Job description

Post

ST4-6 Training post in Forensic Psychiatry.

Base

Trevor Gibbens Unit, Maidstone. Inpatient male admission ward and sub acute ward.

Trust

Kent and Medway NHS and Social Care Partnership Trust

Clinical and education supervisor

Dr Sohail Tariq, Consultant Forensic Psychiatrist, Trevor Gibbens Unit, Maidstone, Kent ME16 9QQ

On call responsibility

1 in 6 for Maidstone General Adult and Forensic Rota

Introduction to the Kent Forensic Psychiatry Service

The Kent Forensic Psychiatry Service (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 1.6 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 medium secure unit for Kent and Medway, at the Maidstone acute hospital site.

KFPS accepts referrals 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.  Trainees are actively involved in the preparation of these reports under supervision.

KFPS liaises with private sector secure hospitals and high secure hospitals to monitor patients from Kent and Medway, in order to ensure that an appropriate care pathway is followed in each case, which may entail their admission to any of the Kent Forensic Psychiatry inpatient units, if necessary, and the involvement of local psychiatric services. 

KFPS has a community team within which there are three forensic community psychiatric nurses. They provide ongoing care and treatment to outpatients of the service. There are six social workers who have dual outpatient and inpatient roles. 

The community team has close relationships with the inpatient service at the Trevor Gibbens Unit and also community mental health teams.

The service has extensive links with courts, prisons, the probation service and Kent social services.  The Kent Forensic Psychiatry service currently provides a police custody  and liaison service in a variety of custody sites across Kent.

There is a service level agreement with the Kent Courts for the production of psychiatric reports both for Magistrates and at Crown Court level and trainees are actively involved in providing these reports under supervision.

There is close liaison with the prison inreach service in the Kent Prisons.

KFPS cooperates with Multi-Agency Public Protection Arrangements (MAPPA), responding to referrals from the Level 3 Multi-Agency Public Protection Panel (MAPPP).  A consultant forensic psychiatrist attends the Maidstone Level 3 MAPPP weekly in a consultative capacity. 

Inpatient Units

The Trevor Gibbens Unit provides an inpatient service with medium secure intensive care, acute, rehabilitation and pre-discharge beds for 65 patients, 49 men and 16 women.  In addition to medium secure beds on the Trevor Gibbens Unit site the service also provides a number of low secure beds.

There is a 20 bed low secure learning disability inpatient unit in Dartford - The Tarentfort Unit, which is staffed by a full multi-disciplinary team and led clinically by two consultant psychiatrists, one of whom is a consultant forensic psychiatrist. 

There is a 20 bed low secure forensic service – The Allington Centre based in Dartford which is staffed by a full multidisciplinary team and led clinically by two consultant psychiatrists, one of whom is a consultant forensic psychiatrist.

The service also jointly provides low secure beds on Saltwood Ward at Godden Green Hospital (in partnership with Cygnet Healthcare). The service is provided by two part- time consultant psychiatrists who are employed by KMPT.

The KFPS is part of The Forensic and Specialist Services Directorate which also includes a variety of subspecialist services such as the Trust’s addiction services and Mother and infant mental health services as well as Neuropsychiatry services, but the post holder will not be expected to provide any routine or emergency cover to these areas.

The Trevor Gibbens Unit

The Trevor Gibbens Unit has a full multidisciplinary clinical team. The unit also receives primary care input in the form of clinics held by general practitioners and input from a primary care nurse. In addition general practitioner input is available out of hours. The nursing team has over 110 members of staff (combined staff nurses and healthcare workers) and is actively recruiting.  Occupational therapists and other professionals form a therapeutic activities team and provide 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.

At the Trevor Gibbens Unit where the post holder will be based the male acute and sub-acute wards are made up of:

• Penshurst Intensive care unit (4 beds)
• Penshurst Ward – Admission ward (11 beds)
• Groombridge ward – Sub-acute ward (12 beds).

There is also a rehabilitation ward Emmetts Ward with 16 beds and a pre-discharge ward with 4 beds.

The female service consists of Walmer ward which has 12 beds and 4 pre-discharge beds.

The post holder will be working across the male acute and sub-acute wards.

Two consultant led multidisciplinary teams work across the male acute admission and sub-acute wards

The inpatient multidisciplinary teams consists of a consultant forensic psychiatrist, a clinical/counselling psychologist, a social worker and an occupational therapist.

Junior doctor support is provided by a Specialty Doctor who works across both teams, with additional support from a GP trainee post.

Professional relationships

The Trevor Gibbens Unit has six whole-time consultant forensic psychiatrists.  There are four higher specialist training posts in total.  There are two basic specialist trainee doctors and three non-career grade doctors working within the inpatients service.

The post holder will be expected to provide some supervision and teaching to the specialty doctor who works on the same team.

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 would also include report writing for case conferences and for the courts under supervision. The post holder will also prepare reports and give evidence in court and mental health review tribunals under the supervision of Dr Tariq.
• 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 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. This office is shared with another doctor on the unit and will be used solely for private study and administrative work.  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, and another office is also available for administrative work. 
• The post holder will be given the opportunity to participate in a 1 in 6 on call rota for general and forensic psychiatrists, acting in a senior role but with a nominated duty consultant providing cover. Duties include providing advice, support and Mental Health Act assessment cover to Maidstone Hospital Accident and Emergency Department and to the junior psychiatrist at Priority House, the local psychiatric hospital on the same site.  In addition, there may be occasional calls for emergency Mental Health Act assessments in the community or the police station in Maidstone.  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.  It should be noted that the frequency of call out is low at the time of writing.
• 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 have an NHS induction to formulate an individual learning plan for the placement.  A specific security induction will be offered before the doctor will be allowed on the unit without an escort.

Clinical supervision

Dr Tariq will provide clinical 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 for their locality.  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.

Clinical and Educational supervision

Dr Tariq is responsible for providing regular, once a week, educational and clinical supervision sessions.

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. In addition trainees are expected to attend the monthly forensic journal club which is chaired by a consultant forensic psychiatrist. There is an active audit programme and potential for research.

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.

1. Providing a good standard of practice and care

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 up to 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 up to 13 inpatients.

Perform regular reviews of mental state.

Prepare case conference reports.

Prepare under supervision mental health review tribunal reports.

Prepare court reports under supervision.

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

Attend MAPPP meetings for inpatients.

Conduct one new assessment a week.  Generally, this will be a patient who has been referred for a legal report or for a risk assessment by partners in secondary care, but may be from another clinical and/or forensic setting.  Patients will be allocated at the weekly referrals meeting.  Provide feedback to the meeting on the outcome of the assessment.

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

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

2. Decisions about access to care

Use the outcomes of clinical assessment 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.

3. 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.

4. Maintaining good medical practice

Maintain and use systems to update knowledge and its application 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.

5. 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.

6. 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.

Engage in KFPS’s approach to teaching police station and court staff on general psychiatric topics. 

7. 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.

8. 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 the NHS indemnity insurance and any additional indemnity insurance, with the educational supervisor. 

9. 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 multidisciplinary team, communicate effectively and demonstrate appropriate leadership.

As a full member of the Kent Forensic Psychiatry Service multidisciplinary 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 multidisciplinary team within the Kent Forensic Psychiatry Service and outside.  They will provide regular written reports on patients to general practitioners and other professionals involved in patient care and for the courts when preparing a 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.

10. Maintaining probity

Ensure that reports, evidence and documents are complete, honest and accurate and are produced in a timely fashion consistent with service guidelines.

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.

11. Health

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

Obtain advice and treatment for mental and physical health problems and ensure that their health does not put patients at risk. Comply with the Trust’s occupational health policy.

Trainee timetable

Trainee timetable

Monday	Tuesday	Wednesday	Thursday	Friday
Supervision	10am referrals meeting	External assessments	9.30am clinical team meeting (Ward round) Groombridge handover room	Academic programme/research/special interest
Directorate meetings	Case conference 2pm Inpatient reviews	Inpatient reviews	Essential assessments Forensic CPD (1in4) Journal club (1in4)	Academic programme/research/special interest

This timetable is flexible according to service and trainee commitments

Consultant timetable

Consultant timetable

Monday	Tuesday	Wednesday	Thursday	Friday
Supervision (ST4-6) Inpatient reviews	10am referrals meeting Clinical lead responsibilities	External assessments Level 3 MAPPPA attendance	9.30am clinical team meeting (Ward round) Groombridge handover room	Inpatient reviews/audit activity
Directorate meetings	Case conference 2pm Inpatient reviews	Inpatient reviews	Essential assessments Forensic CPD (1in4) Journal club (1in4)	CPD