Dr David Nicholl
This is a replacement post which will initially be based primarily at City Hospital (from an administrative and outpatient perspective) and at Sandwell Hospital (from an in-patient perspective). However the Trust will be reconfiguring its services in preparation for MMH in 2022 and the post holder may therefore be required to work at any of the Trust’s sites as all members of the department currently work cross-site.
The Group of Medicine and Emergency Care at Sandwell and West Birmingham Hospitals NHS Trust is seeking to appoint a Consultant Neurologist, as a result of a key member of the consultant body being appointed to a post in another Trust. The Neurology Directorate is a key part of our Team- having successfully moved all neurology –inpatient services as part of a reconfiguration of Stroke and TIA services to Sandwell General Hospital in February 2013. Additional pressures in the Directorate include the need to implement new technologies and treatments in Neurology & Neurophysiology and work with colleagues to ensure compliance with Government targets in service delivery.
The post holder will also participate in team management of patients in the Neuroscience Unit at the Queen Elizabeth Hospital, as other SWBH Consultants do, where there is a weekly neuroscience meeting that all staff participate in.
Out-patient services are delivered both at City Hospital and Sandwell Hospital. In addition, the Trust will be reconfiguring its services in preparation for the opening of Midland Metropolitan Hospital (MMH) in October 2022. As such the post holder may therefore be required to work at any of the Trust’s sites.
The post will initially be based primarily at City Hospital. However the Trust will be reconfiguring its services in preparation for the implementation of the Right Care Right Here Programme and the postholder may therefore be required to work at any of the Trust’s sites. We keen to appoint a Consultant Neurologist with a sub-speciality interest. We are specifically interested in a neurologist with an interest in Headache or Epilepsy, but are open to any sub-specialty interest that will build on our existing department.
Facilities and Resources of the Neurology Department.
The Department of Neurology at SWBH NHS Trust has developed over the last 30 years to be a recognised Sub-Regional Centre in the West Midlands comprising:
- Three consultant neurologists: Prof CE Clarke, Dr DJ Nicholl, Dr A Sivaguru, and an Associate Specialist (Dr J Ismail)
- Two consultant neurophysiologists: Dr S Mytheen and Dr S Ahmed
- Three specialist registrars (2 neurology and 1 neurophysiology)
- Four clinical nurse specialists (Headache (x2), Epilepsy, Multiple Sclerosis). The Trust is recruited 2 a clinical nurse specialist within Epilepsy and a further Headache Specialist Nurse this year, and is looking to appoint a 2nd epilepsy nurse later this year as part of our continuing expansion.
The Neurological team supports outpatient activity at City Hospital, Sandwell General Hospital and community based clinics. In addition to running general neurology clinics specialist activities in the Department include:
- Movement disorders clinics
- Neuro-ophthalmology in collaboration with Consultant Neuro-Ophthalmology Consultant Team at Birmingham and Midland Eye Centre (Lidia Martinez-Alvarez)
- Headache Clinics
- MS Specialist Clinic
- Stroke and TIA service including thrombolysis
- Epilepsy Clinics
Example of a typical outpatient activity per week would be 25 new and 12 Followup with Registrar support, but we would expect outpatient activity to consistent with existent Association of British Neurologists’ guidelines.
In-patient care is provided at Sandwell Hospital and also at University Hospital NHS Foundation Trust.
The Department provides a daily in-patient consultation service across the SWBH Trust and provides in-patient care at Sandwell Hospital for patients with neurological disorders including younger strokes sharing a 21 bedded ward with the Acute Stroke Service. Ward work is supported by a ward based team of junior staff comprising 2 SpRs, and 1 CMT. Our work on acute neurology has been highlighted positively on Channel 4 news in 2017. The Trust is keen to build on existing Acute Neurology services with a ‘Neurologist of the Week’ model and is looking to expand the neurology service considerably as part of the build up to the opening of MMH. This appointment is but the first step as part of this process, which would require a minimum of 6 full-time Consultants
The Neurology team also admits patients to the Neuroscience Department at University Hospitals Birmingham NHS Foundation Trust (UHBFT) when complex management, neurosurgery or neuro-intensive care is required. These patients are managed collaboratively on a team basis.
This post will support the 24 hour on call stroke thrombolysis within SWBH NHS Trust and on call duties will therefore be provided to the SWBH Stroke Rota. (1:8 on call attracting Band A remuneration at 5%)
The Department has access to MRI scanners at City and Sandwell Hospitals including software for specialist sequences eg. DWI, GRE. Fast spiral CT is available at City and Sandwell hospitals and facilities for CT angiography and venography are routinely available. All neuro-imaging in the Trust can be image linked directly to the Regional Neuroscience Centre at UHBFT for immediate neuro-radiological and neurosurgical opinion.
The Neurophysiology Department provides a full range of investigations including EEG, Evoked Potential studies, Ambulatory EEG, EMG and single fibre EMG. Waiting times for investigations are short. The Department of Neurophysiology is a key provider of electrophysiological investigations to hospitals across the Region and provides excellent support for the neurology team at SWBH.
Carotid Doppler and Trans-cranial Doppler studies are routinely available in the SWBH Trust for the management of cerebrovascular disease especially in the sizeable sickle population treated in the SWBH Trust.
The Nuclear Medicine Department provide a full range of isotope neuro-imaging including HMPAO SPECT and DAT scanning.
Neurosurgical support is through the Neurosciences Unit at UHBFT where there are 11 neurosurgeons offering a comprehensive service across the full spectrum of neurosurgical practice.
Neuroscience meetings- there is a weekly clinical and scientific meeting held on Friday lunchtimes at the QE at UHBFT. There is a rolling program of Quality Improvement meetings held in protected time 6 times per year.
Research in the Neurology Unit- the Department is actively involved in Research particularly in the fields of Parkinson’s disease and Neuro-genetics of movement disorders, headache and stroke. Prof Clarke led on the PDMED trial (largest pragmatic trial in Parkinson’s disease), Dr Nicholl was a local PI on the IST3 stroke trial & is a PI on a Phase 3 study in Wilson’s disease. Our Headache Nurse project was featured as part of the RCP’s Future Hospital Programme for its innovative nature, and we have presented nationally to (amongst others) the All-Parliamentary Group on Primary Headache Disorders.
City Hospital is a teaching hospital of the University of Birmingham and the neurologists make a substantial contribution to undergraduate and postgraduate teaching. Prof Clarke and Dr Nicholl run the Birmingham Movement Disorders course. The Department is also involved in delivering training in stroke thrombolysis and has pioneered the training of physiotherapists in the delivery of botulinum toxin for spasticity management. The appointee will be expected to contribute to the teaching activities of the department.
Cross site working.
It is envisaged that the new post will involve some working across both hospital sites, in line with Trust policy. In addition, some flexibility will be required of the new appointee in the delivery of clinical sessions across both sites to enable the development of cross site subspecialty interests.
There is a strong and well developed Academic Department of Medicine of the University of Birmingham at City Hospital.
It is anticipated that the appointee would continue or develop an academic research programme in neurology. The department of Neurology has had an excellent record for clinical work, research and teaching and the appointee will be expected to contribute fully in all these areas and develop their own areas of special interest and help with the overall development of the unit.
The medical academics and the Division of Medicine have responsibilities for the organisation of teaching for the third, fourth and fifth year medical students from the University of Birmingham. The Head of Academy is Dr J Chilvers. The Trust has a strong and developing research portfolio.
Proposed Work Programme
The working week for a full-time consultant is comprised of 10 programmed activities (PAs) each of which has a nominal timetable value of 4 hours. Programmed activities that take place outside the hours of 7am and 7pm Monday and Friday or at weekends or on public holidays will have a timetable value of three hours rather than four.
A job plan and work schedule will set out agreed arrangements for how work is organised, where it is located, what in general terms the work comprises and when it is to be performed.
For this post direct clinical care (work relating directly to the prevention, diagnosis or treatment of illness) includes emergency work (including whilst on-call), outpatient activities, multi-disciplinary meetings about direct patient care, and administration directly related to the above. Supporting professional activities (that underpin direct clinical care), include participation in training, medical education, continuous professional development, formal teaching, audit, clinical management and local clinical governance activities.
Supporting Professional Activities are an essential part of the work of a doctor and the organisation is fully committed to supporting and paying for this work. Effective job planning will define the detail of what activities are to be delivered and how much time is to be given to undertaking these activities. A typical consultant is likely to require a minimum of 1.5 PAs for supporting professional activities to cover Continuous Professional Development (CPD) and General SPA (formal teaching activities outside clinical and education supervisory roles, participation in training, medical education, audit, research, annual appraisal and job planning leading to revalidation), local clinical governance activities, dealing with non-patient administration eg organisational communication and attendance, attendance at operational/staff meetings). Indeed all the neurologists in our department have >1.5SPA due to the significant training, education and research roles, given the high calibre candidates we are after- we would expect a colleague with a passion for similar roles.
As part of a consultant’s SPA allocation it would be expected that an agreed proportion of the SPA time, over and above the CPD and General SPA would be used under the direction of the clinical director for work related to quality, governance, education, pathway design or service improvement. SPA time will be given for those consultants who are undertaking work in specific areas of responsibility directly linked with the business of the organisation, examples include lead roles in clinical governance activities (audit/guidelines, service development, risk management, quality improvement, research), operational clinical management (rota management, committee work) and education and training roles (post graduate clinical tutor, college tutor, head of academy).
*The on call commitment for this post is currently 1 in 8. The oncall availability supplement is currently Category A and currently classed as medium Frequency with an oncall availability supplement of 5% currently payable (this would be paid as 1PA). Consideration of time off in lieu (for example for weekend working) will be taken or for an appropriate candidate a negotiation regarding reduction in other aspects of the weekly job plan to facilitate.
As this post is designed as part of the redesign of neurological services in this Trust, we will review the workload and job plan with the successful candidate after 3 months to ensure that the schedule above is mutually agreeable.
CONSULTANT OFFICE AND SECRETARIAL SUPPORT
There is office accommodation for all consultants using the agile working system (ie ‘hot desking’ in a modern open plan office) in co-location with secretarial services. There is secretarial support for this post (0.5 WTE).
Key Duties of the Post
- To collaborate and work to maintain Neurology services in line with strategic requirements.
- To provide, with the other Consultants in the specialty, routine and emergency Neurology services to the Trust, operating a system of mutual out-of-hours cover, and cover for annual, study and professional leave.
- To provide a consultation and advisory service to medical colleagues in other specialties in the Trust
- To develop a special interest to complement those of the existing Consultants in the department in accordance with the priorities of the Trust.
- To develop appropriate services and techniques required to fulfil clinical needs, within available resources.
- To take responsibility for the professional supervision and appraisal of junior medical staff, in conjunction with colleagues.
- To participate in the education and training of junior doctors, medical students, nurses, paramedics and general practitioners.
- To participate in the training and assessment of specialist registrars rotating through the department
- To liaise with medical staff in other specialties and participate in clinical meetings and postgraduate activities in the Trust.
- To maintain and develop good communications with general practitioners.
- To participate in research in accordance with priorities agreed within the Clinical Groups and the Trust within available resources.
- To contribute to the development of Neurology services, treatment guidelines and the promotion of greater knowledge of the management of Neurology conditions in primary care.
- To demonstrate a firm commitment to the principles of clinical governance, including:
- Developing and maintaining appropriate systems and practice to ensure effective clinical audit and Quality Improvement in Neurology.
- Attending and contributing to the Trust’s Clinical Governance Programme.
- Participating in the Trust’s Clinical Incident Reporting system.
- Developing a programme of personal continuing professional education and development, within available resources and within the workload and priorities of the service, as agreed with the Clinical Director and Group Director and in accordance with the Royal College requirements. The Trust will provide the necessary support for this.
The top tier of management for each clinical group consists of a Group Director, Director of Nursing and a Director of Operations. A Clinical Directorate structure is in place and each specialty has a Clinical Director. Sub-divisional management structures vary depending on the particular needs of the division. Named nursing, HR and finance specialists support the clinical groups management teams.
Neurology sits within Medicine & Emergency Care. The Group Director of Operations is Beth Hughes . The Clinical Director is Dr Chetan Sharma and the Neurology specialty Lead is Dr David Nicholl.
Visits to the Trust and informal enquiries are welcomed. Please contact:
Neurology Specialty Lead: Dr David Nicholl 0121 507 4588
Clinical Director: Dr Chetan Varma Tel 0121 507 5841 (secretary)
CRITERIA FOR SELECTION
- Entry on the Specialist Register in Neurology (or entry expected within 6 months from the date of interview)
- MRCP or equivalent qualification
- Higher Degree
- Clinical training and experience equivalent to that required for gaining CCT in Neurology
- Ability to take full and independent responsibility for the management of acute medical emergencies
- Ability to take full and independent responsibility for the care of patients
- Special interest that complements the existing consultants
Professional and Multi-disciplinary team working:
- Ability to work well with colleagues and within a team
Management and Administrative Experience:
- Ability to organise and prioritise workload effectively
- Ability to plan strategically and to exercise sound judgements when faced with conflicting pressures.
- Ability to motivate and develop the multi-disciplinary team, balancing departmental and personal objectives.
- Experience of conducting clinical audit
- Ability to use the evidence base and clinical audit to support decision-making
Teaching and Training experience:
- Ability to teach clinical skills to medical and nursing staff and other disciplines.
- The ability to appraise junior doctors and other staff.
- Formal training in teaching
Research, Innovation and Service Improvement Experience:
- Ability to apply research outcomes to clinical problems
- An awareness of current specialty developments, initiatives and issues.
- Knowledge and experience of the application of information technology to Neurology
- Publications in relevant peer-reviewed journals in the last five years.
- Evidence of having undertaken original research
- Energy and enthusiasm and the ability to work under pressure
- An enquiring and critical approach to work
- Caring attitude to patients
- Ability to communicate effectively with colleagues, patients, relatives, GPs, nurses, other staff and agencies.
- Commitment to Continuing Medical Education and Professional Development
- Full GMC Registration
- Appropriate Immigration Status (where appropriate)
- An understanding of the current NHS environment, particularly in relation to reforms, initiatives and issues.
- Residence within a reasonable distance of City Hospital
- Ability to undertake clinical commitments at any of the Trust’s sites.