- SHO in Accident & Emergency (based at Raigmore Hospital)
- SHO in Department of Medicine for the Elderly
- Medical Senior House Officer
- Post Of SHO In Medicine (based at Belford Hospital, Fort William)
- Post Of Senior House Officer in Obstetrics and Gynaecology (based at Raigmore Hospital)
- SHO rotating through Ophthalmology / Otolaryngology / Dermatology / Oral Surgery (based at Raigmore Hospital)
- Post Of SHO In Psychiatry
- Post Of SHO In Paediatrics
SHO in Accident & Emergency (based at Raigmore Hospital)
There is one Consultant in Accident & Emergency Medicine, Ms Murphy, who is the Convenor. There are five Senior House Officers. One session a week is covered by both a local General Practitioner and a Doctor on the Retainer Scheme and three sessions by a Staff Grade practitioner. There is close liaison with all Departments in the hospital, with staff readily available, at all levels, for consultation.
All Senior House Officers will be required, as part of their contract to attend and participate in the Department's teaching programme, which will consist of the following:-
- a) for the first three weeks one hourly sessions from 8.00 am to 9.00 am each morning, Monday to Friday.
- b) one afternoon session each Tuesday as part of continuing medical education for Senior House Officers.
Only when Senior House Officers are on other authorised study leave or annual leave will they be excused from attending these sessions. During the teaching sessions appropriate cover is arranged to meet clinical requirements of the service.
Postholders are required to ensure that annual and study leave is not taken when they are on nights. Flexibility by all Senior House Officers on rota has enabled all annual and study leave requests to be met.
The opportunity exists for study and for attending out-patient clinics. A Soft Tissue Review Clinic and a hand Clinic are conducted each week, and the Casualty Officers are encouraged to attend these.
SHO in Department of Medicine for the Elderly
The Senior House Officer posts is primarily based at Raigmore Hospital, Invemess for 4 months where the acute assessment beds are located and two months rotation at the Royal Northern Infirmary where most of the rehabilitation beds are located along with some limited continuing care beds and a purpose built Day Hospital. This post is intending to provide excellent training and experience in modem aspects of Medicine of the Elderly (65+ years of age) and as a preparation for a career in Medicine for the Elderly, General Practice or General Medicine. The Postholders are always encouraged to take appropriate study leave and to prepare themselves for Diploma in Geriatric Medicine, MRCGP or MRCP examinations.
The Department has special interests in organising Parkinsonian patient care, elderly diabetic patients, orthogeriatric and stroke patients. The Postholder is expected to gain sufficient experience in acute assessment/rehabilitation, out-patient clinics, day hospital and specialised Parkinson's disease/elderly diabetic clinics. The Department holds formal teaching in medicine in old age and there are hospital wide weekly x-ray meetings, clinical meetings and tutorials with general medical senior house officers.
Due to reduction in junior doctors hours, the middle grade rota has now been reviewed and the Postholder is expected to work 1 in 5 on-call rota, with protective cover for study leave, attracting 32 class 3 Additional Duty Hours payments. This rota is based in rotation with general medical on-call teams. Their active group A comprise three medical Registrar's and four Senior House Officers (Department of acute General Medicine). Group B comprises of three Senior House Officers in the Department of Medicine for the Elderly and 2 General Practitioners vocational training Postholders. For our Department the Senior House Officer will work along with two GP vocational training Senior House Officers providing duties 1 in 5 to Ward 11 (which is Chest Unit), Ward 5A (acute assessment Geriatric Unit) and to the Royal Northern Infirmary beds primarily. Duties will be shared with the middle grades from both groups by mutual agreement particularly during the busy periods when acute receiving is unexpectedly heavy. However, the rota for Group B should allow reasonable expectation of eight hours rest.
Department Of Medicine For The Elderly - Medical Staffing
Two Consultants:
Dr P K Srivastava
Dr V P Sood
One Associate Specialist:
Dr M McKillop
Three Senior House Officers:
Six months duration
The three Senior House Officers work at two monthly intervals attached to each Consultant and 2 months at Royal Northern Infirmary.
The Royal Northern Infirmary has 52 beds rehabilitation, respite/shared care beds and 20 continuing care beds. A modem 24 place purpose built York Day Hospital is also located there. There is a full range of rehabilitative/paramedical facilities.
Teaching
Undergraduate teaching to medical students from Aberdeen University is also undertaken in the Department and at times the Senior House Officer is expected to take part in clinical teaching of undergraduates. Formal teaching weekly sessions are also undertaken in conjunction with the Department of Medicine. The Postholder overall gains a very good experience to undertake higher Diplomas/examinations.
This post is based at Raigmore Hospital, Inverness. The Medical Unit has 119 general beds, four CCU beds and has integrated with the 30-bedded Chest Medicine/Communicable Diseases Unit. The Medical and Chest Medicine/Communicable Diseases Units comprise of eight Consultants, two Staff Grades, one Visiting Registrar, three Career Registrars, four Senior House Officers, two Vocational Registrars and ten House Physicians. The teams are as follows:
Dr J A Burton General Medicine and Nephrology
Dr 1 J T Davies General Medicine and Postgraduate Education Dr D H Franklin General Medicine and Respiratory Medicine Dr G Hulks General Medicine and Respiratory Medicine Dr F Kerr General Medicine and Cardiology Dr R J MacFadyen General Medicine and Cardiology Dr S MacRury General Medicine and Diabetes/Endocrinology Dr L Potts General Medicine and Cardiology Dr M Steven General Medicine and Rheumatology Dr P Zentler-Munro General Medicine and Gastroenterology
The Care of the Elderly Unit also functions separately and has assessment beds at Raigmore and elsewhere.
The middle grade rotas were reviewed in February 1996 to ensure that there are two middle grade staff to cover receiving duties, one from each of the two groups. Group A comprises the three Career Grade Registrars and four Senior House Officers. Group B comprises the three Senior House Officers in the Department of Medicine for the Elderly, and the two GP Vocational Registrars. Group B works on a 1 in 5 on-call rota, without prospective cover, currently attracting 32 Class 3 Additional Duty Hours payments. It will cover wards 11, 7A and the Royal northern Infirmary beds primarily. Duties will be shared with the middle graders from Group A by mutual agreement. This will provide acute receiving experience for the Group B doctors. At busy periods (usually in the evening) both groups should assist with admissions. The rota for Group B should allow reasonable expectation of 8 hours' rest.
The department of medicine is currently undergoing reorganisation. The aim is to house the department on two floors, with the exception of the CCU beds, and to establish a 34 bedded receiving ward. There will, therefore be changes in current working patterns over the next few months, but these are not expected to affect the Senior House Officers in Group B.
Post Of SHO In Medicine (based at Belford Hospital, Fort William)
Hospital facilities at the Belford Hospital in Fort William serve mainly the district of Lochaber at the Communities NHS Trust. Although not densely populated this serves a wide geographical area. The population approximates to 22,000 but this number increases considerably during the summer months as the result of the tourist trade. This seasonal bias has equalised with the ski development that opened in the winter of 1989.
The bed complement of the hospital is:
| General Surgical | 28 beds |
| General Medical | 17 beds |
| GP Obstetric | 6 beds |
| Geriatric Assessment Unit | 23 beds |
The only other hospital in the district is a long-stay Geriatric Unit sited at Glencoe which provides a further 25 geriatric beds.
Staffing Establishment
The medical staff employed at the Belford Hospital is currently:
2 Consultant Surgeons 1 Senior House Officer in General Surgery 1 Pre-registration House Surgeon 2 Consultant Anaesthetists 2 Consultant Physicians with interests in Diabetes & Gastroenterology including Medicine in the Elderly 1 Clinical Assistant - Casualty Officer (4.5 sessions per week) 1 Senior House Officer - Medical 1 Pre-registration House Physician 1 Senior House Officer in Accident & Emergency 1 Clinical Assistant (general duties)
In addition, visiting Consultants from Raigmore Hospital, Inverness, which is the main hospital in the Highland area, hold out-patient clinics on a regular basis at the Belford Hospital in:
- Obstetrics and Gynaecology
- Orthopaedic Surgery
- Ear, Nose and Throat Surgery
- Ophthalmology
- Dermatology
- Psychiatry
- Chest Medicine
- Genito-urinary Medicine
- Rehabilitation
- Radiotherapy and Oncology
- Radiology
- Paediatrics
Facilities
The laboratory services to the Belford Hospital are provided from Inverness where the Regional Blood Transfusion Service is also located. However, there is provision in the Belford Hospital for analysis of emergency biochemistry and haematology, and there is a small blood bank. The hospital has its own Casualty Department with a higher turnover and 24 hours provision of services. It has its own X-ray Department, Physiotherapy Department and Occupational Therapy Department. Speech Therapy and Dietetic services are available.
A Postgraduate Centre operates within the hospital with regular meetings and teaching sessions. There are monthly GP meetings and the SHO is encouraged to take part in local GP Registrar Groups.
A self contained flat is available within the Belford Hospital for the Senior House Officer.
Workload
It is envisaged that the Senior House Officer will take part in the day-to-day management of the in-patients in the Medical Ward and the Assessment Unit. Because of the size of the hospital close supervision is available from the Consultants. There is no pre-selection of cases referred to the hospital and thus a wide range of clinical experience can be obtained in a relatively short period.
There is opportunity to take part in Medical outpatient clinics in General Medicine, Gastroenterology and Diabetes.
The Senior House Officer in Medicine is presently expected to take part in a 1 in 5 with prospective cover emergency on-call rota (76 hours) with the two House Officers. This would involve being in residence in the hospital every fifth night and covering referrals to the Casualty Department, emergency admissions to the Medical and Surgical wards and continuity of in-patient care.
Post Of Senior House Officer in Obstetrics and Gynaecology (based at Raigmore Hospital)
There are currently 57 Obstetric beds and 24 Gynaecology beds in a Maternity/Gynaecology Unit attached to the main hospital. Up to 12 beds are also available in a dedicated Day Case Unit.
The post to be filled is that of resident Senior House Officer in Obstetrics and Gynaecology. The Consultants at present are Dr M Hulse, Dr D A R Lees, Dr B Milne, Dr D J Herd and Dr Lucy Caird.
There is an establishment of ten other middle grade and junior medical staff. There are two Staff Grade doctors, two specialist Registrars, one Senior House Officer (Supervisory), and five Senior House Officers. Two of the Senior House Officer posts are part of the Highland Vocational Training Scheme for General Practice, the remaining three Senior House Officer posts are usually filled by medical officers who have organised their own personal vocational training programme for General Practice or alternatively those doctors wishing to embark upon a specialist career in Obstetrics & Gynaecology.
The working pattern is partial shift with 23 Additional Duty Hours attached to this post. There is an active departmental postgraduate educational programme in which Senior House Officers are expected to participate. It is also expected that Senior House Officers will undertake some form of audit activity during their period of employment.
During the six months in post there will be adequate opportunities for the appointed Senior House Officer to attend Obstetric and Gynaecological Out-Patient Clinics. Junior staff are also expected to attend monthly departmental audit meetings and other inter-disciplinary hospital postgraduate meetings. The Royal College of Obstetricians and Gynaecologists has recognised this post of postgraduate professional training.
The staffing of the various departments are currently:
| Department | Consultant | Associate Specialist | Registrar |
| Ophthalmology | 4 | 2 + 1 Staff Grade | 1 |
| Otolaryngology | 4 | 1 | 2 |
| Dermatology | 2 | 1 | - |
| Oncology | 2 | - | - |
| Oral Surgery | 1 | - | 1 SHO 3 |
There are currently five Senior House Officers who spend three months each in (1) Ophthalmology, (2) Otolaryngology, (3) Dermatology/Oral Surgery (4)) Oncology/Haematology. Postholders are expected to work as a team and be flexible in altering the rota to enable clinical needs to be met within the Terms and Conditions of Service and Junior Doctors' working hours agreements. The working pattern in these Departments is on-call and there are 31 Additional Duty Hours attached to these posts which will be remunerated at Class 3 rates. On-call cover and covering of leave will be shared by a 5th SHO working in Oncology/Haematology.
The Oncology unit will be located in Ward 1A (15 beds).The ward is shared with ENT and Oral Surgery. In addition, a further 3 beds will be on Ward 2C.
The Duties
Each Senior House Officer will primary be responsible for his/her own unit but close co-operation is expected between the Senior House Officers for acute problems on each other's unit if a colleague is absent, in theatre or at an Out-patient Clinic. The Senior House Officer on-call will be responsible for admission of waiting lists and emergency cases in the evenings and at the weekends for all departments.
The duties will consist of admission and general management of the patients in the respective units. Attendance at Out-patient Clinics and at operating sessions will be encouraged. Training in operative procedures, appropriate for Senior House Officer level can be provided in the Ophthalmology and Otolaryngology Departments. Most of the training in Dermatology will be provided in Out-patients. There are two Oral Surgery lists per week for which patients have to be clerked.
The duties of the SHO in Oncology / Haematology will consist of clerking and general management of the patients in the wards.This will include practical procedures such as drainage of pleural effusions, paracentises abdominus, lumbar punctures and other procedures as appropriate. Supervision and training will be given as appropriate. It is anticipated that administration of combination cytotoxic chemotherapy will be generally nurse based but the applicant should expect to administer intravenous combination cytotoxic chemotherapy on occasions. There is no occupational exposure to ionising radiation.
The senior house officer will also need to provide emergency cover for patients treated in the Radiotherapy department. Attendance at out-patient clinics is encouraged.
Cover at nights and weekends will be on a one in five rota covering ENT, Oral Surgery, Dermatology and Ophthalmology.
Training
The post is recognised for Vocational Training by the Royal College of General Practitioners, for the Fellow of the Royal College of Surgeons and also for the Diploma in Ophthalmology and Diploma in Otolaryngology. A number of initiatives have recently been actioned to improve the training content of these posts.
Craig Dunain Hospital, Inverness is the only hospital for psychiatric illness in the Highlands. It is due to be replaced by a new 84 bed Acute Unit and other facilities for adult psychiatric services by the year 2000.
The current medical establishment for Craig Dunain Hospital consists of:
Area Psychiatric Services
7.54 Consultants
1.00 Associate Specialists
0.50 Staff Grade
4.00 Specialist Registrars
6.00 SH0s
1.10 Clinical Assistants
Learning Disabilities
1.00 Consultant
1.00 Associate Specialist
1.18 Clinical Assistants
In addition one Consultant Psychiatrist is employed by Caithness and Sutherland NHS Trust and works closely with colleagues in the Highland Communities Trust.
There are also research staff attached on an honorary basis.
The Registrar in post will be attached to a Consultant whose training post is approved for general professional training in Psychiatry by the Royal College for Psychiatrists. These particular attachments are already recognised posts used for GP Vocational Training. From time to time because of service requirements it may be necessary to split posts and for the Registrar to be attached to two Consultants.
The post will provide experience in Acute Adult In-Patient Psychiatry and Out-Patient Psychiatry in Clinics and GP Surgeries and may include participation with multidisciplinary Community Mental Health Teams. In addition sessional experience will be available in specific specialised areas including Forensic Psychiatry, Learning Disabilities, Rehabilitation, Drug and Alcohol Dependency. These experiences will be arranged by release from the main attachment.
Teaching will include Case Conferences, Seminars, Journal Clubs and Tutorials as well as individual training with the Consultant. The Registrar will also be free to attend the organised training events for GP's at the North of Scotland Institute for Postgraduate Medical Education, Raigmore Hospital, Inverness.
The on-call rota for Psychiatry is 1 in 6 with prospective cover which equates to 28 ADHs Class 3.
This is a full time SHO post in Medical Paediatrics at Raigmore Hospital, Inverness.
Annual Workload of the Unit
Total annual births - 2800, approximately 2000 within Raigmore. 1500 admissions to 18 medical paediatric beds per annum - 90% emergencies. Day Cases and Ward Outpatients - approximately 80 per month. Admissions to the Special Care Baby Unit (SCBU) - 320 per annum. Out-patient attendance at Raigmore - 3000 per annum including approximately 1000 new cases.
The Post
The details of the post are as follows:
a) Partial shift rota
b) 64 hours per week, the rota to include prospective cover
c) Estimated average weekly hours worked - less than 56
d) Periods of annual and study leave are built into the rota
e) The postholder will take part on an equal basis with 3 other SH0s. An SHO working in Community Child Health will also take part in the rota. The duties of the post are at Raigmore Hospital, Inverness in the Children's Wards (with 44 beds in all including 18 medical beds) and a Special Care Baby Unit (with 20 cots in all including 4 Intensive Care spaces). The postholder will take part in routine ward rounds and in the management of waiting list and emergency admissions. Only in exceptional circumstances will the SHO be required to take part in Out-patient Clinic work. The SHO may be asked to see emergencies in the Accident & Emergency Department and to take part in the emergency transfer of patients to and from other hospitals.
Other Staff in the Unit
Dr G Farmer, Raigmore Hospital NHS Trust Whole Time
Dr J McDonald, Raigmore Hospital NHS Trust Whole Time
Dr S Barclay, Raigmore Hospital NHS Trust Whole Time
Non-Consultant
Part-time Staff Grade (22 hours per week)
2 Career Registrars - full time
3 x SH03s - full time
There are 5 SH0s in all - two six month posts involved in the Vocational Training Scheme, two one year appointments spending six months in Hospital Paediatrics and six months in Community Child Health and one six month hospital post.