The Elderly Care medicine team is a multi-disciplinary team of committed clinicians, specialist nurses and allied health professionals who work collaboratively to deliver high-quality care to our patients on both sites. The current workforce is broken down below.
Expand and Develop Elderly Care Medicine
Elderly care has 2 ward bases: 20 beds at Shrewsbury (Ward 28) and at Telford there is a 38 bedded Unit split between 2 consultants (Ward 10). The post-holders will be primarily based at the Telford site, to work with the existing consultant team delivering high quality care to older inpatients, however the expectation to cross cover at Shrewsbury to help deliver the service will be required if needed. The post holders will also look after medical outliers on Ward 4 (6 per day) and see ward referrals from other specialities (average 1-2 per day). There are close links to primary care and support from the discharge liaison teams to expediate patient discharge home or to other community facilities. There is an in-house mental health team (based on the RAID model) who support the units in caring for patients with delirium and dementia. The department is supported by junior doctors including Specialist Registrars, Internal Medicine Trainees, Foundation Doctors as well as Physicians Associates and ACP trainees. The post-holders will be expected to take on clinical supervision of a trainee once they are established in post.
The post-holders will have a weekly clinic in the speciality of their choice, but ideally in an area that requires development. The clinic depends on the ratio of new patients to follow ups. On average a new patient review is a 30-40 minute time slot, with 20 minutes for each follow up in a session with time to dictate correspondence (average patients seen 7-8)
Support Acute Frailty Services
There is a large ageing population in Shropshire and Telford and Wrekin which attend both acute hospital sites. The Trust and CCG are working together to address patients’ needs and develop a responsive service for older frail patients. The post-holder will be expected to be part of current services which deliver Comprehensive Geriatric Assessment in the Emergency Department and Acute Medical Unit. They will be expected to work closely with the teams in the ED and AMU to improve care for frail older patients. The post-holder will work with a team of therapists, ACPs, and the current training doctors in Elderly Care. They will be supported by therapies to deliver rapid assessment, treatment and as much as possible discharge to community services.
Developing the Virtual Ward
The Acute trust is working local partners to develop a virtual ward base in patient’s homes and care homes. Currently the Acute Frailty team has close links with community services and this will now be a formalised link for the consultant body to provide regular multidisciplinary meetings for selected patient groups
General Medical/On-Call Rota Duties
The general medical take is run through the Medical Admissions Units (AMU) at both hospitals and delivered with a split-weekday take by Acute Physicians and Speciality Physicians on the on-call rota. The present on-call is 1/16 with prospective cover. The Trust admits approximately 25,000 acute medical presentations distributed between both Hospitals. The Acute Physician teams are responsible for admissions, the AMU and Ambulatory Care between 9 am and 5 pm (Monday to Friday). On-call Physicians (Acute and/or Speciality) maintain an on-site presence until at least 8pm with on-call thereafter and extended on-site working at weekends (with subsequent compensatory rest period allotted). Gastroenterologists and Cardiologists operate separate speciality out of hour rotas. Nephrology provides a 24-hour telephone advice service.
The Trust operates a Speciality Ward System and patients requiring continuing care are allocated to wards from the AMU depending on their presentation. The general medicine out-of-hours work currently attracts an on-call availability supplement of 3% and 1.5 PA’s Direct Clinical Care (DCC) in the job plan. The number of patients admitted in 24 hours varies, but on average a post take ward round will be between 8 and 15 patients who need reviewing, if still in the Emergency Department or on outlying surgical wards. Patients on speciality medical wards and AMU are reviewed by the ward team that day. Hence morning commitments such as clinic are cancelled to allow for the Post take ward round.