Employer Information

Royal United Hospitals Bath NHS Foundation Trust is a medium sized acute Trust and provides an extensive range of secondary services for the local population of approximately 450,000.

Psychiatry and GP Placements

Royal United Hospitals Bath NHS Foundation Trust will remain your employer during your psychiatry or GP placement.

Psychiatry placements are with Avon and Wiltshire Mental Health Partnership NHS Trust (AWP), a significant provider of specialist mental health services to adults and older people in: Bath and North East Somerset (BANES), Bristol, North Somerset, South Gloucestershire, Wiltshire and Swindon.

They provide specialist drug and alcohol services and specialist and secure mental health services including prison mental health services, to people living across a wider area.

Increasingly AWP provide treatment and care in people’s own homes and other community settings, reflecting the preferences of our service users. AWPs community services are supported by high quality inpatient services that provide short term assessment, treatment and care.

F2 Placement Descriptions

Information on the placements that make up the F1 rotations at Royal United Hospitals Bath NHS Foundation Trust. Click on the specialty to learn more.

  • F2 Acute internal medicine

    Placement F2 Acute internal medicine (MAU)
    Royal United Hospital
    The department

    Acute Medicine is a busy department, based around the Medical Assessment Unit and Short Stay Unit. The MAU is co-located with the Emergency Department with whom there is a close working relationship. The team is consultant-led with a variety of specialist interests represented including cardiology, endocrinology and respiratory medicine.

    The type of work to expect and learning opportunities

    The F2 trainees will be involved with the initial clerking of patients being assessed for possible admission, presenting these patients on ward rounds and the ongoing care of patients until discharge or transfer to another ward. They will also gain experience on the Medical Short Stay ward.

    Educational opportunities in this placement include:

    Take a history and examine a patientMake a diagnosis and formulate a management planPrescribe safelyKeep an accurate and relevant medical recordUse simple medical devices safelyCarry out clinical procedures under appropriate supervisionRecognise and manage acutely ill patientsTake part in resuscitation process and discuss DNAR decisionsManage time and clinical priorities effectivelyCommunicate effectively with patients, relatives and colleagues

    Use evidence, guidelines and audit to benefit patient care

    Where the placement is based

    Royal United Hospital Bath: MAU, MSS

    Clinical Supervisors for the placement

    Consultants in the department

    Main duties of the placement

    The F2 trainees are responsible for the initial assessment of patients referred to acute medicine, and their on-going care as directed following review by
    registrars or consultants. They will take part in post-take ward rounds and undertake tasks generated therein, and be responsible for patients within their
    ward areas. At night they will review and manage patients throughout the hospital on request, liaising with colleagues where appropriate. They are
    expected to attend the structured teaching programme provided by the departments. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

     

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Cardiology

    Placement F2 Cardiology
    Royal United Hospital
    The department The Cardiology department provides a full inpatient and outpatient service with full invasive and non-invasive provision, based around the CCU, cardiology
    ward, catheter labs, and outpatient department. Primary PCI is performed Mon-Fri 7am to 7pm.
    The type of work to expect and learning opportunities

    F2 trainees in cardiology are based on the CCU and cardiology ward, and are involved in the day to day care of all patients there.

    Educational opportunities in this placement include:

    Take a history and examine a patient Make a diagnosis and formulate a management plan Prescribe safely Keep an accurate and relevant medical record Use simple medical devices safely Recognize and manage acutely ill patients Take part in the resuscitation process and discuss DNAR decisions Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Discharge planning Educate patients

    Where the placement is based

    Royal United Hospital Bath: CCU and Cardiac ward.

    Clinical Supervisor(s) for the placement

    Consultants in the department

    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their ward, under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department as well as the weekly F2 teaching. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

    Thereis an opportunity to engage with the Cardiac Rehabilitation and Heart Failure Teams and to appreciate the challenges of managing some patients discharged
    into the community with advanced cardiac disease

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Emergency medicine

    Placement F2 Emergency medicine
    Royal United Hospital
    The department

    The Emergency Department (ED) is very busy and provides emergency care to a large catchment population of around 500,000 people in Bath and the surrounding towns and villages in North East Somerset and Western Wiltshire. There is a helipad outside which enables patients in the far to reach areas of Somerset and west Wiltshire to receive care in a timely fashion. The department is built around a majors area (18 beds), minors area (8 beds) a paediatric area (6 beds), highcare (6 beds), resus (4 beds) and an observation ward consisting of 8 beds.

    Consultants provide senior on site supervision 8am till 10.00pm 7 days a week. A consultant is always available for advice or to attend if necessary. Further on-site senior medical cover is provided 24hrs a day by the team of higher specialist trainees & specialty doctors not in training in Emergency Medicine.

    All junior training doctors will be fixed to a 16 week rolling rota which consists of day shifts :0800-1700, 0900-1900, 1200-2100, twilight shifts 1600-2400, 1700-0200, and night shifts 2100-0900, 2200-1000.

    There is also compulsory teaching on a Wednesday morning between 0800-1000. This is an extremely useful time for all junior doctors to learn from each other with interesting cases and an hour tutorial from a consultant and another from a senior registrar.

    The type of work to expect and learning opportunities
    • Take a history and examine a patient
    • Identify problems
    • Initiate time critical interventions and procedures
    • Devise effective management plans
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Act in a professional manner at all times
    • Cope with ethical and legal issues which occur during the management of patients with general medical problems
    • Educate patients effectively
    • Become life-long learners and teachers
    Where the placement is based Royal United Hospital Bath: Emergency Department, Observation Ward, RUH,Bath
    Clinical Supervisor(s) for the placement Consultants in the Department
    Main duties of the placement

    The F2 trainees are responsible for the acute assessment of patients presenting to the ED. Under the supervision of more experienced doctors they will initiate interventions, request and interpret diagnostic tests, formulate management plans, discharge home or transfer care to specialty in-patient teams, whilst keeping notes up to date.

    They are expected to attend the structured teaching programme provided by the department, and maintain a close professional relationship with their assigned clinical supervisor. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement Shift pattern of work. Rota details available on request.
    Community Facing Opportunities

    The ED is an essential interface for the health community between secondary and primary/community care. As such all of the trainees are constantly exposed to healthcare in the community, how it results in a hospital presentation and how it impacts on whether patients receive in-patient or community based care.

    The trainees are constantly required to have a dialogue with GPs and community services to ensure a high quality service and appropriate care for the patients. It is essential to develop a good working knowledge of services offered in the community and develop awareness of how care is delivered out of hospital.

    With the new Urgent Care Centre on-site, trainees now have the opportunity to experience the full capability of primary care, including the limits of acuity
    and case mix that community practitioners are able to manage.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Endocrinology and diabetes mellitus

    Placement F2 Endocrinology and diabetes mellitus
    Royal United Hospital
    The department

    The Diabetes and Endocrinology department provides a full service which is both ward based and within the Diabetes Centre. The Consultants are supported by 2 registrars, 2 SHO-grades, 2 F1 trainees and a number of nurse practitioners/specialist nurses. There are joint clinics with the vascular team and a number of general and specialist diabetic and endocrine clinics. The wards have mainly diabetic or general medical patients with a large variety of problems particularly renal medicine.

    The type of work to expect and learning opportunities

    F2 trainees in diabetes and endocrinology are involved in the day to day care of all patients on the ward as well as those in the linked outlying wards.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Recognise and manage acutely ill patients
    • Take part in resuscitation process and discuss DNAR decisions
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues, including general practitioners
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning with community partners
    • Educate patients
    Where the placement is based

    Royal United Hospital Bath, Diabetes and Endocrinology wards and Diabetes Centre

    Clinical Supervisor(s) for the placement

    Consultants in the department.

    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their ward, under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date. They are also involved in outpatient endocrine testing.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department as well as the weekly F2 teaching and F2 Regional Teaching Programme. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities
    • Multidisciplinary meeting with community partners
    • Liaising with GPs about patients
    • Sitting in outpatient clinics
    • Working with Diabetes Specialists Nurses

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Gastroenterology

    Placement F2 Gastroenterology
    Royal United Hospital
    The department The Gastroenterology department provides a full inpatient and outpatient service and, additionally, an endoscopy suite service. The department is accredited for
    bowel cancer screening. The ward has a high throughput of patients with a variety of gastroenterological and general medical problems.
    The type of work to expect and learning opportunities

    F2 trainees in gastroenterology are based on Haygarth ward, and are involved in the day to day care of all patients there, as well as those in the linked outlying wards.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan

    Prescribe safely

    Keep an accurate and relevant medical record

    Use simple medical devices safely

    Recognise and manage acutely ill patients

    Take part in resuscitation process and discuss DNAR decisions

    Manage time and clinical priorities effectively

    Communicate effectively with patients, relatives and colleagues

    Use evidence, guidelines and audit to benefit patient care

    Discharge planning

    Educate patients

    Where the placement is based Royal United Hospital Bath, Bath: Haygarth ward.
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their ward under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department, as well as the weekly F2 teaching and the F2 Regional Teaching Programme. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

    F2 trainees in gastroenterology will have the opportunity to:

    • Interact with community support services including the alcohol liaison team and mental health liaison team
    • Attend gastroenterology outpatient clinics
    • Participate in complex discharge planning in conjunction with the MDT

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 General practice

    Placement F2 General practice
    The type of work to expect and learning opportunities

     Educational opportunities include:

    • Taking a history and examining a patient
    • Making diagnoses, requesting appropriate investigations and formulating management plans
    • Recognising acutely unwell adults and children and when to refer to hospital
    • Deciding when it is appropriate to refer a patient on to another specialty
    • Prescribing safely and effectively, as well as considering costs of medications
    • Keeping accurate and relevant medical records within the computer system
    • Using simple medical devices safely
    • Managing time effectively
    • Communicating effectively with patients, relatives and colleagues
    • Using evidence, guidelines and audit to benefit patient care
    • Educating patients
    • Managing chronic disease in the community
    • Providing reassurance and supporting patients
    • Providing continuity of care for patients
    • Following patients up after discharge from hospital – changing medications, requesting investigations, reviewing them, as required.

    Where the placement is based

    Various GP surgeries

    Clinical Supervisor(s) for the placement

    Experienced GP trainers

    Main duties of the placement

    Initially there will be a full introduction to how the practice is run and sessions where you can sit in with GPs, nurses, therapists and other healthcare professionals who work from the practice.

    You will then progress to conducting your own surgery sessions – usually two a day, with the backing of a designated GP for each session. You are expected to conduct a full consultation with each patient and formulate a differential diagnosis and possible options for investigations and management. Anything you are unsure of should be discussed with the designated GP during the time the patient is at the surgery – if required - the GP can join you for a part of the consultation. You are expected to recognise the limitations of your knowledge and experience and to seek help when these occasions arise. Most referrals should also be discussed. Notes are all computerized and the records should be kept up-to-date, including performing opportunistic medication reviews when patients present.

    There are opportunities to observe and then be observed performing practical procedures e.g. cervical smears/immunisations/joint injections. These can then be done during your own surgery once you are confident.

    Home visits occur daily, after morning surgery has ended. These are basically a consultation in the patient’s own home, for those who are housebound or are in residential or nursing homes. Often the reason for the visit will be known in advance.

    Checking and signing repeat prescriptions, dictating referrals and checking these, as well as telephoning patients on the telephone appointments list, also occur between morning and afternoon surgeries.

    Typical working pattern in this placement

    Weekdays

    09.00 – 17.00: sitting in on GP surgeries/some nurse-led clinics and learning from consultation skills/individual cases, going out on home visits during lunch period - initially with the GPs but then alone, running own surgeries, with the backing of one of the practice GPs.

    No out of hours work is mandatory, but you can accompany a practice GP during their out of hours work if you wish to.

    Community Facing Opportunities

    As this is a community based placement, the F2 has lots of opportunities to interact with community services.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Genitourinary medicine (as part of GP rotation)

    Placement

    F2 Genitourinary medicine (as part of GP rotation)
    Royal United Hospital

    The department The Sexual Health & HIV Medicine department is situated at the RUH and delivers out-patient care through a combination of booked and walk-in clinics. In the event of in-patient admission of HIV patients, liaison and shared care with ward teams is expected.

    The service is consultant led and delivered through a multidisciplinary team approach. Trainee doctors form an integral part of this team.

    The type of work to expect and learning opportunities

    F2 trainees in GUM are based in primary care 3 days a week with 2 days spent in the Sexual Health & HIV Medicine clinic.

    The job is based at the RUH

    Educational opportunities in this placement include:

    • Take a history and examine a patient, with particular emphasis on sexual history and genital examination
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Educate patients
    Where the placement is based Royal United Hospital Bath
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    Duties as above, plus:

    Expected to attend weekly Medical Grand Round and on site generic F2 teaching.

    Responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement The trainee will spend two full days each week in the sexual health & HIV medicine clinic with a variety of booked and walk-in sessions allocated.
    Following completion of induction, he/she will see patients independently with senior support always readily available.
    Community Facing Opportunities As this is a community based placement, the F2 will have opportunities to interact with community based services as well as getting involved in Sexual Health and HIV Medicine clinics on a weekly basis.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 General psychiatry (Bath)

    • Placement
    F2 General psychiatry
    Hillview Lodge
    The department Hillview Lodge, which is on the Royal United Hospital site in Bath, is a ward which has 23 beds and accepts a mixture of adults and older adults with functional mental
    health problems. The case mix is in-patients with acute presentations including psychosis, affective disorders and personality disorders often with associated substance misuse, physical health problems and social difficulties.
    The type of work to expect and learning opportunities

    The F2 will work within the medical team covering the adults of working age and is supported by a core trainee, staff grade doctor and consultant. F2s support the day-to-day running of the ward including admissions, discharges, physical health care and referrals. There are weekly patient reviews and also the opportunity to observe Mental Health Act assessments and tribunals. The in-house teaching includes weekly journal clubs and an academic programme (guest speaker, case presentation & Balint group) along with weekly supervision by Ward consultant and the liaison team.

    There are opportunities for teaching, audit and management experience.

    • Educational opportunities in this placement include:
    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    Where the placement is based Royal United Hospital Bath, Bath: Hillview Lodge
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    The F2 trainee is responsible for assisting the core psychiatry trainee and the staff grade doctor with the medical management of patients on the wards and implementing psychiatric care plans laid out by consultants.

    They are expected to attend the structured teaching programme provided by the department, as well as the weekly F2 teaching.

    They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Assessment of Medically Ill Patients: Guidance for Foundation trainees.

    As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise.

    As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital. Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this.

    Typical working pattern in this placement TBC

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 General psychiatry (Devizes)

    Placement F2 General psychiatry
    Green Lane Hospital, Devizes
    The department

    Imber ward

    Imber ward is a 20 bed, acute psychiatric unit for Adults of Working Age of both sexes. The average stay of patients is less than 28 days, which reflects the very rapid throughput. Patients with varying psychiatric conditions are admitted for assessment and treatment. Three to Four ward reviews are held weekly.

    North Wiltshire Intensive Service

    The NWIS team is a general adult community team for working age adults previously known as the Crisis Home Treatment Team. The NWIS is a 24 hours service, gate-keeping beds and facilitating early discharge in daily liaison with the Inpatient Units. 

    This service provides: 

    • Intensive, home based interventions as an alternative to hospital admission
    • Admission into/timely discharge out of acute inpatient care
    • Emergency face to face assessments within four hours of accepting a referral
    • Urgent face to face assessments within seventy two hours of accepting a referral. 
     The type of work to expect and learning opportunities

     

    The placement is shared between Imber Ward and the Intensive Service, so two trainees will alternate between the two services. For example, week 1 with Imber Ward, week 2 with I.S. There will be opportunity to have individual or joint supervision with the two Consultants according to wish/need. The two Consultants provide reciprocal cover for each other and when one is away, the other will provide supervision to both trainees.

    The F2 trainees and the Core trainee will provide cover 9-5 for the ward between them. 

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients

    Support and Supervision:

    The F2 trainee will be supported by a small team of senior clinical staff including a full time consultant psychiatrist. There will be weekly one hour supervision sessions with the consultant.

    Trainees are expected to attend postgraduate meetings which take place every Wednesday, a.m. and p.m., at Green Lane Hospital and RUH, Bath, and to attend Foundation Training programme one session each week at RUH.

    To provide medical and psychiatric services to the NWIS team. 

    Educational opportunities in this placement include: 

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Assessment of psychiatric emergencies and risk assessment and management
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Management of acute psychiatric illness in the community
    • Experience of Mental health Act Assessments
    • Educate patients
    • Opportunity to gain experience with Primary Care Liaison service ( PCLS) 

    Support and Supervision:

    The F2 trainee will be supported by a full time consultant psychiatrist. There will be weekly one hour supervision sessions with the consultant. 

    Trainees are expected to attend postgraduate meetings which take place every Wednesday, a.m. and p.m., at Green Lane Hospital and RUH, Bath, and to attend Foundation Training programme one session each week at RUH.

    Where the placement is based

    Green Lane Hospital, Devizes

    Clinical Supervisor(s) for the placement

    Consultants in the department

    Main duties of the placement

    Responsibilities of F2 doctor:

    Admitting patients: to include taking a full psychiatric history, mental state examination, collateral information from other professionals and relatives involved in care; physical examination, performing necessary investigations and initiating treatment having discussed with nursing staff/seniors.
    Regular review of inpatients, usually before ward review
    Attendance at ward reviews and contemporaneous recording of discussion and care plans on RIO (electronic patient record).
    Preparation of admission/discharge summaries

    Assessment of Medically Ill Patients: Guidance for Foundation trainees.

    As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise.

    As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital.

    Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this.

     

    Responsibilities of F2 doctor:

    Assessment of patients under the supervision of the Consultant. Assessment will include taking a full psychiatric history, mental state examination, obtaining collateral information from other professionals and relatives involved in the patients care; Liaising with Primary care regarding physical health issues, performing and requesting necessary investigations and initiating treatment having discussed with the Consultant.
    The trainee will join the NWIS on daily assessments and management of service users in the community. The trainee will be expected to attend the daily handover meeting at 14.00 in the NWIS office.
    The trainee is encouraged to accompany the consultant on Mental health Act Assessments. The trainee would have the opportunity to join the Primary Liaison Team on their assessments.
    There is an opportunity to teach medical students as the supervisor is Undergraduate Tutor.
    Audit and research will be encouraged and supervised.

    Assessment of Medically Ill Patients: Guidance for Foundation trainees.

    As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise.

    As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital.

    Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this.

     

    Typical working pattern in this placement

    Weekdays
    09.00 – 17.00: ward rounds and associated jobs.

    On Call
    Weekdays: 09.00 – 17.00 - 1:7

    Weekends: 09.00 Sat – 09.00 Sun - 1:7

    Weekdays
    09.00 – 17.00:

    On Call
    Weekdays: 09.00 – 17.00 - 1:7

    Weekends: 09.00 Sat – 09.00 Sun - 1:7

    The Foundation Doctor will need to be able to drive to community visits and have their own car.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 General surgery

    Placement F2 General surgery
    Royal United Hospital
    The department The Surgical Directorate at RUH Bath is a busy surgical unit which cares for elective and urgent general surgical admissions. Sub-specialty interests
    include: colorectal; benign upper GI; breast and endocrine surgery
    The type of work to expect and learning opportunities

    F2 trainees in surgery are involved in the day to day care of the firm’s patients on the inpatient wards as well as the Day Surgery Unit and the Surgical Admissions Unit.

    We have tried hard to maintain a traditional ‘firm’ structure in the Directorate of Surgery in RUH, Bath. Each firm is led by two or three consultants with support from registrar, senior house officer and Foundation grades. We believe this remains the most supportive learning environment for junior doctors.

    Educational opportunities in this placement include:

    Take a history and examine a patient Make a diagnosis and formulate a management plan Prescribe safely Keep an accurate and relevant medical record Use simple medical devices safely Recognise and manage acutely ill patients Manage time and clinical priorities effectively Communicate effectively with patients, relatives and colleagues Use evidence, guidelines and audit to benefit patient care Discharge planning and summaries Educate patients Attend the operating theatre Generic and surgical teaching sessions

    Where the placement is based Royal United Hospital Bath
    Clinical Supervisor(s) for the placement Consultants in the department.
    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their wards, under the supervision of more experienced surgeons. You will take part in daily ward rounds, usually with others members of the team; assessing patients; requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours you will assess and manage problems in patients on the wards you are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    You are expected to attend the structured surgical teaching programme as well as the weekly F2 teaching and F2 Regional Teaching Programme. You will be responsible for other specific clinical duties as allocated by consultants including helping out in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

    There are opportunities to be involved in the team planning placement of post surgical patients in the community. This may require involvement with specialised teams such as stoma care, nutrition and wound care and their community counterparts.

    Whilst in surgery junior doctors will also have an opportunity to be involved with the ESAC clinic helping to manage semi emergency surgical conditions in the community.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Geriatric medicine

    Placement

    F2 Geriatric medicine
    Royal United Hospital

    The department

    The Care of the Elderly department is a dynamic needs-related service, based around 5 wards in the Older Persons Unit including an Acute Stroke Unite and the Hip Fracture Unit.

    A number of specialist clinics are provided such as movement disorder, falls, memory, and TIA clinics, as well as general clinics in and around Bath.

    The type of work to expect and learning opportunities

    F2 trainees in Care of the Elderly are based on one of the main wards and are involved in the day to day care of all patients there, as well as those in the linked outlying wards.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Recognise and manage acutely ill patients
    • Take part in resuscitation process and discuss DNAR decisions
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    Where the placement is based

    Royal United Hospital Bath, Bath: OPU, ACE Unit, HFU and ASU

    Clinical Supervisor(s) for the placement

    Consultants in the department

    Main duties of the placement

    The F2 doctors are responsible for the day to day care of patients on their ward and any ‘outliers’, under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department, as well as the weekly F2 teaching.

    They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

    F2 trainees will regularly liaise with the community teams to plan ongoing care and safe discharges from hospital.

    The geriatric consultants also perform regular ward rounds at local community hospitals. There is opportunity to attend these ward rounds on an ad hoc basis if ward staffing allows.

    A number of specialist clinics (movement disorders, falls and syncope) are held in community hospitals with extensive input from the community therapy and nursing teams. F2 trainees can arrange to attend these community clinics.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Obstetrics and gynaecology

    Placement F2 Obstetrics and gynaecology
    Royal United Hospital
    The department The O&G department provides a full inpatient and outpatient service, based around CDS (Central Delivery Suite), Mary Ward (Antenatal & postnatal), Day Assessment Unit, Charlotte Ward (Gynaecology) and clinics.
    The type of work to expect and learning opportunities

    F2 trainees in O&G are based in Princess Anne Wing and rotate around the different areas within O&G: Obstetrics, Gynaecology and emergency clinic.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Recognise and manage acutely ill patients
    • Take part in resuscitation process and discuss DNAR decisions
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    • Opportunity to attend specialist clinics in gynaecology in all subspecialized areas.
    Where the placement is based Royal United Hospital Bath, Bath: Princess Anne Wing
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    The F2 trainees are responsible for the patients on Charlotte ward, carrying out daily ward rounds, clerking gynae referrals in ED, reviewing post natal patients on Mary ward, seeing patients who attend CDS, assisting with elective and emergency C-sections, running EPAC (Early Pregnancy clinic) and GEAC

    (Gynae Emergency clinic). There will always be an on call registrar and on call consultant who will be available to help with any queries and will review patients if necessary.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities During the placement doctors have the opportunity to work in both gynaecological and antenatal clinics under consultant supervision. This provides experience in how to manage many problems which are often dealt with in the community. For example period-problems, female incontinence and HRT issues as well as routine
    AN care. Our department works closely with the community midwives and there are opportunities for trainees to visit any of the four midwifery-led units in our
    area. They can also gain experience in caring for women with drug, alcohol and social problems, teenage pregnancy and unwanted pregnancy.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Otolaryngology

    Placement

    F2 Otolaryngology (ENT)
    Royal United Hospital
    The department The ENT team cares for elective and emergency patients with a wide variety of ENT problems.
    The type of work to expect and learning opportunities

    F2 trainees are based in the ENT outpatient area and are involved in the day to day care of the firm’s patients on the Day Surgery Unit, the Surgical Admission Unit, Emergency Dept, Paediatric Unit and other wards.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely (drainage of quinsy, nose cautery)
    • Recognise and manage acutely ill patients
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    Where the placement is based

    Royal United Hospital Bath, Bath: ENT outpatient area

    Clinical Supervisor(s) for the placement

    Consultants in the department

    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their wards under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department as well as the weekly F2 teaching. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Placement Opportunities

    Whilst doing ENT F2's are closely involved in the discharge planning of patients. We run a mutli-disciplinary service in which head and neck specialist nurses, dieticians, speech and language therapists and head neck specialist nurses all contribute to patient journey once they leave hospital. The junior medical staff are an integral part of this team. In addition, the F2 doctors take part in our emergency clinic service which requires them to liaise closely with local GPs both before and after the patient encounter.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Paediatrics

    Placement F2 Paediatrics
    Royal United Hospital
    The department

    The Royal United Hospital in Bath is a busy district general hospital. The area serves a population of approximately 500,000 and has 5,500 births a year. The Children’s Centre comprises a purpose built outpatient department, pre-school assessment centre, and a 38 bed Paediatric ward including an acute assessment area, which takes all medical and surgical in-patient admissions. The neonatal unit, designated as a Local Neonatal Unit, has 21 cots and works as part of the Western Neonatal network with the smallest and most unwell babies being transferred to the lead centres by the network transport team. In summer 2011 we moved into a new purpose built neonatal unit. This is a unique sustainable building, which has won several awards. The department has established a neonatal nursing outreach service to support early discharge of small infants.

    General paediatrics is busy and varied. General paediatric outpatient clinics are provided both at the RUH and throughout the Bath clinical area. There is also an urgent outpatient service triaged by the consultant of the week. The paediatric department works closely with tertiary services, predominantly in Bristol and a number of specialist clinics are held in Bath including Paediatric cardiology, rheumatology, dermatology, oncology, nephrology, urology, cystic fibrosis, allergy, immunology, tuberous sclerosis and epilepsy. Community Child Health services are provided by Sirona Care and Health with whom the department has a close working relationship.

    All the consultants have an interest in research and a local research fund, the ‘Bath Unit for Research in Paediatrics’, has supported many projects. The Dyson Foundation has also funded research into the impact of the new NICU on parent, staff and environmental factors.

    The department works closely with Consultant Community paediatricians and staff from Sirona Care and Health Social Enterprise who are responsible for community paediatrics and social care locally.

    There are a number of visiting consultants from Bristol Children’s Hospital who do regular clinics.

    Middle Grade cover

    The middle grade cover is provided by eight posts. Individual posts may be occupied by two flexible trainees as a slot-share:

    SHOs/Foundation

    There are 9 ST1-3 posts, 4 are attached to GP vocational training schemes, the others are Paediatric specialty trainees, plus 2 F2 posts. Together these post-holders provide the first tier on call - All junior staff posts are recognised for training.

    The type of work to expect and learning opportunities

    Main duties are detailed as below. Senior support is always available. Seniors appreciate that you are used to ‘adult’ medicine and have little/no experience of paediatrics, and will therefore guide you with decision making, are always open to questions and will help whenever asked.

    Objectives are to gain enough experience to:

    • Take a history and examine a child
    • Identify medical and psychosocial problems
    • Prescribe safely in children
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Act in a professional manner at all times
    • Cope with ethical and legal issues which occur during the management of patients with paediatric medical problems
    • Educate patients effectively
    • Become life-long learners and teachers
    • Develop paediatric clinical skills such as cannulation, venipuncture, lumbar puncture and neonatal resuscitation

    There are twice weekly tutorials for the F2s/GPVTS/ST1-3s in “bleep free time". There is a weekly ST4-8 training afternoon. There are monthly X-ray and perinatal mortality meetings. Clinical governance and audit meetings are held every other month. Twice a year joint educational meetings are held with the Department of Paediatrics of the North Bristol Trust. There are monthly meetings with the Obstetricians and Radiologists. There is a monthly Grand round often presented by invited external speakers. There is an induction programme for all staff.

    Where the placement is based RUH Bath – Paediatric unit and NICU
    Clinical supervisors Consultants in the department
    Main duties

    Rota covers both Paediatrics and neonates.

    Paediatrics – main responsibilities:-

    Ward:-

    Consultant/registrar ward round and doing any jobs needed (bloods/TTAs/discharge summaries/organizing and chasing investigations)

    Acute admissions:-

    Clerk patient, formulate differential diagnosis and then normally have discussion/review with registrar, formulate a management plan and carry out any required investigations.

    Jaundice clinic:-

    Clerk babies referred from community with jaundice and arrange appropriate blood tests

    NICU – main responsibilities – covering NICU ward round jobs and deliveries, and reviewing any babies that the midwives have concerns about on Mary Ward.

    CDS bleep:-

    Attend deliveries and provide resus support if required. (Registrar will come to first few with you).

    Working pattern TBC
    Community Facing Opportunities One Gp post has a day a week of community placements. This post also covers the paediatric assessment unit 4 days a week, thereby freeing up the other STs and F2s to have days that they can use to attend clinics or community based placements such as days with health visitors, school nursing service, paediatric lifetime nursing service etc.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Respiratory medicine

    Placement F2 Respiratory medicine
    Royal United Hospital
    The department The Respiratory department provides a full inpatient and outpatient service, based around the respiratory ward and outpatient department. The ward has a high-care
    bay for NIV, there is a large lung cancer workload, and specialist interests include pulmonary hypertension, cystic fibrosis, and COPD.
    The type of work to expect and learning opportunities

    F2 trainees in respiratory are based on the respiratory ward, and are involved in the day to day care of all patients there, as well as those in the linked outlying wards.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Recognise and manage acutely ill patients
    • Take part in resuscitation process and discuss DNAR decisions
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    Where the placement is based Royal United Hospital Bath: respiratory ward.
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    The F2 trainees are responsible for the day to day care of patients on their ward, under the supervision of more experienced doctors. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend the structured teaching programme provided by the department, as well as the weekly F2 teaching and F2 Regional Teaching Programme.They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement TBC
    Community Facing Opportunities

    Many of the departments’ patients require chronic disease management and thus there are several community facing opportunities including

    • Liaising with the IMPACT team – a multidisciplinary community based COPD intermediate care team that inreach and expedite discharges
    • Weekly social MDT where all inpatients’ discharge arrangements are discussed in presence of social worker and therapists
    • Liaising with other community healthcare providers, including GPs, mental health liaison, palliative care, drug and alcohol liaison services etc.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Stroke Medicine

  • F2 Trauma and orthopaedic surgery

    Placement F2 Trauma and orthopaedic surgery
    Royal United Hospital
    The department The Trauma & Orthopaedics department is a busy unit which cares for a variety of elective and non-elective orthopaedic patients, and emergency trauma
    patients.
    The type of work to expect and learning opportunities

    F2 trainees in T+O are based mainly on Forrester Brown and Philip Yeoman wards, and are involved in the day to day care of the firm’s patients there. Occasionally patients are cared for on the Day Surgery Unit.

    Educational opportunities in this placement include:

    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Use simple medical devices safely
    • Recognise and manage acutely ill patients
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Discharge planning
    • Educate patients
    • Opportunity for theatre work/ basic surgical skills
    Where the placement is based Royal United Hospital Bath: Forrester Brown, Philip Yeoman wards
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    The F2 trainees are responsible for the day-to-day care of patients on their wards, under the supervision of more experienced doctors. This may include cross-cover for other orthopaedic teams if required. They will carry out ward rounds daily, usually with others members of the team, assessing patients, requesting and interpreting tests and keeping notes up to date.

    When on ‘cover’ duty out of hours they will assess and manage problems in patients on the wards they are covering at the request of nursing staff, liaising with more senior members of the team as necessary.

    They are expected to attend weekly F2 teaching and Regional Teaching Programme. They will be responsible for such other specific clinical duties as allocated by consultants including performing other duties in occasional emergencies and unforeseen circumstances.

    Typical working pattern in this placement

    TBC

    Community Facing Opportunities

    F2 trainees will attend the morning Trauma Meeting at which the admissions will be discussed including their social circumstances. This helps to guide early and effective discharge planning. Trauma patients often have complex needs at discharge, and the F2 trainees will work closely with other Health Professionals such as Physiotherapists and Occupational Therapist to ensure clear and timely communication between the hospital and the Community teams.

    It is important to note that this description is a typical example of your placement and may be subject to change.

  • F2 Urology

  • F2 Old Age Psychiatry

    The department North Wiltshire Intensive Service
    The type of work to expect and learning
    opportunities

    To provide medical and psychiatric services to the NWIS team.

    The NWIS team is a general adult community team for working age adults previously known to the Crisis Home Treatment Team. The NWIS is a 24 hours service, gate-keeping beds and facilitating early discharge in daily liaison with the Inpatient Units.

    • Educational opportunities in this placement include:
    • Take a history and examine a patient
    • Make a diagnosis and formulate a management plan
    • Assessment of psychiatric emergencies and risk assessment and management
    • Prescribe safely
    • Keep an accurate and relevant medical record
    • Manage time and clinical priorities effectively
    • Communicate effectively with patients, relatives and colleagues
    • Use evidence, guidelines and audit to benefit patient care
    • Management of acute psychiatric illness in the community
    • Experience of Mental Health Act Assessments
    • Opportunity to gain experience with Primary Care Liaison service (PCLS)
    • Support and Supervision

    The F2 trainee will be supported by a full time Consultant psychiatrist. There will be weekly one hour supervision sessions with the consultant.

    Trainees are expected to attend postgraduate meetings which take place every Wednesday, a.m. and p.m., at Green Lane Hospital and RUH, Bath, and to attend Foundation Training programme one session each week at RUH.

    Where the placement is based Royal United Hospital Bath, Bath, Green Lane Hospital Devizes
    Clinical Supervisor(s) for the placement Consultants in the department
    Main duties of the placement

    Responsibilities of F2 doctor:

    Assessment of patients under the Supervision of the Consultant. Assessment will include taking a full psychiatric history, mental state examination, obtaining collateral information from other professionals and relatives involved in the patients care; physical examination, performing necessary investigations and initiating treatment having discussed with a Consultant.

    The trainee will join NWIS on daily assessments and management of service users in the community. The trainee will be expected to attend the daily handover meeting at 14.00 in the NWIS office.

    The trainee is encouraged to accompany the consultant on Mental Health Act Assessments.

    The Trainee would have the opportunity to join the Primary Liaison Team on their assessments.

    There is an opportunity to teach medical students as the supervisor is an undergraduate tutor.

    Audit and research will be encouraged and supervised.

    Assessment of Medically Ill Patients: Guidance for Foundation trainees.

    As a Foundation doctor, you may be called on to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community. It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and you are not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support, catheterisation. In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice. In the event that a patient needs more immediate and complex physical assessment, it is advisable to discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise.

    As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call. It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital. Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this.

    Typical working pattern in this placement TBC