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:
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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;
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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:
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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)
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Dr. Grace Robinson
Dr. John Park
Dr. Catherine Thomas
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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:
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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.
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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.
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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.
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Lung Function Laboratory with ability to also measure SNIP and Flight assessment
service
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Thoracic Ultrasound machine for pleural interventions
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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
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Nurse led clinics and open referral service for patients with airway diseases including
COPD and asthma.
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Rehabilitation courses for COPD.
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Long term oxygen therapy LTOT service including dedicated input from a CNS in line
with the new national oxygen contract
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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
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Nebuliser loan service
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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:
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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:
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Weekly TB clinic
Weekly TB MDT
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Quarterly TB/HIV and Paediatric TB MDTs
TB laboratory experience
TB nursing experience and Mantoux testing
TB audit and research
Cohort Review process
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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:
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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