Health Education Thames Valley (HETV) Rehabilitation Training Programme
This document outlines the training programme for Specialist Registrars who wish to obtain
further training towards a consultant post in Rehabilitation Medicine. The programme has six
trainees who are based in two main centres – the Department of Rehabilitation, Royal Berkshire
Hospital in Reading and the Oxford Centre for Enablement (OCE), Oxford University Hospitals
NHS Trust in Oxford. The programme covers all domains of the training programme, and
allows further specialist training in most domains including Spinal Cord Injury rehabilitation at
the National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury. It is a four year
programme, with sufficient flexibility and opportunities to allow specialised experience in a
wide variety of areas including Trauma rehabilitation in a Major Trauma Centre, at the John
Radcliffe Hospital, Oxford. Contact for further information given on page 6.
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.
Summary of Programme.
This outlines the programme, but it must be stressed that the small number of trainees on the
programme coupled with varying numbers recruited in a particular year means that the order
may vary from this programme.
Months
Location
0 - 12
Royal Berkshire
Hospital,
Reading
Comment
Experience will include: all aspects of neurological Rehabilitation;
and opportunities for experience of palliative care, pain
management, shoulder problems, foot & ankle problems,
paediatric transition, neurogenic bladder management,
environmental control assessments. Settings include in- and outpatients, ward referrals, & community settings. Opportunities for
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
13 - 16
17-28
29 - 36
36 – 39
40-48
Page 2
audit, service management, clinical governance.
National Spinal
Spinal Cord Injury rehabilitation: sub-acute and longer-term
Injuries Centre,
rehabilitation. Will specifically learn about respiratory
Stoke Mandeville management for high cord injury, baclofen pumps, skin care,
Hospital,
autonomic dysreflexia and expected impairments at common
Aylesbury
levels of injury. May also learn about burns management.
Oxford Centre for Prosthetics and all aspects of neurological rehabilitation
Enablement
(Prosthetics experience occurs in parallel). Opportunities for
(OCE), Oxford
spasticity and botulinum toxin clinics, orthoptic clinics, pain
management, neuro-psychiatry, orthotics, wheelchair and
specialist equipment clinics, and experience with other aspects of
assistive technology. Opportunities for audit, management
projects, pain and functional disorders, etc
John Radcliffe
Rehabilitation after major trauma (all except burns), and
Hospital, Nufmusculo-skeletal rehabilitation including chronic pain and
field Orthopaedic fibromyalgia. Opportunities for acute rehabilitation: ITU
Centre & OCE
rehabilitation, ventilator experience etc
OCE
Long-term community-based and day-hospital neurological
rehabilitation but allows the trainee to visit other settings (e.g.
nursing home rehabilitation) and see specialised services and
clinics. Also prolonged disorders of consciousness.
Options
The trainee may be based in their preferred service to gain extra
specialist experience, but will be expected to acquire experience
in additional areas such as paediatric, cardiac and vocational
rehabilitation and liaison psychiatry or learning disability.
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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The hospitals/Trusts involved.
There are two primary hospitals involved in Oxford and Reading, but trainees may also spend
time in other hospitals and Trusts as part of their training.
The two main hospital Trusts are:
Oxford University Hospitals NHS Trust, Oxford
Training in this Trust occurs in the following named hospitals:
 John Radcliffe Hospital: trauma rehabilitation and in-patient referrals, with other
specialities seen as appropriate
 Nuffield Orthopaedic Centre; the Oxford Centre for Enablement which cover almost all
other rehabilitation training, especially neurological rehabilitation, prosthetics, and
musculo-skeletal
 Churchill Hospital; pain, palliative care and other specialities
The hospital (Trust) website is http://www.ouh.nhs.uk/
Royal Berkshire Hospital, Reading
Training in this Trust is based in the single hospital, but extends into various community
hospitals and settings.
The hospital (Trust) website is http://www.royalberkshire.nhs.uk/
Other hospital Trusts where trainees will or may go are:
Buckinghamshire Healthcare NHS Trust
The primary training in this trust is in spinal cord injury rehabilitation, which occurs in the
National Spinal Injury Centre, Stoke Mandeville Hospital, Aylesbury. Most trainees will
undertake their necessary training in spinal injuries here in an attachment of four months;
trainees wanting to specialise in this are able to spend up to a further eight month here.
In addition trainees may spend short times working in other services within the Trust,
usually attending out-patient clinics but also potentially visiting to see other models of care:
 The burns unit, in order to gain exposure to one aspect of trauma rehabilitation not
available at the John Radcliffe hospital
 Amersham hospital, where there is an in-patient service (Buckinghamshire Neurological
Rehabilitation Service). This is not currently a part of the training programme, but could
be visited.
 Rayner’s Hedge, Aylesbury, which is a community neurological rehabilitation service
with no medical input. This is not currently a part of the training programme.
 Camborne Centre, Aylesbury which runs both a Community Head Injury Service and a
vocational Rehabilitation service (“Working Out”). Training clinics can occur here.
The hospital (Trust) website is http://www.buckshealthcare.nhs.uk/
In Reading, the Royal Berkshire Hospital has a 16 bedded in-patient rehabilitation unit within
an acute general hospital, and includes close liaison with and out-reach to acute stroke care,
intensive care unit, and neurology. It is a recognised Level IIa specialist service. Furthermore
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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the department has access to West Berkshire Community Hospital, Newbury where about 5-6
inpatients have longer-term rehabilitation for neurological conditions.
There are two consultants, Dr Hamid Sultan and Dr Faraz Jeddi and one Associate Specialist,
Dr Peter Tun. There will be a dedicated senior house officer. There are usually two but
sometimes one and rarely three specialist registrars present at any one time. There is a full
rehabilitation team in the hospital with a community team; both have clinical psychology input.
Access to orthotics, orthoptics and a local wheelchair service is available in the hospital. There
are clinical nurse specialists for rare neurological conditions, Parkinson’s Disease and Multiple
Sclerosis who work closely with the rehab team. The service is closely integrated with the
neurology service with training opportunities within neurology. Trauma rehabilitation services
are developing.
In Oxford, the Oxford Centre for Enablement has 26-30 inpatient beds primarily for acute
phase but including some slow-stream neurological rehabilitation. It is a recognised Level I
specialist service. Inpatients mainly come from Oxfordshire (population 700,000) and
Buckinghamshire. It is part of the Regional Trauma service and this involves providing
specialist rehabilitation input into the Trauma wards for patients immediately after admission.
There are a large number of out-patients and day patients.
It has four full-time consultants (Dr Wade, Dr Kischka, Dr Henderson Slater, and one to be
appointed in trauma rehabilitation), usually two but sometimes three specialist registrars, and
one GP trainee senior house officer. It has very many therapists, nurses, and other specialists
including clinical neuropsychologists, clinical engineers, orthotists, prosthetists, an orthoptist,
etc. Recently a formal academic link with Oxford Brookes University has formed, with research
projects being run jointly.
The specialist registrars are currently is on-call one in four for the centre, but this will be subject
to review by the Trust and it is possible that registrars will join the acute medical on-call rota at
a level that does not disrupt training.
Aylesbury/Buckinghamshire
The National Spinal Injuries Centre has 110 beds in five adult wards and one paediatric ward,
in a building complex that is joined to but separate from the main acute general hospital (Stoke
Mandeville Hospital). The Centre is a self-contained specialist rehabilitation centre that can
provide exposure to every aspect of spinal injury rehabilitation.
The centre provides acute phase rehabilitation, including for people with very high spinal cord
injuries who need ventilatory support. It also provides elective admissions for further
rehabilitation, and assessment of later problems related to the spinal injury. The centre has a
significant out-patient department for long-term follow-up and management of complications.
It does not admit children acutely, but provides inpatient rehabilitation and life-long follow-up
for children with spinal cord injuries from birth onwards.
There are five consultants (Mr M Saif, Mr F Derry, Mr M Belci, Dr A Graham and one to be
appointed), an associate specialist, and 5 SHOs. There is a full rehabilitation team including
especially peripatetic nurse specialists. It is likely that there will be no more than one registrar
present at any one time.
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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Rotation Information
The rotation is subject to continuing change as rehabilitation services are changing and
developing in all parts of the Region, and as the organisation of the NHS changes. The
information given reflects the present situation. Changes are unlikely to affect the general
content or location of training posts but may affect some details. Generally the changes will
lead to a greater opportunity for trainees to gain experience.
Furthermore the rotation is designed to allow individual trainees to develop their own areas of
interest and specialisation as far as this is possible and compatible with service and training
requirements.
Thirdly an academic rehabilitation unit is being developed primarily with Oxford Brookes
University. Trainees are encouraged to take opportunities to be involved in academic activities
(teaching, attending research meetings etc) and may become involved in projects involving
Oxford Brookes University, the University of Oxford and other collaborating universities.
The general rehabilitation training rotation is given below, and applies to all trainees. The
precise order and durations of each part necessarily vary because the small numbers of trainees
and irregular arrival and departure of trainees makes prediction impossible.
All trainees are expected to gain extra (specialist) experience in at least one part of rehabilitation,
and this is possible within the four year programme for the recognised specialities (neurological
rehabilitation, prosthetics, trauma and musculo-skeletal rehabilitation, spinal injury
rehabilitation) and indeed would be considered in other specialities (e.g. paediatric
rehabilitation) after discussion with the Training Programme Director.
Note on spinal injury training
Trainees may, if they wish, decide to spend a total of up to twelve months at the National
Spinal Injuries Centre within the four year programme, gaining considerable experience
that would be quite sufficient to take on a post involving spinal injury rehabilitation.
Trainees should be aware that the British Association of Spinal Cord Injury Specialists
(BASCIS) suggests that a total of 36 months is needed in spinal injury rehabilitation for
someone to be a full specialist in spinal injury rehabilitation. However this is not an
official requirement, and has no statutory basis, and consultants have been and will be
appointed into spinal injury rehabilitation posts without fulfilling this extent of experience.
Any trainee who wished to complete the unofficial BASCIS curriculum would need to take
an additional two years of out-of-programme-experience based at the National Spinal
Injuries Centre, Aylesbury in order to achieve this. Any trainee who wished to do this
would need to discuss the option with the Training Programme Director. One option
would be to obtain a CCT and then take on a training fellowship. For a trainee educational
agreement might be given, but funding agreement would be needed from the National
Spinal Injures Centre.
Anyone wishing to discuss this should contact the Training Programme Director.
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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For most trainees the general pattern of the rotation is as follows:
Time
Twelve
months
Location
Royal Berkshire Hospital,
Reading
Four
months
National Spinal Injuries Centre
Stoke Mandeville Hospital,
Aylesbury
Twelve
Months
Oxford Centre for Enablement,
Nuffield Orthopaedic Centre,
Oxford
Twelve
months
Nuffield Orthopaedic Centre,
John Radcliffe Hospital,
Oxford Centre for Enablement
Oxford Centre for Enablement
Four
Months
Eight
months
Options
Content/comment
Neurological Rehabilitation and disability
management, Palliative care, Pain
management, Spasticity management,
Environmental Control Assessment,
Community-based rehabilitation, specialist
care for people with Motor Neurone Disease,
Multiple Sclerosis, Parkinson’s Disease. Also
paediatric transition to adult services, acute
stroke care, bladder management with
urology department and close links to and
working with neurology department.
Spinal injury rehabilitation,
Also covering general parts of the curriculum
including specialised seating, environmental
controls, and orthoses
Neurological Rehabilitation, Prosthetic
Rehabilitation spasticity management and
intra-thecal baclofen, low awareness states,
acute and long-term rehabilitation, stroke
care, psychiatric and psychological aspects,
specialist clinics at John Radcliffe, specialist
seating, environmental controls and almost
all aspects of neurological rehabilitation.
Trauma rehabilitation, musculo-skeletal
rehabilitation, Chronic Spinal pain, pain
management. Some neuro-rehabiitation.
Long-term day-hospital and communitybased neurological rehabilitation
The trainee may be in one service that they
wish to gain extra experience of (e.g.
neurological or spinal cord rehabilitation).
During this time they need to gain experience
in other areas (often identified at the
Penultimate Year Assessment ARCP) such as:
psychiatry, palliative care; respiratory care;
community head injury service and
vocational rehabilitation (Aylesbury)
Teaching
Most teaching is on a one to one basis by the consultants, either in relation to a specific case or
in relation to a process (e.g. assessing mental capacity) or technique (e.g. botulinum toxin
injection).
Trainees are encouraged to attend the Neurology Grand Round at the John Radcliffe hospital
(held weekly), and the monthly Rehabilitation Grand Round at the Oxford Centre for
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Enablement. There are monthly neurology trainee teaching sessions open to rehabilitation
trainees, held alternately in Oxford and Southampton. Local rehabilitation trainees have
organised teaching meeting in conjunction with London Trainees, and have recently started
more organised monthly local meetings.
There are regular in-house teaching sessions for the whole rehabilitation team in all settings,
and the trainees should attend these when appropriate and will also be asked to teach at them
from time to time.
Duties of Post
The trainee is expected to fulfil the clinical, service duties specific to each post which will
include aspects of:
 managing inpatients medically: clerking admissions, supervising junior medical staff,
seeing patients regularly, checking diagnoses, diagnosing and managing intercurrent
illness etc
 managing inpatients in their rehabilitation: setting goals as part of the team, participating
in and leading team meetings, liaising with the team, and with many other professions
and organisations, seeing family and others etc
 seeing new referrals in other settings from intensive care to nursing home and the
patient’s own home
 seeing out-patients, both new and follow-up
 participating in specialist clinics and services (e.g. spasticity clinics)
 responding to and managing any acute, new clinical problems in patients known to the
service
 liaising with other professionals who seek advice
They will also be expected to fulfil the normal supporting clinical activities such as:
 participating in, or organising and undertaking departmental or service audit
 using any pathways, procedures and protocols that may be in place
 facilitating any research being undertaken within or in association with the service
 teaching – students, other professions, other doctors, the public
 taking part in any service development projects being carried out
And, of course, they will be expected to further their own training in consultation with their
educational and clinical supervisors.
Further Information
Anyone who wants further information or advice on Rehabilitation Medicine, on training, or
about this programme can contact
Dr Derick Wade
Professor and Consultant in Neurological Information
Oxford Centre for Enablement
Windmill Road
Oxford OX3 7HE
Tel: 01865 737310 (direct), 01865 737451 (secretary), 07818 452133
email: derick.wade@ouh.nhs.uk or derick.wade@ntlworld.com (or both)
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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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-timedirective
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
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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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 250254 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/JuniorDoctors
DentistsGPReg/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/nhsemployment-check-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
HE Thames Valley. Rehabilitation Medicine Training Programme. 03-Nov-2014
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at http://specialtytraining.hee.nhs.uk/. Please ensure that you inform Health Education
Thames Valley of any changes to your contact details.