Northern School of Anaesthesia & Intensive Care Medicine
Core Trainee Changeover Form
This form must be emailed to your new hospital within the next 7 days
Start date at this hospital:
Surname:
First Name:
Address:
Postcode:
Email Address:
Home Telephone Number:
Mobile Telephone Number:
Current Hospital Base:
Switchboard Number (including bleep/
dect number):
Do you work Full time or Flexible?
If Flexible, please contact the consultant rotamaker to
discuss your working arrangements.
Year of Core Training:
Date of Entry to your current Year of Training:
Date of planning to sit Primary FRCA:
Date of passing Primary FRCA:
Induction
Have you worked in this hospital before? If yes, at what grade?
Please give details of your training/experience in Anaesthesia & ICM post-Foundation:
Have you completed your 3 month ICM core training: YES / NO
Do you have any Obstetric Anaesthesia experience? If so, please give details:
Competencies required in this Unit
List of specialties and reasons:
Rota Details (Do not delay sending your form if you do not have this information)
My last on-call will be:
My last weekend on-call will be:
Leave Requirements – NOTE: official forms must also be completed and sent to the appropriate
anaesthetic dept.
Study Leave
Name of Course
Has this course been authorised? **
From:
To:
YES / NO
YES / NO
**If no, please send your study leave request form to the rotamaker.
**If yes, please send a copy of the confirmation to the rotamaker.
Exam Leave:
From:
To:
From:
To:
From:
To:
From:
To:
Annual Leave
Other Leave e.g. maternity/paternity leave:
From:
To:
From:
To:
Not on-call requests for the first six weeks:
From
To
From
To
Please state how long you will be working in this anaesthetic department?
working day:
From
To**
Please state your last
**If you are planning to leave the department before the next changeover date then you must put this
in writing to the rotamaker, copy to the anaesthetic secretary.
BLOOD TRANSFUSION
It is a national requirement that from November 2010 all personnel involved at any stage of the blood
transfusion process must be formally assessed on their competence. This is to be reassessed on a 3 yearly
basis.
Please fill in the table below if you have undertaken formal blood transfusion competency training for the
areas listed below. You will be expected to provide proof that you have undergone this assessment.
It is still to be confirmed, however if you have completed this in one Trust it is likely that it will be accepted in
all other Trusts in the region.
Competency
Hospital
Date Achieved
Collecting blood components for Transfusion
(Some Trusts specifically exclude this for medical staff)
Patient identification and labelling of
Pre-transfusion blood samples
Preparing to administer and administering a blood
component transfusion
It is expected that you will start your new hospital at the changeover time. If this is not the case, please write
to the Rotamaker explaining your late arrival. A copy of the letter/email should be sent to the Service
Coordinator/Anaesthetic Secretary.
This form must be emailed to your new hospital within the next 7 days.
Please do not send this form to Barbara Sladdin.
Please keep a copy for your file
Copies of this form must be emailed to the Office Manager/Anaesthetic Secretary at your new hospital base.
forward this information to the Consultant rotamaker. Please keep a copy for your file.
Secretaries will
Hospital
Name
Title
Email Address
Cumberland Infirmary
Kerry-Ann Armstrong
Anaesthetic Secretary
Kerry-Anne.Armstrong@ncumbria-acute.nhs.uk
Freeman Road Hospital - general
Carole Baggaley
Senior Anaesthetic Secretary
anaestheticsSecretariesFreeman@nuth.nhs.uk
Freeman Road Hospital - cardio
Diane Robson
Cardio Anaesthetic Secretary
diane.robson@nuth.nhs.uk
James Cook University Hospital
Sue Styan
Office Manager
Sue.Styan@stees.nhs.uk
Memorial Hospital (Darlington) NHS Trust
Tanya Allan
Anaesthetic Secretary
Tanya.allan@cddft.nhs.uk
North Tyneside General Hospital
Wansbeck General Hospital
Queen Elizabeth Hospital
Joanne Ackinclose
Anaesthetic Secretary
Liz Brandon
Anaesthetic Secretary
Joanne.Ackinclose@northumbriahealthcare.nhs.uk
Liz.Brandon@ghnt.nhs.uk
Royal Victoria Infirmary
Sunderland Royal Hospital NHS Trust
Julie Angus
Dr Judith Wilkes
Carolyn Ross-Allison
*Service Coordinator
*Specialty Training Modular Organiser
Anaesthetic Secretary
Anaesthetics.Secretaries@nuth.nhs.uk
Judith.Wilkes@nuth.nhs.uk
Carolyn.Ross-Allison@chs.northy.nhs.uk
University Hospital of Hartlepool
Belinda Trotter
Anaesthetic Secretary
Belinda.Trotter@nth.nhs.uk
University Hospital of North Durham
Emily Hutchinson
Susan Currien
Debbie Ghani
Anaesthetic Secretary – shared post
emily.hutchinson@nhs.net
Susan.Currien@cddft.nhs.uk
debbie.ghani@nth.nhs.uk
*Please email form to both
*Please email form to both
University Hospital of North Tees
Educational Administrator - Anaesthetics