Caroline Whitton is a Geriatrician working in NHS Greater Glasgow and Clyde currently based in the Victoria Infirmary, Glasgow which is soon to be subsumed into the South Glasgow University Hospital. She has several educational roles which include Foundation Programme Director, Consortium Lead for NHS Education Scotland and Associate Director of Medical Education for NHS Greater Glasgow and Clyde.
For me, the adventure began when I was asked to deputise for my Clinical Director at a meeting to discuss junior doctor staffing of a new admissions unit. The meeting was hosted by the medical directorate, and I was the lone geriatric voice amongst a cast of many. From that meeting began a process that has, for the time being, taken over my professional life! Do I regret my initial impulse to go along? No – because it initiated a journey which has enabled me to be involved with the design of a completely new service. It has made it possible for me to influence the way in which I provide care to my patients and deliver training to my junior colleagues.
The genesis of the South Glasgow University Hospital and Royal Hospital for Sick Children started many years ago. It has involved the birth of a brand new hospital, said to be the largest hospital in Europe, rising like a phoenix from the ashes of the old and dominating the skyline of Glasgow. Soon four busy hospitals will be subsumed into one. The adult hospital will have more than 1100 beds of which almost 200 will be acute Geriatric beds with a further almost 90 stroke beds. There will be an additional around 360 geriatric beds off site spread across 6 sites in the South and West of the City. 21 Consultants are coming together to provide this service and we will have around 55 junior doctors from FY 1 to ST 7 working with us.
Following that very first meeting many months ago it became clear that no-body was going to organise our service but ourselves and that we would have to negotiate for our junior doctor support.
We began by metaphorically ripping up everyone’s job plans and starting from scratch. This was a wonderfully liberating process which allowed a group of us to determine exactly what we felt we would need to provide a safe and effective service within a high quality training environment. Naturally we did not have absolute ‘carte blanche’ and were bounded by having to be ‘resource neutral’ in terms of provision of Consultant input. Indeed there was a small loss of resource across the city. However, within certain parameters, we were given the power to determine the shape of our service.
So a group of us, lead by a blond trio (I’m more ‘mousy’ than blond in all honesty but refer to my inner blond) set to work! The first step was to determine exactly the resource we would need, allocating units of time to all of the activities we would be undertaking – post receiving, ward rounds, clinics, SPA etc. The next step was to divide the total work amongst the group of Consultants, taking in to account current job plans and personal preferences. We had group meetings where as many of the Consultant body came along as possible while we presented progress, took on board ideas and progressed our design.
The junior doctor work occurred alongside this. It became clear that every service going into the new hospital would be competing for trainees. Additionally there were many calls for transfer of trainees across the city and to units out with Glasgow. In order for us to deliver optimum Geriatric care, adequate junior support would be essential. In this part of the world, historically we have never been overburdened with junior colleagues so it felt like an uphill struggle. I began to write papers which I sent to service leads, pointing out the ways in which we required junior doctors in order to function.
With my ‘education’ hat on I was determined that we would provide a high quality training environment in our shiny new department. I saw this as a wonderful opportunity to combine the two drivers to my professional life – providing high quality care and high quality education. I see Geriatric medicine as an enormously fertile ground for the provision of many areas of medical education. We have medically unstable and complex patients who require us to be thoughtful in terms of balancing multiple co-morbidities and combining many medications. There are often challenging ethical questions around capacity, end of life decisions and how far to take treatment and interventions. Our patients have communication difficulties and complex social concerns which include families who are not always of one mind. Perhaps more importantly I saw an opportunity to bring Geriatric medicine and it’s ethos of empowering our patients and patient-centred care to as many trainees as possible.
With these factors in mind I wrote a further paper which I sent to the Dean in Glasgow, to the TPDs for Foundation, GP training, Core Medical Training, Specialty Training, the Heads of the Scottish Foundation School and anyone else I could think of to show what we as a Department would offer to trainees of all grades. I talked to people (though ‘pestered’ and ‘badgered’ might be more accurate descriptions) and became quite evangelistic about the whole thing.
In the end, many meetings, countless discussions, a few frank exchanges of views and thousands of typed words later it seems to have paid off. Our Consultant service has been agreed and we have been promised the trainees we need to fulfil our vision. As a group of 20 odd Consultants we have remained amicable and there is a strong sense of a pioneer spirit as we head towards the brave new world. We are now counting down the days and weeks until we are one big happy family but the overwhelming majority of us are looking forward to this with positive feelings. Personally I think that is because we took ownership of the process. Additionally I think work went on behind the scenes from supportive colleagues who had a little more clout than I personally had. One can never underestimate the value of ‘powerful’ allies! There are certain to be challenges ahead (not least car parking) and it remains to be seen whether what we have designed will fulfil its purpose. But we think it will and are looking forward to it.
Image credit: petantik via Flickr