SPECIALTY DOCTOR

IN

STROKE MEDICINE

10 PROGRAMMED ACTIVITIES PER WEEK

JOB DESCRIPTION

Apr 2018
LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

1. BACKGROUND INFORMATION

The L&D is a growing general hospital with approximately 650 in-patient and day case beds.
The hospital provides a comprehensive range of general medical and surgical services,
including A&E, for a population of over 400,000, which includes approximately 63,000
children between the ages 0-14 years in Luton, Bedfordshire Hertfordshire and parts of
Buckinghamshire.

With over 5,000 deliveries per year, the maternity unit has one of the highest delivery rates in
the East of England region and has the responsibility for treating the most premature babies
across the whole of Bedfordshire and Hertfordshire. Further population growth is anticipated
with continuing new arrivals from Eastern Europe and plans for new homes in Luton and
South Bedfordshire, increasing the population by some 60,000 by 2021.

41% of Luton’s population are from different cultural and ethnic backgrounds; the main
groups are Pakistani, Bangladeshi, Indian, African-Caribbean and Eastern European. Luton
is an area of high deprivation; consequently our local population display diseases and
conditions more usually associated with those of an inner city area.

The L&D has developed some specialist services including cancer, obesity, neurophysiology
and oral and maxillofacial surgery.

1.1. Foundation Trust

On 1 August 2006 the L&D became the first hospital in Beds, Herts and Bucks to become a
NHS Foundation Trust (NHSFT). Being a Foundation Hospital gives the freedom to run our
own affairs while remaining fully part of the NHS.

The development of NHSFT's is a key part of the Government's commitment to NHS reform
and modernisation. NHS Foundation Trusts are a completely new kind of organisation known
as public benefit corporations. They are all about the NHS being run locally, and being
accountable to its local community rather than to the Secretary of State. The L&D is now
directly accountable to the local public through our elected Council of Governors - which
includes 22 members of the public.

1.2. University Hospital

In 2011 the Trust became a University Teaching Hospital of University College London.

1.3. Patient Safety

At the Luton and Dunstable Hospital patient safety is our highest priority. Our Medical team
have a key role to play in leading work to improve the safety of patients both in terms of
demonstrating exemplary practice and in participating in improvement initiatives. Job plans will
reflect this emphasis and a key objective will be to demonstrate your contribution to driving up
patient safety at the hospital and the L&D’s aim to “Lead the NHS in Patient Safety”.

1.4. Divisional Management Structure

A clinical management structure was established in April 2010. All clinical services are
organised into one of four divisions as follows:-
  Medicine
 Surgery & Anaesthesia
 Women’s & Neonatal Services
 Clinical Support Services

Each of these divisions has a Divisional Director, Divisional General Manager and a Head of
Nursing. Within each division there are Clinical Directorates lead by a Clinical Director,
supported by an Assistant General Manager, Modern Matrons and Operational Leads. The
Divisional Directors, Clinical Directors, General Managers and Assistant General Managers
are members of the Management Executive Team.

2. THE CLINICAL DIRECTORATE OF MEDICINE FOR THE ELDERLY

2.1. Strategic Business Unit

The directorate of Stroke Medicine offers hyper acute stroke services to Bedfordshire, North
Hertfordshire and Milton Keynes for a population of 700,000. 20% of all admitted strokes are
thrombolysed. The unit admits an average of 600 stroke patients annually with a further 300 non
stroke patients.

The unit has 10 hyperacute monitored beds, 18 acute care beds. It has also expanded to have
a further 8 rehabilitation beds. The unit has good nursing and therapy support.

The unit also runs a daily TIA service with dedicated MRI / carotid Doppler slots.

The unit also has been funded for a full pledged stroke research team with 1.8 wte stroke
research nurses and 1 wte research administrator. It has currently 11 research studies ongoing.

The unit is a separate business unit with a dedicated Stroke Manager.

2.2. Acute Care Unit

A 24 hour, 7 day a week Acute Care Unit is also in operation.

The 51 bed Acute Care Unit (ACU) has been established consisting of an assessment zone
(Zone 1) and two short-stay zones (Zones 2 and 3). General Practitioner referred patients,
patients referred from the Accident and Emergency Department and surgical patients will be
assessed by the appropriate specialist teams or ACU staff. Short stay patients in Medicine and
Medicine for the Elderly (DME) who are expected to be discharged within 48 hours will be
managed on the ACU under the care of the Acute Physicians. Patients requiring longer stay or
care in a specialist ward will be transferred to the appropriate unit within 48 hours of admission.
The Unit is run by two Consultant Acute Physicians and a third Consultant (post is advertised) in
conjunction with Dr Daniel Fishman, Lead Clinician for Emergency Medicine and Consultant
Rheumatologist.

A number of management protocols are in place and some suitable patients will follow a
pathway direct to the appropriate specialty service e.g. coronary care and acute stroke
patients.

2.3. Admission Policy

Elderly patients with a medical illness requiring admission are admitted according to an age
related policy and fulfill the following criteria:
a) Are aged 78 years and over
b) Are aged 65 to 78 years with an acute stroke, or are resident in a Residential or Nursing
Home, or are currently known to a Consultant in the Department

Exclusions to the policy include patients admitted with an exacerbation of a medical condition
for which he or she currently attends a General Physician’s out-patient clinic, and elderly
patients with acute abdomen, head injury or lower limb fracture requiring hospital admission.

2.4. Intermediate Care

The Department of Stroke Medicine works very closely with the Primary Care Trusts and
Housing & Social Services Departments in the development of the Community Rehabilitation
and Early supportive discharge teams.

There are further developments in progress about linking chronic disease management with
Rapid Response Acute Care Services and the rest of Intermediate Care Services, so that
these services can grow together and complement each other.

The present focus of Intermediate Care is working towards making it an integral part of
emergency care reform, chronic disease management, and to develop closer working
relationship with mental health teams

With the current local and national directives there are plans to manage patients in the right
environment particularly outside in the community.

The appointee will have the opportunity to contribute further to the development of
Community stroke rehabilitation and early supportive discharge teams.

2.5. Medical Staff

Consultants:
Dr L Sekaran F/T
Dr D E D Phiri F/T

Dr L Alwis F/T
Dr A Asaipillai F/T
Dr S Sethuraman F/T

Specialty Doctors: Dr E Smith F/T

Vacant post F/T

Specialist Registrars: Vacant

FY2/ST1/ST2 2 x WT
FY1 Posts 2 x WT

The Directorate works closely with the Directorate of Medicine and Medicine for Elderly. There
are currently 26 full-time Consultants in Medical Division, each with special interests, which
include diabetes, endocrinology, gastroenterology and hepatology, respiratory medicine and
rheumatology, elderly care, nutrition, ethics etc.

There are also dedicated consultants in cardiology, dermatology, neurology, neurophysiology,

and genito-urinary medicine

Table 1 below shows the current distribution of clinics between the consultants:
2.6. The Division of Medicine and Medical Specialties

Both in-patient and out-patient services are based at the Luton and Dunstable Hospital.
Currently just over 140 beds allocated for use by General Medicine and related specialties. In
addition, there is a newly refurbished Coronary Care Unit with 5 high dependency and 8
additional cardiac monitoring beds. There is a 7-bedded Intensive Care Unit and 5-bedded
High Dependency Unit.

There is a satellite renal dialysis unit at the Hospital. The base for this service is the sub-
regional unit at the Lister Hospital in Stevenage. This development has facilitated renal out-
patient services at Luton.

There are well-established services in Cardiology, Diabetes, Gastroenterology, Endocrinology,

Respiratory Medicine, Rheumatology, Neurology, Neurophysiology, Dermatology, and
Genito-Urinary Medicine.

2.7. Consultant Staff

The other consultants in the Division are:

Dr Didi, (Clincial Firector) Elderly Medicine

Dr Wijayasiri, Elderly Medicine
Dr Chanda, Elderly Medicine, Orthogeriatric care
Dr A Subanandan, Elderly Medicine
Dr N Mohammad, Elderly Medicine (Locum)
Dr J Philippananthan, Elderly Medicine (Locum)

Dr S-C Soo, (Clinical Director) General Medicine and Diabetes

Dr M T A Rehman, General Medicine and Diabetes
Dr R Banerjee, General Medicine, Endocrinology and Diabetes
Dr A Naziat, Actute Medicine and Endocrinology and Diabetes
Dr KF Wong. General Medicine and Diabetes and Endocrinology

Dr A E Griffiths, (Clinical Director) General Medicine and Gastroenterology

Dr M W Johnson, General Medicine and Gastroenterology
Dr S Sen, General Medicine and Hepatology/Gastroenterology
Dr P Khanna, General Medicine and Gastroenterology
Dr R Gao, General Medicine and Gastroenterology
Dr E Tash, General Medicine and Gastroenterology
Dr S Shieh, General Medicine and Gastroenterology
Dr K Bundhoo, General Medicine and Gastroenterology

Dr D Fishman, (Clinical Director) General Medicine and Rheumatology

Dr R Balaji, General Medicine and Rheumatology
Dr M Nisar, General Medicine and Rheumatology
Dr V Quick, Rheumatology
Dr T Baqai, Rheumatology
Dr M Chan, General Medicine and Rheumatology

Dr J R Ramsay, (Medical Director) General and Respiratory Medicine

Dr P Kantha Pillai, (Clinical Director) General and Respiratory Medicine
Dr S Tariq, General and Respiratory Medicine
Dr T Chapman, (Clinical Director, Acute Medicine) Respiratory Medicine
Dr N Ramsundar, General Medicine and Respiratory Medicine
Dr I Southern, General Medicine and Respiratory Medicine
Dr V Joshi, General Medicine and Respiratory Medicine
Dr J Gnanapragasam, General Medicine and Respiratory Medicine

Dr P Albert, Acute Internal Medicine

Dr K Thayaparan, Acute Internal Medicine
Dr S Seneviratne, Locum Acute Internal Medicine
Vacancy

Dr C M Travill, (Clinical Director) Cardiology

Dr N Marcus, Cardiology
Dr Al-Bustami, Cardiology
Dr G Kumar, Cardiology
Dr S Kohli, Cardiology

Dr P M Watts, (Clinical Director) Neurology

Dr A Cohen, Neurology
Dr A Batla, Neurology
Dr A Schrag, Neurology
Dr A Gale, Neurology
Dr L Parsons, Neurology
Dr C Tur, Neurology (Locum)

Dr B D De Silva, (Clinical Director) Dermatology

Dr C Vlachou, Dermatology
Dr M Ghazavi-Khorasgani, Dermatology
Dr H Recica, Dermatology (Locum)

Dr T Balachandran, (Clinical Director) Genito-Urinary Medicine

Dr M Kawsar, Genito-Urinary Medicine
Dr J Turner, Genito-Urinary Medicine
Dr H Colver, Genito-Urinary Medicine (Locum)

Mr D Kirby (Deputy Medical Director), Emergency Medicine

Ms C Farrow, (Clinical Director) Emergency Medicine
Mr S Dhinakharan, Emergency Medicine
Ms M Hemavathi, Emergency Medicine
Mr A Tarique, Emergency Medicine
Dr G Kamaras, Emergency Medicine
Dr D Burns, Emergency Medicine
Dr M Viegas, Emergency Medicine (Locum)
Dr C Whitehouse, Locum Consultant in Emergency Medicine (Locum)

2.8. Junior Medical Staff in Medicine

9 x W/T Specialist Registrars

5 x FY2
5 x CMT (Core Medical Training)
1 x GPVTS
1 x WT Clinical Fellow (SHO equivalent)
10 x FY1

There are separate junior staff at all grades to cover the Department of Medicine for the Elderly
(DME), where there are 5 consultant physicians. Many posts rotate already, but full integration
of all junior staff in Medicine and DME is planned in the coming year.
3. THE POST – SPECIALTY DOCTOR

3.1. Duties and Responsibilities;

Whilst in the directorate of stroke medicine, the Specialty Doctor will:

3.1.1. be required to provide a middle grade level of staff for the department
3.1.2. So far as is consistent with the proper discharge of the above duties, undertake to
deputise from time to time for absence colleagues.
3.1.3. undertake, exceptionally, to perform additional duties in occasional emergency and
unforeseen circumstances.
3.1.4. The appointee will undertake, exceptionally, to be available for such irregular
commitments, outside normally rostered duties as are essential for patient care.
3.1.5. attend ward rounds both with the Consultants and with the Specialty Training Doctors
/ Foundation Year 2 doctors. The locum Specialty Doctor may be responsible for
unaccompanied ward rounds.
3.1.6. work under the supervision of and be responsible to his/her respective consultant, or
the on call consultant and, ultimately the Clinical Director for Stroke Medicine Dr L
Sekaran
3.1.7. In case of difficulties of any kind, the Locum Specialty Doctor will seek the advice of
the appropriate consultant. The Locum Specialty Doctor is not expected to
participate in any work beyond their level of expertise.
3.1.8. The time-table will be reviewed by the Clinical Director as part of the annual appraisal
process.

3.2. Provisional Timetable (Subject to change)

Morning Lunch Afternoon

Monday Stroke/TIA Medical Division Consultant Ward Round
teaching Meeting
Tuesday WR Grand Round Teaching, Journal Club
Wednesday TIA clinic Radiology Meeting Family Clinic (Patients and
Combined Cardiac pacing Relatives)
meeting Stroke thrombolysis
Thursday Consultant Ward Round Clinical admin
Governance/SSNAP
Friday Ward Round – Patient teaching Audit / research/stroke
Review MDT Tx oncall. thrombolysis

This post would have all the training elements of the current Specialty Registrar programme.
The postholder would be encouraged to participate in audits / research with allocated time in
their time table. He/She would have access to all our Library facilities, and be encouraged to
attend the Regional Specialist Registrar Programme Teaching Sessions. He / she would be
entitled to study leave as prescribed by the deanery. He/She would have an allocated
Educational Supervisor for all e portfolio activities.

3.3. Qualifications / Experience required for Appointment

Basic medical degree recognised by the GMC. Appointees will hold MRCP and must have
completed 24 months as an SHO (or equivalent) in Medicine or Medicine for the Elderly.

You are required to comply with the standards set by the General Medical/Dental Council. A
breach of such standards may lead to action by the Trust independent of any action taken by
the GMC/GDC. Any breach would be investigated fairly and appropriate steps taken to
prevent a recurrence and address any wider causes.
3.4. Private Patient Facility – Cobham Clinic

The Cobham Clinic is a thirteen-bedded Private Patient facility on the first floor of the surgical
block. Two fully equipped consulting rooms are also available for out-patient consultations.

Junior medical and dental staffs are not required to treat private patients in the Cobham Clinic
unless by explicit individual arrangement by the Consultant in charge of the patient and with the
agreement of the junior doctor concerned.

The only exception to the above is in the case of a "Cardiac Arrest" when junior medical staff in
Medicine and Anaesthetics will be expected to attend any patients in the hospital, including the
Cobham Clinic.

Amenity patients in the Cobham Clinic are NHS patients and junior doctors are expected to
attend to these patients

4. VISITING ARRANGEMENTS
Further information about the post is available by contacting Dr L Sekaran on 01582 497130.
Informal visits will be welcomed following shortlisting.

5. MAIN CONDITIONS OF SERVICE

5.1. The appointment will be subject to the Terms and Conditions of Service for Hospital
Medical and Dental Staff (England and Wales) and the General Council Conditions of
Service as amended from time to time by local agreements.

5.2. The appointment is on a whole-time basis. A candidate who is unable for personal
reasons to work full-time will be eligible to be considered for this post. The ability to
work part-time only should be indicated when applying and, if such a person is
appointed, modification of the job plan will be discussed and agreed between yourself
and the clinical director/general manager.

5.3. All Specialty Doctors are expected to provide cover for colleagues for leave and other
authorised absences from duty upon a mutually agreed basis.

5.4. Arrangements for annual leave: This is arranged by mutual agreement of consultant
colleagues and approval of the Clinical Director, in accordance with standard
Trust/NHS regulations. It is essential that as a minimum six weeks notice is given to
allow for proper planning and prevent cancellations of patients’ appointments/surgery.

5.5. All Specialty Doctors have a continuing responsibility for the care of patients in their
charge, to assist with the proper functioning of their department, and are required to
undertake the administrative duties associated with that responsibility.

5.6. The successful candidate will be required to reside within reasonable travelling time
of the Luton & Dunstable University Hospital NHS Foundation Trust.
5.7. The Trust requires the appointee to have and maintain full registration with the
General Medical Council. Medical and Dental Staff are advised to continue to be
members of one of the medical defence organisations.

5.8. The present salary scale is £37,923 - £70,718 per annum, plus an on call availability
supplement if appropriate. The successful candidate will commence on the minimum
of the scale unless advised differently during the appointment process.

5.9. This post is exempt from the provisions of Section 4 (2) of the Rehabilitation of
Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974
(Exemptions) Order 1975. Applications are, therefore, not entitled to withhold
information about convictions which, for other purposes, are “spent” under the
provisions of the Act and, in the event of employment, any failure to disclose such
convictions could result in dismissal or disciplinary action by The Luton & Dunstable
University Hospital NHS Foundation Trust. Any information given will be completely
confidential and will be considered only in relation to an application for positions to
which the Order applies.

5.10. Health Questionnaire – Prior to taking up appointment, the successful candidate will
be required to pass a Health Assessment from the Occupational Health Department
and provide evidence of Hepatitis B status from a United Kingdom Trust or Public
Health Service Laboratory.

5.11. The Trust is committed to carefully screen all applicants who will work with children
and vulnerable people and the successful applicant will therefore be required to
obtain a Disclosure & Barring Service Check (Police Check). Further information can
be obtained from the Medical Workforce Department.

General Notes

5.12. Changes to job description

The duties outlined above are subject to changes, after consultation with post holder, which
meet the needs of the service as a result of the full implementation of the Trust Plans.

5.13. Information technology

Employees of The Luton & Dunstable University Hospital NHS Foundation Trust are
expected to develop the IT skills necessary to support the tasks included in their post. They
will, therefore be required to undertake any necessary training to support this.

5.14. Health and safety

The post holder is required to conform to The Luton & Dunstable University Hospital NHS
Foundation Trust Policies on Health and Safety and Fire Prevention, and to attend related
training sessions as required.

5.15. Major incidents

As the Trust is a receiving hospital for major incident casualties, the post holder is required to
conform to The Luton & Dunstable University Hospital NHS Foundation Trust Policy on Major
Incidents and to attend related training sessions as required.
5.16. Confidentiality

In the course of their duties employees will have access to confidential material about
patients, members of staff and other Health Service business. On no account must
information relating to identifiable patients be divulged to anyone other than authorised
persons, for example, medical, nursing or other professional staff, as appropriate, who are
concerned directly with the care, diagnosis and/or treatment of the patient. If there is any
doubt whatsoever, as to the authority of a person or body asking for information of this
nature, advice must be sought from a superior officer. Similarly, no information of a personal
or confidential nature concerning individual members of staff should be divulged to anyone
without the proper authority having first been given. Failure to observe these rules will be
regarded as serious misconduct, which could result in serious disciplinary action being taken
including dismissal.

5.17. Policies and procedures

The duties and responsibilities of the post will be undertaken in accordance with the policies,
procedures and practices of The Luton & Dunstable University Hospital NHS Foundation
Trust may amend from time to time.

5.18. Infection control

It is the personal responsibility of the post holder to adhere to The Luton & Dunstable
University Hospital NHS Foundation Trust’s policies and procedures outlined in the Infection
Control Manual and any other Infection Control policies, procedures and practices which may
be required from time to time. This is to help achieve the Trust’s objective of NO
AVOIDABLE INFECTIONS.

5.19. No smoking policy

In recognition of the Trust’s commitment to health promotion and its health and safety
responsibility, the Trust has a no smoking policy that prevents all staff from smoking whilst on
duty.

5.20. Equal opportunities

The Luton & Dunstable University Hospital NHS Foundation Trust’s duty is to ensure that no
existing or potential employees receive less favourable treatment on the grounds of sex,
sexual orientation, race, colour, nationality, ethnic origin, religion, marital status, age or
disability, or are disadvantaged by conditions or requirements that cannot be shown to be
justifiable. This also applies to patients – the Trust has a duty to ensure patients have the
right to equal access, care and treatment. All employees are expected to comply with this
policy.

5.21. Data quality

The information that you record as part of your duties at the Trust must be ‘fit for purpose’,
reliable and easily accessed by appropriate/authorised personnel. To achieve this standard
the information must be: accurate, legible (if hand written), recorded in a timely manner, kept
up-to-date, appropriately filed.
All staff must monitor and take responsibility for data quality throughout the areas of the
system used locally, all users maintain timely input, and ensuring that data is checked with
the patient, and staff (in relation to their staff record), whenever possible, and to support
initiatives to improve data quality.
Recorded information includes: patient information entered in case notes and entered on any
computerised care records system, financial information, health and safety information e.g.
incident reporting and investigation, personnel information recorded in personnel files etc.

Failure to adhere to these principles will be regarded as a performance issue and will result
in disciplinary action.

5.22. Freedom of Information Act 2000

As an employee of The Luton & Dunstable University Hospital NHS Foundation Trust, you
are required to recognise a request from the public for Trust information and treat the request
in accordance with the Trust’s Freedom of Information Act 2000 Policy & Procedures.

Failure to comply with this requirement could result in action being taken against the Trust by
the Information Commissioner (the overseeing body for the Freedom of Information Act
2000).
 LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
PERSON SPECIFICATION
POST: Specialty Doctor in Stroke Medicine – 10 sessions per week
BASE HOSPITAL: Luton and Dunstable University Hospital NHS Foundation Trust

ESSENTIAL DESIRABLE
Qualifications  MBBS or equivalent medical  MRCP
qualification.
 Full Registration with the GMC at time
of application.
Clinical  Minimum 4 years full-time (or  Higher grade experience.
Experience equivalent) post-graduate training (eg.  Evidence of acquired skills.
Successful completion of Foundation
Programme and 2 years of core or
speciality training in a relevant
speciality with evidence of associated
competencies.
 Good practical skills
 Experience in stroke thrombolysis
Management  Ability to organise and manage out-  Direct experience of audit.
and patient priorities.
Administrative
Experience
Teaching  Teaching undergraduate students and  Ability to teach clinical skills to
Experience junior doctors undergraduate and postgraduate
trainees.
Research  Have knowledge and understanding of  Understanding of the principles of
Experience research methods. applying research outcomes to clinical
problems.
 Participation in research projects.
Clinical  Able to demonstrate a broad
governance understanding of the principles and
elements of clinical governance.
Personal  Be able to communicate clearly and
Attributes effectively with patients, relatives,
nurses, GPs and other agencies
 Show a caring attitude to patients, staff
and colleagues
 Be able to work effectively in a team
 Committed to work within Trust policies
as guided by the Clinical Director
 Have a commitment to Continuing
Medical Education / Continuing
Professional Development
 Possess an enquiring and critical
approach to work
 Honest and reliable
 Be fit to carry out the duties of the post
 Live within reasonable travelling time of
Luton and Dunstable Hospital
April 2018