Consultant in Mental Health Services for Older People
Services are commissioned by the Vale of York Clinical Commissioning Group. York and Selby is one of four geographical localities in Tees Esk and Wear Valleys NHS Trust which was awarded the contract to provide secondary care mental health services in York and Selby with effect from October 2015. Services in the locality are managed through four directorates; Mental Health Services for Older People (MHSOP), Adult Mental Health, Adults With Learning Disabilities and Child and Adolescent Mental Health Services.
MHSOP community services are delivered through two community teams (Northeast and Southwest). There is a Care Home and Dementia Team which works with care home residents and people with dementia who are in crisis in their own homes. Specific consultant memory clinics are managed separately from the generic community clinics, and all community consultants contribute to the memory clinic work. Within each team, community consultant psychiatrists for the elderly work with one of two multi-disciplinary older people’s cells (North, East, South or West). Inpatient care is the responsibility of three consultant psychiatrists who do not work with the community teams. The inpatient consultants all also work in the liaison psychiatry service for older people in York Hospital.
Local working arrangements
Job plans for consultants include 25% of time for supporting professional activities. This post consists of 7.5 clinical PAs and 2.5 PAs for supporting professional activities. See indicative timetable below for explanation of how the direct care component and supporting professional activities time for this post are configured in practice.
MHSOP community services in the York and Selby locality are provided by two community teams (North-East and South-West). Referrals to the service are accepted through the single point of access which triages the urgency of a referral, allocating referrals requiring a same-day response to the Crisis Assessment Service. Referrals requiring a less urgent response are passed to the MHSOP cell in the appropriate community team for allocation to a team member for assessment. Within the teams staff are organised in multi-disciplinary cells according to geography (in the North-East Hub there is a North cell and an East cell), overseen by band one band 7 team manager and one band 7 advanced nurse practitioner who work with both MHSOP cells in the NE team. The holder of this post will work for 6.5 clinical PAs with the MHSOP cell in the Eastern half of the North-East Hub.
The North-East Team base is at Huntington House in the North of York. Plans are in progress for a new hospital to provide from one purpose-built new facility the inpatient services which are currently delivered in a number of locations in York.
In common with all community services in the trust, the North Cell operates along Purposeful and Productive Community Service (PPCS) lines, based around daily short team meetings known as huddles.
The caseload for the whole of the NE team (both the North cell and the East cell) is currently 392. For the whole NE team (both the North cell and the East cell), between March 2018 and August 2018, the mean number of referrals of people over the age of 65 was 45 per month.
The holder of this post will work for 1 clinical PA in the memory service alongside three other community consultants who also work in the memory service. The total number of senior medical clinical PAs in the memory service is 8.5. One clinical PA in a job plan equates to one memory clinic each week. The Memory Services model involves a band five practitioner seeing new patients for an initial assessment, with consultant outpatient clinic appointments subsequently for diagnosis and initiation of drug treatment as appropriate. Appointments in consultant memory clinics last for 45 minutes. In one four-hour clinic session, three hours is allocated for patient appointments and one hour for admin tasks. Up to four patients can be seen in each clinic.
When patients have been assessed, given a diagnosis, established on treatment (if appropriate) and offered cognitive stimulation therapy they are discharged back to primary care for ongoing monitoring. The memory service does not therefore hold an ongoing caseload. Although in the past, memory clinic patients have been offered an appointment in the sector of the service where they live, in order to ensure that memory clinic waiting times across the locality are equitable, from the spring of 2018 memory service patients will be offered the next available appointment irrespective of the sector in which they live. The most recent activity data for the memory service shows that the mean number of referrals to the memory service in York and Selby over six months was 64 referrals per month.