Old Age Psychiatry

Why should I consider Specialty Training in Older Adult Psychiatry?

Older Adult Psychiatry is a great mix of functional and organic illness. You’ll also deal with patients who have more physical comorbidities and medications. The increased complexity makes for more interesting and varied practice, and helps keep up your skills in physical healthcare. You’ll 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.

You will encounter a wide range of disorders, including many of those you’d find in General Adult (but less personality disorder) along with organic illnesses of later life. While diagnosing and treating Older Adult patients you will often work closely with doctors outside psychiatry including GPs, radiologists, neurologists, geriatricians, movement disorder specialists, etc. Older Adult psychiatry takes a genuinely multi-disciplinary team approach, and you will also work with a wide range of allied health professionals including occupational therapists, physiotherapists, speech and language therapists, psychologists, psychiatric nurses, district nurses, social workers, and more.

With increased global awareness of the cost of dementia on patients and health/social care systems, there is a renewed focus on prevention and finding new treatments for dementia. If you start in Older Adult psychiatry now, hopefully you’ll see treatment transformed during your career.

Training scheme

We offer a three-year higher training programme in Older Adult Psychiatry for doctors who have already demonstrated the essential competencies, completed core training from CT1 to CT3 and obtained membership of the Royal College of Psychiatrists. We also offer 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. Here we focus on the Older Adult side, but if you are interested in dual training please also see the separate information about General Adult training.

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 (https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/old_age_psychiatry_curriculum_march_2019.pdf). 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. Entry to the programme is through the National Recruitment System administered by Health Education England North West (https://www.nwpgmd.nhs.uk/st4_psy_train_rec_oview).

It is also possible to gain an endorsement in Liaison Psychiatry during your training – https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/liaison_psychiatry_curriculum_march_2019.pdf

“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 relationship between physical illness and psychological distress and contribute to the development and delivery of effective services.”

Please note: Endorsement are not applied for, or allocated, as part of the higher training application and need to be separately agreed once in training.

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, but all are 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, dementia rapid response and other out of hours teams; and performing Mental Health Act assessments in hospital, the community, police custody, etc. 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).

What are the available clinical opportunities in the East Midlands?

Training in Older Adult Psychiatry in the East Midlands 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 brand new and follow up patients in a variety of settings, often building your own caseload. Trainees will take part in an on-call rota during evenings and weekends; the nature of these were vary depending upon your location but invariably will involve participating in Section 12 work (Mental Health Act assessments). 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.

Throughout the three/four years, trainees are required to complete psychotherapy cases in a range of modalities and will have dedicated supervision either individually or as a group to discuss from a psychological perspective. If psychotherapy interests, you then you may also choose to involve yourself in the running of local Balint groups for junior trainees and medical students.

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. Uniquely we have a close working relationship with local universities and medical schools and many opportunities are available to you both in medical education and clinical research.

There will also be two dedicated sessions a week for special interest and research, tailored to your training needs e.g. Electro Convulsive Therapy (ECT), Nottingham specialist depression service, research, management experience, education/teaching, etc. There is a lot of flexibility in this for trainees to pursue their own interests, subject to approval.

What else does the East Midlands Offer?

Being in the middle of the county you have easy access to everywhere in the UK and are well served by road, rail and an international airport.

You have a choice of city living or countryside, and easy access between the two, making it a great place to live. House prices are also 62% lower than London. Excellent schools in the area make it an ideal place for family life.

A large amount of historic and cultural sites as well as top class sporting events in all of the major cities in the region.

Where can I work?

The local trusts are well-established centres, with close links to national resources including the Royal College of Psychiatrists. The scheme operates as two carousels (you choose which to apply for, at the point of your higher training application):

East Midlands North includes Nottinghamshire Health Care NHF Foundation Trust, Derbyshire Healthcare NHS foundation Trust and Lincolnshire Partnership NHS Foundation Trust.
East Midlands South includes Leicestershire Partnership NHS Trust and Northamptomshire Health Care Foundation Trust.

North programme

The Older Adult posts in North Scheme are in Nottingham, Chesterfield, Mansfield, Derby and in Lincoln.

South Programme

There Older Adult posts in the South Scheme are in Leicester and in Northampton.

Who are the lead contacts for Older Adult Psychiatry?

The Training Programme Director for the whole deanery is Dr Mike Parker m.parker4@nhs.net

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.

Nottingham & Mansfield DME Kehinde Junaid Kehinde.Junaid@nottshc.nhs.uk

Derbyshire & Chesterfield DME Dr Vishnu Gopal vishnu.gopal@nhs.net

Lincolnshire DME Beena Rajkumar beena.rajkumar@nhs.net

https://www.lpft.nhs.uk/work-for-us/medical/programmes/higher-trainers

Northamptonshire Health Care Foundation Trust Dr Bryan Timmins

Leicestershire Partnership NHS Trust Dr Judith West

What would my training look like?

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. It is expected that trainees will spend time in at least two different trusts during their higher training.

Teaching and Academic

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. The schedule usually incorporates a North/South trainee meeting where trainees are offered a safe space to confidentially comment on any training issues which can be shared and subsequently resolved with support from the wider specialty training committee. 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).

Research and Quality Improvement

Health Education East Midlands is an immensely supportive environment to train in General adult Psychiatry as part of Academic Clinical Fellow Posts. There is a strong research focus, and trainees supported by the Trust and the National Institute of Health Research. Not only enjoyable but this experience has helped the trainee to develop further as both a clinician and researcher. There are also links with the Institute of Mental Health in University of Nottingham. 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. Trainees are encouraged to use one of their special interest sessions each week for research, with opportunity for recruitment to multi-centre studies. 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.

Leadership and management experience

The East Midlands 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. 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. There are also many opportunities to take active leadership and management roles in the organisation local events that promote the specialty. Special interest time can also be used to gain management experience. Furthermore, some local education providers provide a route to gaining postgraduate qualifications in leadership and management. Leadership and management topics are included in the local monthly academic programme for trainees and trainees are supported to attend the Health Education East Midlands leadership training days.

What else should I know?

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 available on site, free of charge. Where business mileage or parking charge are incurred, these can be reclaimed.

Useful Resources

Royal College of Psychiatry https://www.rcpsych.ac.uk/training

Faculty of Older Adult Psychiatry https://www.rcpsych.ac.uk/members/your-faculties/old-age-psychiatry

Institute of Mental Health, Nottingham https://www.institutemh.org.uk

Quotes from Older Adult trainees

“I’m nearing completed of my Higher specialist training in old age psychiatry, and can thoroughly recommend the East Midlands North training programme.

“Typically you are expected to spend at least one of the three years (WTE) in central Nottingham, both to experience the busier and varied on calls, but also to be exposed the more specialised services available (e.g. Working Age Dementia, specialist older adult liaison psychiatry etc.). Across Nottingham, Derby and Lincoln there are several posts available that you can choose in active discussion with the training programme director.

“What I found particularly good was the personalised nature of the training. My interests in liaison and neuropsychiatry were valued by the training programme, allowing me to complete a liaison sub-specialty endorsement over two years (50% in ST4 and ST5), alongside essential training such as functional inpatient. We were supported to be innovative in how we use our special interest time, and I was able to pursue addictions which has been of great benefit. Finally in approaching CCT the training programme actively sought to sure up your consultant career, beginning serious discussions in ST5.

“The region is a varied and pleasant one to live in. It is possible to base yourself centrally and commute to all the trusts, who are understandable that you may have had to travel. It is also a great place to bring up a young family. I am looking forward to commencing a consultant post in the region shortly.” - Dr Kaanthan Jawahar, ST6 Old Age and Liaison Psychiatry, HEEM North

“Having done my Core Training in Derby and Nottingham I moved to Leicester for my Higher training in Older Adult Psychiatry as I was keen to stay in the East Midlands deanery- a decision which I have not regretted. When I moved to Leicester I felt very welcomed by the consultant I worked for as well as the wider team- a pattern which has been followed through all the jobs in my higher training. I have been encouraged to get involved with different projects that have been of interest to me, as well as undertaking a Post Graduate Certificate in Medical Education and being involved in a variety of teaching opportunities. I have always found my supervisors- both clinical and educational supportive both in terms of day to day supervision as well as carer guidance. The TPD was always approachable and tried to facilitate our job preferences where possible. As training comes to an end I am looking forward to starting my Consultant Career in the East Midlands.” - Dr Katherine Farrington, ST6 Old Age, HEEM South

“Variety of jobs on offer which allow flexibility in order for you to gain experience in a number of different settings. Have always felt supported by my supervisors and encouraged to explore areas that interest me.”- A South ST5 Trainee

“Due to the support given to me by my consultant supervisors I have been able to design a training pathway which allowed me to explore many of special interests. I have always been encouraged to develop my interests in management and liaison within my other clinical jobs.” - A North ST6 Trainee

Example Weekly Timetables

	Morning	Afternoon
Monday	Special Interest	Community/Flexible Clinical
Tuesday	Community MDT meeting	Follow-up clinic
Wednesday	New patient clinic	Admin
Thursday	Local teaching*	Community/Flexible clinical
Friday	Research	Community/Flexible clinical Supervision

Flexible clinical time might include home visits to house bound patients, nursing home visits, joint assessment with CPNs, providing advice or phone support to the CMHT and assorted clinical admin. * There is also a monthly all-day deanery-wide HST teaching session.

	Morning	Afternoon
Monday	Ward round	Ward Round
Tuesday	Home visits	Clinic
Wednesday	MDT	Supervision Admin
Thursday	Admin	Clinic
Friday	Special Interest / Research	Special Interest / Research