Old Age (Devon Partnership Trust)

Wonford House,  Exeter, EX2 5AF

Franklyn Hospital Exeter EX2 9HS 

Chadwell Centre,  Paignton, TQ3 2DW

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M.

Administration

[potential to run memory clinic]

Community Team Meeting

Liaison and supervision with team

Liaison with OPMH home treatment team

Community visits

Outpatients or community visits/work

[Memory clinic Day]

P.M.

Supervision with Consultant

Community visits

Supporting activities – educational meeting monthly, audit bimonthly, management meetings monthly.  CPD, educational supervision

 admin/community work

Franklyn Hospital has 2 wards, a 12 bedded dementia care ward and a 16 bedded older adult ward for those with functional illness.

The Trainee will work alongside Dr McCollum and will have the opportunity to play the lead role in the management of Patients.  There are 2 Junior Trainees who will be supervised by Dr McCollum, but the Registrar will also be expected to have a supportive, leadership role for the Junior Trainees.

The Trainee would gain experience in writing reports and presenting at Tribunal hearings, Best interests meetings and S117 aftercare meetings as well as in all aspects pertaining to the responsibilities of senior medical staff at the Hospital.

There is the opportunity to attend and run the twice weekly ECT Clinic held in Exmouth, initially under the supervision of Dr McCollum, but when competent, without Dr McCollum in attendance.

Dr McCollum has close links with Exeter community teams and also with the older adult liaison service at the RD&E Hospital.  The Registrar will have the option of spending regular sessions with these Teams.

Medical students attend Franklyn hospital for various attachments regularly and the Trainee will have excellent teaching opportunities, both with medical students, but also with the wider MDT at Franklyn.

It is anticipated that any other Training needs could be accommodated due to the wealth of Psychiatric services in the local area.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Special Interest Day

Ward Work / Admin /Supervision

Rougemont Ward Round

Belvedere Ward Round

Ward Work / Admin

P.M

Special Interest Day

Rougemont Ward Round

Rougemont Ward Round / Liaison at RD & E

Ward Work

Ward Work / Admin / Liaison / ECT

The work is hugely varied and involves everything from advice on placement and psychotropic medications to complex neuropsychiatric assessments and brief psychotherapies.  Team members also attend ward based multi-disciplinary meetings and are involved in teaching nursing and medical staff about mental health and related matters. 

The team consists of a full time consultant psychiatrist, a Clinical Team Leader, three specialist nurses, a part time foundation doctor and full time admin and secretarial support.

Medical SpRs join the team for attachments, as well as medical students.

The OPMH Liaison Service is co-located with the younger adults’ liaison service and the Research and Development team at Wonford House Hospital in Exeter. Patients are seen in the Emergency Department, Acute Admissions unit and inpatient wards at the Royal Devon and Exeter Hospital which is next door to Wonford House.

This post would suit either an old age trainee or a trainee who was considering working in Liaison Psychiatry.

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.

The cornerstone of liaison psychiatry work is education and it is expected that the higher trainee would take part in teaching programmes in the general hospital for junior doctors and nursing staff.

Any pre-existing special interest sessions and research projects would be fully supported.  Dr Owens would be extremely happy to work with the trainee to develop special interests and research projects. The team have close links with both the trust Research and Development department and medical consultants and teams in the acute trust.  Audit projects would be strongly encouraged and fully supervised.

There is a well attended journal club and education meeting every week.  The trainee may also wish to consider attending medical grand rounds in the acute trust.

Dr Owens has been a consultant for a number of years and is familiar with the training needs of ST4-6s and the preparation required for consultant interviews and transition. He is currently the clinical director for Older People’s Mental Health and there would be opportunities for exposure to and project work in management and service development. He has interests in psychodynamic psychotherapy, neuropsychiatry and medical education.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Clinical Team Meeting/ Boardround

Liaison Work in RD&E

Clinical Team Meeting/ Boardround

Liaison Work in RD&E

Local Academic meeting

Clinical Team Meeting/ Boardround

Liaison Ward Round

Clinical Team Meeting/ Boardround

Liaison Work in RD&E

Research/ Special Interest

P.M

Liaison Work in RD&E

MDT Team meeting (monthly)

MDT Team educational meeting  (monthly)

Educational Supervision

Liaison Work in RD&E

Liaison Work in RD&E

Research/ Special Interest

Training Opportunities:  Dr Srinivasan has trained CT1-3 and is actively involved in a considerable amount of regular teaching at Peninsula Medical School.  She has management responsibilities in the organisation as Associate clinical director for Devon Memory services. She runs a Memory Clinic every Friday at Wonford house and has a special interest in pre-senile dementias.  She has trained in Cognitive and Analytical Therapy and sees patients when time allows.  She is a firm believer that Speciality Trainees should be supernumerary and they should have enjoyable as well as useful attachments. 

This post provides a good opportunity for getting involved in teaching, research and management activities.  Trainees are encouraged to attend case conferences and Journal Clubs which run on Tuesdays at Wonford House Hospital.  The final timetable and the nature of the work undertaken by the Speciality Trainee would be determined by their educational objectives and training needs. Trainee will be encouraged to develop Management skills and can work alongside on the operational and strategic management of the Devon Memory Service. 

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Community work

Community work

Journal Club

Case Conference

Team Meeting

Supervision

Specialist Interest

Memory Clinic

P.M

Community work

Community work

Community work

Research

Memory Clinic

This post offers an opportunity for a Specialty Trainee to gain experience in a community based Old Age Psychiatry service with additional opportunities.

The trainee will join a multi-disciplinary community team (a Clinical Team Leader, Three specialist nurses, and an OT, two Nurses, one OT, one Social worker and full time medical secretary and a part time SAS doctor) based at Honiton Hospital serving the beautiful East Devon rural patch serving a population of approx. 20,000 (over 65’s).

The trainer has worked in various inpatient and community roles, and teaching and management positions. The trainer currently has management responsibilities in the organisation as the clinical director for older people's mental health services for Devon Partnership NHS Trust, as well as Vice Chair for the Royal College of Psychiatrists’ South West Division. 

The trainee will be supported to spend some time in trust management activities and gain experience in service development and management.

The trainee will also have opportunities to gain clinical experience in Exeter memory clinic and inpatient services for older people based in Exeter if needed.

There are diverse opportunities to pursue research and special interests with strong links across many disciplines. Local opportunities to develop special interests include neurology, geriatric, inpatients and liaison services; as well as memory service and ECT service.

For senior trainees, the post will allow an opportunity to act in the capacity of ‘Consultant’ for a part of the patch to experience the challenges to help prepare for future roles. 

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

CPD/Governance meeting/Community work

Special Interest/Research

P.M

Community work

Journal club/Case conference Exeter

3pm Supervision

Clinical admin

Special Interest/Research

The team is composed of experienced mental health practitioners including an advanced nurse prescriber and it has 1.6 FT consultant time.

You will be based at Tiverton hospital however there is other DPT office space in Crediton and Okehampton available when it is more convenient. MDTs are held weekly alternatively in Tiverton and Crediton.

You will offer expertise in the diagnosis and treatment of patients being managed by the team as well as other expert clinical services in support of patients and their families/carers judged necessary. You will have opportunities to encounter a diversity of organic and functional presentations from community setting, nursing homes, from the two rehabilitation wards at Tiverton hospital. You will see patients in clinic and in their homes working closely with primary care, social services, crisis team, and other agencies such as the Alzheimer society.

The workload will consist of a mixture of new patient assessments, reviews, consultation advice and support to the team and other practitioners such as GPs, social workers, AMHPs etc. There is a MSNAP accredited memory service to which you will contribute. You will be involved in capacity assessments and complex best interest decision making process; you will gather extensive experience regarding the interface between MCA/MHA/DOLS.

In addition to weekly educational and clinical supervision, there will be close clinical contact with the consultant for discussion of cases etc.

Other areas of experience available in the trust in the local area are: ECT, liaison psychiatry, a clozapine outpatient clinic, a gender identity clinic, a personality disorder service and you could also pursue special interests via the RD&E Hospital radiology, neurology or geriatric medicine consultant colleagues.

There is an active research development department in DPT, working with Exeter University; you will be encouraged to pursue your special interests in research. You would be supported to attend and contribute to the lively teaching at Wonford House in Exeter once a month and to become involved in teaching at Exeter medical school and with the regional MRCPsych teaching.

There are also opportunities to teach other members of the team and student nurses attached on placement.

There is wide availability to contribute to quality improvement projects and develop leadership skills.

You will participate in the locality- wide section 12 daytime duty rota across Exeter, East, Mid and North Devon and in out of hours on-call rota as second on-call supported by a consultant psychiatrist.

Dr Brown has been a consultant since 2015; she has interests in psychodynamic psychotherapy, mental health legal framework and medical education.

Clinical work

Tiverton Hospital

Clinical work

Tiverton Hospital

MDT Meeting

Alternating between Tiverton/Crediton Hospital

Memory Clinic

Exeter Wonford House

/Clinical Work Tiverton Hospital

Special Interest/ in agreement with educational supervisor

Consultant Supervision

Tiverton Hospital/

Clinical work Tiverton Hospital

Teaching (once a month) Wonford House Exeter/

Clinical work Tiverton Hospital

Clinical work/New Patient Slot

Tiverton Hospital

Memory Clinic

Exeter Wonford House/

Clinical work Tiverton Hospital

Research/ in agreement with educational supervisor

This is an exciting opportunity for a higher trainee to join our liaison psychiatry team, based in Wonford House and covering patients in the Royal Devon and Exeter Hospital.  The team is truly multidisciplinary and contains various grades of junior doctors, nurses, occupational therapists, social workers, psychologists, health care assistants and is led by a team of consultant psychiatrists.  We are well supported by a comprehensive administrative team. 

We are an “ageless” team (from 18 years up) and a significant part of the workload involves assessment of cognitive disorders/dementia and input into the elder care wards regarding management of behavioural and psychological symptoms of dementia.  We also regularly see a wide variety of functional presentations in older people.  Part of the liaison team works exclusively with older adults as part of the wider ACE (Acute Care of the Elderly) pathway within the RD&E which has a remit to minimise admissions and support early discharge among older people.

The team workload is hugely varied and typically involves assessments following self harm/overdose, reviews of inpatients with a variety of mental health presentations including psychotic illness, affective illness, anxiety disorder and personality disorder.  We are also responsible for caring for perinatal patients whilst inpatient in the RD&E and for patients with a learning disability with a need for psychiatric care in hospital.  The team also forms part of the Integrated Psychological Medicine Service, one of the aims of which is to reduce the length of stay and readmission rates of patients with comorbid long term physical and mental health conditions.

The Exeter memory clinic is based in the RD&E and provides a “one stop shop” for assessment of outpatients with possible dementia.  This is run jointly with the Elder Care consultants in the RD&E.  Trainees will be supported to shadow and take on work in these clinics.

Other clinical work will consist of reviews of current liaison patients, assessment of new patients and consultation work both within the liaison team and with medical teams.

The trainee will meet with Dr Kirkwood weekly for psychiatric supervision and discussion of cases and is also able to access support and advice from other liaison consultants should Dr Kirkwood be away.

The team have close links with the Devon Partnership Trust research and development team, with whom we are co-located, and with the simulation training centre on which Dr Kirkwood is leading.  We also host medical students from various years on a regular basis and provide teaching into various departments in the Royal Devon and Exeter Hospital and into the University of Exeter Medical School.  Interested trainees could take advantage of these research and teaching opportunities, which could form part of their special interest time if desired.  Any pre-existing special interests would be fully supported.

There are usually several quality improvement projects and audits taking place within the team; the trainee would be expected to contribute to these.

The team includes a psychologist and various psychotherapies are delivered locally. Trainees would be supported to meet their psychotherapy competencies in this post.

There is a vibrant monthly clinical education programme including journal club and case presentations, as well as key note speakers.  The trainee would be expected to attend this and will be fully supported to participate.  There are also opportunities to attend the medical grand round, Schwartz round and other meetings in the Royal Devon and Exeter Hospital.  The weekly neuroradiology meeting may be of particular interest to old age trainees.

The trainee would be supported towards gaining liaison accreditation on completion of training.

Dr Kirkwood has been a consultant since August 2018 and is familiar with the training needs of higher trainees.  He has interests in medical education and patient safety and has recently been appointed joint Director of Medical Education for Devon Partnership NHS Trust.

The suggested timetable can be adapted to suit part time trainees or existing commitments where possible.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

A.M

Board Round

Clinical assessments/ reviews 

Allocation meeting

Clinical assessments/reviews

Board Round

P.M

Group Reflective Practice (alternate weeks)

Clinical assessments and reviews

Team business meeting (alternate weeks)

Team teaching

This post offers the Specialty trainee the opportunity to work on Belvedere ward, an organic inpatient ward for older adults at Franklyn Hospital.  The trainee will be encouraged to work with the consultant to develop a timetable and training opportunities which meet their stage of development and offer an interesting and enjoyable experience.

Belvedere ward is in an inpatient ward for patients with challenging behavioural and psychological symptoms of dementia or suspected dementia.  The trainee will work as part of the multidisciplinary team.  They will gain experience in the assessment and management of people with challenging dementia in the context of cognitive impairment.  Depending on their experience they will take responsibility for a caseload of patients with support and supervision from the consultant.  They may contribute to Tribunals and Hospital Manager’s Hearings.  They will develop a good understanding of the interface between the Mental Health Act and Mental Capacity Act, and will gain experience in preparation for becoming an Approved Clinician.  They will be encouraged to participate in and ultimately Chair ward meetings including the multidisciplinary review, Best Interest meetings, Section 117 aftercare and Discharge planning meetings.

As the consultant is part time, Dr McCollum, who is also based at Franklyn Hospital, will provide cross cover.  The trainee may choose to gain clinical experience for one day a week on his ward (older adults with functional mental health problems).  Alternatively there are opportunities for clinical experience in the Memory Service, Crisis & Home Treatment team, or with the Community Mental Health team. 

In addition to the clinical work the trainee will be encouraged to develop Management skills and can work with the consultant on the operational and strategic management of the Devon Memory Service.  There are numerous teaching opportunities and they will be encouraged to develop their interest in research and submit articles for publication.  The consultant has a particular interest in the ‘Recovery’ model and wellbeing in mental health and dementia, and has published in many journals including Advances in Psychiatric Treatment.  The consultant also holds an honorary contract with the University of Exeter and is involved in joint projects which will offer other opportunities for trainees who are interested in developing their academic career.

The post would suit a full or part time trainee at any stage of higher training.

MONDAY

TUESDAY

WEDNESDAY

Supervisor cover

Dr McCollum

THURSDAY

FRIDAY

Supervisor cover

Dr McCollum

Mini ward review with medical & nursing staff

Patient reviews

Clinical & Educational supervision

Patient reviews and family meetings.

Mental Health Act work for patients on the ward.

Special Interest (Wed or Friday – flexible)

Quality improvement projects

Multidisciplinary ward review meeting (Medical, nursing, Ward Manager, Occupational Therapists, Physiotherapists, Psychology, Discharge planning team)

Special Interest (Wed or Fri – flexible)

Quality improvement projects

Radiology / Neurology joint meeting

P.M

Section 117 aftercare and discharge planning meetings

Memory Service / Management opportunity / CMHT  / Crisis & Home Treatment / Rougemont (Functional older adult ward) depending on trainees interest / educational need

(to be agreed at start of post)

Research session (Wed or Fri – flexible)

Clinical Education Programme (CEP) meeting (2^nd Wednesday of month)

Other academic study & teaching

Memory Clinic / CMHT  / Crisis & Home Treatment / Rougemont (Functional older adult ward) depending on trainees interest / educational need

(to be agreed at start of post)

Research session (Wed or Fri – flexible)

Other academic study & teaching

This is a community older adult training post based that the Health & Wellbeing Clinic, Chadwell Centre.  The employing Trust is Devon Partnership NHS Trust.

The clinical supervisor for this post is Dr Arun Devasahayam. He is a fulltime consultant for Torbay Older People’s Community Mental Health Team. He is also the Deputy Clinical Director for Older People’s Mental Health Services at Devon Partnership NHS Trust.

Dr Arun Devasahayam is the educational supervisor for the trainee.

The trainee will work at the Health & Wellbeing Clinic, Chadwell Centre which is the base for Torbay community mental health team for older people. Torbay community mental health team is one of the seven community mental health teams for older people in Devon. It is collocated with older the people’s social care team from the Torbay and South Devon NHS Foundation Trust. The Torbay community mental health team for older people is a well-established multidisciplinary team of doctors, nurses, psychologists, occupational therapists, social care staff and community support workers. It covers a population of approximately 31,000 people aged 65 and over and there are 2 community old age consultant psychiatrists working in this team, including Dr Arun Devasahayam.

Depending upon experience, the trainee will be invited to act as a senior clinician within the team, providing medical expertise to the team members. This higher trainee will provide expertise in diagnosis and treatment of patients suffering from functional mental illnesses. This higher trainee is not routinely expected to carry a caseload but will be expected to play a senior medical role within the team which includes supporting the team members, including a junior doctor to manage patients effectively and efficiently. The community team has a highly specialist sub-team looking after care homes in the Torbay area. This Care Home Educational & Support Team (CHEST) will provide expert support for care home residents who are referred for mental health support. The team members also provide education/training to the care home staff members. The higher trainee will have excellent opportunities to work with CHEST in developing the educational support programme for the team members and the care home staff. They will be actively encouraged in developing and implementing quality improvement activities within the team.

Another unique opportunity in this post will be the chance for them to work closely with social care services. The social care team of the Torbay and South Devon NHS Foundation Trust is collocated with the older people’s mental health team. This will provide an excellent opportunity for the trainee to understand the systems and processes within the social services and enable joint working to provide holistic care for our patients.

As the educational supervisor of this post is also the Deputy Clinical Director for older peoples mental health services for Devon Partnership NHS Trust, the trainee will have an excellent opportunity to further their leadership / management skills. Every opportunity will be provided to further those skills by shadowing him at senior management meetings, active involvement in governance of OPMH services as well as taking up time limited management projects if appropriate.

The higher trainee is largely considered a supernumerary post within the team. The main priority for the post holder would be to achieve their intended learning outcomes, which will be agreed at the beginning of the placement.

Core clinical work:
It is anticipated that the trainee will undertake assessment of older people who are referred to the community team who might have functional and / or organic illnesses. They will be encouraged to devise multidisciplinary management plans including risk management plans.

The trainee is predominantly required to provide senior medical supervision for other team members in the form of supervision sessions. They might choose to undertake a joint visit to see patients in the community or care homes.

The trainee will also have the opportunity to work closely with the local Crisis & Home Treatment Team. If the trainee is interested then there will be provisions to allow session to work with the Crisis Team specifically. Agreement from the relevant crisis team consultant would need to be sought prior to undertaking this.

Devon Memory Service is a dedicated service for assessment for patients referred with memory problems. In South Devon, memory clinic happens 4 days a week at Torbay Hospital. The trainee’s supervisor participates in the memory clinic once a fortnight. Depending upon the experience of the trainee, they will be actively encouraged to participate on the memory clinic rota. This will provide a very good opportunity to further their diagnostic skills in dementia.

The trainee is expected to provide senior medical support for CHEST. They will be actively encouraged to visit the care homes and to encourage the care home staff to provide holistic care for the patients. There will be an opportunity for the trainee to undertake focused educational sessions for the care home staff.

The trainee is also expected to participate in Care Programme Approach meetings and Section 117 aftercare meetings. There will also be an opportunity to lead multi-professional meetings discussing patient care as well as best interest meetings, as appropriate. As mentioned above, this post has a unique opportunity to work closely with the social care team and the social services manager who is also based at the Health & Wellbeing Clinic Chadwell.

The trainee will participate in the on-call rota covering Torbay and surrounding areas. There is 1 every 14 days on-call and will have a named consultant’s supervision available at all times.

Academic training:
In addition to their research / special interest sessions, the trainees are encouraged to participate fully in the local academic programme. The trainee will be able to attend the Torbay based teaching programme which occurs monthly. These academic sessions are also regularly attended by national/regional experts providing insight into various topics relevant to their training needs.

The trainee would be able to negotiate the most appropriate day for their research / special interest sessions. Ideally it can be undertaken on Thursday, however, this is negotiable. There will also be plenty opportunities within the Trust to get involved in research and quality improvement activities.

The trainees will be provided with appropriate support to be able to attend the higher trainees peer group meetings on a regular basis.

Supervision:
The trainee will have at least 1 hour of timetables supervision per week. The timing of this can be mutually agreed based on specific needs. This currently occurs on a Wednesday afternoon. Clinical supervision will be available throughout all working days, either face to face or via telephone /video consultation. Work place based assessments can happen on a planned basis or on an ad hoc basis.

How intended learning outcomes will be achieved:
This post allows access to necessary clinical enrolments to achieve many of the major components of the curriculum of old age psychiatry. As a community older people’s mental health team, we see a broad range of psychopathology and many patients have severe an enduring mental illness. This will be an excellent opportunity to work with multi-professionals including social workers. CHEST will provide opportunities to enhance their experience of looking after patients in care homes. This post also offers an excellent opportunity to develop leadership and management skills.

This post will provide a good exposure to the clinical requirements along with team working, leadership and broader professional skills required to be a consultant.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

Community work/Memory clinic (fortnightly)

P.M

Outpatient clinics/Memory clinic (fortnightly)