Junior Leadership Fellow in Ambulatory and Acute Medicine

OUH offers this role as an Out of Programme opportunity for advanced training that is complementary to existing specialist curricula. The successful trainee would leave their specialist training programme for the duration of the role (1 year minimum). The post is full time with additional scheduled hours of work (on call banding). Clinical 80% of basic time will focus on delivering and leading clinical care that is ambulatory by default at the John Radcliffe and Horton Hospital sites. This will be based in the both the Ambulatory assessment unit and the Emergency Medical unit. Input will focus on extending the reach and application of contemporary ambulatory care, will complement the current senior- and middle-grade input to ambulatory services. The ambulatory team will also spend time with the medical on call teams to help progress ambulatory medicine in other parts of the hospital. The additional hours (beyond basic) commitment will focus on delivery of leadership in ambulatory care support peak periods. Typically, urgent care pathways see sustained surges in demand from lunchtime until late evening; Chief Registrar leadership of early, rapid assessment, treatment and pathway determination during this period will be a vital component in delivering better patient outcomes and ensuring that every appropriate patient is home by midnight. Service Transformation In aggregate, 20% of basic time will be allocated to supporting service transformation towards an ambulatory by default model: delivered in all assessment settings, 24-7, with exceptional patient-centred outcomes and inclusive use of innovative pathways that minimise use of traditional inpatient settings and optimise value. Delivering this will require close work with management teams, to initiate and develop projects including those identified by the Chief Registrars. All activities will embrace the Trusts vision of patient-centered service transformation and be aligned with the Future Hospital

Commissions recommendations for ambulatory care

with greater vertical and horizontal integration of acute services transcending traditional hospital-community and intra-hospital barriers. Such activities will complement Trust service improvement initiatives and will have patient safety and the delivery of high-quality, better safe, compassionate care at their core. Service Transformation (Generic) The postholder will support existing and new projects led by Chief Registrar colleagues and the broader team.

Example projects include

The development and embedding of comprehensive ambulatory care pathways for o common and less common discrete medical presentations o complex and/or frail patients, complementing existing services. o conditions with existing dedicated pathways but where further embedding, development or a complementary approach is needed to deliver best outcomes and resource use (e.g. DVT and TIA/minor stroke). Evaluating care through the development and embedding of relevant patient-centred outcome measures, and useful measures of whole pathway resource use Developing systems to support clinicians outside hospital (GPs, ambulance teams) to deliver effective care in the home. Introduction and evaluation of pragmatic telemedicine systems The AAU is embedded within the research and innovation infrastructure forming the Academic Health Sciences Centre (AHSC). Supervision and support are readily available to support projects that are aimed at improving clinical outcomes through changes in service models. The specialist fellows will participate alongside the Chief Registrars in the dissemination of quality and service improvement outcomes locally and with relevant national fora including the Ambulatory Emergency Care Network, the Acute Frailty Network and the Royal College of Physicians Future Hospital Commission. Opportunities for Specialist Interest Development The Trust and its partners offer multiple opportunities to incorporate the development of specialist interests into the programme of activity. Particular support and infrastructure are offered to candidates with an interest or qualifications in point of care ultrasound (POCUS), Echo, leadership and quality improvement projects (QIP). Teaching and Training The postholder will support teaching of medical students and training of trainee doctors and other clinicians within the Geratology and AGM departments. Reflecting contemporary service provision and teaching/training needs, programmes are increasingly innovative in nature.