The post-holders will be supported by a team of junior doctors (of training and non-training grades), advanced practitioners, nurses, therapists, and in reach of specialists across the hospital. Higher Specialty Trainees working toward Single specialty CCT and Senior Clinical Fellows working toward a CESR in GIM via our internal training programme will be attached to the department. Our aspiration is to provide a team able to meet the needs of complex, comorbid patients, that is patient centric in an environment that is rich with educational opportunities for the entire team resulting in a happy and valued team.
On both sites we have a dedicated Acute Medical Unit (20 beds at RSH and 17 on PRH) and SDEC (chairs & trolley spaces). RSH also has a 26 bed Medical Short Stay Ward (26 beds) with imminent plans to develop a Short stay ward on the PRH site (28 beds).
There are General Medical and Speciality wards on both sites with Cardiology and Stroke Medicine based at PRH and Gastroenterology based at RSH with speciality in reach on the other site. Respiratory medicine, Diabetes and Endocrinology and Care of the Elderly and Frailty are equally represented on both sites. The General Internal Medicine ward base is based on the RSH site.
Developing a Formal Department in General Internal Medicine
The medical needs of the population are changing. The increasing number of elderly patients as well as the growing number of co-morbidities has led to an increase in the number of patients admitted with complex general medical care needs who don’t fit easily into a single specialty.
The Joint Committee of Shropshire and Telford & Wrekin Clinical Commissioning Groups has approved plans for the NHS Future Fit. Funding has been approved to develop Acute and General Medical services and modernise facilities with RSH becoming a centre for Specialist Emergency Care and PRH becoming a dedicated Planned Care site.
The national response to this trend towards an ageing population with complex needs and obesity linked multi-pathology has been for training and services to regress from early specialisation and instead emphasise the importance of internal medicine being an integral part of a physician’s core role to manage the evolving patient needs.
In creating Internal Physicians, we would provide a more definitive structure for managing unselected medical inpatients beyond the timeframe of an Acute Medicine physician. This in turn would also release current Speciality Consultants providing base ward care in to delivering a mixture of In Reach, Same Day Emergency care and Outpatient clinics instead. Our model includes in house training to ensuring we focus on developing a more robust strategy for creating a strong future workforce.
We are therefore very excited to be developing a formal Department of General Internal Medicine to better care for this cohort of patients. At present we have one Consultant General Internal Physician supported by several competent locum consultants and aim to recruit substantively to build a thriving department. This is a very exciting time to join the team as Health Education England (HEE) funding has been secured for trainees in general internal medicine who will be training towards either their CCT or CESR in General Medicine (a three-year training programme).
Opportunity to increase community links with community in reach clinics and potentially symptom based triaging clinics. That link could include the support of virtual wards.
The Job Plan
- 7.5 Programmed Activities (PAs) of Direct Clinical Care - includes clinical activity, clinically related activity and predictable and unpredictable emergency work.
- 2.5 Supporting Professional Activities (SPAs) - includes CPD, audit, teaching and research.
The post comes with a 1 in 14 on-call commitment for acute unselected take for weekdays and weekend working. The on call 1/14 template includes:
- Monday to Thursday on call on site from 5 to 8pm with overnight off site on call and post take ward round form 8 until 9:30am.
- Friday onsite on call 5-8pm, off site on call overnight and post take ward round 9am-1pm
- Saturday am post take ward round 8am-12pm to support Friday post take
- Saturday-Monday on-call, on site Saturday 2-8pm, Sunday 8am-2pm and 5pm-8pm. This shift includes a day off in lieu nominally Tuesday.
The Acute Unselected Take is supported daytime by Acute Medical Team and the evening by an Acute medical Physician covering SDEC and supporting rest of the take.
Additional opportunities will be available according to individual interests. These may include undergraduate teaching, postgraduate teaching, in situ sim development, MRCP and PACES teaching, quality improvement and research. Including supporting the right candidate to progress with specialist registration should this be of interest.