Older Adult Psychiatry is a great mix of functional and organic illness. You will be working as part of a team dedicated to meeting the needs of the particular patient demographic and are generally well resourced and also well supported by patients’ families and outside organizations.
Mental health, physical health and social problems in old age are closely related, hence Older Adult psychiatry takes a genuinely multi-disciplinary team approach. Old age psychiatrists collaborate closely with many different agencies including GPs, radiologists, neurologists, geriatricians, movement disorder specialists, social services, occupational therapy, physiotherapists, speech and language therapists, psychologists, psychiatric nurses, district nurses and voluntary agencies.
Nowadays, there is a strong emphasis on community care and delivering interventions and care packages that enable older people to stay in their own homes.
An understanding of the legal and philosophical issues regarding protection of individuals’ human rights, end of life decisions, capacity, informed consent and mental health legislation is essential in providing safe, holistic care of a high quality. Clinical decisions are always balanced with ethics.
Old age psychiatry services may be provided in acute general hospitals (as a liaison service given the recognition of the high prevalence of mental health problems suffered by patients in these hospitals) as well as in community settings including residential and nursing facilities or in mental health in-patient units for those requiring a hospital admission.
We offer a three-year higher training programme in Older Adult Psychiatry for a single CCT and a four-year higher training programme for a dual CCT in Older Adults & General Adults. Dual trainees will typically spend two years in Older Adult settings and two in General Adult.
Clinical training is provided through the three mental health trusts in the region. Posts are mapped to the College curriculum through the joint working of the TPDs and the Trust Directors of Medical Education (DMEs). Trainees are guaranteed a well-rounded and robust curriculum coverage to achieve all the necessary competencies.
The postgraduate training programme is based on the Competency Based Curriculum for Specialist Training in Older Adult Psychiatry developed by the Royal College of Psychiatrists). It is designed to support training for obtaining a CCT in Older Adult Psychiatry by working towards an Annual Review of Competency Progression (ARCP) each year.
It is also possible to gain an endorsement in Liaison Psychiatry during your training. Specialists in Liaison Psychiatry work with others to assess, manage and treat people with mental health problems in conjunction with physical (medical or surgical) illness. They have particular expertise in the interface between physical illness and psychological distress and contribute to the development and delivery of effective services.
Please note: Endorsement are separately applied for and not allocated, as part of the higher training. It is a deanery wide application and is usually advertised by the trusts.
Experienced Consultant Trainers will provide supervision on a weekly basis throughout the training. Study leave will form part of the educational programme and is arranged in conjunction with the trainee’s Educational Supervisor and Training Programme Director.
Trainees will take part in an on-call rota covering evenings, nights, and weekends. The nature of these varies depending upon your location and can either resident or non-resident. Most on-call rotas are not specific to older adults so you will cover general adults and potentially other specialties.
On-call work generally includes providing senior support for junior doctors (typically foundation, core psych trainees or GP trainees on ward cover); advice to liaison, crisis, and other out of hours teams. Trainees will invariably be participating in Section 12 work (Mental Health Act assessments and sometimes S136 triaging).
There will always be a consultant on-call to provide more senior support to the registrar (and for RC responsibilities which cannot be delegated to the registrar).
Training in Older Adult Psychiatry in the East of England provides a range of inpatient, outpatient, community, and emergency work in diverse locations from historic cities to small towns to very rural settings.
This is a multidisciplinary profession and we receive a range of referrals; and you will be involved in making decisions regarding the direction and outcomes for these referrals (e.g. CPN allocation, redirection to Memory Assessment Service, appointment in outpatient clinic, etc.) During working hours you’ll be involved in seeing new and follow up patients in a variety of settings, often building your own caseload. You should also have the opportunity to gain experience in the tribunal process, from preparing reports to representing the medical team in the tribunal itself.
As a higher trainee you will be encouraged to develop competencies in a wide variety of areas including but not limited to, Management & leadership, Medical Education, Clinical Governance, Clinical Audit, Quality and improvement and Research. Many of the trusts will run schemes which can even enable you to achieve postgraduate qualifications in the aforementioned.
There will also be two dedicated sessions a week for special interest and research, tailored to your training needs. There is a lot of flexibility in this for trainees to pursue their own interests, subject to approval.
Clinical training is provided through the three mental health trusts in the region. Posts are mapped to the College curriculum through the joint working of the TPDs and the Trust Directors of Medical Education (DMEs). Trainees are guaranteed a well-rounded and robust curriculum coverage to achieve all the necessary competencies.
1. Cambridgeshire and Peterborough NHS Foundation Trust
provides innovative integrated community and mental health care and offers single and dual training in old age psychiatry. The training posts are spread through the county including posts in Peterborough, Huntingdon and Cambridge and trainees would typically spend time in different parts of the county during their training county in order to experience the variety in sociocultural and educational opportunities. One of the higher training posts is in Liaison psychiatry, based at Addenbrookes Hospital and provides an endorsement in liaison psychiatry. The strong links with The University of Cambridge provide excellent research and teaching opportunities. The mental health trust is also part of an active research network and trainees may contribute to portfolio studies. The Trust has an excellent teaching programme with weekly cases conferences and academic lectures. We have a strong reciprocal training relationship with Medicine for the Elderly and Neurology. Trainees have the opportunity to gain clinical experience in these specialities are very welcome to attend their local teaching programmes.
2. Hertfordshire Partnership NHS Foundation trust
offers single Old Age Psychiatry and dual Old Age / General Adult Psychiatry training opportunities with placements ranging from inpatients wards, outpatients clinics, Memory clinic services and liaison. As a university trust, the Trust has strong links with the University of Hertfordshire where trainees can undertake various postgraduate and research degrees courses such as Masters degree programmes in Psychiatric Practice, Medical Education and other areas. Several past trainees have completed doctoral research degrees leading to the award of MDs and PhDs supported by the Trust.
3. Bedfordshire and Luton NHS Foundation trust
provides a vast range of experience in inpatient wards, community mental health teams and specialist memory clinics. The training posts benefit from a protected session for special interests and another research purposes. There are various opportunities to pursue special interest sessions in liaison psychiatry, geriatric medicine, neurology, neuroimaging and drug and alcohol services locally and in neuropsychiatry at Northampton. There are excellent opportunities to be involved actively in teaching medical students and trainee doctors. Higher trainees have successfully run several mock CASC exams locally which are popular and sought after by core trainees in and around Bedford and Luton. Other resources available locally include a well-stocked medical library, a well-established teaching programme and a group of committed and enthusiastic trainers.
Trainees are encouraged to be involved in teaching University of Cambridge medical students. At a minimum, this is 1:1 teaching for students placed with their team. Further supervised opportunities include:
- Small group communication skills teaching (co-led by an experienced communication skills expert) using the internationally-renowned Cambridge-Calgary method
- Preparation of on-line learning resources
- Writing and standard setting for end of placement exams and finals
- Plenary lectures
- Conducting medical education research
Trainees involved in medical student teaching are encouraged to attend the free University of Cambridge IFME 'teaching the teachers' course
The Head of School is Dr Anna Conway-Morris (Anna.Conway-Morris@cpft.nhs.uk)
The deputy head of School is Dr Esther Sabel (esther.sabel1@nhs.net)
Training Programme Director for the whole deanery is Dr Fiona Thompson (fiona.thompson@cpft.nhs.uk)
Directors of Medical Education (DMEs) can also give you specific information on local education providers and some providers have created individual websites to highlight the wide-ranging opportunities available.
Trainees typically rotate between three posts (four for dual) of 12 months each. Inpatient posts in Older Adult are less common than in General Adult, so much of the training is community based. However, there will be an inpatient element to the training and the potential to do more as part of a special interest or a three-month acting-up post in the final year.
Trainees receive a day a month of speciality teaching, which is run by the trainees with consultant support. This training is not older adult specific but covers various specialist areas of psychiatry, many of which may be encountered in older adults. These sessions provide an opportunity for trainees to learn together, continued professional development, facilitate peer group discussion and support. Trainees also attend the weekly Academic Programme/Journal/Case club within the appropriate Department or Trust. Trainees also have the opportunity to teach on the MRCPsych Teaching Programme. Trainees will often supervise medical students during their clinical placements, teach and facilitate aspects of their programme such as clinical task groups. There is protected consultant supervision incorporated in the timetable for one hour each week, for the trainee to use as they require – completing Work Place Based Assessments, discussing cases or scenarios, assessing their progress, learning about the realities of being a consultant, etc. A study budget and time allowance is also available for trainees to attend courses and conferences (subject to approval).
Health Education East of England is an immensely supportive environment to seek research opportunities. There is a strong research focus, and trainees supported by the Trust and the National Institute of Health Research.
In East of England School of Psychiatry, trainees are encouraged to seek special interest training and research . You will have one day, i.e. 2 sessions per week to develop a special interest and/or research project of your choice. With strong links to the universities in the region (University of Cambridge, University of East Anglia, University of Hertfordshire, Anglia Ruskin University, University of Essex), trainees have excellent opportunities to get actively involved in research projects. There are also multiple other opportunities to get involved in research within local NHS Trusts and most of the Trusts which provide postgraduate training in our region are active research hubs in their own right.
There are chances to undertake postgraduate qualifications, for example Diploma, PG certificate, Masters or MD. These opportunities are not limited to Academic fellows and are open to all higher trainees.
There is a culture within the deanery where trainees are positively encouraged to take opportunities to develop in other areas in addition to clinical practice, such as quality improvement projects both through collaboration and in developing their own projects. Trainees can undertake additional training in Quality improvement to help fine tune their skills and support their individual projects.
The East of England Deanery have a long history of promoting leadership and management at a local and national level and trainees in the scheme are actively encouraged and supported to develop their skills in this area.
Development of leadership and management skills is an essential part of higher training. The School offers a leadership course for Higher Trainees in Psychiatry, which is organized by the Cambridgeshire and Peterborough NHS Trust. Trainees who are ST4 and above are encouraged to apply to the course.
Trainees will gain excellent experience in leadership and management, including having the opportunity to work with or alongside clinicians/senior managers who undertake these leadership roles, as well as having support and time to lead on Quality Improvement initiatives, audit and other practical management projects. The trainees are offered specific lectures on management and leadership and undertake a service development project.
- Higher trainees are expected to be Section 12 approved. Ideally this will be in place at the point of starting higher training. Failing that, trainees should be qualified for Section 12 approval, have completed the necessary S12 Induction course, and have started the application process. Actual approval can take some time and an application which is still pending will not stop you beginning your higher training (though it may affect your early on-call shifts).
- Trainees are expected to drive their own vehicle. Home visits should be arranged in close liaison with the members of the multidisciplinary team. Trainees will also need to travel during their on-call shifts. Your insurance will need to cover you for business use (cover for commuting is not sufficient for on-call work and home visits).
- On-call Mental Health Act assessments are usually paid separately by the local authority. These are paid untaxed and trainees will need to register with HMRC for Self-Assessment and ensure they declare this income and pay necessary income tax on it. When completing MHA assessments on-call, although you will be paid separately for them, they are considered part of your work for the trust and so you are covered by the trust’s indemnity.
- You may have the opportunity to be the second doctor for MHA assessments outside your day job and on-call shifts, in which case this counts as private work. It is not covered by the trust’s liability scheme and you will need to ensure you have appropriate cover for this private work from the MDU/MPS/etc.
- Trainees will be provided with office space at a base location and appropriate IT facilities. This usually includes a laptop (with remote access to trust systems) and a smartphone.
- There is flexibility within training (LTFT, External posts, Academic posts).
- Each Team is supported by one or more medical secretaries who are based on-site.
- Car parking is usually available on site, free of charge. Where business mileage or parking charge are incurred, these can be reclaimed.