The appointee will take part in the General Medicine on-call rota of one in eight however this will be in line with the development of the service provision according to the Medical Services Medical Model where the successful appointee may focus on respiratory medicine provision for the island of Jersey. During the on-call the consultant will cover all medical inpatients in the event of deterioration or medical emergencies. For weekday on-call a post take ward round is undertaken at 5pm, the following morning the on-call consultant is only required to post-take patients who are not on the Emergency Assessment Unit. During weekends and bank holidays the consultant will undertake post take ward rounds and discharge ward rounds in line the medical model at 8am & 5pm. Weekday on-calls operate 8am-8am the following day. Weekend on-calls operate from 8am on Friday to 8am Monday. The Respiratory Service The legacy of cheap tobacco in the past has resulted in a high incidence of smoking related illnesses. The South West Cancer Registry indicates that Jersey has an incidence of lung cancer 30% above the average for the U.K. There are an equivalently high number of patients with COPD. In 2019 Respiratory Medicine had 740 outpatient referrals and 49 bronchoscopy procedures were undertaken. The average weekly referrals to the respiratory service is as follows: 2019 = 17 per week 2020 = 14 per week 2021 to date = 15 per week Currently Respiratory Clinics typically consist of a portfolio of 8 to 10 patients, depending on the type of consultation required. Number of patients seen per bronchoscopy list is 3. The consultant establishment for Respiratory Medicine is as follows: Vacant, Consultant in Respiratory & General Medicine (2 posts) The Clinical Investigation Unit (Manager Andrew Norman, who is a Senior qualified Respiratory Physiologist) provides a comprehensive range of services for patients with respiratory illnesses incorporating: 1. Full lung function testing using body plethysmography 2. Sleep studies and provision of CPAP 3. LTOT and nebulizer services 4. A dedicated drop in Asthma clinic 5. Histamine/Methacholine challenge testing The respiratory services are supported by a comprehensive radiological department offering CT and MRI. One of the consultant radiologists, Dr Salman Zaman, have a special interest in respiratory disease offering expert opinion and biopsy services. The Radiology Department provides CT, MRI, ultrasound, mammography and general X-Ray services. An on call service is provided for CT, ultrasound and general x-ray. The Radiology Department has undergone extensive development and renovation in the last few years. A new GE PACS/HSS CRIS system (with access from home) went live in 2010. A new GE 750 Dual source 64 slice CT (inc CT Fluoro) was commissioned in October 2010. A Phillips 1.5T Intera MRI was commissioned in 2007. 4 new General rooms with either CR or DR were commissioned with the new PACS in 2010. There is a new Phillips screening/interventional suite with a C arm and remote control and a dedicated US machine for biopsy/drainage. We comply with the guidelines on ultrasound guided chest drain insertion and expect the successful candidate to continue this service. When the Consultant is not available, the Radiology department performs ultrasound of the chest to guide drain insertion. We have presented the successful introduction of this service at the National Emergency Medicine conference. There are 2 new Phillips IU22 Ultrasound machines (2009/10) in the main department. The department recently became ISAS accredited. Community outreach service supported by 1 full time and two part time respiratory specialist nurses who are providing care to patients with asthma/COPD. 1 T.B specialist nurse and 1 lung cancer nurse, continue to support patients in the community and support early discharge. The respiratory department works closely with the Consultant Microbiologist in the Management and Control of TB and HIV. Lung cancer surgery is performed in Southampton General Hospital. The Thoracic Surgeon, Dr Martin Chamberlain, visits four times each year. Surgery is provided to NSF guidelines. The hospital participated in the NLCA ( National lung cancer audit) and our performance ranks among the best performing centres nationally. PET-CT scans are performed at Southampton and we have an electronic link for sharing x-ray and CT images. Weekly lung cancer meetings are held are attended by the following: Consultant Radiologists (Salman Zaman), One Consultant Histopathologist Miklos Perenyi or Bruce Lyons), Consultant Respiratory Physician (this post), Acute Physician with specialist interest in respiratory medicine Dr Petra Schinle, Consultant Medical Oncologist (Mohammad Butt) Nicola Bailache Associate Specialist Palliative Care, MDT coordinator who helps organising the meeting and keep records. There are 3 Consultant General Histopathologists (as above) providing general histology and cytopathology, and there is full laboratory back up for immunohistochemistry. There is access to specialist referral centres for molecular and gene analysis of tumours. We have close links with Southampton to coordinate the management of interstial lung disease and severe Asthma, the successful applicant will have the opportunity to develop further tertiary links. The respiratory service is supported by the ambulatory care service located and supported by the acute medicine physicians delivering ultrasound guided pleural procedures including pleural aspirations, ambulatory drainage and pleurex drains. An Endoscopy unit is based at Jersey General Hospital consisting of two procedure rooms, the Respiratory Medicine service has dedicated bronchoscopy sessions within this unit. Respiratory Medicine has access to the Medical Day Unit providing day case treatments Monday Friday consisting of 5 treatment couches. The island has a dedicated chemotherapy unit with clinical oncologist & medical oncologist support on island. Palliative care facilities are provided by a charitably funded body called Jersey Hospice Care and operates from an independent facility called Clarkson House. Jersey Hospice Care provides in-patient beds for respite services both hospital discharges and in the community. An Associate Specialist in Palliative Care with nursing support has recently been appointed with responsibility and funding split between the Hospice and Hospital. The respiratory service in Jersey has a close links with Southampton to coordinate the manage interstitial lung disease.The Respiratory Service sits within the Medical Services Care Group which comprise the following range of services, a full structure chart of the care group can be found in the appendix: Ambulatory Emergency Care Cardiology Dermatology Diabetes Emergency Admissions Unit (EAU) Emergency Department Medical Day Case Unit Medical outpatients Medical Wards - Bartlett, Corbiere and Rozel Wards Neurology Oncology Haematology Palliative Medicine Rehabilitation Ward Plemont Ward (Interim Rehabilitation Unit) Renal Medicine Respiratory Rheumatology Pathology Sexual Health Medical Services Care Group Medicine in Jersey is fully age and specialty integrated. There are 3 medical wards, Bartlett, Rozel and Corbiere. A 5-bedded Enhanced Care Area is sited on EAU and there is a separate intensive care unit led by intensivists. There is also an Ambulatory Emergency Care Unit on EAU led by a SAS doctor with consultant support. There is a 16 bed Emergency Assessment Unit. Currently there are 11 consultants, 8 SAS doctors, 7 FY1 and 2 FY2 doctors who between them comprise 8 medical teams and the EAU team. 6 Clinical Fellows offer further support to the teams. SAS doctors are responsible for the day-to-day management of their patients on the wards with the help of clinical fellows, FY1 or FY2 doctor whom they closely supervise. On call, the SAS doctor is responsible for seeing patients referred by the Emergency Department and reviewing patients admitted to the EAU by GPs in conjunction with the EAU team. A core responsibility of the Division of Medicine is the provision of a safe acute medical service. The Division provides named Consultant supervision for non-Consultants at all times and ensures that prompt review and treatment is provided for acute medical emergencies referred by General Practitioners or the Emergency Department. The Consultants share on-call cover for the general medical take on a rolling 24hr rota, 8am-8am. Consultant-led post take ward rounds take place at 5pm and 8am. Being on an Island, the physicians need to be able to cover the full range of medical emergencies while on call. The Consultants share responsibility for ongoing management of patients admitted acutely to the wards. At present, Consultants have responsibilities for ongoing management of inpatients for a 4- week period of each 8-week rota cycle. Leave is by preference taken during the remaining 4 weeks with the remainder of the time allocated to an increased intensity of specialist elective work. Consultants are responsible for producing and updating guidelines for the management of acute medical emergencies in their specialist area.