includes Clinical
Supervision with agreed learning objectives to support professional development. Study
Leave is available for attending approved courses.

There is an excellent up-to-date Medical Library, with a fully qualified Medical Librarian in
attendance. A series of Post-Graduate lectures is held for Medical Staff and the
incumbent is expected to attend these as well as other Post-Graduate activities. Other
occasional lectures arranged by the B.M.A. and/or Local Medical Society are also held in
the various centres

Location
The post holder will generally be expected to undertake their programmed activities at
the principal place of work or other locations agreed in the Job Plan. Exceptions will
include travelling between work sites and attending official meetings away from the
workplace. A planned and cost effective approach is expected, and is included in the
DCC sessional allocation. The post holder may be required to work at any site within the
Health Board, including new sites.

Review

This job description will be regularly reviewed. It is intended as a guide to the general
scope of duties and is not intended to be definitive or restrictive. It is expected that
some of the duties will change over time and this description will be subject to review in
consultation with the post holder

Cover / Leave Arrangements

The post holder will work closely with colleagues to discuss and agree the required cross-
covering for annual and study leave with a further ability to draw upon support from Consultant
colleagues from the other areas if needed.

On Call Arrangements

1:6 or 1:8 on-call rota with prospective cover

SAS Doctors Development and Mentoring Programme

The Health Board runs a successful Development and Mentoring Programme within the
Health Board; this programme is specifically designed to meet the needs of SAS Doctors
and offers a current and future focus by:
 Developing you as a senior leader, to enable you to effectively contribute to
Hywel Dda and its future direction.
 Enhancing your capability as a senior leader and to support you to deliver
organisational priorities
 Build capacity for the future, by aligning current priorities with planning for
delivering future service.
 delivering development aimed at consultants, enabling you to translate the NHS
Medical Leadership Competency Framework (MCLF) behaviours into practice

The programme has been designed to support SAS Doctors to achieve the competencies
required from the Medical Leadership Competency Framework (MCLF). This framework

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has been included within the NHS Leadership Framework (LF), and as such is consistent
in its language and approach.

The Service

Electro-Convulsive Therapy

The ECT service is a Consultant led service delivered in Carmarthen and is fully accredited
with the Royal College of Psychiatrists ECTAS standards. The ECT Team will support the
post holder in prescribing ECT via our long standing Integrated Care Pathway.

Neuropsychological Assessment:

The psychologist is an active member of the MDT and provides comprehensive

neuropsychological assessments as required by the team. CT and, MRI scanners are
available in Bronglais, WWGH and Prince Philip Hospital. SPECT scans can be requested
from Cardiff. EEG is available in West Wales General Hospital, Carmarthen.

Occupational Therapy

There is an active OT department providing assessment and assisting in the development

of person centred care plans.

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Person Specification – Specialty Doctor/Senior Clinical Fellow - Adult Psychiatry
Requirements Essential Desirable Measurable by
- Full GMC Registration and Licence to Practice
- Valid Certified Advanced Life Support Skills MRCPSYCH
- ATLS Section 12 Approved
4 years full-time postgraduate training (or part-time
Qualifications equivalent), at least 2 of which in a specialty training Application
programme in a relevant specialty
Or as fixed term specialty trainee in a relelvant specialty
OR
MBBS or recognised equivalent
- Commitment to team approach and multi-disciplinary - Experience of NHS
working - Wider experience, research
- Broad based experience in Psychiatry and training in providing
- Knowledge of UK hospital systems (or equivalent) sub specialty service
- Knowledge and participation in CPD - Evidence of above average
- Competence in Acute General Medicine performance
- Able to apply knowledge - Additional clinical
- Safe and effective written and verbal communication qualification(s)
Clinical skills - Application/
Experience - Knowledge and experience of communicating bad news Interview
- Meet the requirement of the GMC’s “Good Medical
Practice”
- Ability to take independent clinical decisions when
necessary and to seek advice from senior doctors as
appropriate
- Ability to manage own time and work load
- Experience of the assessment of emergencies
- Liaison with other agencies
- Evidence of participation in clinical audit and - Knowledge of risk
understanding role of audit in improving medical management
Clinical Application/
practice - Knowledge of annual job
Governance Interview
- Comprehension of core philosophy and building blocks planning/appraisal review
of Clinical Governance process
- Experience and knowledge of critical appraisal of - Evidence of initiating,
evidence so as to improve clinical outcomes progressing and concluding
Application/
Research research projects with
Interview
publication
- Research degree
- Evidence of organising programmes and teaching - Organisation of further
medical students and junior doctors teaching programmes in
Application/
Teaching - Willingness to teach all grades of professional medical education
Interview
multidisciplinary staff - “Training the Trainers”
experience
- Knowledge of the management and structure of the - Evidence of management
Application/
Management NHS training
Interview
- Willingness to participate in clinical management
- Ability to cope with stressful situations and undertake - Evidence of leadership
responsibility attributes
- Excellent interpersonal skills and team-working skills - Motivational skills
Personal
- Ability to work as part of a multidisciplinary and multi- Interview
Qualities
agency team and alone
- Ability to work flexibly in response to the changing
needs of Geriatric Service
- All applicants to have demonstrable skills in written and
spoken English adequate to enable effective
communication about medical topics with patients and
colleagues
- Satisfactory Immigration Status
Other Application/
- Satisfactory Health Clearance
Requirements Interview
- Satisfactory Declaration, Enhanced CRB Disclosure
Check
- Ability to fulfil all duties of post, including on-call
commitments and travel to meet requirements of the
post

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