Job description

Post

ST4-6 Training post in Forensic Psychiatry.

Base

Trevor Gibbens Unit, Maidstone

Trust

Kent and Medway NHS and Social Care Partnership Trust

Clinical and education supervisor

Dr Shahid Majid, Consultant Forensic Psychiatrist, Trevor Gibbens Unit, Maidstone, Kent ME16 9PL.

Introduction to the Kent Forensic Psychiatry Service

The Kent Forensic Psychiatry Service (KFPS) is part of the Forensic and Specialist Care Group at Kent and Medway NHS and Social Care Partnership Trust (KMPT).  KFPS provides the NHS forensic mental health service for the county of Kent and the unitary authority of Medway.  Kent and Medway has a population of approximately 1.7 million, which includes urban and variably populated rural areas.  Socio-economic status is also variable, with the most relatively deprived areas being the Medway towns, Thanet and Dover.  KFPS is based at the Trevor Gibbens Unit, the regional secure unit for Kent and Medway, at the Maidstone acute hospital site.  The Trevor Gibbens Unit provides an inpatient service with medium secure intensive care, acute, rehabilitation and step-down places for 62 patients, 47 men and 15 women.

KFPS accepts tertiary referrals from Kent and Medway.  Referrals come from courts, prisons, probation service, general adult and older adult psychiatry teams, secure units (including psychiatric intensive care units), and special hospitals.  The service provides clinical assessments and makes recommendations, particularly in the context of clinical risk assessment and management of individuals with a mental disorder, for inpatient or outpatient care and treatment.  The service admits patients to the Trevor Gibbens Unit and has an access assessment role for transferring patients to secure hospitals beyond Kent and Medway, for whom the service retains a monitoring role.  KMPT is a member of the Kent, Surrey, Sussex Provider Collaborative for Adult Secure Services, with eight other organisations providing forensic and secure care, which commenced in July 2018 and has the aim of improving care pathways for patients into secure care (or alternative provisions), within secure care (in terms of the quality of care and treatment provided) through to their timely discharge to appropriate aftercare from community provisions.  KFPS liaises with independent sector secure hospitals and high secure hospitals for patients from Kent and Medway, to ensure that an appropriate care pathway is followed for each individual.

The Trevor Gibbens Unit is the base for a Forensic Outreach and Liaison Service (FOLS) which became fully operational in April 2019 and which is commissioned to manage 92 outpatients.  FOLS provides expert management of patients in the community in Kent and Medway who have forensic ‘caseness’, the majority of whom are conditionally discharged restricted patients, 

individuals discharged from hospital who are subject to ‘life licence’, having been discharged by a mental health tribunal and released by the Parole Board and patients discharged from a secure service subject to a Community Treatment Order under section 17A of the amended Mental Health Act 1983 who present a risk to other people in relapse.

KFPS operates a commissioned Criminal Justice Liaison and Diversion Service (CJLDS), operating in police custody suites throughout Kent and Medway 12 hours a day, 365 days a year and also in the magistrates’ courts in Kent and Medway.

KFPS cooperates with Multi-Agency Public Protection Arrangements (MAPPA), responding to referrals from the Level 3 Multi-Agency Public Protection Panel (MAPPP).

KFPS has a 20 bed male low secure unit in Dartford, the Allington Centre, at the Little Brook Hospital site, which also has a male secure learning disability inpatient unit, Tarentfort Unit, and a step-down rehabilitation ward, Brookfield.

The Care Group also includes the Trust’s specialist services, but the post-holder will not be expected to provide any routine or emergency cover to these areas.

Prisons in Kent and Medway are served by a prison in-reach service from outside the Trust.  It provides a primary and secondary care mental health service to all adult prisoners and young offenders in Kent.  The prison in-reach service refers patients to KFPS for a forensic psychiatry opinion or admission to secure hospital provisions when commissioning responsibility lies with a Kent Clinical Commissioning Group (CCG).  Appropriate communication is maintained between KFPS and Kent and Medway prisons for the offender population.

The multi-disciplinary team at the Trevor Gibbens Unit

The Trevor Gibbens Unit has a full multi-disciplinary clinical team.  A general practitioner conducts  clinics within the unit.  The nursing team has approximately 40 trained staff and 50 nursing assistants and is actively recruiting.  Occupational therapists and other professionals form a therapeutic activities team which provides a comprehensive service to inpatients and a limited outpatient service.  A psychology team provides individual and group treatment for inpatients, particularly focusing on offending behaviour work and related issues.  A social work team has a dual inpatient and outpatient role.

There are five inpatient clinical teams at the Trevor Gibbens Unit.  Each is led by a responsible clinician who is a consultant forensic psychiatrist.  Consultants have multiple roles, including a geographical locality for liaising with counterparts in secondary care and providing representation in committees within the Unit, service, Trust, partner organisations and national initiatives.  One consultant is clinical director for the Kent Forensic Psychiatry Service.

All clinical teams have a secretary and full administrative support.

The Forensic Outreach and Liaison Service (FOLS) has three consultant forensic psychiatrists, for whom the FOLS component to their post is a part-time commitment as they have other responsibilities.  FOLS has a comprehensive multi-disciplinary clinical team and work closely with co-located social workers employed by the Local Authority.

Core components of the post

• Assessment and management of male inpatients of KFPS. This includes actively managing day to day concerns and crises, formulating care pathways and longer term management plans, performing risk assessments, chairing multidisciplinary team meetings including the weekly clinical team meeting and case conferences. The post also includes report writing for case conferences. The post holder will also prepare reports and give evidence in court and mental health review tribunals/managers hearings under the supervision of Dr Majid.
• Medico-legal work: Assessments for courts, Parole Board and Probation service, participating in multidisciplinary and multi-agency case conferences concerning mentally disordered offenders in prison, hospital and the community. This will involve cooperating with the Multi-Agency Public Protection Arrangements.
• Receiving referrals from and providing assessments for patients admitted to specialist secure psychiatric hospitals (low, medium and high secure).
• Assessing patients referred by secondary care mental health services for advice on risk assessment/management. The post holder will have the opportunity to carry out assessments in a wide variety of settings, including hostels, care homes and general psychiatric hospitals. These assessments are frequently conducted jointly with a colleague from an appropriate discipline and may involve interviews with the family and other professionals.
• Conducting assessments for prisoners, principally for the preparation of legal reports or admission assessments.
• Secretarial support and offices are available on the same site as the consultant offices and that of the team secretary, who will also provide secretarial support to the post holder. The post holder will have ready access to telephone and computer, with an individual email and Trust intranet/internet account.  Separate facilities are provided on site for clinical interviews with inpatients and outpatients.
• The post holder will be expected to participate in a 1 in 7 ‘second tier’ on-call rota for general and forensic psychiatry, acting in a senior role but with a nominated duty consultant providing cover, including acting responsible clinician cover.  Duties include providing advice, support and Mental Health Act assessment cover to Maidstone Hospital Accident and Emergency Department (assisting the liaison psychiatry service) and at Priority House, the local psychiatric hospital on the same site (which has a section 136 suite) and support to the junior psychiatric trainee who provides ‘first tier’ cover.  When on-call, the post holder should be available to attend in Maidstone within a reasonable time.  If they can demonstrate that this is the case, then it may be possible to be on-call from home, even beyond the standard 10 mile limit.
• Students in all disciplines and at various grades rotate through the Trevor Gibbens Unit, including GKT medical students whom ST4-6 doctors are encouraged to support and teach. The post also offers the opportunity to teach ST1-3 doctors, non-career grade doctors, other members of the multidisciplinary clinical team, police station staff and court staff on general psychiatric topics.  The post holder will also have the opportunity to teach general psychiatric trainees as part of the regular Tuesday morning academic programme at Maidstone Hospital Postgraduate Medical Centre and to participate in MRCPsych teaching.  The postgraduate centre has a medical library with a substantial mental health publication collection, together with Medline and Psychlit search facilities. 

Induction

At the beginning of the placement the post holder will take part in an induction programme if they have not worked at the Trust before.  They will be introduced to the workplace and informed of the requirements of the post, including the nature of the on-call commitment.  They will formulate, with the educational supervisor, an individual learning plan for the placement. 

They will be required to attend a specific induction for all new starters at The Trevor Gibbens Unit and a specific security induction for the unit prior to being allowed into the unit without an escort.

Supervision

Dr Majid will provide weekly clinical and educational supervision for this post, but the other consultants are also available to provide clinical supervision, and will generally do so for patients referred for risk assessment from their locality catchment area or where they have specific expertise.  When the post holder is on call, the Consultant on call will provide clinical supervision, the Consultant Forensic Psychiatrist on call for patients under the care of KFPS and the general adult consultant psychiatrist for other patients. 

When advice is sought, the name of the clinical supervisor and the advice given must be clearly documented in the patient’s clinical record.

Academic activities

Trainees are expected to attend the Forensic CPD programme which takes place one afternoon a month at the Trevor Gibbens Unit. The emphasis is on forensic topics and all trainees, speciality doctors and consultants attend. There is an active audit programme and potential for research and quality improvement projects.

Duties and opportunities

The duties of the post, performance criteria and the learning opportunities available are set out following the structure of the psychiatry specialty curriculum (as approved by PMETB, 2006) which in turn is based on the headings of the GMC’s Good Medical Practice.

Providing a good standard of practice and car

Undertake clinical assessment of patients with mental disorder within a forensic mental health context, according to the core components of the post described previously.

Attend once weekly clinical team meeting and take part in formulating treatment plans for approximately 13 inpatients within conditions of medium security.

Chair the Clinical Team Meeting with appropriate support and supervision.

Develop a working knowledge of the treatment needs of inpatients under the care of the inpatient clinical team.

Perform regular reviews of mental state.

Prepare case conference reports

Prepare under supervision mental health review tribunal/managers hearing reports

Provide evidence at Mental Heath Review Tribunal Meetings and to Crown Courts with appropriate supervision.

Prepare court reports under supervision.

Attend MAPPA meetings for inpatients and outpatients.

Conduct risk assessments and prepare court reports for patients in secondary care, the community, prisons or other KMPT arranged inpatient/residential services. Patients will be allocated at the weekly referrals meeting. 

There will be the opportunity to gain experience in other parts of the service which may include, the women’s service, acute admission ward, the rehabilitation and pre-discharge wards, participation in a number of therapeutic groups, as well as the FOLS service.

Maintain legible, contemporaneous and useful clinical records for all patients. 

Decisions about access to care

Use the outcomes of clinical assessments and structured tools to enable effective patient management.

Under the supervision of the clinical supervisor, coordinate multi-modal care and treatment for inpatients, and make recommendations for care and treatment for individuals assessed within the criminal justice system and for other mental health service providers.  Make referrals to other professionals as appropriate, following discussion with the clinical supervisor.

Treatment in emergencies

Within the duties of the post, emergency psychiatry is likely to be encountered most frequently within the intensive care areas of the unit and admission wards. The post holder will be expected to manage acute psychiatric emergencies on the wards which may range from the management of acutely suicidal patients to management of violence and will include assessment of patients with regards the use of rapid tranquilisation and seclusion and they will be expected to be up to date with regards trust policies in relation to these emergencies. They will also be expected to respond to medical emergencies. The post holder may supervise more junior medical staff with regards some of these duties.

The post holder is likely to encounter psychiatric emergencies when on call.  When on call, they provide senior medical cover to a basic specialist trainee performing assessments on patients presenting at Maidstone Hospital Accident and Emergency Department and Priority House, the local psychiatric hospital on the same site.  Advice from the on call consultant is readily available, from the consultant forensic psychiatrist for work undertaken at the Trevor Gibbens Unit and the consultant psychiatrist for work undertaken at Maidstone Hospital and Priority House.

Maintaining good medical practice

Maintain and use appropriate systems to update knowledge and apply this to aspects of professional practice.

During the placement, participate in relevant academic training and attend relevant courses consistent with recommendations and guidance from the Deanery.   Maintain an up to date learning portfolio to bring to meetings with the educational supervisor.  As a minimum, this will be at the beginning, mid-term and at the end of the placement. 

Attend mandatory training provided by the Trust and take appropriate study leave opportunities.

Apply the principles of philosophy and strategy which guides the Kent Forensic Psychiatry Service, and adhere to the principles of clinical governance, quality and excellence.

Maintaining performance

Participate in the workplace-based assessment programme of the Psychiatry Specialty Training Curriculum and use feedback from this process to inform critical self-awareness.  Discuss these assessments with the educational supervisor.

Participate in clinical audit under the direction of the educational supervisor.

Teaching and training, appraising and assessing

Participate in teaching within the local academic programme for ST1-3 doctors and the occasional teaching of medical students, help identify and obtain consent from suitable patients for the students to interview to develop their clinical skills, listen to clinical presentations and discuss the patients they have seen.

Appraise colleagues within accepted appraisal frameworks, including completing workplace-based assessments for ST1-3 doctors.

Provide teaching to the multidisciplinary team as appropriate.

Relationships with patients

Maintain a professional doctor-patient partnership.

Wherever possible, obtain informed consent from patients.  Observe rules on patient confidentiality at all times.  Share information appropriately with colleagues, under the guidance of the clinical supervisors.

Dealing with problems in professional practice

Bring any problems with the conduct or performance of a colleague to the attention of the educational supervisor or another consultant.

Cooperate fully with any complaints procedure or formal enquiry. 

Cooperate fully with any formal inquiry or inquest into a patient’s death.

Early in the placement, discuss the provisions of NHS indemnity insurance and any additional indemnity insurance, with the educational supervisor. 

Working with colleagues

Continuously promote value-based non-prejudicial practice.  Maintain a legal, ethical and fair approach towards working with colleagues and respect diversity.

Work effectively as a member and a leader of the multi-disciplinary team, communicate effectively and demonstrate appropriate leadership.

As a full member of the Kent Forensic Psychiatry Service multi-disciplinary clinical team, discuss the experience of working with other disciplines in meetings with the educational supervisor.

Appropriately assume, delegate and devolve responsibility.

Access advice, assistance and second opinions when delegating and making referrals.

As well as keeping clinical records, the post holder will discuss patients’ care and treatment with other members of the multi-disciplinary team within the Kent Forensic Psychiatry Service and outside.  They will provide written reports on patients to other professionals involved in patient care and for the Courts when preparing a medico-legal report.

Educational and clinical supervisors will provide guidance as to the level of responsibility to assume in individual clinical situations.  Obtain advice and assistance if unsure.

Maintaining probity

Ensure that reports, evidence and documents are complete, honest and accurate.  Record patient contacts on the Trust’s electronic patient record within 24 hours of the contact.  Generally, medico-legal reports should be provided within two weeks of the interview unless further information is needed, in which case the Court should be informed of this.  Outpatient letters should be sent within one week of the consultation.  For police custody liaison and diversion work, a brief summary should be available on the day of assessment. 

Unless instructed otherwise, reports for risk assessments and legal reports must be checked by one of the post holder’s clinical supervisors before being sent out.

Properly manage financial and commercial dealings.  Do not accept any gift from patients, or solicit any fee or payment from a patient or third party without agreement from the educational supervisor or one of the clinical supervisors.  Do not meet with any representatives of the pharmaceutical industry during work time, unless this is at a post-graduate meeting that has been organised within ABPI guidelines.

Avoid conflicts of interest and advise others on preventing and dealing with conflicts of interest.  Inform the educational supervisor of any real or potential conflict of interest. 

Maintain medical confidentiality under all circumstances unless there is an immediate need to override confidentiality in accordance with current guidance.  Any non-urgent overriding of clinical confidentiality should be discussed first with the educational supervisor or one of the clinical supervisors.

Health

Ensure that your health and the health of others do not put patients at risk.

Obtain advice and treatment for mental and physical health problems.  Comply with the Trust’s occupational health policy.

Dr Michael Kingham

Consultant Forensic Psychiatrist

Trainee timetable

This timetable is flexible according to service and trainee commitments

Trainee timetable

N/A	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Clinical team meeting	10am referrals meeting	Supervision	Special interest	External assessments
PM	Directorate meetings	Inpatient clinic	Case conference and inpatient reviews	Acadeic programme research. Special  interest	Inpatient management

Consultant timetable

Consultant timetable

N/A	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Clinical team meeting	10am referrals meeting	Supervision for trainees	External assessments	Admin
PM	Directorate meetings	Inpatient clinic	Case conference and inpatient reviews	External assessments	Inpatient reviews