Introduction

Many consultants in liaison psychiatry find the first few years of their appointment to be a struggle and feel ill-prepared to deal with the many administrative and managerial problems which have to be overcome, involving support services, office space, junior medical staffing and managerial responsibility.

These notes are written by liaison psychiatrists with a range of experience in establishing liaison services in different hospitals in the hope that they will help future consultants negotiate some of the difficult problems which will face them following their appointment.

The notes should be read in conjunction with the "Model job description for consultant in liaison psychiatry" which is available to in print form from the College or from the officers of the Liaison Psychiatry Faculty.

Preliminary negotiations

It is important to learn as much as possible about the post before making an application and certainly before attending for interview if shortlisted. The job description should be compared with the model job description referred to above.

Most liaison psychiatry consultant posts are new appointments; this implies that there is usually only a rudimentary service in place although this situation is likely to change in future. It is important to meet the Medical Director and Chief Executive of the employing Trust and to establish what their aspirations are for a liaison psychiatry service.

It should be clarified whether the post involves responsibility for emergencies in the Accident & Emergency Department and provision of a service for patients admitted following deliberate self-harm.

With the expansion of posts for specialist psychiatric nurses in Accident & Emergency Departments, some new consultant posts are being developed to provide supervision for these nurses who may also carry out deliberate self-harm assessments. In these cases, it is important to ensure that the post includes other aspects of liaison psychiatry, and sufficient time for this work.

If the liaison post is half-time or associated with sessions in general psychiatry, the liaison psychiatry sessions should be identified and protected.

The College will not approve job descriptions for a split post if there are fewer than five liaison sessions. The job description should clarify who will be covering the general psychiatry component of the post whilst the clinician is doing the liaison psychiatry sessions. The commitment to general psychiatry should be reduced in relation to the number of available sessions.

If the employer is a mental health trust it is also necessary to meet the key individuals of the acute general hospital trust in which the service will be located, including the Medical Director, Chief Executive and relevant academic clinicians.

Some liaison psychiatry posts have been developed specifically with the support of medical specialists, such as HIV, neurology or liver transplantation, and it is obviously important to discuss plans with these key individuals. The scope of the post should be established together with plans for accommodation, support staff and, if appropriate, in-patient beds.

If the job description does not reflect a post that is going to be workable then you will need to negotiate changes to the job description prior to interview. In many cases, the prospective candidate will be discussing the development of a new liaison service, and may well be involved in helping to write or formulate the job description.

If you are offered this role, you will be able to tailor the job according to your needs and ensure that resources will meet demands.