NHS Lothian
Acute Hospitals Division
Directorate of Surgery
Department of Renal Medicine, Royal Infirmary of Edinburgh
Clinical Fellow in Renal Medicine with an interest 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 February 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 to the 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. In addition, there is an active Live donor programme including
an ABO/HLA incompatible transplant programme and pancreatic islet transplantation. 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. Prof James Barbour 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.
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:
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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:
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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:
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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
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
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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:
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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 co-located 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 South-East 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
2.2 Community Healthcare Partnerships
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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 community-based 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:
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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.
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:
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 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.
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 coDATE
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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:
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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.
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 J Neary,
Dr W Metcalfe, 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 out-patient 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.
The Transplant high dependency has four beds. There is considerable overlap between the two 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 21 bed transplant ward and an outpatient ambulatory care area for renal and
transplant patients to be assessed and treated as day cases where appropriate. 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 operating three shifts a day;
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 operating three shifts a day, a 12 station satellite haemodialysis unit at the Borders General
Hospital operating 3 shifts per day, and a 10 station Satellite unit at St Johns Hospital, Livingston 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 multidisciplinary 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
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review new patients and patients on the transplant list.
Directorate meeting.
There is also a two monthly multidisciplinary
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.
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. 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). An Islet cell transplant programme is also
established.
The Transplant Surgical team are Professor S Wigmore (Professional Lead); Mr JLR Forsythe, Mr M Akyol
Mr J Casey, Ms L Marson, Mr J Powell, Mr I Currie and Mr G Oniscu.
Approx 100 renal transplants and 15-20 combined kidney and pancreas transplants are carried out per year at
present. 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 but it is envisaged that this post-holder would support the establishment of a new additional
weekly renal/SKP Transplant follow-up clinics with support from recent new appointments in transplant
surgery.
In addition, there is a Renal Transplant Assessment clinic which is primarily provided by Transplant Surgeons,
Transplant Coordinators, anaesthetists and it is envisaged that this appointment will provide Transplant
medicine advice to this assessment clinic.
6. Details of the Post
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Description of the duties of the post
The successful candidate will be expected to joint the Renal Transplant Service.
He/She will provide clinic-based follow-up of transplant (Renal/SKP) patients in conjunction
with a Consultant Transplant surgeon. The successful candidate will also contribute to the
weekly multi-disciplinary Transplant Assessment clinic. Specifically, the successful candidate
will be expected to take both a strategic and clinical lead in new Transplant service
developments such as the ABO incompatible programme in conjunction with Surgical and
H&I colleagues.
The on-call commitment would be on the Renal StR rota and is Currently a 1b banding
covering non-resident on-call week nights and weekend daytime cover. In addition to inpatient 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.
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7.
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.
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 Dr L Marson.
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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. It is evident that consultant leadership will be required more broadly to
support this work.
8.
Teaching
The postholder will have the opportunity to participate in undergraduate and postgraduate teaching
as well as in the teaching and training of renal medical and nursing staff.
There are excellent opportunities for collaborative research and the postholder will have the
opportunity to supervise research/audit projects undertaken by junior medical staff.
9.
Job Plan
Example timetable:
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AM
Monday
0830-1130
Transplant ward
round
Tuesday
0830-1130
Transplant
ward round
Wednesday
0830-0930
Transplant ward
round
1230- 1300
weekly ABOi
planning
meeting
09.30 – 12.30
Transplant clinic
PM
Thursday
0830-Transplant
M&M
09.00 - 1130
Transplant
round
Friday
0830-1130
Transplant ward round
ward
Transplant
assessment Clinic
1400-1600
1530
Department
Educational
meetings
1630-1700
Pathology
Meeting
1630-1700
Transplant
results
1530-1630
Handover round
1630-1700
Transplant
results
1700 - 1730
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
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12.00
Weekly
Renal
Transplant MDT
13.00 Weekly SPK MDT
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1630-1700
Transplant results
Old Dalkeith Road
EDINBURGH
EH16 4SA
Tel: 0131 242 3679
Email:
3
Person Specification
REQUIREMENT
QUALIFICATIONS/
TRAINING
ESSENTIAL
DESIRABLE
GMC Registered
Practitioner
Medical
Completed higher medical
Have a CCT and be on the training in renal medicine
GMC Specialist Register or
Not
in
a
substantive
be eligible for inclusion on
Consultant post
the GMC Specialist Register
or be within 12 months of a
CCT in Renal Medicine and
able to take time out of
programme.
EXPERIENCE/
KNOWLEDGE
1. Wide
experience
in 1. Experience in high risk
Renal Medicine and
Transplant programmes –
Transplantation
eg ABO incompatible
2. Experience in Teaching
and HLA incompatible
(formal and informal) to 2. Ability to establish links
junior
doctors
and
with related specialties
undergraduates
3. SAn
interest
in
3. Experience in Audit
development of Patient
4. Experience in Research
Safety
5. Evidence of commitment
to
learning
and
continuous professional
development
ACADEMIC
ACHIEVEMENTS
Publications in peer reviewed 1. Higher academic degree
journals
2. Keen
to
develop
clinically focused/patient
orientated research in
transplantation
PERSONAL
1. Good
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communication 1. Able
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to
motivate
ATTRIBUTES
skills
2. Ability to function in a
multidisciplinary team
3. Able to organise time
efficiently
and
effectively
4. A Valid Driving Licence
5. Able to contribute to oncall cover required of the
post
HEPATITIS
Evidence of Hepatitis
immune status
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B
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departmental colleagues