General Adult (Livewell Southwest)

This post also offers exciting opportunities to work at the forefront of addictions treatment.  Dr Battersby is Academic Secretary for the Addictions Faculty of the Royal College Psychiatrists and this gives the trainee the opportunity to participate in national projects.  Opportunities exist for pursuing a research project during the post.  The postholder will gain the skills needed to thoroughly assess and work with people with any addition problem including sex, internet and gambling addictions.  The postholder will also learn how to prescribe for and detoxify individuals with addictions.  Opportunities also exist to learn about the preparation of medicolegal reports for asylum seekers who have experienced trauma/torture.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

OPA weeks 1 and 3

CPD

P.M

General Adult MDT

Lee Mill provides care and treatment for adult males who have severe and enduring mental health problems and complex needs including: autistic spectrum disorders, learning disabilities, drug and alcohol problems and acquired brain injury and are not experiencing an acute episode to enable people to work on their own recovery.

Some service users may have a history of offending behaviour, including persistent antisocial offending and serious offences resulting in harm to others and some may have been detained under the Mental Health Act (including forensic sections).

We are nationally commissioned by the South of England Specialised Commissioning Group to provide local Low Secure Services. We provide a step down from Medium Secure, eg. The Butler Clinic and Psychiatric Intensive Care (PICU) and a step up from local provider services, eg. The Glenbourne Unit and Recovery Inpatient Units.

The multi-disciplinary team comprises:

• Consultant Psychiatrist
• Speciality Doctor
• Psychologist
• Mental Health and Learning Disability Nurses
• Occupational Therapists
• Health Care Assistants
• Technical Instructors
• Housekeeping
• Secretarial
• Chaplain
• Advocacy
• Pharmacy

Low Secure Forensic Rehabilitation psychiatrists work with people with long-term and complex mental health problems, the majority of whom have a diagnosis of schizophrenia. Although many people with severe and enduring mental health problems such as schizophrenia experience ongoing active symptoms of illness and impairments in cognition and drive, social stigma and the secondary handicaps consequent on the illness, those who are referred for Low Secure Forensic Rehabilitation are those whose problems are of such complexity or severity that they have not been able to be discharged home following an acute admission. These problems include treatment resistance (non-response to first-line medications), cognitive impairment (most commonly affecting executive function and verbal memory), pervasive negative symptoms (e.g. apathy, amotivation, blunted affect), and co-existing problems (e.g. substance misuse, premorbid intellectual disability, developmental disorders such as those on the autism spectrum). These complex problems contribute to major impairments in social and everyday functioning and to challenging behaviours that impede recovery and increase the risk of adverse outcomes. Comorbid, chronic physical health problems are also commonly present.

Consultants in Low Secure Forensic Rehabilitation psychiatry have expertise in the assessment and long-term treatment and management of this patient group. They adopt a biopsychosocial approach that embraces recovery-oriented practice.

Specialist trainee will be obtain the following experience from Lee Mill Low Secure Unit.

1. Detailed assessment and management of patients with complex mental health needs in Low Secure Forensic Rehabilitation settings. This includes:

• expertise in medication management for treatment-resistant

conditions;

• Risk assessment and management (eg. HCR-20)
• physical health screening and medical liaison with colleagues in

primary and secondary care;

• appropriate use of psychosocial interventions;
• appropriate use of mental health and mental capacity legislation,
• safeguarding processes, appointeeship and Court of Protection;
• detailed knowledge of local supported accommodation provision;
• Expertise in managing patients’ transitions between different settings.

1. Second opinions and advice to colleagues on the diagnosis and management of patients with complex mental health needs.
2. Support and advice to services that provide supported accommodation and complex community care packages for this group.
3. Review of patients in out-of-area placements.
4. Close working relationship with the paired consultant and team
5. Liaison and smooth transition of care to other consultant

• Low Secure Forensic Rehabilitation psychiatrists use their clinical leadership skills to facilitate successful partnership working with voluntary sector agencies that facilitate social inclusion, including those that provide supported accommodation, vocational training and employment.
• Low Secure Forensic Rehabilitation psychiatrists should sit on the local ‘placement’ panel to ensure the appropriate placement of patients in facilities that are tailored to their needs, that opportunities for local treatment and support have been fully explored prior to a placement being made out of area, and that there is ongoing review of an individual’s suitability for local repatriation at the earliest opportunity (Royal College of Psychiatrists, 2011).

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Consultant Meeting

Supervision

(SPA)

MDT

(DCC)

Teaching /CPD

(SPA)

Assertive Outreach Service

(DCC)

Special Interest

P.M

Assertive Outreach Service

(DCC)

MDT/Admin

(DCC)

Out of Area Patient/ Referral

Assessment

(DCC)

Assertive Outreach Service

(DCC)

Special Interest

Trainer:

Base:

The Liaison psychiatry Team at University Hospitals Plymouth (Known as Derriford Hospital) has developed over many years and currently the quality standards and staffing levels are envisaged at “Core 24” model in 2021.

Following the merger of two teams, (Liaison Service for patients aged 18-65 years and one for older adults over 65 years), service commitment is to further develop a consultation and Liaison Service of “an all age” (Ageless) for people with mental health problems attending at University Hospitals, Plymouth.

In addition the Safeguarding Adults Team, Alcohol Liaison Nurses, Frailty Nurse and Liaison Learning Disability team are co-located within the base.

A separate service exists for CAMHS referrals including regular attendance by Youth workers for adolescents with alcohol problems.

The Liaison Team at UHP is involved early at the point of triage in Emergency Department and provides biopsychosocial assessment, conducts risk assessment and management, care planning, contingency planning and medicolegal advice.

The Liaison Team is heavily involved in group and team work, education, training, mentoring and network building to forge excellent relationship with our medical and nursing colleagues at University Hospital, Plymouth.

Responsibilities and opportunities of the Post

1. To perform biopsychosocial assessments and formulation of management plans in complex cases, advising medical teams on appropriate integrated care.

2. To provide clinical leadership, medical advice to Liaison team, to enable excellence in care to be delivered.

3. To provide advice regarding patient management to colleagues in secondary and primary care and bridging the gap with regard to management of psychosomatic conditions in the community (e.g. medically unexplained symptoms).

4. To assess and manage risk (e.g. suicide risk, violence/aggression, absconding etc.) relating to psychiatric conditions in general hospital settings.

5. Prescribing and giving advice to medical teams on psychotropic medication.

6. Providing expertise, and fulfilling a statutory role, in managing medico-legal issues using Capacity and Mental Health legislation.

7. Teaching and training of non-training grade doctors and psychiatric trainees allocated to Liaison team.

8. To advise and assist in the planning of services and setting goals and targets for the team according to local and national drivers.

9. To play an active part in psychiatric teaching. There is an active postgraduate teaching programme in psychiatry and there are opportunities to contribute to other academic meetings.

10. Medical students from the Plymouth University Peninsula Schools of Medical and Dentistry (PUPSMD)l attend regularly to obtain psychiatric experience as an integral part of their training, and Higher Trainee will be encouraged to participate in teaching and providing feedback sessions for these medical students.

11. An interest in research and a willingness to participate will be encouraged.

12. To undertake clinical audit activity and to participate in both internal and external audit as required for clinical governance.

13. To participate in Continuing Professional Development (CPD) as approved by the Royal College of Psychiatrists. Livewell Southwest is committed to CPD and the study leave allocation. The organisation facilitates participation in CPD for its trainees and all routine Journal Clubs and Case Conferences are validated for Internal Module CPD. A substantial part of each Wednesday is set aside for CPD activities.

14. To challenge stigma and discrimination towards psychiatric patients and professionals – by raising awareness, presentations/teaching sessions and informal discussions with various professionals etc. in a general hospital setting

15. To take an active interest in Medical management. The Trainee will work alongside the consultant and Service Manager to ensure smooth functioning of the service.

16. Higher Trainee will be encouraged to attend Livewell Southwest Senior Medical Staff Group and the Directorate Consultants’ Planning Group Meetings

17. To uphold the principles of Clinical Governance and adhere to Livewell Southwest’s clinical governance requirements.

18. To adhere to all the organisations policies and procedures.

Academic

There is a weekly academic programme, including case presentations, a journal club, and a monthly grand round, run by the psychiatrists for core trainees, all trainees including Higher Trainee have protected time built into their job plans to attend. Some of these meetings may be chaired by the ST4-6. There will be opportunities for teaching of medical staff and students as well as other members of the multidisciplinary team.

The MRCPsych Course for CT1-3 doctors is held locally. Higher Trainees working in the three mental health organisations within the peninsula are encouraged to assist in the delivery of modules.

Teaching and development

Medical students from the Plymouth University Peninsula Schools of Medical and Dentistry (PUPSMD) attend regularly to obtain psychiatric experience as an integral part of their training, either on observational placements in Years 1 and 2, or on pathway placements in Years 3 and 4. Higher Trainee will be encouraged to participate in teaching these medical students.

Research / Quality Improvement / Audit

Higher Trainee will be encouraged to participate in research. The Quality Improvement and Support Team (QUIST) consist of two Quality Improvement Facilitators and a NICE Audit Facilitator who are able to offer expert information, support and analysis for those wishing to undertake audit. They are supported by Meridian and SNAP systems for data management and analysis. The team supports a yearly cycle of regular audit as determined by national and local policy and guidance, as well as individual audits at the request of teams or individual clinicians. They play a key role offering advice and support throughout each stage of the audit cycle. Local academic links can assist with getting high quality own-account research or audits published. Any pre-existing special interest sessions and research projects would be fully supported.

Supervision

One hour of supervision weekly with the consultant on a mutually agreed weekday. In addition to the allocated sessions for educational and clinical supervision, there will be regular clinical contact with the consultant for discussion of cases etc. The timetable for the ST4-6 trainee is flexible and will depend on the training needs of the doctor. It is anticipated that the workload will consist of a mixture of reviews, consultation advice and support to the team and acute medical staff, together with single handed and multi-disciplinary assessments.

On-call duty rota

The general psychiatric consultant on-call rota is 1:14 with the back-up of a consultant. There is a middle grade on call (SAS Doctors) from 5pm-10pm weekdays and at weekends. The ST4-6 on-call rota is 1:13 fixed on-call every 2 weeks and 4 weekend within 12 months with the back-up of a Consultant

Learning Objectives;

Supervision

Training Base

NorthWest Community Mental Health Team Cumberland Centre, 1st floor, Damerel Close, Devonport, Plymouth, PL1 4JZ Tel: 01752 435589

Perinatal Mental Health Team Ridgeview, Plympton Clinic, 1st floor, Station Road, Plympton, Plymouth, PL7 2AU Tel: 01752 431607

This is a split post in Perinatal Psychiatry and Adult Community Psychiatry – North and West CMHT. The teams are not collocated and the distance between the bases is about 5 miles.

 Every Wednesday AM, the regular CPD event for all medical staff takes place at Mount Gould Hospital and trainees are supported to take part in it, with the provision of protected time to do so.

The Perinatal team is a newly formed service to Livewell SW and working with the team entails active involvement in the shaping, planning and managing the service, as well as reviewing patients and their carers and offering specialist advice. The aim is to prevent, detect (early, if possible) and manage mental health problems that complicate pregnancy and the postpartum period (currently, during the first year of the baby – due to be expanded until 2 yo). It is a community based team that comprises of a Consultant Psychiatrist, Psychologists, Perinatal Mental Health Nurses and Student Nurses (from the University of Plymouth), a Specialist Midwife, Family Support Workers, a Team Secretary. Peer Support Practitioners are going to be employed, and the team will start accepting Students of the Peninsula Medical School for their clinical placements. The team works closely with midwives at Derriford Hospital and community colleagues caring for women/new mums. Referrals to the team are made by professionals or services within Plymouth, who support women around childbirth where there are concerns about their mental health and wellbeing. The team liaises closely with other Perinatal Mental Health teams that work in the rest of Devon (run by Devon Partnership NHS Trust) as well as the Mother & Baby Unit (Jasmine Lodge) at Exeter, Wonford House Hospital site. Patients under the team’s caseload are being reviewed at our offices or at their own residence, if they prefer so. Trainees are invited to contribute, not only to the clinical work of the team, but also to the development of the service and raising awareness about mental health within other disciplines (e.g. educational programme for midwives and health visitors).

The NW CMHT is a fully established service and there are other Consultants (substantive and locum), Specialty Doctors and Junior Doctors working along the MDT. The CMHT provides coordinated community psychiatric care for adults of working age across the North and West locality within Plymouth (co-terminus with Social Services and GP practices). Patients are managed under CPA or Standard Care (no need for Care Coordinator). Currently, several specialist services are being developed within Livewell SW and case load is expected to reduce. There has also been an agreement with Primary Care for the discharge of patients in Clusters 1-3 back to the care of their GP with a Rapid Reassessment Pathway (RPR) for patients. The trainee is expected to contribute, not only to the clinical work (regular and urgent reviews of patients), but also to service development with their ideas and fresh eyes. Currently, Primary Care is moving towards the Primary Care Networks and there is close collaboration between the CMHTs and GPs in order to develop integrated care pathways and ensure constant communication between professionals.

CMHT

team meeting

Direct Clinical Care time & shadowing supervisor

Perinatal Team

MDT meeting

Lunchtime Journal club

CMHT

team meeting

Direct Clinical Care time & shadowing supervisor

Perinatal team

Direct Clinical Care time & shadowing supervisor

OR

MRCPsych teaching (depending on schedule)

lunch time

Direct Clinical Care time & shadowing supervisor

lunch time

Direct Clinical Care time + supervision

lunch time

Direct Clinical Care, MDT meeting OR CPD, Special Interest, Research etc.

lunch time

Supervision

Direct Clinical Care time & shadowing supervisor

lunch time

Direct Clinical Care time & shadowing supervisor OR MRCPsych teaching (depending on schedule)

Training Base

Greenfields Unit Mount Gould Hospital Mount Gould Road Plymouth PL4 7QD

Service description

The Greenfields (9 female beds) and Syrena House (9 male beds) units are part of a city-wide service that forms a recovery pathway consisting of two single sex in-patient recovery units, a community support team and access to social inclusion and vocational services. There are links with supported accommodation providers for housing. The aim is to provide a whole systems approach to recovery for people who have complex disorders and are often well known to mental health in-patient and community services. The inpatient units support patients who step down from secure services, need transition from acute services to the community or those who have become non-progressive in their recovery and may require intensive therapeutic intervention. The units are managed by a RMHN manager and deputy manager. There are additionally approximately 9 WTE Registered Nursing Staff, 1 Assistant Practitioner and 8 WTE unregistered Nursing Staff. Consultant Psychologists provide sessional input into the two recovery units. Medical input includes the consultant and core trainee.

More information can be found in the Greenfields/Syrena house operational policies on the intranet. There is also a junior doctor handbook prepared and updated by previous rehab junior doctors.

Clinical Role

1. Detailed psychiatric assessment and management of patients with complex mental health needs.

2. Liaison and close working with Lee Mill low secure unit and other secure units when referrals are being considered.

3. Contribution to and chairing weekly MDTs.

4. Supervised report writing for tribunals, managers’ hearings, etc. The trainee can be supported to attend tribunals as well.

5. Working with community colleagues in the shared care of patients as they are transitioning between services.

There is a staff-grade rota which covers the community until 10pm.

There is an in-house academic programme which includes case conferences and journal clubs. There is also provision for training in psychotherapy, including a Balint group which is currently facilitated by Dr Daoud (rehab consultant psychiatrist), in accordance with Royal College guidelines.

Leadership Role 

There are many opportunities to develop and lead change in rehabilitation services which can be discussed with the consultant.

SPA Fortnightly consultant meeting/senior medical forum Tribunals/report writing

Greenfields weekly MDT

Balint Group CPD Weekly supervision for trainee (one hour).

Syrena House weekly MDT

Special interest

SPA Fortnightly consultant meeting/senior medical forum Tribunals/report writing.

Greenfields clinical work

Community rehabilitation team outpatients

Syrena House clinical work

Special interest

Training Base

This is a general adult acute in-patient post based at the Glenbourne Unit on the Derriford Hospital site. The Glenbourne unit consists of a female ward (Bridford ward) and a male ward (Harford ward). This post is primarily for the female ward (Bridford ward) however it is likely that the higher trainee will also gain experience on the male ward too.

The post involves in-patient management of patients, many of whom are detained under the Mental Health Act. There is no out-patient work. The post will give good opportunity to become confident in the practice of inpatient psychiatry, especially those subject to the Mental Health Act. There will be opportunity to write reports and present evidence at manager’s hearings and tribunals. The post will also give opportunity to become familiar with other aspects of the Mental Health Act such as Consent to Treatment and Section 17 leave requirements. A few patients will be managed on the ward under Deprivation of Liberty and Safeguards thus familiarisation with this framework will occur. There will be opportunity for the higher trainee to take a lead in patient management, setting up treatment plans, leading weekly ward rounds and leading on risk management and professionals meetings. The Glenbourne Unit has the on-site Place of Safety suite for Plymouth so there is opportunity to undertake Mental Health Act assessments on a regular basis for those detained under Section 136. Glenbourne is also within walking distance of Derriford Hospital there are frequent opportunities to undertake MHA assessments in A&E and medical wards. The Glenbourne Unit hosts the Plymouth’s ECT suite and there is opportunity to participate in this if interested.

Glenbourne Unit is a well- run unit and has been rated as ‘Excellent’ by the CQC in its report from January 2020.

Bridford ward has a good compliment of nursing staff, occupational therapists, ward based support workers. There is an excellent Occupational Therapy department on site offering a range of activities. There is a well-resourced Discharge Team to help facilitate a timely safe discharge of patients from hospital. There is a Psychologist attached to the Glenbourne who provides input for patients on both the male and female ward.

As higher trainee you will have dedicated office space within the admin block based at Glenbourne Unit with access to IT support. You will have access to a Medical Secretary.

There are opportunities to gain experience in non-clinical areas such as taking the lead on Quality Improvement projects, supervision of medical students on placement on the unit, participation in teaching and opportunities to present cases/journal club through the local CPD programme. There is a research department in Livewell and other higher trainees have had opportunity to be involved in these projects. Bridford ward has 1-2 junior doctors attached to it at any one time and there will also be opportunity to provide input into their training too.

An hour’s weekly supervision will be provided as part of the rotation and will probably occur on a Monday although can be re-allocated to a different time in the week dependent on the trainee’s need.

You will participate in a 1 in 14 non-resident on-call rota. You will be supervised by the on-call consultant as required. You will be the first port of call for any out of hours Mental Health Act assessments that should take place. MHA assessments form the main bulk of the on-call work out of hours however you will also be expected to provide support to junior doctors covering the Glenbourne Unit and any liaison and advice for some of the satellite units not covered by junior doctors (Lee Mill, Greenfields, Syrena House and Edgecumbe ward).

Senior Psychiatrist meeting

Supervision 1 hr

Ward Rounds

Ward reviews/Tribunals/MHA assessments

Special Interest Day