1 NHS Wales Betsi Cadwaladr University (BCU) Local Health Board JOB DESCRIPTION Post Title: Line Manager: Accountable to: Medical Director Chief Executive BCU Chief Executive for all strategic, professional and regulatory issues for doctors and dentists (hereafter Doctors). Chief Medical Officer/ Medical Director, NHS Wales, Welsh Government for professional advice. Key Relationships: Remuneration and Terms and Conditions: Location: BCU Board members Senior clinicians and clinicians in primary care, secondary care and mental health Directors and management team Bangor University, College of Medicine and other Educational institutions (higher and further) Postgraduate Dean Other NHS organisations including Health Boards and Trusts Local Authorities Local and national voluntary organisations Members of the Stakeholder Reference group Staff representatives and trade unions Professional bodies and associations Patients / service users and their relatives/carers /the public Community Health Councils Local partnerships Independent Contractors Professional and regulatory bodies Advisory Committees Assembly Members, MPs, Ministers and Welsh Government Officials As determined by the Health Board Remuneration and Terms of Service Committee within the Policy Framework set by the Welsh Assembly Government. Health Board Headquarters
2 JOB PURPOSE The prime responsibility of the Medical Director is to provide medical leadership for the safety and quality of our services so that population health outcomes improve. The Medical Director will be responsible for medical leadership, building, motivating and developing a team of clinicians, to drive forward service transformation across the BCU Health Board healthcare community, building a strong platform for the continuing development of integrated care. As an Executive member of the Board, the Director will hold corporate responsibility jointly with other Board members for the strategic direction, corporate policy making and development and delivery of the Health Board s objectives. The Medical Director will provide strategic medical advice to the Board. Particular key responsibilities will be to: Act as the principal source of medical advice to the Board and act as a professional lead for all doctors and clinical networks within the healthcare community employed by the Health Board. Jointly lead on the clinical governance agenda, in conjunction with the Nurse Director and Director of Therapies and Health Science, for the overall discharge of clinical governance in the Health Board. Specific governance responsibilities to be agreed with the Chief Executive. Work closely with primary care providers and local authorities to develop integrated care. Ensure that the Health Board makes a significant contribution to health improvement and the reduction of health inequalities. Support excellence in research and development, and champion best practice in care. The Medical Director will be the nominated Responsible Officer for all doctors within the LHB as required by the General Medical Council. Undertake the role of Caldicott Guardian, ensuring that systems and processes for safeguarding the quality of clinical information are in place and working effectively. Support the development of, and governance arrangements for, undergraduate and postgraduate education. KEY ACCOUNTABILITIES Improving Population Health and Patient Services With Director Colleagues championing and leading the transformation of service from in-hospital care to effective prevention, early intervention and long-term community based support. With the Director of Public Health, ensure that prevention is embedded in all aspects of clinical practice.
3 Drive redesign and modernisation across the healthcare services.. Lead and foster effective clinical leadership so that the Health Board provides safe, high quality, acceptable care for patients / service users in accordance with NHS standards for services in Wales, within the resources available. Initiate and facilitate effective partnerships and alliances between the Health Board and other agencies, so as to influence the agendas of these bodies and to draw on their experiences and perspectives in creating local NHS and community strategies, policies and actions, to deliver longterm health improvements. Leadership of an integrated healthcare system across primary, secondary and community sectors by working with the Director of Primary and Community Care and Mental Health Services and the Director of Public Health; providing leadership and management of the integration of the various components of the Health Board, to develop a unified organisation which delivers a service that: o delivers improved population health and well being; o reduces inequalities; and o improves patient safety using the 1000 Lives Campaign on quality improvement Motivate all clinical staff to benchmark services continuously against best practice evidence, research and audit, to ensure high quality standards of patient care. Foster a culture which embraces and recognises the opportunities for the utilisation of new clinical and service technologies. Performance With Director colleagues, ensure effective clinical and managerial structures are in place to achieve safe, high quality standards of care, which meet the financial and corporate objectives set for the Health Board; ensuring the effective, efficient and economical use of resources in achieving planned activity and delivery of all required performance targets. Take strategic responsibility for service and policy development, particularly relating to national or regional initiatives and guidance from the National Institute of Clinical Excellence (NICE), Healthcare Inspectorate Wales, the 3 year planning framework and condition specific delivery plans. Ensure the development of clinical information strategies, to assess health needs and to support evidence based decision making. Responsibility for effective local systems, which will enable individual doctors and clinical professionals to discharge their professional obligation to report clinical colleagues if there is cause for concern, or reason to believe that their conduct, performance or health might present a threat to patients / service users as outlined in 'Duties of a Doctor' and to raise these concerns in confidence. Responsibility for ensuring that effective clinical audit processes are in place.
4 Support the Chief Operating Officer in the performance management of clinicians in management and leadership roles. Strategic Development and Partnership Working Engage with and promote co-operation and collaboration with primary and community-based care, the voluntary sector and other organisations, to develop strategic partnerships and alliances to improve the health of local communities and ensure effective partnership working. Actively support the development of effective strategic links between health service planning and delivery and the public health function. Support the development of a culture of public involvement that is open and transparent, ensuring that users, carers and the general public s views are effectively represented and appropriately incorporated into decision making across the Health Board. Develop effective relationships with the Community Health Councils, Professional Fora and Stakeholder Reference Groups, to ensure strategic plans are developed with full cognisance of their views. Governance With Director Colleagues develop effective organisational arrangements and capacity that enables the Health Board to meet its strategic aims within a framework of strong, effective governance. This should be consistent with the standards of good governance set for the NHS in Wales, which are based on the Welsh Government s Citizen Centred Governance Principles. Responsibility and accountability for all medical clinical governance issues and shared responsibility with the Nurse Director and Director of Therapies and Health Science for the overall discharge of clinical governance in the Health Board. Specific lead governance role to be agreed with the Chief Executive. Ensure a robust and clearly understood approach is taken to clinical governance, including Clinical Risk for the health Board. Establish clear lines of accountability and ensure that all relevant clinical staff are managed, supervised and trained appropriately with regard to clinical services, managing through a strong governance framework and in accordance with the regulatory requirements. Improving whole system clinical governance to ensure that effective clinical governance is in place across the whole patient journey, including the interface between primary and secondary care. Monitor the quality of patient care against national and local indicators. Establish appropriate working relationships with relevant local representative organisations.
5 Improving the quality of prescribing by giving expert medical support to the Prescribing Advisory Team and others as required. Co-ordinate engagement with external bodies including the Royal Colleges, the Deanery and response to National Confidential Enquiries. The Medical Director will advise the Health Board of the outcome and implications of external inspections and will ensure that recommended actions are implemented. Ensure a proactive approach to risk management, including the systematic, identification, assessment and management of risk. Ensure that senior incidents / never events are reported to the Board and Welsh Government and that there is a system to ensure investigation and that lessons learnt are shared with medical staff. Contribute to the development and continued operation of a framework of strong, effective governance, consistent with NHS values in terms of safety, openness, probity, and accountability. Leadership of the Medical Profession Lead a strong team which will provide clinical leadership. Work with Board colleagues to optimise clinical leadership, full engagement and commitment of all clinicians, to deliver improvements to patient care and clinical outcomes. Develop an organisational culture, working closely with the Chief Operating Officer and other director colleagues, that supports clinical engagement in decision making and a drive for continuous service change and improvement to deliver high quality, safe services. Facilitate the development of an organisation, which encourages personal development and learning; encourages and supports innovation; team building and creative partnerships and a commitment to patient safety. Improving the quality and scope of health outcomes achieved by primary care, by means of ensuring that the benefits of the General Medical Services contract are realised. This includes the process of verifying the Quality Outcome Framework, or any successor contract. Advise the Board on the impact of legislation, and national policy affecting the medical workforce on the Health Board s ability to deliver services Provide advice on medical staffing issues, having regard to statutory requirements and national and local policy and guidance. This includes the implementation of national policy, directives and the use of clinical indicators, to ensure safe and appropriate standards in medical practice. Take a lead role in the resolution of any employment matters for the Health Board medical staff, working closely with the Director of Workforce and Organisational Development. This relates to
6 conduct, capability, competence or performance and to manage the exclusion and disciplinary procedure for medical and dental staff, on behalf of the Health Board, ensuring that there are appropriate processes in place to embrace all medical and dental staff across the Health Board area. Ensure that job planning and appraisal for senior doctors is conducted to a high standard. Ensure that appraisal and job planning for senior doctors and dentists occurs and is carried out to a high standard with clear objectives being given, which meet the needs of the doctor/dentist, the Health Board and cognisant of validation requirements, liaising with the GP appraisal coordinators as and where appropriate. Ensure effective medical workforce planning in order to provide the appropriate level and mix of skilled to address the health needs of the Health Board, both now and in the future. Act as a communication channel between the Health Board and the Welsh Government, the office of the Chief Medical Officer/ Medical Director for Wales, the General Medical Council, and National Clinical Assessment Service. Manage regulatory and performance issues within all medical staff groups. Education, Research and Development Champion clinical research and development, in liaison with the Bangor University. This will include fostering an evidence based culture by working with clinical colleagues to ensure appropriate use of research evidence in order to improve practise and service delivery. Work with Bangor University and other universities, and the Postgraduate Dean to facilitate teaching and training. Take a key role in the Research and Development strategy, either directly or, by working closely with the R&D Director. Ensure that standards of postgraduate medical education and training meet national requirements and contribute to the successful recruitment and retention of doctors in training, across all areas of healthcare. Maintain and develop links with Higher Education Institutions, ensuring robust communication takes place with the Postgraduate Dean and Royal College Advisors on postgraduate training issues and the Medical College. Ensure that all recommendations from external visits have an action plan and that these are implemented. Oversee processes for the delivery of undergraduate education in conjunction with Undergraduate Organisers. Ensure that appropriate medical education is in place for doctors in training and for all career grade doctors within the Health Board.
7 Ambassador for the LHB To contribute to NHS Wales strategy development and delivery and to actively engage in work at a national level. As one of the cadre of senior leaders within Wales, to contribute to the wider health and organisational agenda of NHS Wales and Welsh Government. The Medical Director will act as an ambassador of the Health Board and NHS Wales. OTHER RESPONSIBILITIES The post holder may be required to undertake other relevant duties, including the operational lead for specific services and localities, as required by the Chief Executive. PERFORMANCE APPRAISAL Performance will be appraised and objectives agreed on an annual basis with the Health Board s Chief Executive.
8 PERSON SPECIFICATION Qualifications Qualified Medical professional. Unblemished registration with GMC. Evidence of continued professional development. Post graduate medical qualifications. Further evidence of management training and a commitment to ongoing professional development. Experience and Must be or have been a practising GP or worked at Medical Consultant level. Knowledge Clinical Governance. Medical Management Significant organisational change experience / managing difficult and complex change. A track record of achievement in: o Effective performance management; o Introducing robust systems and processes; and o Facilitation of groups. Undertaking sensitive negotiations. Successful initiation and facilitation of strategic partnership working and alliances. A good understanding of the health and social care management environment in Wales and of roles and responsibilities within it. A good understanding of national targets. A good understanding of performance management methodology. Developing an organisational culture that promotes clinical engagement in decision making and leading continuous change and improvement in services, encouraging the use of new clinical and service technologies. The safety and standards agenda. An understanding of the principles of Public Health Medicine that are relevant to, and underpin the work of the LHB. Abilities and Personal Qualities Innovative, with strong service focussed approach, exceptional communication, interpersonal, negotiating and influencing skills. Ability to think and act strategically and to articulate a clear sense of direction and vision to a wide audience. Ability to build effective relationships with a range of internal and external stakeholders. Demonstrable leadership and ambassadorial skills with an ability to demonstrate a flexible leadership style. Commitment and passion for citizen focused service with the ability to embed such an ethos at all levels of the organisation. High level of; o Negotiating skills; o Interpersonal skills; and o Communication skills. Ability to contribute to policy development. Decisive leader, capable and committed to translating policy and analysis into practical actions. Strong prioritisation skills with the ability to manage competing demands. High degree of analytic skills. High degree of report writing skills. Team player with experience of managing teams. Ability to deal with the media.
9 NHS Wales Medical Director Behavioural Competence Structure Drawn from NHS Wales Leadership Qualities Framework, NHS Wales Executives Behavioural Competency Structure and other strategic documents. Seizing the future Thinks and acts for the future. Intellectual flexibility Handles information and clarifies complexity. Broad scanning Gathers information from a wide range of sources. Political Astuteness Understands the politics / power bases. Drive for results Sustains a focus on improving performance to meet challenging goals. Financial Leadership Ensures sustainable financial viability and most effective use of resources to achieve strategic aims. Setting Direction Acts now to articulate, shape and implement a compelling, shared vision that takes current service developments into a coherent future strategy. Acts quickly and decisively in a crisis and builds new programmes and capabilities rapidly. Introduces flexible, innovative approaches to achieve service improvements and promotes organisational ability to cope with change and shape the future. Leads continuous service improvement, encouraging the use of new clinical & service technologies. Synthesises, reframes and prioritises complex demands, consequences and critical points from a mass of disparate and conflicting data. Demonstrates ability to move between significant detail on the ground and the strategic big picture, modifying plans and actions to take account of new/diverse views, information and standpoints. Interprets complex medical workforce strategic agenda into action on the ground. Checks what is happening on the ground, asking patients / service users, their Carers and staff about their experience of services and is visible and accessible at all levels walking the talk. Actively seeks out diverse viewpoints, promoting inclusivity. Purposely uses wider networks to keep up with developments in medicine, health, social care, housing, and education, building relationships with partners, clinical and academic colleagues. Builds consensus alliances through purposeful engagement with key networks of interest groups and influencers to shape and deliver change. Demonstrates understanding of complex stakeholder networks and ensures actions take account of political sensitivities in building agreements. Balances political, professional, technical, financial and cultural considerations to achieve change. Focuses and clarifies objectives and boundaries and is goal focused, resisting any pressure to be deflected from achieving quantifiable service improvements. Takes calculated risks within integrated governance, to achieve longer-term service improvements creating enduring benefits of improved healthcare for patients / service users and carers. Wants to make a real difference to people s health and well-being by delivering a high quality service and by developing improvements to service. Uses a range of strategies to shift the organisational emphasis from in-hospital care to effective prevention, early intervention & long term community based care Ensures high standards of medical care, using audit and clinical information strategies to demonstrate quality outcomes for patients and their Carers. Contributes to the management of financial flows in the LHB to deliver short & long term objectives. Focuses use of resources on achieving the future vision of the organisation, advising on the impact of diverting resources from current programmes to invest in development and change.
10 Demonstrates financial literacy/quantitative problem-solving skills. Contributes to the delivery of agreed recovery plan and contributes to resolving deficits. Ensures a high standard of financial management and control, with financial systems / procedures promoting the efficient and economical conduct of business, safeguarding financial proprietary, governance and regularity throughout within the organisation. Leading change through people Makes change inclusive mobilising people s energy and commitment Holding to account Promotes a high performance culture. Empowering others Fosters independence. Effective and strategic influencing Uses range of influencing strategies. Delivering the Service Engages others as partners in developing a shared vision within the organisation and across the local health and social care and academic community to achieve buy-in and commitment. Aligns efforts and shares leadership and power to achieve integrated service improvements, winning and retaining the respect of other clinicians. Builds organisational frameworks for continuously improving quality and safeguarding high standards of care supporting others who lead implementation. Builds effective clinical leaders and teams, removing obstacles to effective working. Holds team members to account through stretching performance and rewards systems. Accepts personal responsibility for the medical workforce, holding others directly accountable for delivering what has been agreed, both within and outside of the organisation. Intervenes swiftly and consistently to address poor performance or inappropriate behaviour where this is impacting on patient safety and effective service delivery. Challenges and confronts conflict affecting service standards or safety, brokering agreement. Embeds the duty of providing high quality patient / service user care throughout the organisation, ensuring that the Board receives reports on quality and safety and that appropriate action is taken. Provides high quality advice to the Board on all matters relating to medicine. Ensures statutory and regulatory aspects of medicine are delivered, including validation requirements for all doctors. Delegates effectively, securing resources as required and providing space for others to be creative. Takes risks with others, coaching their development using failure as an opportunity to learn. Explains clearly and concisely the reasons for plans and actions to affected people, stakeholders and partners and listens and acts on responses. Leads the investment in talent management, ensuring that appropriate development processes are in place for the medical workforce (including succession management). Coaches and mentors others to help them maximise their contribution. Nurtures doctor s ability to lead and encourages the development of clinical leaders. Uses a range of effective influencing strategies that will bring about desired outcomes and long term change in health services, building and using extended networks of influence. Gains commitment and credibility from the local community through responsive involvement of local people, staff and other agencies in shaping local health priorities and strategy. Champions the organisation in external forums e.g. local authorities, Government bodies and national organisations and represents both the organisation and the medical profession at local, national and international level.
11 Collaborative working Engages constructively with internal and external stakeholders. Creates the conditions to promote sustainable partnerships and works closely with health, social care and academic partners on all important investment decisions to ensure joined up action which creates enduring benefits for stakeholders. Leads the shared duty to engage the public and other bodies in planning and monitoring services and is informed on the current and changing priorities of partners, modifying own plans in order to seek win-win outcomes. Demonstrates effective management of relationship with Chief Executive, Chair and Board members, jointly creating cohesive strategies for delivering world class health care. Self belief Inner confidence to succeed. Self awareness Understands own emotions, strengths and limitations. Self management Manages own emotions and demonstrates resilience. Personal integrity Commitment to openness, honesty, inclusiveness and high standards. Personal Qualities Takes on stretching challenges that some peers may back away from. Constructively challenges others, regardless of position or status. Willing to take tough decisions and is openly optimistic about achievement of goals. Stand up for what they believe in, speaking up and have a can do sense of confidence. Makes the care of people first concern, treating them as individuals respecting their dignity. Understands the nature and cause of own emotional reactions to particular situations and takes account of the likely implications and impact of own behaviour. Role models effective behaviours and shows understanding of own strengths and limitations in providing leadership that makes a difference to patients / service users, carers and staff. Manages responses and reactions consistently when under pressure remaining calm in a crisis and without transferring unnecessary stress on others. Takes conscious steps to manage own emotions and absorbs and deals constructively with criticism and performance feedback. Models a healthy approach to work / life balance, having a range of interests outside of work. Stands up for that which is consistent with stated NHS values and delivers on own commitments even when this is difficult and there may be personal cost. Acts as a consistent role model for engaging staff, patients / service users and other stakeholders at all times, taking a fair and inclusive approach to decision making within a framework of integrated NHS governance. Open, and honest, acts with integrity and uphold the reputation of the medical profession. Requires and expects others to be open and honest in their communication. Works with others to protect and promote the health and wellbeing of patients / service users, their families and carers, and the wider community. Provides a high standard of practice and care at all times, respecting people s confidentiality.
12 Professional Integrity Commitment to the medical profession and to standards of conduct and ethics Models a professional approach to medicine and maintains practical competency and credibility. Accountable for actions and omissions in personal clinical practice and is always able to justify own decisions. Always acts lawfully, whether those laws relate to own professional practice or personal life. Maintains clear professional boundaries with those in their care or anyone close to them. References: NHS Wales - Leadership Qualities Framework ( LQF ); NHS Wales Chief Executive Development Center - Competence Framework Welsh Assembly Government - Accountable Officer Memorandum for Chief Executives of NHS Trusts Welsh Assembly Government - Accountability, Performance and Development Handbook for NHS Wales Chief Executives Welsh Assembly Government One Wales Welsh Assembly Government Consultation Document on Reorganisation NHS Institute for Innovation and Improvement Leadership Indicators NHS England - Competence and Experience Framework for Chief Executives NHS Wales & IHM - Leadership Framework; Audit Commission Report - Financial Failures in NHS Trusts, Department of Health UK - Kennedy Bristol Inquiry Report on Care of Children; Leadership Roles in Meeting the Challenge of Change - University of Leeds Review of Leadership Theory and Competence Frameworks - Exeter University Centre for Leadership Studies Seven Leadership Leverage Points - Institute for Healthcare Improvement (MDcomp framework v2 0309)