NHS Lothian
Acute Hospitals Division
Directorate of Surgery
Department of Renal Medicine, Royal Infirmary of Edinburgh
Clinical Fellow in Transplantation
1.
Outline of the post
Further particulars are presented for a Clinical Fellow post in the Department of Renal Medicine at
the Royal Infirmary of Edinburgh a particular focus on the Renal Transplant service.
This is a full-time post which has been funded by NHS Lothian for one year from August 2015 to
provide further sub-speciality training in medical aspects of Transplantation. The post is intended for
post CCT training or out of programme training for senior Renal trainees who intend to pursue a
career focused on transplant medicine.
The Royal Infirmary of Edinburgh provides kidney transplantation to the North, East and South-East
of Scotland, and kidney-pancreas transplantation for the whole of Scotland. Recent changes in
organ procurement and allocation has resulted in a significant increase in renal and SKP transplant
activity, both inpatient and outpatient, at the Royal Infirmary of Edinburgh. The team within the RIE
plays an active role in developing techniques for organ preservation and procurement, and is leading
the way in the UK with normothermic regional perfusion. Consultant surgeons and nephrologists also
have an active research profile in both clinical and laboratory based renal transplant research. There
is an active Live donor programme including ABO/HLA incompatible transplantation and a successful
pancreatic islet transplant programme. The Royal Infirmary of Edinburgh also provides liver
transplantation for the whole of Scotland and there would be the opportunity for the appointee to
spend time in the liver transplant service if interested.
The post holder will be based mainly in the Department of Renal Medicine at the Royal Infirmary of
Edinburgh and would participate in the StR on call rota.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental health
and hospital services. Mr Tim Davison is Chief Executive and Dr David Farquharson is Medical
Director.
The NHS Board determines strategy, allocates resources and provides governance across the health
system. Services are delivered by Lothian University hospitals division, the Royal Edinburgh hospital
and Associated mental health services, 4 community health (and social care) partnerships (CH(C)Ps)
in City of Edinburgh, West Lothian, East Lothian and Midlothian, and a Public Health directorate.
NHS Lothian serves a population of 850,000.
The Transplant unit provides a supra-regional service to Fife, Tayside, Borders, Grampian and
Highland regions and serves a population of 3.5 million for renal Transplantation and 5.5 million for
pancreas transplantation.
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2.1
University Hospitals Division
The University Hospitals Division provides a full range of secondary and tertiary clinical services
to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The Division is one
of the major research and teaching centres in the United Kingdom.
Hospitals included in the Division are:
The Royal Infirmary of Edinburgh
The Western General Hospital
The Royal Hospital for Sick Children, Edinburgh
St Johns Hospital
Royal Victoria Hospital
Liberton Hospital
The Princess Alexandra Eye Pavilion.
The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of
the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres,
and is equipped with modern theatre and critical care equipment and monitoring. Within the main
building is a dedicated, multidisciplinary, 5 theatre day surgery complex. The hospital provides for
most specialities and is the centre for:
 General surgery with a focus on the upper GI tract
 Vascular surgery
 Hepato-biliary and Transplant medicine and surgery
 Cardiac and Thoracic surgery
 Elective and trauma Orthopaedics surgery
 Neonatology
 Obstetrics & Gynaecology
 Cardiology
 Renal Medicine
 Sleep Medicine
 Regional major Accident and Emergency centre.
There is a Combined Assessment Unit which takes unselected GP or direct emergency referrals,
and from A&E. CAU includes the Dept of Liaison Psychiatry and the Scottish Poisons Bureau and
Treatment Centre. There are full supporting Laboratory and Diagnostic Radiology Services
(including CT, MR, Ultrasound and NM and PET scanning will be available in 2008). There is a
full range of lecture theatres, a library and AV facilities.
The Western General Hospital (WGH) has 600 beds and 5 operating theatres and is equipped
with modern theatre and critical care equipment and monitoring. The Anne Ferguson building
was completed in 2001. The hospital provides for most specialties and is the centre for:
 Neurology, Neurosurgery and neuropathology
 UK CJD unit
 Colorectal Surgery
 Urology and Scottish Lithotriptor Centre
 Breast Surgery and Breast screening
• Gastro-Intestinal disease
 Rheumatology
 Infectious Diseases
 Haematology Oncology
 Medical Oncology
 Radiation Oncology (including 6 LINACs)
 Dermatology (Inpatient)
 Medicine of the Elderly/Stroke Medicine
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There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance medical cases
on a zoned basis within the city, and a nurse led Minor Injuries Unit. There is no trauma unit at
this hospital. There are full supporting Laboratory and Diagnostic Radiology Services (including
CT, MR, Ultrasound and NM).There is a full range of lecture theatres, a library and AV facilities.
St John’s Hospital opened in 1989 and is located in the centre of Livingston, a new town about
30 minutes drive west from Edinburgh. The hospital provides for most common specialties but
does not have emergency general surgery or orthopaedic trauma operating. The hospital has a
paediatric ward and is the centre for:
 General Medicine with specialists in Cardiology, Diabetes & Endocrinology,
Gastroenterology, Respiratory Medicine and Care of the Elderly
 Obstetrics & Gynaecology
 Child Health including Paediatrics and community child health
 The supraregional Burns and Plastic Surgery unit.
 Oral and Maxillofacial Surgery
 ENT
 Critical Care (ITU, HDU and CCU)
 Accident and Emergency
 General Surgery
 Orthopaedics
 Anaesthetics
 Mental Health including ICCU and ICPU
Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH
being developed as a major elective centre for the region. Lothian’s ENT service was relocated to
SJH to create an integrated head and neck unit with OMFS and Plastic Surgery.
Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit,
a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit
and a £2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology
Services (including CT, Ultrasound and NM).
The hospital has been accredited full teaching hospital status by the University of Edinburgh.
There is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and
specialist services for children. The hospital is situated in a residential area close to the centre of
Edinburgh and is approximately 3 miles from the site of the New Royal Infirmary and the colocated University of Edinburgh Medical School and 3 miles from the Western General Hospital.
The RHSC is a 151-bedded Hospital, and is the main paediatric teaching hospital for the SouthEast of Scotland providing general and specialised services on a local, regional and national
basis. It acts as the local paediatric referral centre for the children of Edinburgh and surrounding
areas, and as a tertiary referral centre for intensive care patients; gastroenterology, hepatology &
nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology; haematology;
neonatal surgery; plastic surgery; orthopaedic surgery; urological surgery and aspects of general
surgery.
Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8 bedded
Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3 bedded Neonatal
Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full
range of audio-visual equipment.
All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy
services. The local radiology department provides on site Magnetic Resonance Imaging, CT
Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry,
haematology, pathology and neuropathology services
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2.2 Community Healthcare Partnerships
The four established Lothian Community Health (and Social Care) Partnerships serve the
population of Edinburgh, Midlothian, East Lothian and West Lothian.
Hospitals in the CH(C)Ps include:
The Astley Ainslie Hospital in Edinburgh
Rosslynlee Hospital in Midlothian
Herdmanflat Hospital
Roodlands Hospital in East Lothian.
The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian
Councils bringing together those responsible for planning, managing and providing communitybased health services for the population of Edinburgh and the Lothians.
There are 7,500 members of staff. In addition, there are approximately 1,000 independent
contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A
population of 850,000 people is served across health board area. The range of services care of
the elderly, medical rehabilitation, community mental health, substance misuse and learning
disability, district nursing and health visiting, family planning, well woman, , comprehensive dental
care and those provided by Professions Allied to Medicine, such as physiotherapy, pharmacies
and optometrists. Specialist services provided include brain injury rehabilitation, bio-engineering
and prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and
Family Psychiatric Services.
2.3 Royal Edinburgh hospital and Associated Services
The Royal Edinburgh and Associated Services provides a range of Mental Health services to the
population of Lothian and other Boards within Scotland.
The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises
some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the
following range of specialities: Acute Mental Health
 Rehabilitation
 Psychiatric Emergency Team 24/7
 Outpatients
 Assessment Phychiatry of Old Age
 Forensic Medium Security Unit
 Inpatient facilities for under 18s
 Psychotherapy Service
 Psychology Services
 Services for Eating Disorders
 Day Hospitals – Psychiatry of Old Age
There are an additional 46 bed and 1 day hospitals for Psychiatry of Old Age in the north of the
city at the Royal Victoria Hospital.
The hospital is currently housed in a mix of accommodation ranging from 19th century to present.
There is a major project now in place to take forward a reprovisioning programme in line with the
strategic vision with the “Delivery for Mental Health” Scottish Executive 2006.
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2.4 Department of Public Health Medicine
The aim is to improve the health of the people of Lothian in collaboration with many other
partners. Using our range of knowledge, experience and networking capability, our
distinctive contributions are:
 the promotion of specific measures to monitor and improve health;
 the collation and interpretation of health related information.
The following objectives have been agreed as the basis for the Department’s work plans:
1. To monitor the health status and health needs of people in Lothian;
2
To promote improvements in the health of Lothian people directly, and by providing information
and advice to the public on health matters;
3. To assist Lothian NHS Board to fulfil its statutory obligations;
4. To contribute to strategic changes within the NHS in Lothian by providing information on clinical
effectiveness;
5. To facilitate improvements in health and health care services directly, and through ‘managed
clinical networks’ and wider alliances;
6. To contribute on a 24 hour basis to the control and prevention of communicable diseases and
environmental hazards;
7. To maintain commitments to teaching, training, professional development, audit and
research.
To enable efficient management of the Department: there are at present four groups in the
Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health
Information.
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3. University of Edinburgh
The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom
located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research
University and within the top 5 Universities in Europe for its Biomedical Sciences.
The University of Edinburgh’s College of Medicine and Veterinary Medicine (CMVM; Head Professor
Sir John Savill) is an internationally leading force in basic-to-clinical translational research. The
College has a consistent 30-year strategy of interdisciplinarity and integration of basic and clinical
sciences. In the most recent Research Assessment Exercise (2008), the University of Edinburgh was
top in the United Kingdom within the UoA4 category of Hospital-based Clinical Subjects. In 2008/9,
CMVM attracted over £120 million in external peer-reviewed grant funding.
It has established several major interdisciplinary research Centres:
i. MRC Centre for Inflammation Research (Director, Professor John Iredale)
ii. Centre for Cardiovascular Science (Director, Professor Brian Walker) incorporating the BHF
Centre of Research Excellence (Director, Professor John Mullins)
iii. Centre for Reproductive Biology (Director, Professor Phillipa Saunders) and MRC Human
Reproductive Sciences Unit (Director, Professor Robert Millar) including the Tommy’s Centre
(Director, Professor Jane Norman).
iv. MRC Centre for Regenerative Medicine (Director, Professor Sir Ian Wilmut)
v. Centre for Molecular Medicine (Director, Professor David Porteous)
vi. Centre for Cancer Research (Director, Professor David Harrison)
vii. Centre for Population Health Sciences (Director, Professor Harry Campbell)
viii. MRC Human Genetics Unit (Director, Professor Nick Hastie)
These Centres are predominantly based at two sites: the Queen’s Medical Research Institute at the
Royal Infirmary, and the Institute of Genetics and Molecular Medicine at the Western General
Hospital. The co-location of basic science and clinical groups within state-of-the-art infrastructure and
technology provides an excellent and exciting opportunity to conduct translational research at the
highest level.
This academic power base is supported by clinical research infrastructure that includes:
i
ii
iii
iv
v
vi
Wellcome Trust Clinical Research Facility
Clinical Research Imaging Centre
Edinburgh Clinical Trials Unit (UKCRN Registered) and Health Services Research Unit
Scottish Brain Imaging Research Centre
Experimental Cancer Medicine Centre
Academic and Clinical Central Office for Research and Development
4. NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
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5. Departmental Information
The Department of Renal Medicine
The Department provides an area renal service for Edinburgh, Lothian and Borders (population
800,000). There are 8 NHS consultants (Dr C Whitworth (ADMD), Dr P Gibson, Dr J Goddard
(Clinical Lead), Dr W Metcalfe, Dr J Neary, Dr S Watson, Dr L Henderson and Dr P Phelan) and six
Honorary Consultants (Professor AN Turner, Dr R Phelps, Dr D Kluth, Dr J Hughes, Dr B Conway
and Dr N Dhaun) who all contribute to the clinical services both in Renal and Transplant. There are
two Speciality Doctors, Dr S Miya and Dr S Mikros, who have a primary responsibility to the outpatient dialysis service.
There are 3-4 Specialty trainees in Renal Medicine, and 7 CMTs/FY2s.
The Renal Unit at present has a six bed renal high dependency ward with dialysis stations for
unstable patients. There is considerable overlap between renal and transplant areas with a new build
merger to a 14 bed combined renal and transplant HDU with work commencing in 2015. There is a
22 bed general nephrology ward and an outpatient ambulatory care area for renal and transplant
patients to be assessed and treated as day cases where appropriate is due to open January 2015.
The hospital also has a Medical Day-case unit and a Day-bed Surgical unit for patients admitted for
procedures such as renal biopsy, angiography and vascular access.
There is a 38 station haemodialysis unit at the Royal Infirmary of Edinburgh; within this area there is
an 8 station area for patients colonised with multi-resistant microbes, and 2 cubicles for patients with
blood-borne virus infections. There is a 9 station satellite haemodialysis unit at the Western General
Hospital, a 12 station satellite haemodialysis unit at the Borders General, and a 10 station Satellite
unit at St Johns Hospital, Livingston all operating 3 shifts per day. There are currently approximately
275 haemodialysis patients under the care of the unit, five home haemodialysis patients and
approximately 35 peritoneal dialysis patients (CAPD and APD). There are 80 new patients to renal
replacement treatment. The Royal Infirmary has a busy Intensive Care Unit and a general High
Dependency unit, the regional Cardiothoracic Unit and the Scottish Liver Transplant Service and
Fulminant Hepatic Failure Service: a renal advisory service and renal replacement support are
provided to these areas. The Renal Unit also provides an area advisory service for other hospitals in
Lothian and Borders.
There are weekly general renal clinics and a joint renal-diabetes clinic at the Royal Infirmary of
Edinburgh as well as weekly outreach general renal clinics at the Western General Hospital and at St
John’s Hospital, Livingston. In the Royal Infirmary of Edinburgh there are also a weekly end-stage
clinics for peritoneal dialysis, home haemodialysis patients and hospital haemodialysis.
There is a weekly programme of Renal research/audit/clinical meetings during term time and joint
meetings with the Transplant Unit. There is a weekly renal biopsy review meeting. There is also a
monthly multi-disciplinary meeting where renal replacement therapy is planned for patients
approaching dialysis, a monthly Community Dialysis meeting (home haemodialysis and peritoneal
dialysis), and a weekly transplant meeting to review new patients and patients on the transplant list.
There is also a two monthly multidisciplinary Directorate meeting.
The Unit has a well-established computer database (Proton) for the dialysis and transplant patients,
with terminals throughout the Unit. Computer links to laboratories enable automatic updating of
laboratory results.
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The Renal Transplant Service is based on a combined renal, pancreas and liver transplant ward
with 4 high dependency beds and 21 ward beds for transplant patients although there is considerable
flexibility with bed usage with the Renal Unit as above. A renal transplant service (living donor and
Cadaveric) is provided for Lothian, Borders, Fife, Tayside, Grampian and Highland giving a
catchment population of 2.6 million. The Transplant Unit also provides pancreas transplantation for
the whole of Scotland (5.1 million).
The Transplant Surgical team are Professor S Wigmore (Clinical Director); Professor JLR Forsythe,
Mr M Akyol Mr J Casey, Ms L Marson (Clinical Lead), Mr J Powell, Mr I Currie, Ms Adair, Mr E
Harrison and Mr G Oniscu.
Approx 100 renal transplants and 15-20 combined kidney and pancreas transplants are carried out
per year at present. The Transplant Unit is also centre to The Scottish National Pancreatic Islet
Transplant Programme and has carried out 31 islet transplants since it was established in 2009. At
present there is a local renal transplant follow up population of approximately 400 but with additional
follow–up of patients who are ultimately repatriated to referring areas when stable, approximately
3000 follow-up appointments per year are currently required. Currently there are three renal
transplant follow up clinics per week and it is envisaged that this post-holder would support at least
one of these clinics as well as a new ambulatory care area which is being established to support
early follow up of recent transplant recipients.
In addition, there is a Renal Transplant Assessment clinic which is primarily provided by Transplant
Surgeons, Transplant Nephrologist, Transplant Coordinators and anaesthetists. It is envisaged that
this appointment will help provide support to this assessment clinic.
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6. Details of the Post
The successful candidate will be expected to join the Renal Transplant Service.
He/She will provide clinic-based follow-up of transplant (Renal/SKP) patients in conjunction with a
Consultant Transplant surgeon and Nephrologist. The successful candidate will also have the
opportunity to contribute to the weekly multi-disciplinary Transplant Assessment clinic.
This is likely to include involvement with the living donor programme, and engagement with the
weekly living donor multidisciplinary team meeting. There will be an opportunity to undertake
clinical research within living donor or deceased donor transplantation.
As part of national commissioning of renal transplant services, there has been agreement that
early follow up post transplant will be supported by members of the RIE team. The post holder
will work with referring clinicians to ensure that this is set up, using a variety of methods, such as
teleconferencing, skype and virtual clinics.
The on-call commitment would be on the Renal StR rota and is currently non-resident on-call
nights and weekend daytime coverIn addition to in-patient transplantation (Wards 117 and 206T),
on call cover will include the care of patients with acute renal failure (mainly on Renal HDU Ward
115 and Ward 206) and general nephrology inpatients (Ward 206R). The successful candidate
will be expected to reside within 10 miles of the Royal Infirmary of Edinburgh, and to provide
reciprocal cover for colleagues during periods of annual/professional and sick leave. The
successful candidate would have the opportunity to develop complementary interests.
The appointee would be expected to be in an approved StR post or equivalent or have recently
gained a CCT in Renal Medicine but not yet appointed to a substantive Consultant post.
This an Exposure Prone post.
7. Research and Development
There are ample Research opportunities with well-established research groups based in the
Centre for Inflammation Research led by Prof AN Turner, Dr RG Phelps, Dr D Kluth, Dr J
Hughes, Dr B Conway, Dr N Dhaun and Dr D Ferenbach. Dr J Goddard and Prof D Webb also
lead a group looking at endothelial dysfunction and renal disease. There are also Transplant
Research groups led by Professor S Wigmore and Miss L Marson.
In addition, the Transplant Unit has close collaborative links with the departments of
Histocompatability and Immunohistochemistry, Microbiology and Pathology. The successful
candidate will have dedicated time within their programme to undertake transplant-related
research.
Dr Metcalfe is currently chair of the Scottish Renal Registry and there may be opportunities to
undertake registry work related to transplant outcomes depending on the interest of the
candidate.
NHS Lothian is also committed to improving the quality and safety of its services for patients.
NHS Lothian is participating in the Scottish Patient Safety Programme and it is evident that this
initiative is strongly supported by clinical staff with many elements of the programme impacting
on Renal Medicine.
8. Teaching
The postholder will have the opportunity to participate in undergraduate and postgraduate
teaching.
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9.
Job Plan
Example timetable:
AM
Monday
0830-1130
Transplant
ward round
Tuesday
0830-1130
Transplant
ward round
Wednesday
0830-0930
Transplant
ward round
Thursday
0830-Transplant
M&M
Friday
0830-1130
Transplant
round
ward
09.00 - 1130
1230- 1300
09.30 – 12.30 Transplant ward
weekly Live Transplant
round
12.00 Weekly Renal
donor MDT
clinic
Transplant MDT
13.00 Weekly SPK
MDT
PM
Ward work
Research & Research
& Transplant
Development Development
assessment
Clinic
1330-1600
1530
Department
Educational
meetings
1630-1700
Pathology
Meeting
1630-1700
Transplant
results
DATE
Ward work
1530-1630
Handover round
1630-1700
Transplant
results
1630-1700
Transplant
results
Page 10 of 12
1630-1700
Transplant results
1630-1700
Transplant results
10. Contact Details
For further information and arrangements to visit please contact:
Dr J Goddard
Consultant Renal Physician and Clinical Lead
Department of Renal Medicine
Royal Infirmary of Edinburgh
51 Little France Crescent
Old Dalkeith Road
EDINBURGH
EH16 4SA
Tel:
0131 242 1206
Fax:
0131 242 1233
Email:
jane.goddard@luht.scot.nhs.uk
Ms Lorna Marson
Transplant Surgeon
Royal Infirmary of Edinburgh
51 Little France Crescent
Old Dalkeith Road
EDINBURGH
EH16 4SA
Tel: 0131 242 1715
Email: lorna.marson@ed.ac.uk
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3
Person Specification
REQUIREMENT
QUALIFICATIONS/
TRAINING
ESSENTIAL
GMC Registered Medical
Practitioner
Have a CCT and be on the
GMC Specialist Register or be
eligible for inclusion on the
GMC Specialist Register
DESIRABLE
Completed higher medical
training in renal medicine
Not in a substantive Consultant
post
or be within 12 months of a
CCT in Renal Medicine and
able to take time out of
programme.
EXPERIENCE/
Wide experience in Renal
Medicine and Transplantation
Experience in Teaching (formal
and informal) to junior doctors
and undergraduates
Experience in Audit
Experience in Research
Evidence of commitment to
learning and continuous
professional development
Experience in high risk
Transplant programmes – eg
ABO incompatible and HLA
incompatible
Ability to establish links with
related specialties
An interest in Renal vasculitis
An interest in development of
Patient Safety
ACADEMIC
ACHIEVEMENTS
Publications in peer reviewed
journals
Higher academic degree
Keen to develop clinically
focused/patient orientated
research in transplantation
PERSONAL
ATTRIBUTES
Good communication skills
Ability to function in a
multidisciplinary team
Able to organise time efficiently
and effectively
A Valid Driving Licence
Able to contribute to on-call
cover required of the post
Able to motivate departmental
colleagues
HEPATITIS
Evidence of Hepatitis B
immune status
KNOWLEDGE
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