HEALTH EDUCATION THAMES VALLEY: SPECIALTY TRAINING PROGRAMME IN RESPIRATORY MEDICINE Welcome to the Respiratory Training programme! I hope that this document gives you an insight into what our programme has to offer you. We wish to encourage any trainee interested in excellence in respiratory medicine. For the majority of trainees this includes higher research; and robust general medical training as a dual specialty. We pride ourselves on being a close knit, smaller programme giving you individual time within a full regional programme involving our Tertiary centre- Oxford University Hospitals, and our district general hospitals. You keep the same Educational supervisor for your training period of 5 years to allow support and mentorship. Best wishes Dr. Charlotte Campbell Training Programme Director. charlotte.campbell@buckshealthcare.nhs.uk About Health Education Thames Valley We are the Local Education and Training Board (LETB) for Thames Valley covering Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of effective workforce planning and excellent education and training to develop a highly capable, flexible and motivated workforce that delivers improvements in health for the population of Thames Valley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees. Health Education Thames Valley is a relatively small organisation with a defined geographical area which serves as a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some programmes will require successful candidates to indicate a location and specialty. Future placements will usually be based on individual training and educational needs. Please note that applications are to the Health Education Thames Valley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs. The RESPIRATORY MEDICINE Training Programme The Respiratory Medicine training programme is a 5 year programme, starting at St3. During this time, the trainee's work will be monitored for satisfactory progress by an allocated Educational supervisor, and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews. The posts on this rotation have been approved for Specialist Training by the JRCPTB. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training (CCT). The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals. The programme is based in several different Trusts throughout the Thames Valley; trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals: Trust Oxford University Hospitals NHS Trust http://www.ouh.nhs.uk/ Hospitals and Locations Churchill Hospital, Oxford John Radcliffe, Oxford Horton Hospital, Banbury Milton Keynes NHS Foundation Trust http://www.mkgeneral.nhs.uk/ Milton Keynes General Hospital Royal Berkshire NHS Foundation Trust http://www.royalberkshire.nhs.uk/ Royal Berkshire Hospital, Reading Frimley Health NHS Trust: Heatherwood and Wexham Park Hospitals Wexham Park Hospital, Slough http://www.heatherwoodandwexham.nhs.uk/ King Edward VII Hospital, Windsor Buckinghamshire Healthcare NHS Trust http://www.buckshealthcare.nhs.uk/ Wycombe General Hospital Stoke Mandeville Hospital Rotation Information Training in respiratory and general internal medicine in Oxford region is based on broad practical experience with appropriate training to cover the respiratory and GIM curriculums. Consultants in the centres are approachable, and give on the job teaching and feedback in inpatient and outpatient settings. In addition there are regular regional meetings and audit, research, journal clubs and grand round teaching, within each centre. Specialist grade regional teaching is held monthly in Oxford, and has scored highly in the GMC survey of trainees. There is an excellent pass rate of the SCE exam. Trainees are themselves involved in the training and feedback is encouraged. Study leave to attend national and international meetings is encouraged. Trainees will usually spend the first 1-2 years of programme within one of the District General Hospitals gaining experience in both GIM and general respiratory disorders. Within the final 3 years each trainee will work in the Churchill Hospital for at least 12 months and within the John Radcliffe ICU for 3 months. Where possible the rotation is agreed at the beginning of the placement, but can be subject to changes depending on the requirements of other trainees. Rotations may at times change in response to clinical need from the Trusts. Many trainees live in Oxford and commute to the various DGHs. Some trainees live in hospital accommodation. Within the region there is special expertise and training in: Respiratory physiology Asthma and difficult airways Sleep disorders Lung immunology and interstitial lung disease Pleural disease and Thoracoscopy Clinical trials Epidemiology Lung infection and TB Cystic fibrosis and bronchiectasis Lung cancer, respiratory oncology and interventional bronchoscopy COPD The rotations at the tertiary centre of Oxford include modular training of specialist areas e.g. CF, in line with the curriculum for respiratory medicine developed by the Royal College of Physicians. There are established links to centres for transplant and pulmonary hypertension experience. Research: There are manifold opportunities for research which is actively encouraged in our region, and most trainees have progressed to complete higher degrees by taking take out of programme experience in research (OOPR). OOP time is allowed commencing February or August start dates and with a minimum of 6 months notice. Academic clinical lecturer posts in respiratory medicine occur periodically which allow those pursing research careers the opportunity to combine clinical and research training for the last period of their training. This is usually by spending 3-6 month periods alternating lab based work with clinical placements. Dual training: Trainees in our region have applied and commenced dual training in Intensive Care medicine (previously triple training with GIM). Working less than full time: Trainees for personal reasons, may choose to work less than full time. After an application to HETV, we arrange the training if possible in a job share with another LTFT trainee in respiratory medicine. Management: There are management training opportunities in each of the Trusts. The respiratory training committee (STC) is attended by a trainee rep voted by the trainees. The rep also chairs a respiratory trainee committee that meets to discuss issues and allows the rep to feedback to the STC and HETV. The rep also sits on a All specialities trainee committee at HETV to feedback to the deanery. Trainees in our region have successfully applied for national management schemes such as the NICE scholar programme. Teaching: Some trainees have taken out of programme time for teaching. In addition participation in the Physicians as Educators scheme has been done by several. TRUST INFORMATION Oxford Centre for Respiratory Medicine, Churchill Hospital The Oxford Centre for Respiratory Medicine (OCRM) is the base for the specialist respiratory medicine in the Oxford Specialist Registrar Training Rotation. OCRM is a Regional Specialist Respiratory Unit and is part of the Oxford Radcliffe Hospital Trust and academically part of the Nuffield Dept of Medicine, Oxford University. There are four clinical trainees at the OCRM at any one time, and they rotate through subspecialism and ward work on a modular basis. This process is pursued flexibly to the mutual advantage of the trainee and the unit. The registrars take par tin on call duties covering the Churchill hospital site. Infrastructure The Oxford Centre for Respiratory Medicine has the following infrastructure. 1. 20 in-patient beds situated on Geoffrey Harris ward at the Churchill Hospital, 2. A dedicated out-patient unit consisting of a suite of 7 rooms including consultation and treatment rooms. 3. A respiratory treatment centre for the assessment of acutely ill patients, setting up of NIV/CPAP, administration of various treatments (e.g. omalizumab), ABGs/CBGs, etc. 4. An interventional bronchoscopy/thoracoscopy service runs two bronchoscopy lists and one interventional pleural list per week, and delivers general anaesthetic interventions in collaboration with thoracic surgery. The unit is equipped with modern video bronchoscopes, thoracoscopes, the necessary facilities for biopsy cytology, trans-bronchial biopsy, trans-bronchial needle aspiration, airway stenting, electrocautery, cryotherapy, pleural ultrasound, thoracoscopic pleural biopsy, talc pleurodesis, autofluorescence thoracoscopy, indwelling pleural catheter management etc. Fluoroscopy screening facilities are available through the modern imaging fluoroscope in the Regional Radiology Unit. 5. A respiratory sleep unit including 6 dedicated sleep laboratories equipped to RCP recommended standards, as well as domiciliary systems. 6. A respiratory high dependency unit with facilities for non-invasive ventilation. 7. A lung function laboratory equipped to British Thoracic Society recommended standards. This has the facilities for dynamic ling volumes, gas transfer estimation, oesophageal and trans-diaphragmatic pressure monitoring, body plethysmography, pharyngeal acoustic reflectance and exercise training. 8. A clinical research unit with facilities for ambulatory and beat to beat non-invasive blood pressure measurement, ambulatory 24 hour ECG monitoring, autonomic tone assessment including heart rate variability, and baroreflex testing, the objective quantification of excessive sleepiness, respiratory pattern monitoring, etc. 9. A UKCRC registered Respiratory Clinical Trials Unit running both single centre and multi-centre clinical trials. 10. A pulmonary rehabilitation unit allied to the lung function laboratory and including exercise testing/training equipment. 11. The regional thoracic imaging service which includes on site helical CT and PET/CT scanning, MR scanning, radionuclide imaging including lung ventilation/perfusion, isotope bone scanning and inhaled DTPA measurement and ultrasound imaging. This service provides a full portfolio of image guided biopsy of the lung, mediastinum and pleura. 12. Thoracic surgery is provided by the regional cardiothoracic surgical unit based on the adjacent John Radcliffe site, where the service is supplied by one dedicated thoracic surgeon and two cardiothoracic surgeons. 13. The regional medical and clinical oncology units are on the Churchill Hospital site in a new, state-of-the-art regional cancer centre. 14. There are close links with the regional infectious diseases/HIV service that has its inpatient service supplied through John Warin ward and to which the respiratory trainees have on call commitments, and share tuberculosis care with this team. Staff The Oxford Centre for Respiratory Medicine is staffed as follows: Senior Medical Staff Dr. Steve Chapman Consultant and Senior Lecturer, Adult Cystic Fibrosis Centre and a broad practice in general and respiratory medicine. Dr. William Flight, Consultant in CF and Bronchiectasis Dr Henry Bettinson, Joint ITU/Respiratory Consultant with interest in TB and ILD Dr Alistair Moore Consultant Lung Cancer and Interventional bronchoscopy Dr. Anny Sykes, Consultant in Lung cancer Dr. Naj Rahman, Oxford Respiratory Trials Unit and Pleural disease service Unit and Unit academic lead. Lead clinician for pleural diseases plus a general respiratory and sleep medicine practice. Dr Maxine Hardinge. Consultant physician with particular interests in COPD and respiratory sleep and lead for pulmonary rehabilitation. Dr Hardinge is the Strategic Health Authority lead for COPD Dr. Annabel Nickol: Consultant in Respiratory Sleep Unit and lung function. Dr Ling-Pei Ho, Senior Lecturer and Consultant. Dr Ho has a research and clinical interest in sarcoidosis and diffuse lung disease. Dr Rachel Hoyles. Lead clinician for the interstitial lung disease service, and has a broad respiratory and general medical practice. Prof I Pavord: Difficult airways disease Dr. Mona Bafadhel: Difficult airways disease. Dr. Fergus Gleeson. Consultant Radiologist. Director of the Regional Thoracic Imaging Service. Dr Rachel Benamore, Consultant Thoracic Radiologist Specialist Registrars and Senior House Officers OCRM has three Academic Clinical Lecturers (specialist registrar grade). OCRM has four full time clinical registrars on the Churchill site (see timetables below) which comprise the posts included in the current training scheme. They are currently five full time research fellows studying laboratory or clinical doctoral projects. Three full time Senior House Officers. Respiratory Sleep Disorders One respiratory sleep clinic sister/co-coordinator. One clinical sister. Four specialist nurses, four health care assistant and one technical engineer. Pleural Disease One specialist nurse working with the lung cancer specialist nurse service. Cystic Fibrosis Four cystic fibrosis specialist nurses, three specialist cystic fibrosis senior physiotherapists, one dietician and one clinical psychologist. Pulmonary Rehabilitation One senior occupational therapist, one senior physiotherapist, two occupational therapy assistants. Bronchoscopy Two part time nurses and one part time health care assistant. Lung cancer Two lung cancer nurse specialists Clinical Research Unit/Respiratory Trials Unit/Lung function laboratory One operations director, one senior and two trial managers, data manager pending appointment, lead for trial QA, trial monitor, nine research nurses, statistician and database programmer support and two lung function technicians Other Senior Nurses One ward sister, one lecturer practitioner, two respiratory specialist nurses with a specific role in early COPD discharge policy. Workload General Respiratory Medicine The Oxford Centre for Respiratory Medicine provides a service to the population of Oxford and surroundings (approx. 550,000). The unit managed about 1400 in-patients last year. Two of the beds are in a dedicated high dependency unit specialising in post intensive care recovery and non-invasive ventilatory support and NIV is also given via other unit beds. The medical and specialist respiratory nurse staff provide a consultation service to the other Oxford Hospitals. The unit runs 23 out-patient clinic sessions per week and handles about 8000 out-patient events every year. The out-patient new patient to old patient ratio is 1:3. This service provides the opportunity for a rounded training in specialist respiratory medicine. Bronchoscopy and Thoracoscopy; pleural interventional service. The thoracic interventional service is expanding and currently performs 6-8 local anaesthetic, and 2/3 fluoroscopic/general anaesthetic bronchoscopies, 6 local anaesthetic thoracoscopies each month, and a large number of more minor pleural procedures. Bronchoscopic procedures include standard bronchial lavage, brushing and biopsy for malignancy and infection, interventional bronchoscopic procedures including electrocautery, argon plasma coagulation, cryotherapy and tracheobronchial stenting under general and local anaesthesia. The Unit is a tertiary referral centre for pleural diseases and provides an active regional thoracoscopy service, a large volume of physician-delivered pleural ultrasound and ambulatory indwelling pleural catheter service. Thoracoscopic intervention includes pleural biopsy, adhesiolysis and talc pleurodesis. Special patient groups are seen including the immunocompromised (both HIV and therapeutic immunosuppression) and patients with substantial respiratory impairment. Procedure outcomes (biopsy positivity rate and complications etc) and numbers of procedures are documented. Trainees are given records of their procedures etc. The unit is acknowledged as a centre of excellence for training in bronchoscopy, endobronchial intervention and thoracoscopy. Respiratory Sleep Medicine The unit sees 1200 new referrals with possible sleep and breathing disorders each year. It has 8000 patients on long term nasal CPAP for sleep apnoea (with 16 more being added each week) and over 500 on nasal ventilation for nocturnal hypoventilation, including neuromuscular cases (about 4more being added perweek). It performs 1350 sleep studies per year and patients are seen in 4 clinics a week on two days when there are also dedicated technical ‘equipment clinics’. This service supplies the facilities for respiratory sleep training to the standards required to run a regional respiratory sleep unit. Whilst an SpR on the ward, there is the opportunity to take a lead in managing in and out patient ventilator associated problems, and to attend sleep reporting sessions. Cystic Fibrosis The adult cystic fibrosis (CF) centre is an expanding unit which currently has 90 patients, increasing to an estimated 130 patient over the next five years. The specialist clinics are multi-disciplinary with input from two consultants, a specialist registrar, CF specialist nurse, specialist CF physiotherapists, dietician and clinical psychologist. As well as providing the full range of essential services outlined in the CF Trust Management Guidelines, including annual reviews and a home care service, our centre provides a wide range of treatment and services not readily available at local CF clinics e.g. insertion and management of totally implantable venous access devices, expertise in nasal ventilation and bronchial artery embolisation. In addition we have liaison within Oxford with specialists with an interest in CFrelated gastro-intestinal disease, CF-related endocrine conditions and fertility problems. If trainee numbers are expanded in the future, there is an opportunity for a dedicated attachment in cystic fibrosis. Bronchiectasis This service is run by one consultant and specialist nurses based on the treatment centre to co-ordinate out-patient intra-venous antibiotic treatment. The specialist clinics are multidisciplinary with input from one consultant, a specialist registrar, specialist nurse and senior physiotherapists. The cohort of patients is managed by providing a comprehensive annual review service including education regarding self-management of condition, with additional telephone contact support at the time of clinical need. COPD and Pulmonary Rehabilitation The department has dedicated COPD clinics with input from specialist nursing team, runs an early discharge scheme for COPD and is part of a countywide COPD nursing strategy. There is non-invasive ventilation for acute COPD and experience with long term home ventilation. Liaison with thoracic surgical centres exists for transplantation and lung volume reduction surgery. The pulmonary rehabilitation programme was established in 1996 and runs throughout the year. Lung Cancer The Oxford Centre for Respiratory Medicine is part of the Oxford Regional Lung Cancer Service. Patients are seen and then discussed in a multi-disciplinary meeting including physicians, surgeons, medical and clinical oncologists, specialist lung cancer nurses and two thoracic radiologists. Patient care is co-ordinated through the physician assessment, medical oncology, radiotherapy, interventional palliation and palliative care services all on the Churchill Hospital site. Last year these services handled over 300 patients with lung cancer. This range of services provides the facilities for a complete training in lung cancer management. Interstitial Lung Disease & Sarcoidosis The unit has two consultants with a declared interest in the interstitial lung diseases, running both sarcoidosis and general interstitial lung disease clinics. Complex cases are discussed at a monthly interstitial lung disease multi-disciplinary meeting with rheumatologists, pathologists and radiologists. Close links with the rheumatology department at the Nuffield Orthopoedic Hospital ensure a complex mix of connective tissue associated lung disease cases. The sarcoidosis clinical service is allied to the sarcoidosis research programme. Respiratory Research The Oxford Centre for Respiratory Medicine performs "bench to bedside" research, including genetic and cellular inflammation and lung immunology in disease areas including lung and pleural infection, pleural malignancy, and diffuse lung disease; translational animal models in lung infection; a UKCRC registered Respiratory Trials Unit and single and multi-centre clinical trials and cohort studies in asthma, COPD, pleural disease, sarcoidosis and respiratory sleep disorders. Major research themes include; Clinical Trials Respiratory sleep disorders: Dr. A. Nickol. Clinical trials (particularly focused on the vascular complications of sleep apnoea), cohort epidemiology, new treatment methods, and interventional physiological studies. Pleural diseases: Dr. Naj Rahman. Clinical trials, cohort and interventional physiological studies in malignant and infective pleural disease. Lung infection: Dr. Steve Chapman, Prof D Crook (microbiology). Novel molecular rapid diagnostic strategies in lower respiratory infection, and biofilm disruption therapy in suppurative airway disease/CF. Lung imaging: Dr F Gleeson: Regional functional lung imaging, novel PET/CT strategies, and high level image processing in collaboration with the computing laboratory of Oxford University Sarcoidosis and diffuse lung disease: Dr L-P Ho, Dr. R Hoyles. A research group based at the MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine working on immune regulation in T cell mediated diseases, and the clinical aetiopathology of sarcoidosis. Translational models of lung viral infection: Dr L-P Ho. Airways disease: Prof Ian Pavord, Dr. Mona Bafadhel. Specialist Registrars are encouraged to become involved in research projects during their clinical attachments and where appropriate, facilities are available for consolidated research periods leading to a higher degree. HIV/Infectious Diseases The Specialist Registrars have on call duties on the regional infectious diseases unit that also manages the majority of the HIV infections in Oxford. This unit provides the opportunity of clinical exposure to the full range on infectious diseases. Modular Activities: these are open to the Day Unit and JR SpRs as permitted by their timetables John Radcliffe (General Medicine): Oxford University Hospitals Main duties and responsibilities Resident medical officer for acute takes on Firm D The St3 has the opportunity to work with consultant members of Firm D. Firm D Consultants: Firm Lead: Dr Pete Watkinson (ITU) Other Consultants and their sub-specialty interests: Dr Jon Salmon (ITU) Dr Clare Colebourne (ICU) Dr Maggie Hammersley (Diabetes & Endocrinology) Dr Josephine Lightowler (General Medicine) Dr Bheeshma Rajagoplan (General Medicine) Also on take (12 hour take) with post take ward round (8.30am after night takes and 4.30pm after day takes). Teaching Supervising SHO and HO activities. Weekly student teaching Administration/Management (secretarial assistance/office space) Secretarial support for clinic letters and organising student teaching. Shared responsibility for discharge summaries with SHOs. Training: General medical SpR teaching. A formal teaching programme exists on alternating Wednesday and Monday afternoons monthly. A wide range of topics of relevance are covered. Opportunity to attend Respiratory St3 teaching (takes permitting) Firm meeting-opportunity to listen to Consultant presentations; present Consultant ‘blind cases’, or to deliver own presentation. Grand Round weekly Horton Hospital – District General Hospital; Oxford University Hospitals The Horton General Hospital in Banbury serves the growing population 180 000, in the north of Oxfordshire and surrounding areas. It has both inpatient and day case beds and also provides outpatient clinics, and is an acute general hospital providing a wide range of services, including: emergency department (with an emergency admission unit) general surgery acute general medicine trauma and orthopaedics obstetrics and gynaecology paediatrics critical care / coronary care unit (used flexibly for intensive care) cancer resource centre. The majority of these services have inpatient beds (250) and outpatient clinics, with the outpatient department running clinics with visiting consultants from Oxford in dermatology, neurology, physical medicine, rheumatology, ophthalmology, radiotherapy, oral surgery and paediatric cardiology. Acute general medicine also includes a short-stay admissions ward, an emergency assessment unit, a day hospital as part of specialised elderly care rehabilitation services and a cardiology service. Duties of the post The current consultant post is being increased to 2 respiratory consultant posts. The main duties of the St3 are the inpatient ward, take part in the General Medical on-call Rota and a Chest and General Medical Clinic per week. The registrar undertakes bronchoscopy weekly. Opportunities are also available for the trainee to contribute to the Lung Function Clinic, general management of ITU patients and the Pulmonary Rehabilitation Programme. Teaching The St3 assists in teaching the SHOs at the bedside and in practical procedures. He is also responsible for organisation of a programme of more specific subject-orientated teaching for SHOs and House Officers which takes place on Wednesday lunch time. There is a learning opportunity for at least an hour of every week day including Journal Club, X-Ray Conference, Didactic Teaching, Departmental Meeting and Hospital Grand Round. Dr J Grayez Consultant Physician 1x Specialist registrar (Oxford region) Ward Junior doctors Secretary Buckinghamshire NHS Hospitals - Stoke Mandeville Hospital and Wycombe Hospital The Trust is made up of two hospitals- Stoke Mandeville Hospital and Wycombe Hospital, as well as Amersham Hospital which houses non acute activity, and some community hospitals. Between them the hospitals provide a comprehensive range of acute hospital services; and some regional and national specialist services. Stoke Mandeville Hospital has: A&E services, Acute Medicine Unit, short stay and general medicine incl respiratory inpatients, critical care unit. Ambulatory care unit for medicine surgery, paediatrics, obstetrics and haematology inpatients. The Trust has around 1000 beds. Ophthalmology, rheumatology, dermatology, neurology, ENT, GUM. Spinal Injury services Regional Burns and plastics service. The Trust serves residents in Buckinghamshire, Thame (Oxfordshire), Tring (Hertfordshire) and Leighton Buzzard(Bedfordshire), a combined population of 500,000. It serves a much larger population for Burns and Plastics services (1.5m) and Spinal Injuries (14m). Wycombe Hospital has: a cardiology admissions unit for the region with specialist inpatients beds incl. the cardiac catheterisation service Regional Stroke Unit, and medicine for the older person step down unit Day assessment Unit for medical patients elective surgery. Critical care unit The Respiratory trainees are based at Stoke Mandeville Hospital What do we expect of you as our trainee? - participation in our multidisciplinary respiratory team for inpatients and outpatients - participation in your clinical supervision - Supervision and teaching of juniors - GIM rota - Involvement in audit and management roles. - Involvement in patient safety and clinical governance aims The Respiratory Unit: Workforce: 5 fulltime consultantsDr. Mitra Shaididi Dr. Charlotte Campbell Dr Anjani Prasad Dr David Taylor Dr. Chris Wathen Additional consultants involvedMiss Emma Beddow Dr Nic Bates and Dr Niki Panakis Lead for TB; roles in management and IT. Lead for Pleural; Lead in Training (current Training Programme Director) Lead for lung cancer and NIV; EBUS lead; spinal injures unit link consultant Lead for chronic cough; Clinical Governance Lead Management roles ; Level 1 USS Lead for lung function and Oxygen, Lead for ILD; Level 2 USS; roles in Training. Visiting Thoracic Surgeon Lung Oncologists 3 x specialist registrars (Oxford Region) 2 CMT (Oxford region) 4 FY2s 6 FY1s. Specialist nursesLesley Broad (Matron) 2x ward sisters 5x respiratory nurses for early discharge scheme for COPD, nebuliser, oxygen and Zolair3 X 3 x Lung cancer nurses, 1x community lung cancer nurse 1x TB nurse: Margaret Holland 3 Lung physiologist with lung function labs each hospital site 6 Medical secretaries Infrastructure of the inpatient Respiratory Unit: There are two respiratory firms covering 2 respiratory wards- 24 bedded and 17 bedded, and an escalation GIM bay of up to 12 patients: there are daily consultant ward rounds and afternoon board rounds (the consultants rotate inpatient duties. NV patients and chest drain care are looked after in the respiratory unit. There is an active integrated respiratory service providing early discharge of COPD patients, pulmonary rehabilitation and oxygen services. An outpatient iv antibiotics service is also used for respiratory patients. Patients are triaged to chest from the acute take daily. Patients are also transferred from Wycombe for specialist respiratory input. The Unit provides in reach to the acute medical unit and referrals from the hospital. Main duties and responsibilities of respiratory registrars: The 3 registrars rotate 4 monthly between the 2 firms on the inpatient unit and a clinic job: Ward registrar commitment - inpatient care to one ward - supervise and teach the juniors - attend bronchoscopy - MDT - 2 clinics a week. Clinic job commitment -attend 3 clinics - respiratory referrals in conjunction with the consultants -attend bronchoscopy - MDT Each registrar is given teaching or management roles such as rota management, clinical governance lead. Speciality services provided by the unit: The respiratory medicine unit offers: - Respiratory Unit with NIV and pleural ultrasound - integrated respiratory care. - OP clinics incl. dedicated lung cancer, TB and cough clinics - bronchoscopy including EBUS - pulmonary function laboratory, CPET testing, flight assessment. - respiratory radiology incl monthly ILD meeting, weekly XR meeting - TB service - smoking cessation service - Thoracic surgeon visits weekly for MDT; lung cancer MDT service - spinal injuries unit respiratory medicine. General medicine: The oncall commitment is at SMH mainly. When on call the registrar has no other duties. On call patients are triaged to the appropriate specialty daily- cardiology, respiratory, gastro, endo, etc. Currently there is a 4month period of on call at Wycombe in rotation with the other medical registrars to give experience in stroke and cardiology referrals. Teaching: Tuesday: journal club Wed: medicine xr meeting and teaching Thursdays: a hospital Grand Round; Thursday respiratory afternoon: morbidity and mortality meeting Fridays: practical respiratory teaching and registrar difficult or hot cases There are monthly - clinical governance half days. - ILD meetings - a Unit management meeting. We hope you enjoy your time at Bucks, Dr. Charlotte Campbell 2015. Royal Berkshire Hospital The Royal Berkshire Hospital is a Foundation Trust and provides a wide range of services for the people living in the west of Berkshire. Our area extends as far as Hungerford in the west, to Henley on Thames and Bracknell in the east, part of Hampshire to the south and parts of Oxfordshire to the north. The population is expanding and stands at approximately 570,000. Facilities are those associated with a very large District Hospital and Include; Medicine: General Medicine, Gastroenterology, Renal Medicine, Diabetes & Endocrinology, Cardiology, Elderly Care, GU Medicine, Dermatology, Respiratory Medicine, Rheumatology, Clinical Haematology (level2), Neurology, Rehabilitation and Stroke Unit. Surgery: Trauma & Orthopaedics, General Surgery, Urology, ENT, Maxillo-facial Surgery and Ophthalmology. Obstetrics: Gynaecology and Paediatrics, including SCBU and NICU Clinical Support Services: Pathology, Radiotherapy, CT Scanning, MRI, Nuclear Medicine, Radio-isotopes, Accident & Emergency, Intensive Care Unit at the Royal Berkshire Site, High Dependency Unit, and Day Bed Unit. Oncology General Medicine at The Royal Berkshire Hospital All acute medical patients are currently admitted via the Clinical Decision Unit, which is a 56 bedded unit based near to X-ray and A+E. This is an admissions centre for all medical patients requiring hospital assessment apart from direct admissions to CCU for patients with suspected acute coronary syndromes. Patients considered to have short stay requirements may be retained in the CDU and are reviewed by the CDU team. Within the CDU there is a Higher Monitoring Area (HMU or Medical HDU) of four beds providing experience in care of the critically ill including non-invasive ventilation, CVP monitoring and step down from ITU. The HMU is supported by an ITU outreach team. The respiratory team are heavily involved in the management of the HMU and look after patients requiring NIV and those with respiratory problems. The unit is staffed daily by a team comprising highly dedicated nurses and: Consultant Physician of the Day Consultant Geriatrician of the Day Consultant Cardiologist of the Day Specialist Registrars (2-3) 3 –5 SHO’s on various rotas F1 (2) POD GOD COD There are also daily rounds from each specialty including neurology. The respiratory trainee takes part in the GIM rota. The Department Of Respiratory Medicine The Respiratory Department is based in South Block, Royal Berkshire Hospital. The present staff consists of: Dr. Chris Davies Dr. Andrew Zurek Dr. Anne McGown Consultant in GIM and Respiratory Medicine (Full time) Consultant in GIM and Respiratory Medicine (Full time) Consultant in GIM and Respiratory Medicine (Part time) Dr. Grace Robinson Dr. John Park Dr. Catherine Thomas Two Specialist Registrars (Full-time) on the Oxford St3 Scheme One ST1-2 (GIM rotation) One Senior House Officer/ST1-2 (Critical Care rotation) Two Foundation year 1 Consultant in Respiratory Medicine (Full time) Consultant in Respiratory Medicine (Full time) Consultant in Respiratory Medicine (Full time) There are 4-5 secretaries working within the department Other staff within the department includes: Two Specialist Respiratory Nurses, who provide the Acute Respiratory Assessment Service (ARAS) for COPD and asthma patients. Two Specialist Respiratory Nurse in TB Two Clinic Nurses Lung Function Laboratory technician. Two Sleep Nurse/Technicians Part-time Respiratory Physiotherapist Designated Psychologist for respiratory patients. The Department is situated in a new self-contained area within South Block and consists of a separate waiting area and reception, areas for clinic nurses and administrative staff and 7 clinic rooms. Pulmonary function laboratory and the Sleep Unit are also situated within the department, There is a treatment area used for some day case procedures such as pleural procedures The team is responsible for 28 in-patient beds in Castle Ward, within the new Battle block. Day cases can also be seen on this ward. The ward has expertise in the management of most common respiratory disorders and also provides facilities for use of non-invasive ventilation for acute and chronic conditions. In addition the team cares for patients in the HMU, with occasional outliers depending on the hospital workload. -There are currently 13-15 out-patient clinics at RBH and 2 at Newbury District Hospital (West Berkshire) per week. Three of these clinics (run concurrently) are designated for lung cancer patients. Lung cancer is managed in conjunction with West Berkshire Cancer Care Unit at the Royal Berkshire Hospital. There are two dedicated thoracic oncologists, two Lung Cancer Nurses, Palliative Care Physicians, and two hospices within the area. We have one visiting thoracic Surgeon (Mr John Pilling), from Guy’s Hospital in London who visits each week and does a clinic at RBH. There is a multidisciplinary team meeting (MDT) every week which is co-ordinated by dedicated MDT co-ordinators. There is an active Cancer Network. - - Tuberculosis Service –There are 2 open contact clinics per week and a BCG Service is provided for West Berkshire. A neonatal service is provided for high risk families and a community clinic has been set up in an urban GP practice. There is a designated Tuberculosis Nurse. There are about 80 cases of TB each year in Reading, many co-infected with HIV. A diagnostic bronchoscopy service – 2 lists/week, with facilities for TBNA. - Lung Function Laboratory with ability to also measure SNIP and Flight assessment service - Thoracic Ultrasound machine for pleural interventions - Sleep Laboratory currently with two/three nurses/technician and a research nurse funded by the MRC as part of a multicentre project with Oxford. The laboratory now uses out-patient Embletta study systems as well as a Visi-Lab system available for in-patients, and several oximeters for home screening. There are facilities for nCPAP, and also NIV for both acute and chronic ventilatory failure with currently 70+ patients on domicilary ventilation - Nurse led clinics and open referral service for patients with airway diseases including COPD and asthma. - Rehabilitation courses for COPD. - Long term oxygen therapy LTOT service including dedicated input from a CNS in line with the new national oxygen contract - Shared care of cystic fibrosis patients with the Royal Brompton or the Churchill Hospital, Oxford. There is a 3 monthly joint CF clinic with Oxford and Dr Robinson - Nebuliser loan service - X-Ray services include spiral CT and MRI. Teaching Multidisciplinary cancer/surgical meeting is held every week Grand Round Thursday 12.10pm – 1.10pm X-Ray meeting Monday 1pm – 1.45pm weekly ILD MDT Monthly Departmental Meeting Thursday RBH 8.30am – 9.30am Frimley Heath NHS Trust: Heatherwood and Wexham Park Hospitals Heatherwood and Wexham Park Hospitals (HWPH) provide hospital services to a population of more than 450,000. It covers a large and diverse population and includes affluent areas such as Ascot, Windsor and Maidenhead, and also the larger urban area of Slough. The towns of Bracknell, Maidenhead, Slough and Windsor house two-thirds of the total population, the remainder living in rural areas or small towns. Much of the District lies within the designated Green Belt areas. The Trust is an Acute Hospital Trust which has in excess of 800 beds. The General Medicine and Respiratory in-patient component of this post is based at Wexham Park Hospital, Slough. There are currently 4 Registrars attached to Respiratory Medicine based at Wexham Park Hospital: 3 Respiratory training posts and 1 G(I)M training post. Wexham Park Hospital Wexham Park Hospital, Slough, is a District General Hospital with a full range of standard services and specialities. There is a large Accident and Emergency department, expanded and refurbished in November 2013, supported by a large Acute Medical Unit comprising 2 wards (Ward 8 for male and Ward 7 for female patients).; General Medical Wards to which patients are subsequently moved are then largely Speciality and Consultant based. An 8-bedded Coronary Care Unit opened in January 2002, with 6 PCCU beds and the Cardiologists run a separate on call rota to include that for Primary PCI (Mon – Fri 8am – 6pm). Emergencies out of these hours are referred to the Royal Brompton Hospital. Acute Stroke services share an on call rota for thrombolysis with Buckinghamshire. In 2008 the Respiratory Unit (Ward 9) was refurbished and 6 beds were upgraded to level 2 status for NIV provision. There is a Procedure Room on the Ward with a bedside Ultrasound scanner available for pleural interventions. There is a 12 bedded combined ITU / HDU. Chest Clinic Services Currently the majority of specialist out-patient services for Respiratory Medicine are provided at the Chest Clinic at King Edward VII Hospital, Windsor. This clinic was completely refurbished in 2000 to provide excellent patient and clinical facilities, including a seminar room and small research laboratory. The Chest Clinic is currently staffed by: Dr Lorraine Hart PhD FRCP Dr Jayne Norcliffe FRCP Dr Sarah MenziesMRCP Dr Angela Jones MRCP Dr Gareth Roberts MRCP Dr Sharon Power MRCP Dr. Rahul Mogal MRCP Miss Emma Beddow FRCS Dr Fiona Lisney Dr James Gildersleve Dr Andreas Polychronis Dr Abrar Hussain Consultant in General & Respiratory Medicine Consultant in General and Respiratory Medicine Consultant in General and Respiratory Medicine Consultant in General and Respiratory Medicine Consultant in General and Respiratory Medicine Consultant in General and Respiratory Medicine Consultant in General and Respiratory Medicine Consultant Thoracic Surgeon Royal Brompton & Harefield Hospitals Trust Consultant Palliative Care Physician. Consultant Oncologist Consultant Oncologist Consultant Liaison Psychiatrist 3 Specialist Registrars (Oxford region) 1 G(I)M Registrar (Oxford region) Clinic Matron (Respiratory Specialist trained) 3 TB Liaison Nurses 2 Lung Cancer ANP 1 COPD/Oxygen ANP 1 Asthma ANP Oxygen Service Team 2 Respiratory Physiotherapists Respiratory Physiologist 1 Clinic Staff Nurse 1 HCA 1 Secretary 1 WTE 3 WTE 2 WTE 0.95 WTE 1 WTE 2 WTE 1.65 WTE 1 WTE 0.53 WTE 0.75 WTE 1 WTE 2 Receptionists 2 Clerical staff 2.0 WTE 1.2 WTE The Consultant staff has special interests and expertise in: Asthma, COPD, TB, Bronchiectasis, ILD, Lung Cancer and NIV. At present there is a clinic each weekday: Monday am Tuesday am Tuesday pm Wednesday am General Respiratory Clinic LH Palliative Care Clinic FL Joint Lung Cancer Clinic LH/JN/GR/EB/JG/AP General Respiratory Clinic RR TB Evaluation Clinic SM/AJ alternate The Trust considers that the responsibilities of a Registrar level trainee doctor should include a full commitment to both the General Medical and Speciality needs of the patients within the community and hospitals. G(I)M: unselected take is on a shift based rota system. Respiratory: The Registrars work in a team based on Ward 9 on the Wexham site. The ward has 38 beds, 6 of which are Level 2 equipped. The team has 2 FY1, 3 FY2/CT1/CT2 working with the 4 Registrars. There are currently 2 International Medial Graduates (IMGs) working on a supernumerary basis, pending full integration into the Trust and the on call system. It is expected that the Registrars will: Undertake 1 independent Ward Round per week Undertake 2 Out-patient clinics sessions per week See Ward Referrals as requested Attend the weekly Bronchoscopy list on a rotating basis Teaching: A Trust Academic Half-Day takes place each month covering wide ranging topics and includes a regular Audit presentation session. Attendance at these meetings is compulsory for both junior and senior medical staff, apart from those on-call. In addition there is a weekly Academic Physicians meeting on a Monday lunchtime. Ward 9 run a weekly departmental Journal Club and also weekly ‘in-house’ trainee teaching. Specifically for the attachment to HWPH Trust, there are 2 modular areas where further experience is expected to be gained: HWPH TB module S Menzies Approximately 100 patients with TB are seen annually by our Trust, with TB rates for Slough being amongst the highest in the UK outside London. Hence, registrars undertaking a 3-6 month TB module in TB have the opportunity to gain a great deal of experience in this subspecialty. This includes: Weekly TB clinic Weekly TB MDT Quarterly TB/HIV and Paediatric TB MDTs TB laboratory experience TB nursing experience and Mantoux testing TB audit and research Cohort Review process TB incident meetings (ad hoc) HWPH Lung Cancer module J Norcliffe At the Chest Clinic there is a weekly MDT and dedicated Lung Cancer Clinic offering an excellent experience, not just with the opportunity to see New and FU patients with Lung Cancer, but also the opportunity to observe and participate in Surgical or Oncological Clinics which run side-by-side. A 4 month module in this sub-speciality offers: Weekly MDT and Lung Cancer Clinic Specific Surgical or Oncology experience Exposure to available Clinical Trials for Lung Cancer Lung Cancer Audit Exposure and involvement in Peer Review Overall, we hope you have an enjoyable and rewarding attachment with us! MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST The Milton Keynes Hospital NHS Foundation Trust provide a wide range of services for the local population of around 300 000 people. The facilities associated in this hospital include: Medicine: General Medicine, Respiratory Medicine, Cardiology, Gastroenterology, Endocrinology, Elderly Care, GU Medicine, Dermatology, Rheumatology, Clinical Haematology, Neurology, Rehabilitation Stroke Unit and on site Oncology service with designated Consultant Medical and Clinical Oncologists. Surgery: Trauma and Orthopaedics, General Surgery, Vascular Surgery, Urology, ENT and Ophthalmology. Obstetrics: Gynaecology, Obstetrics and Paediatrics including SEBU and NICU. Clinical Support Services: Pathology, Radiology which provide excellent CT scanning service and MRI. We have designated interventional Radiologists who provide a wide variety of image guided interventions and this is in addition to the two designated Consultant with special interest in Chest Radiology. Other Support Services include Intensive Care Unit and High Dependency Unity. Milton Keynes Hospital NHS Foundation Trust should soon become a University Teaching Hospital, and we provide training for undergraduate medical students from the newly started University of Buckingham Medical School. DEPARTMENT OF CHEST MEDICINE AND RESPIRATORY PHYSIOLOGY Current Consultant Staff Dr Aji Kavidasan: Consultant Chest Physician and Specialty Lead Visiting Professor in Pulmonary Medicine, Amrita Institute of Medical Science; Amrita University-India Dr Milan Bhattacharya, Consultant Physician and Divisional Director for Medicine and A & E Dr Rabinder Randhawa, Consultant Chest Physician and Clinical Governance Lead for Medicine Dr Raza Mansoor, Consultant in Infectious Diseases Mr Niall McGonigle, Consultant Thoracic Surgeon, Visiting Thoracic Surgeon from Harefield Hospital Dr Vikas Somani, Senior Speciality Doctor in Respiratory Medicine Dr Conor McGeary, Senior Speciality Doctor in Respiratory Medicine Other Members of the Medical Team One Specialist Registrar from Oxford Deanery One CMT Trainee from Oxford Deanery, One FY2, 3FY1 One Speciality Doctor at Registrar Level One Speciality Doctor at SHO Level The daily delivery of service is supported by the following key members of the team: Two Senior Respiratory Physiologists Two Advanced Nurse Practitioners for Lung Cancer One Specialist Nurse for Lung Cancer One Advance Nurse Practitioner for TB One Advance Nurse Practitioner for NIV and Airway Disease Two Advance Nurse Practitioners for COPD, Asthma and Home Oxygen Service Infrastructure of the Service, training and Education The department of Chest Medicine and Respiratory Physiology at Milton Keynes Hospital NHS Foundation Trust provide inpatient support for one male and one female ward catering a total of 57 inpatients at a time. This includes a 6 bed High Dependency NIV for the management of Hypercapnia Respiratory Failure patients and this Service is led by Dr Randhawa. During the placement the trainee registrar will get exposure to patients with a wide variety of common and specialist respiratory problems and will be attached to all three Consultants for Inpatient activity. Outpatient clinics are conducted from Monday to Friday and the SpR will be doing two outpatient clinics, one with Dr Kavidasan and one with Dr Randhawa; however there are facilities to attend specialist clinics such as thoracic surgery and oncology. The trainee will participate in the general medicine on call rota. Bronchoscopy and thoracoscopy We conduct bronchoscopy on Monday, Wednesday and Thursdays and thoracoscopy on Monday and Wednesdays. The SpR will get exposure to ample number of diagnostic bronchoscopy and also get experience in ward based thoracic ultrasound scan, during their placement here at Milton Keynes Hospital. Lung Function and Sleep Medicine We do have a diagnostic sleep service, which primarily includes overnight oximetry and detailed sleep study with embletta and a successful CPAP service has been conducted over the last year and currently we have seen more than 100 patients with obstructive sleep apnoea who are well established on CPAP treatment. The trainee SpR will get experience in sleep study reporting, particularly of embletta as well as exposure to instigation and monitoring of CPAP treatment. Investigation and Management of Lung Cancer and Pleural Disease Dr Aji Kavidasan is the lead for lung cancer services in the hospital. There is an MDT every Tuesday which the trainee is expected to attend. We also run an outpatient thoracic ultrasound guided pleural procedure list on an ad hoc basis and the registrar is expected to attend this and get experience both in thoracic ultrasound scan as well as diagnostic and therapeutic pleural aspiration. The Lung Cancer Service is rapidly expanding and the recently established on site Oncology Service is supported by Professor Hany El-Deeb along with another medical oncologist who provides a robust service for patients diagnosed with lung cancer. Chemotherapy is provided on site and radiotherapy is provided in the local private firm (Linford Road Surgery). Surgery for proven lung cancer is provided at Harefield Hospital and Mr Niall McGonigle, Consultant Thoracic Surgeon, conducts an outpatient clinic here at Milton Keynes Hospital NHS Foundation Trust and also participates in our Multidisciplinary Team Meeting held every Tuesday. Teaching In addition to regular teaching during ward rounds, clinics and bronchoscopy sessions, there are designated teaching opportunities as follows: 1. Respiratory Case Discussion Meeting on Monday 1 – 2 pm 2. Lung MDT 12.30 – 2.30pm every Tuesday 3. Medical Grand Rounds Wednesday 12.45 – 1.45pm 4. General Radiology Meeting 1 – 2pm every Friday John Radcliffe (ITU) – 3 month attachment The general Intensive Care Units admit over 1000 patients per year. The majority of patients are level 3 and have an admission APACHE score of 20-30. The overall mortality is low as is the SMR. Approximately 20% of admissions are elective surgical patients and the remainder are critically ill emergency patients with a wide range of medical and surgical pathologies. Oxford is the tertiary referral centre for major trauma, spinal, interventional cardiology, oesophageal, vascular, major maxillo-facial surgery, interventional radiology, haematological malignancy and transplantation (including bowel and pancreas). This is reflected in the pathology of patients on the AICU/CICU. A full range of invasive monitoring and all major forms of organ support are employed. The majority of patients require multi-organ support and invasive monitoring. Trainees can expect to gain experience of oesophageal Doppler monitoring, thrombo-elastography, renal replacement techniques, echocardiography, bronchoscopy, ultrasound, BILEVEL and noninvasive ventilation as well as more basic procedures such as line placement and resuscitation. The units are medically staffed in multiple groups: three groups of trainees (from both an anaesthetic and non-anaesthetic background) and the consultant tier. The presence of trainees from a variety of backgrounds provides a fantastic training environment and so represents a rare opportunity given the UK system of early specialisation. It is particularly useful for those trainees doing professional exams and helps our high success rate in the FRCA final/DICM and EDIC. The twelve consultants cover each unit separately on a split week system. The consultants come from a background in anaesthesia, medicine, military services and research. There is local expertise in clinical trials research, bench research, sepsis and genomics, ventilation, difficult airways, teacher training, simulation, international transfer, primary trauma in developing countries, resuscitation, follow up, ultrasound and echocardiography. The unit has an active teaching programme. This includes protected teaching, weekly unit meetings, daily microbiology rounds and various yearly meetings. The senior trainees have an active exam orientated program in addition to one half-day per month of protected teaching. This contributes to the high success rate in the Diploma in Intensive Care in the region. Teaching Respiratory There is a Structured Training Programme which is held monthly based in Oxford. The STP covers the main topics of the respiratory curriculum over a 3 year period. Attendance at 70% of teaching is expected and monitored. Each session is supervised by 1-2 senior clinicians with input into the session by 2 trainees. General Medicine All-day GIM teaching is held monthly in Oxford. Trainees are required to attend 70% of teaching to achieve the required number of hours GIM teaching. Main Conditions of Service Appointments to this programme are subject to the Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales). In addition appointments are subject to: Applicants having the right to work and be a doctor or dentist in training in the UK Registration with the General Medical Council Pre-employment checks carried out by the Trust HR department in line with the NHS employment check standards, including CRB checks and occupational health clearance. The employing Trust’s offer of employment is expected to be on the following nationally agreed terms: Hours – The working hours for junior doctors in training are now 48-hours (or 52-hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors in training also have an individual right to opt-out if they choose to do so, but they cannot opt-out of rest break or leave requirements. However, the contracts for doctors in training make clear that overall hours must not exceed 56 hours in a week (New Deal Contract requirements) across all their employments and any locum work they do. http://www.nhsemployers.org/your-workforce/need-to-know/european-working-time-directive Pay – you should be paid monthly at the rates set out in the national terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service (England and Wales), “the TCS”, as amended from time to time. The payscales are reviewed annually. Current rates of pay may be viewed at http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/pay-and-conditionscirculars/medical-and-dental-pay-and-conditions-circulars Part time posts will be paid prorata Pay supplement –depending upon the working pattern and hours of duty you are contracted to undertake by the employer you should be paid a monthly additional pay supplement at the rates set out in paragraph 22 of the TCS. The current payscales may be viewed at http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/pay-and-conditionscirculars/medical-and-dental-pay-and-conditions-circulars The pay supplement is not reckonable for NHS pension purposes. The pay supplement will be determined by the employer and should be made clear in their offer of employment and subject to monitoring. Pension – you will be entitled to join or continue as a member of the NHS Pension Scheme, subject to its terms and rules, which may be amended from time to time. If you leave the programme for out of programme experience you may have a gap in your pension contributions. More information can be found at http://www.nhsbsa.nhs.uk/pensions Annual Leave – your entitlement to annual leave will be five or six weeks per annum depending on your previous service/incremental point, as set out in paragraphs 205-206 of the TCS. The TCS may be viewed at http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-andconditions/junior-doctors-dentists-gp-registrars/junior-doctors-terms-and-conditions-ofservice-and-associated-documents Sick pay – entitlements are outlined in paragraph 225 of the TCS. Notice –you will be required to give your employer and entitled to receive from them notice in accordance with paragraphs 195-196 of the TCS. Study Leave –the employer is expected to offer study leave in accordance with paragraphs 250-254 of the TCS. Local policy and procedure will be explained at induction. Travel Expenses – the employer is expected to offer travel expenses in accordance with paragraphs 277-308 of the TCS for journeys incurred in performing your duties. Local policy and procedure should be explained at induction. Subsistence expenses – the employer is expected to offer subsistence expenses in accordance with paragraph 311 of the TCS. Local policy and procedure should be explained at induction. Relocation expenses – the employer will have a local policy for relocation expenses based on paragraphs 314 – 315 of the TCS and national guidance at http://www.nhsemployers.org/PayAndContracts/MedicalandDentalContracts/JuniorDoctorsD entistsGPReg/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx You are advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure. Pre-employment checks – all NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements, which are expected to be in line with national guidance at http://www.nhsemployers.org/your-workforce/recruit/employment-checks/nhs-employmentcheck-standards Professional registration – it will be a requirement of employment that you have professional registration with the GMC/GDC for the duration of your employment. Though the post is covered by NHS Indemnity, you are strongly advised to register with the MPS for professional indemnity. Health and Safety – all employers have a duty to protect their workers from harm. You should be advised by the employer of local policies and procedures intended to protect your health and safety and expected to comply with these. Disciplinary and grievance procedures – the employer will have local policies and procedures for dealing with any disciplinary concerns or grievances you may have. They should advise you how to access these, not later than eight weeks after commencement of employment. Educational Supervisor – the employer or a nominated deputy (usually the Director of Medical Education) will confirm your supervisor on commencement. General information on the LETB’s management of Specialty Training programmes, including issues such as taking time out of programme and dealing with concerns or complaints, is available at www.oxforddeanery.nhs.uk and in the national ‘Gold guide’ to Specialty Training at http://specialtytraining.hee.nhs.uk/. Please ensure that you inform Health Education Thames Valley of any changes to your contact details. February 2015