General Adult (Cornwall Partnership Trust)

Cornwall Partnership NHS Foundation Trust:

The Specialist Registrar will provide supervised medical input to a comprehensive mental health service for patients registered with Marazion Surgery in Marazion within the North Penwith Community Mental Health Team.  The whole zone comprises five general practices. In addition to Marazion Surgery, it includes Cape Cornwall (St. Just), Stennack (St. Ives), Bodriggy (Hayle) and Phoenix Surgery  (Camborne). The trainee will cover a surgery with five general practitioners.

The Consultant Psychiatrist for the South Penwith area is Dr S. Kustermann.  He will provide personal supervision regularly for one hour per week as well as additional clinical supervision when appropriate.  The trainee will be given a wide range of clinical experience in General Adult Psychiatry and work with sub-specialist teams, eg Assertive Outreach Team and Home Treatment Team.  The other consultants for adult psychiatry in the west of Cornwall are: 

Dr Colin Hunter (South Penwith and Isles of Scilly)

Dr Darren Mackintosh (South Kerrier)

There are consultants working in Child and Adolescent Psychiatry, Old Age Psychiatry, Learning Disability and Drug Misuse covering west Cornwall.  In addition, there are consultants working in Liaison Psychiatry, Recovery and in the Early Intervention in Psychosis Teams.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Community Meeting Team Supervision

P.M

Out-patient clinic

or

Admin

In-patients review

Research/Special Interest

 The job involves working closely with the existing senior medical team (consisting of 1 WTE consultant plus 0.1 WTE Associate Specialist) to deliver a high quality Rehabilitation service to 18 inpatients in Fettle House, Bodmin Hospital

which also involves an Outreach Team with which you will be encouraged to engage. The trainer has also recently established a new service providing fast-stream rehabilitation (at Cove Ward, Longreach House, Camborne & Redruth Community Hospital), which gives opportunities for experience in service development, as well as other leadership skills. There is a full time Junior Doctor employed for this team.

You will be encouraged to participate in Multidisciplinary Assessments, providing the medical focus and expertise within this for people referred to our service. All assessments are then discussed at our Referrals Meeting, where senior team members will be
available for discussion and support with decision making.

Secretarial support will be available and there will be office space, a mobile phone and a laptop supplied by the Trust.

This post will enable interested trainees to gain appropriate skills to receive an endorsement in Rehabilitation on their Psychiatry CCT, as well as enabling the trainee to experience a rehabilitation setting which is socially and occupationally focused with a commitment to supporting and promoting individual autonomy.

There will be opportunities to teach medical students, nursing students and work with a true multidisciplinary team with varying levels of expertise within an open and friendly environment. Dr McDermott has a particular interest and experience in teaching at all levels

Educational objectives are agreed between the trainee and supervising consultant at the start of the post. Consideration will be given to the educational needs of the trainee and his / her previous experience.

There is a local weekly training programme and involvement by senior trainees is encouraged.

There are numerous teaching opportunities.

Local CPD is held monthly with frequent and external trainers

THE TEAM:

SupervisingConsultant

Based at

Medical Secretary

Other Drs in team

Team Members

Dr Celice McDermott, Consultant in Rehabilitation Psychiatry

Banham House, Bodmin Hospital

Kate Moss

Dr Mike Badve, Associate Specialist

Ward Manager, Deputy Ward Manager, Occupational Therapists, Art Therapist, RMN's, Social Inclusion Workers, Rehabilitation Outreach Nurse & Ward Secretary

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Admin & Supervision

Referrals Meeting (Fettle Ward)

CPAS & Supervision (MHRTs/Managers Reviews) (Cove Ward)

Trust CPD

Fettle Ward / Assessments

Special Interest Session

P.M

MDTS/CPA (Fettle Ward)

MDTs/CPAs

Personal development and team development

Monthly Team Meeting (Fettle Ward)

Fettle Ward MDTs/CPAs

Research Session

Consultant Psychiatrist (currently vacant) based in West Cornwall and Chygovenck (sees LD adults with mental health and behaviour issues and LD patients with epilepsy and dementia)

Dr Rohit Shankar Consultant Neuropsychiatrist based in East Cornwall and Chygovenck (sees adults and LD adults with epilepsy and dementia and is also the medical lead for LD services)

Dr David Cox, Consultant Psychiatrist based at Chy Govenek and East Cornwall (sees adults and patients with complex epilepsy and dementia)

Dr Anu Shyam, Consultant Psychiatrist in the Child & Family Service with special responsibility for learning disabilities

There is also one CT1-3 post in the service and another ST4-6 post.

The post holder will be working with Dr Shankar and will be responsible for assisting with provision of outpatient care and community-based services in the Learning disability patients for mental and behavioural issues, dementia and Neuropsychiatry Epilepsy Service at the East Resource Centre. This will include outpatient clinics and home visits, and working with different members of the community team. There are excellent links with mental health colleagues, local neurologists and GPs.

Joint assessment and joint working with other members of the team is encouraged and expected. The post holder will be expected to attend the weekly allocation and MDT meetings.

The post holder may be required to make emergency assessments during the working day at the request of the supervising Consultant, and it would be advantageous to be approved under Section 12 of the Mental Health Act.

The post holder would also be expected to take part in liaison with general adult mental health services for inpatients with learning disabilities, along with other team members.

The post holder will be expected to communicate appropriately with Primary Care services with regard to the advice and changes in treatment initiated by the service.

The holder of this post will be encouraged to participate in special interests, research and postgraduate activities and audit.

There is an active education programme at Bodmin Hospital, which the post holder will be encouraged to attend and regular multidisciplinary case conferences in localities also take place.

Study leave allowance will be in keeping with the Terms and Conditions of Service.  Cornwall Partnership NHS Trust supports Continuing Professional Development and life-long learning and to support clinical governance one session per week is dedicated to training and peer review.

Dr Shankar is an honorary associate professor with the Exeter Medical School and deputy chair for the Trust’s research and governance committee and the CPD chair. He is also the innovation lead for RCPsych south west division. The post holder would be encouraged to take the opportunity to join and work with him. His research interests include SUDEP, epilepsy, autism, dementia in Down’s syndrome, forensic aspects of learning disability and sensory processing disorders.

The post holder will be encouraged to complete at least 1 audit, 1 international peer r/w poster presentation and a peer r/w publication during their tenure.

Monday

Tuesday

Wednesday

Thursday

Friday

A.M

General LD MDT meeting & Outpatients

Core LD

Outpatients

Epilepsy

Academic

Programme/

CPD/SMSC

Admin/emergencies

Doctors peer group once a month

meeting/IST

MDT once a month/ fortnightly IST patient r/ws

P.M

home visits/

Dementia clinic

Outpatients

epilepsy

Epilepsy MDT

Supervision

Research/

special

interest

Research

/Special Interest

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

MDT meeting

Ward Round

Teaching/Management Training/ Additional Supervision

Special Interest

Clinic

P.M

Clinic

Supervision

Clinical Administration

Home Visits/ Complex case management

Research

Emergency Assessments

General Adult Psychiatry

 Dr Alind Srivastava 

Trevillis House, Liskeard

This is general adult psychiatry job with continuity model i.e. patch consultants.  This involves both inpatient and community work.  Therefore it completes the core requirement for higher trainee (i.e. inpatient and community) without needing to do two one year posts in each.  There is ample opportunity to take up psychological work with appropriate supervision.  The job will provide a wide range of experience ranging from affective disorders to psychotic disorders including schizophrenia and neuropsychiatric disorders like Tourette’s syndrome. It is an excellent post to build up a strong foundation of generic general adult psychiatry and think about further specialisation.  You will have use of a desk in the office and a medical secretary shared by all doctors in the patch i.e. consultant, SHO and higher trainee.    There will be a good balance of autonomy with back-up/supervision as needed.  There is weekly supervision for an hour built in the time-table.  The on call system has already been mentioned on page 1 of the job description.

The community mental health team based at Trevillis House in Liskeard has two patch consultants based on GP surgeries.  The team has one team manager, specialist practitioner (AMHP), Band 6, 5 and 4 nurses.  There is one clinical psychologist in one post and another 0.5 post, which needs backfilling due to maternity leave.  There are 5 support workers who help people with day to day functioning including completing forms for other agencies e.g. housing etc.

The inpatient ward is at Bodmin Hospital at Bodmin.  The acute ward is Fletcher and the PICU ward is Harvest.  The ward round on Fletcher is as stated in the time-table.  MDT/Ward rounds discussion is an excellent venue for chairing meetings, leading ward rounds, risk assessments and management.

Trainees are encouraged to participate in quality improvement and management.  There may be an opportunity to shadow either the clinical directors or the medical director with agreement.  There is a newly appointed clinical leadership mentor of trainees and you are encouraged to contact him in order to participate/lead on quality improvement projects.  You will need to keep the mandatory training up to date as required by the Trust.

The Perinatal Mental Health Team in Cornwall was established in 2013 in order to provide specialised care to women during pregnancy and in the post-natal period, and to provide preconception advice; for women with, or at risk of, serious mental illness. The team has undergone a significant expansion in the last 2 years, following success in winning bids from NHSEngland. This has meant an expansion in resources and a genuine multi-disciplinary team, that continues to develop. The service provides specialist advice, support and oversight, working with health and social care professionals in primary care, maternity services, early years and adult mental health.

Patients are referred from Midwifery, Health Visiting, primary care, and from other secondary care teams, and can also self-refer. The team is currently commissioned to triage, to assess, and to provide a full package of care to a number of patients equivalent to around 5% of all live births in the county.

Patients under the care of the team have an allocated key worker and are often cared for solely by the Perinatal Mental Health team, though the team sometimes also work alongside some of the trusts other mental health teams.

The main service objectives are:

• To provide a leadership role to the local health community, raising awareness and capability through the provision of training, information and evidence based advice and guidance.
• To provide a direct clinical service within the criteria agreed in the service specification. This will include having direct oversight of the care of women with serious mental health needs.
• To provide clinical assessment of mother-baby relationships where these have been referred as being particularly problematic and cannot be managed by health visitors or primary infant mental health specialists
• To support professionals, women and their families to understand the emotional and physical changes associated with childbirth and the risks which these present to women with pre-existing mental health conditions; who have risk factors such as family history; or who develop mental health conditions during or after their pregnancy.
• To ensure that all women who have, or develop serious mental health problems during pregnancy have access to up to date, consistent advice on the risks and benefits of medication in pregnancy and while breastfeeding. This advice may be provided directly by the service, but also through training and information to GPs, Mental Health and Maternity professionals.
• Support a managed transition of women on the caseload to other services after the perinatal period, including preparation for future pregnancies
• To improve awareness of risks, particularly ‘red flag’ risks and triggers amongst all professionals who work with women and their babies during and after pregnancy.
• To improve awareness of the impact of both ante-natal and post-natal mental health problems on the mother-infant relationship and attachment.
• To support the development and improvement of the local care pathway including agreement of common policies and procedures for use by all providers involved in the care of pregnant women and their infants.
• To establish and manage systems for sharing information about individual women who have a risk assessment and/or care plan between primary care, maternity services, adult mental health and health visiting.
• To promote the development of effective clinical governance mechanisms across all agencies responsible for delivering the care pathway
• Participate in local, regional and national networks, as appropriate in order to share learning and good practice. This will include participating in any opportunities for peer review with other services.

The service co-ordinates care, under non-CPA, for women with serious mental illness (bipolar disorder, schizoaffective disorder, schizophrenia, other psychoses, previous postpartum psychosis, severe depression with and without psychosis) who are at high risk of relapse postnatally, but are currently well and therefore not open to mental health services and ineligible to receive a service from adult mental health teams.

The service does not take over care coordination of women who are already under the care of an adult mental health team. Responsibility for these women remains with the existing mental health team, with advice and adjunct specialist input from the specialist team as required.

The service does not have the capacity to provide direct support to women with mild to moderate anxiety and depression but will provide signposting, advice and guidance and training in relation to mental health conditions during the perinatal period.

The service takes an active role in ensuring tight clinical governance across organisations to coordinate and secure evidence based medicine, efficient and effective care pathways and care planning, adequate data collection for auditing purposes and effective patient safety tools (incident reporting, RCA management).

The service works in partnership with Primary Care, Maternity Services, Adult Mental Health, local MBUs to provide support for women from pre-conception through to the infant’s first birthday.

The service undertakes joint risk assessments with GPs, maternity services, and Early Years services (Health visitors and Primary Mental Health Services). It provides specialist advice on medication during pregnancy, and supports the development of mental health care plans.

Clinical Duties

• Work as a member of the CFT Specialist Perinatal Mental Health Team (PNMH team)
• Provide daily support to the Specialist PNMH keyworkers in managing routine and urgent clinical care for patients on the caseload.
• To provide planned assessment and review of service users in the community and in clinic settings.
• To undertake urgent assessments of women who have suspected symptoms of Post-partum psychosis where capacity allows
• To provide specialist input into risk assessment, care planning, and crisis planning for women with a pre-existing mental health need or a new onset severe mental health problem who have been identified as being at risk in the antenatal or postpartum period.
• To provide medical input to the weekly MDT meeting and assessments of patients referred to the team.
• Attend CPA reviews and other care reviews organised by the responsible key-worker/care co-ordinator
• To provide specialist advice to GPs, Consultant Obstetricians and Adult Mental Health clinicians on the use of mental health medication during pregnancy and breastfeeding.
• To liaise with other parts of the perinatal pathway and GPs and non-NHS organisations wherever applicable; and attend meetings in relation to work with non-NHS oragnisations, for example child protection conferences
• Participate in regular supervision with the teams Consultant Psychiatrist.
• To maintain paper and electronic health records in accordance with Trust Health Policies, and to ensure effective and timely documentation and communication of clinical decision making and management plans

AM

PM

The trainee will be part of a medical and nursing team providing psychiatric services to the Royal Cornwall Hospital, Treliske. The team comprises a CORE 24 service with two full-time Consultant Psychiatrists. There is an ST2 trainee and an F1 doctor. There is a Team Manager,

three clinical lead nurses, ten other band 6 Psychiatric nurses, two administrators and two medical secretaries. There is also some Clinical Psychologist time funded via a National Suicide Prevention initiative.

The team accepts referrals for the full range of psychiatric presentations in the general hospital. The majority of referrals are for self-harm, although a wide range of other conditions are seen including eating disorders, alcohol withdrawal with severe behavioural disturbance, delirium, complex presentations and medically unexplained symptoms, acute psychiatric emergencies presenting at ED e.g. acute psychosis and catatonia. There is an out-patient follow up provision for complex presentations and we are also involved with the complex presentations and frequent attenders pathway at RCHT. The trainee will have an opportunity to see these patients, particularly more complex presentations and to supervise more junior medical staff in their assessments. They will be expected to provide advice and support to the senior nursing staff within the team and joint assessments are encouraged where possible.

The assessment of more complex referrals is where the trainee will have their predominant role. These referrals include neuropsychiatric presentations, perinatal psychiatric presentations (in conjunction with the perinatal team), complex somatoform disorders and co morbid common mental health disorders that are influencing the presentation of long term medical conditions.

The trainee will be directly supervised by the Consultant for one hour each week. The Liaison Service is establishing links with many other hospital departments.

There will be an opportunity to establish a special interest in one of these areas and an excellent opportunity for service development and research.

The timetable is flexible and can be adjusted according to commitments. It provides an opportunity to supervise the F1 doctor.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Liaison Ward work

Supervision

Liaison Ward Work

P.M

Administration / F1 supervision

The Specialty Trainee will undertake work in an apprenticeship role focusing on developing the skills and experience necessary for working as a consultant psychiatrist.
The trainer will undertake to provide the trainee with a rich and broad range of clinical experience, working in a highly collaborative manner, as part of a hard working but cohesive clinical team.
The post will involve inpatient and community work. The trainee will provide medical input to a comprehensive mental health service for adults of working age registered with GP Surgeries in Redruth and North Kerrier. The trainee will be expected to attend ward rounds, complete new assessments and outpatient reviews, undertake joint visits with community colleagues and attend GP Hub meetings. There will be plenty of opportunity to gain experience of working with the Mental Health Act including participation in MHR Tribunals.
The acute inpatient beds are based on Bay Unit at Longreach House, Redruth where there are 45 acute beds shared between eight consultant psychiatrists. Bay Unit is divided into three wards; Perran, Cove and Carbis Wards. There is a CT1 trainee attached to the team, who supports the inpatient workload and also assesses community patients in the outpatient clinic.
The CMHT is based at The Coach House, adjacent to the hospital and outpatient clinics are held at the Basset Unit clinic on the same site.
The trainer aims to have close working relationships with local GPs. Many patients and GP surgeries are close to the CMHT base meaning that travel time is minimal and there is strong sense of being part of the local community.
The supervising consultant provides medical cover to the Home Treatment Team and community forensic patients (also working one day a week with the Community Forensic Team). Intensive care, rehabilitation and low secure beds for the whole of the county are located at Bodmin with separate medical cover; though the supervising consultant is called on to provide cover when colleagues are away.
The trainee will be provided with at least one hour direct supervision per week. The trainer has managerial and teaching commitments within the trust which would allow opportunities for the trainee to gain experience in these areas. Teaching opportunities are available in the form of medical students attached to the team. Teaching at the academic meetings for junior doctors will also be encouraged.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

Ward MDT

CMHT MDT

Education

Special Interest

Clinic

P.M

Supervision Admin

Early Intervention Team consists of two multidisciplinary teams situated in the East (Bellingham House, Bodmin Hospital) and the West (Kernow Building, Wilson Way, Pool, Redruth) of the county.  The staff in each team consists of one Consultant Psychiatrist (covering both teams), a staff grade psychiatrist, a core trainee (covering both teams), clinical psychologists, clinical associate psychologists, keyworkers (CPNs, OTs, social workers), support workers, administration, IPS workers (employment support). 

We do not currently manage inpatients as patients are cared for by iCMHT consultants when admitted to the ward but we do like to inreach and keep some link in with ward reviews.  The nature of work is the assessment, review and coordination of first episode of psychosis interventions including the use of psychotropic medication.  We provide a up to 3 year service for anyone of adult age with a first episode of psychosis (but only those >35 years of age with a duration of untreated psychosis under 18 months). 

You would be on the S12/RC rota with a nominated RC supervisor who would be oncall with you, where you would be first point of contact for S12 work during office hours and out of hours with the back up of RC oncall to supervise you or complete nominated RC work. 

We have an admin team as well as medical secretarial support.  There may be opportunity to engage or even develop a psychoeducative group or engage in national or local audit, and teach medical students or local trainees.  The west office is located next to the research team and would be good opportunities to engage in research locally. 

There are a number of targets regarding physical health which would be great to continue quality improvement programmes.  The bases have some office space but remote working will continue to be encouraged and facilitated.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Clinical Appointments – West (could be Friday as alternative)

P.M

Clinical and Educational supervision.  (could be Friday as alternative)

Special Interest Time (could be Monday as alternative)