SUSSEX COAST JOINT TRAINING PROGRAMME IN
INFECTIOUS DISEASES-MEDICAL MICROBIOLOGY AND
VIROLOGY
2016
Academic Clinical Fellowship, ST3 level
PROSPECTUS
Brighton and Sussex Medical School (BSMS) in collaboration with Brighton and Sussex University
Hospitals NHS Trust (BSUH) and the Brighton PHE collaborating centre are pleased to the
availability of an Academic Clinical Fellowship (ACF) in Infectious Disease and Microbiology
sponsored by the National Institute of Health Research. The academic component of the
fellowship will be primarily focussed on the development of WGS methods for Neisseria
gonorrhoeae and their integration into workflows for clinical management and public health.
The post attracts funding from the NIHR to fund a Masters level qualification with additional
funds for courses and meetings. Successful applicants will be encouraged to enrol on the
BSMS/Brighton University Masters of Research (MRes) degree course which is the vehicle for
delivering the taught component of the ACF. The Fellowship is a three-year post, 75% clinical
and 25% academic with block release for research, and will attract a run-through training
number.
The regional infectious diseases unit at Brighton is the centre of an established joint training
programme in clinical microbiology and infectious diseases. The scheme accommodates seven
trainees who rotate between BSUH, other NHS sites in Sussex and Surrey and spend a year in
one of the London centres. All our posts have GMC approval for Core Infection Training. On
call banding is funded locally for our training posts.
BSMS has a strong track record delivering successful ACL/ACF posts in infection. Currently two
ACFs and one ACL are in post. Previous ACFs have gone on to secure research funding,
undertaken and completed doctorates, published in high impact journals and achieved
substantive appointments. A vacant NTN is available from 2016.
Our success in this area has been built on the close working relationship between Dr Martin
Llewelyn (Reader in infectious diseases at BSMS, Lead consultant, Department of Microbiology
and Infection at BSUH) and Dr John Paul (PHE, Consultant Microbiologist BSUH). Brighton is
one of four sites working in collaboration with PHE as part of the Modernising Medical
Microbiology (MMM) consortium led from Oxford [http://modmedmicro.nsms.ox.ac.uk/] and
funded by UKCRC (£5.5m) and HICF (£2.7m). JP is a co-applicant to grants that support MMM
and is co-leader with Dr Xavier Didelot for the theme: Methods for integrated genetic and
epidemiological analysis, within the NIHR HPRU grant: Development of Modelling
Methodology(Imperial College London). ML is an MMM collaborator and chairs a genome wide
association study group on behalf of MMM. He leads on a work package and also of a substudy for the Antibiotic Reduction and Konservation (ARK) consortium working in association
with MMM in Brighton and Oxford. He is a co-investigator on clinical trials through the UK
Clinical Infection Research Group and runs a wet-laboratory programme studying host
immunological responses to infection.
Brighton also provides access to a highly evolved research environment for the study of
sexually transmitted infections. This ACF proposal builds on ongoing studies in Brighton to
investigate antimicrobial resistance in Neisseria gonorrhoeae, using WGS and conventional
microbiological and epidemiological methods to track transmission and develop methods for
predicting resistance using WGS. An ACF engaged in the proposed project would benefit from
progress already accomplished through a collaborative PHE/MMM pilot study. This includes
development of bioinformatic tools applicable to N. gonorrhoeae (Dilrini Da Silva, Oxford),
sequencing of a back catalogue of 900 isolates, ethical approval for collecting enhanced
epidemiological data prospectively, building collaborative relationships with the reference
laboratory at Colindale (Michelle Cole, Stephanie Chisholm), with Imperial College (Xavier
Didelot; mathematical modelling) and CDC Atlanta (Gail Bolan, David Trees; sharing of
resistant strains etc.). The pilot study was formatted around an out of programme experience
for a PHE ID/microbiology trainee (Joanna Peters) and in addition attracted the award of a
BASHH fellowship for a GUM trainee (Fiona Cresswell). Abstracts and papers relating to this
pilot phase are in preparation.
Unanswered questions remain about the contribution made by different genes to resistance
and part of the proposed project would involve collaborative working with MMM and the
reference laboratory to refine methods for genetic prediction of resistance. There is also a
need to explore how a WGS method could be integrated with conventional workflows to
enhance surveillance. This issue would form a
core part of the ACF research project.
BSMS hosts a range of other infection research groups (http://www.bsms.ac.uk/research/ourresearch/infection-immunology/) including Prof Kern (CMV and TB immunology) Dr Waddell
(Innate immune responses to mycobacteria) and Dr Sacre (innate immune cell signalling), Prof
Newport heads one of five new Wellcome Trust Centres for Global Health Research that
support
researchers
in
public
health
and
tropical
medicine
[http://www.wellcome.ac.uk/News/2013/News/WTP051591.htm].
An ACF would have
additional opportunities to form collaborative relationships with staff involved in projects
investigating antimicrobial resistance in samples collected at units in Zambia, Ethiopia and
Sudan.
Outline of the programme
The objective of the post is to produce specialists with adequate training and experience to
be awarded a Certificate of Completion of Training (CCT) in Medical Microbiology and
Infectious Diseases. It also aims to focus training on research and health protection and is
formally linked to the HPA. Training will be in accordance with the requirements laid down by
the PMETB approved RCP/RCPath programme on combined training in Medical Microbiology
and Infectious Diseases, August 2010.
This is up to a 6-year programme, which will be adjusted flexibly to meet the needs of
individuals depending on previous experience and will comply with the Joint Training
Programme of the JCHMT.
2
The joint training offered in Medical Microbiology/Infectious Diseases is based in the
integrated Microbiology and Infection Service at BSUH and rotates through BSUH and hospitals
within the South Coast region. The training programme is overseen by KSS Deanery.
Research and the Academic Clinical fellowship
Infectious diseases is a major academic theme at Brighton and Sussex Medical School. The
academic training posts in infectious diseases have historically been very successful and
previous post holders have achieved success with published and presented research, going on
to secure funding for further academic training to PhD.
The successful applicant will be paired with a member of faculty to develop a research
project in line with the trainee’s interests and academic background. Projects may be
patient focused or lab-based (microbiology, immunology or genetics). Major areas of research
at the moment are as follows:
Dr Llewelyn works on clinical and immunological assessment of patients with healthcareassociated infections such as Staphylococcus aureus and Clostridium difficile. He is working
with the modernising medical microbiology consortium (www.modmedmicro.ac.uk) to use
microbial whole genome sequencing to study transmission and pathogenicity of these
organisms and with the UK Clinical Infection Research Group to undertake a multicenter
Randomised Controlled Trial of rifampicin in the management of S. aureus bacteraemia
(www.ukcirg.co.uk). With Prof Florian Kern at BSMS he is developing the measurement of
host immune responses as tools for risk stratifying patients who are exposed to healthcare
associated infections. Prof Newport is Professor of Infectious Diseases and Global health and
works on genetic regulation of immune responses and susceptibility to infectious diseases such
as tuberculosis. Dr Agranoff is consultant in infectious diseases and acute medicine. He is
currently PI at BSUH for the ProMISe trial (protocolised management in sepsis) and has
additional research interests in proteomics and metal ion transport in intracellular pathogens.
The Academic Clinical Fellowship provides for 25% protected research time per year for up to
3 years. The particular configuration of clinical and research time will be tailored to
individual candidates’ needs, balanced against service and clinical training requirements. The
programme is designed to be flexible and every effort will be made to accommodate
individual training needs. The trainee will be assigned an academic educational supervisor and
will have opportunities to follow research interests in Brighton or elsewhere.
Where a candidate does not already have a higher degree (most cases), the focus during the
protected research time will be on generating preliminary data to support an application for a
clinical research fellowship from one of the major funding bodies e.g. Wellcome Trust/MRC to
pursue a higher degree. If the candidate is unsuccessful in securing funding during the first 3
years of the programme, training will continue on the existing joint clinical training
programme.
The successful appointee should contact Dr Llewelyn to discuss the post as soon as possible
after appointment.
Supervisory Arrangements
Academic Lead for IAT Programme:
Name:
Timothy Chevassut
Position:
Senior Lecturer and Honorary Consultant in Haematology
Institution: Brighton and Sussex Medical School /
Brighton & Sussex University Hospitals NHS Trust
Address:
Medical Research Building
University of Sussex
3
Town:
Postcode:
Telephone:
Email:
Falmer
Brighton
BN1 9PS
01273 873232
t.chevassut@bsms.ac.uk
Academic Supervisor:
Name:
Dr Martin Llewelyn
Position:
Chair Geriatrics and Stroke Medicine
Institution: Brighton & Sussex Medical School /
Brighton & Sussex University Hospitals NHS Trust
Address:
Audrey Emerton Building
Royal Sussex County Hospital
Eastern Road
Town:
Brighton
Postcode:
BN2 5BE
Telephone: 01273 523361
Fax:
01273 523366
Email:
m.j.llewelyn@bsms.ac.uk
Partnership Details
Dean of Medical School:
Name:
Professor Malcolm Reed
Position:
Dean Brighton & Sussex Medical School
Institution: Brighton & Sussex Medical School
Address:
BSMS Teaching Building
University of Sussex
Falmer
Town:
Brighton
Postcode:
BN1 9PX
Telephone: 01273 877577
Email:
m.reed@bsms.ac.uk
Postgraduate Dean:
Name:
Position:
Institution:
Address:
Town:
Postcode:
Telephone:
Email:
Professor Graeme Dewhurst
Dean
Kent Surrey & Sussex Postgraduate Deanery
7 Bermondsey St
London
SE1 2DD
020 7415 3402
GDewhurst@kssdeanery.ac.uk
Trust Chief Executive:
Name:
Matthew Kershaw
Position:
Chief Executive
Institution: Brighton & Sussex University Hospitals NHS Trust
Address:
Chief Executive's Office
Sussex House
1 Abbey Road
Town:
Brighton
Postcode:
BN2 1ES
Telephone: 01273 696955
Email:
matthew.kershaw@bsuh.nhs.uk
4
1.0 Sussex Coast Training Programme - overview
Training programme director
Dr Dan Agranoff (daniel.agranoff@bsuh.nhs.uk)
BSUH Consultants in
Microbiology /Infectious
Diseases
Microbiology and virology:
Dr M Cubbon, Dr M Ibrahim, Dr J. Paul
Infectious diseases:
Dr D Agranoff, Dr M Llewelyn, Prof M Newport
Consultants in Microbiology at
other training programme sites
in Sussex
Chichester:
Dr M Greig, Dr S Jerwood;
Crawley (and Redhill, Surrey):
Dr K Knox, Dr D Lyon, Dr B Stewart;
Worthing:
Dr J Bates, Dr J Child, Dr J Legg
Frimley Pk Hospital:
Dr D. Garner
Dr J Paul (Brighton)
HPA regional microbiologist
Programme director
Educational supervisors:
Dr Dan Agranoff (Consultant in Infectious Diseases, RSCH)
Prof. Melanie Newport , Dr Martin Llewelyn , Dr Eli
Alexander, Dr Dan Agranoff
The Department of Microbiology and Infection at BSUH NHS Trust is the hub for the South Coast Training
Programme in Infectious Diseases and Microbiology and offers joint Infectious Diseases/Medical
Microbiology training with trainees rotating through neighbouring laboratories in Chichester, Worthing,
Crawley/Redhill and Frimley Pk/Guildford. There are currently 7 specialist training posts in the programme
(2 Medical Microbiology/Virology and 5 Joint Medical Microbiology/Virology - Infectious Diseases posts).
The trainee will follow the Royal College of Pathologists Curriculum for Specialist Training in Medical
Microbiology and Virology (2010), and the Joint Royal Colleges of Physicians Specialty Training
Curriculum for Infectious Diseases (2010).
In the joint programme:
1. At least two years will be spent acquiring training in laboratory based infections
and health protection (as agreed with the HPA).
2. At least two years of direct patient care on the infectious diseases unit(s) and in related clinical
disciplines.
There will be opportunities (depending on interest and availability) to spend additional time in research
and to explore aspects of clinical microbiology, virology, public health microbiology and infectious
diseases in greater depth (see below under elective options)
Training is organised in two parts:
1. Medical Microbiology at BSUH/rotation to Microbiology services at Chichester or Crawley,
Worthing or Frimley Pk/Guildford plus experience at HPA sites
2. Infectious Diseases at BSUH/London
The programme incorporates the following training sites:
ii.
iii.
The Royal Sussex County Hospital, Brighton
Worthing hospital
5
iv.
v.
vi.
vii.
St Richard’s Hospital, Chichester
East Surrey Hospital, Redhill / Crawley Hospital
Frimley Park Hospital / Royal Surrey Hospital, Guildford
A London-based placement in Infectious Diseases
1.1 Indicative programme outline
Year 1: Medical Microbiology* (complete Part 1 FRCPath at the end of year)
Year 2: Clinical Infectious Diseases in Brighton (+3 months protected research time)
Year 3: Medical Microbiology* (complete Part 2 FRCPath at the end of year) (+ 3 months protected
research time)
Year 4: Clinical Infectious Diseases in Brighton/London
Year 5: Infectious Diseases/ Microbiology Clinical Research – as OOPR
Year 6: Flexible year depending on training needs (usually 6 months ID/
6 months Micro)
* I year of Medical Microbiology training will take place in Brighton and the other year will be at one of the
District General Hospitals on the rotation i.e. St Richard’s Hospital (Chichester), Worthing Hospital,
Crawley/East Surrey Hospitals (Redhill) or Frimley Pk/Royal Surrey Hospital (Guildford).
During the Microbiology training there may be an opportunity to enrol on the 2 year Medical Microbiology
MSc course in London (1 day per week – Tues for pt1, Thurs for pt2)
1.2 Elective options:
Elective rotations may be available by negotiation. Options include: 



Infection Prevention and Control
Genito-urinary Medicine
Attachment to an established Infectious Disease/Virology unit abroad.
Attachment to an HIV unit in Brighton.
1.3 Appraisals, Assessments and Examinations
Progress through the programme will follow the appropriate appraisals, assessments and examinations
organised by the RCP, RCPath and Deanery as agreed with PMETB.
1.4 Enrolment with college
Specialist trainees are expected to enrol with the RCP at the commencement of joint training. A portfolio
and a record of training will be maintained in accordance with the requirements for joint trains as required
by the RCPath and RCP.
2.0 Infectious Diseases and Microbiology at Brighton and Sussex
University Hospitals NHS Trust (BSUH) – The Royal Sussex County
Hospital, Brighton.
2.1 What we do at BSUH
6
BSUH is the regional teaching hospital working across two sites: the Royal Sussex County Hospital in
Brighton and the Princess Royal Hospital in Haywards Heath. It is the hub of the KSS training programme
in ID-MMV. The Brighton campus includes the Royal Alexandra Children’s Hospital and the Sussex Eye
Hospital, and the Haywards Heath campus includes the Hurstwood Park Regional Centre for
Neurosciences.
We provide general acute services to our local populations in and around the City of Brighton and Hove,
Mid Sussex and the western part of East Sussex and more specialised and tertiary services for patients
across Sussex and the south east of England.
Both hospitals provide many of the same acute services for their local populations. In addition, the
Princess Royal is our centre for elective surgery and the Royal Sussex County Hospital is our centre for
emergency and critical care. Our specialised and tertiary services include neurosciences, paediatrics,
cardiac, cancer, renal, infectious diseases and HIV medicine. We are currently developing our capability
as the designated major trauma centre for the region.
We treat over half a million patients each year. Working as one hospital across two sites, and playing to
the strengths of both, gives the flexibility to develop services which meet the needs of our patients at
different stages of their treatment and care.
Central to our ambition is our role as developing academic health sciences centre, a provider of high
quality teaching, and a host hospital for cutting edge research and innovation; and on this we work with
our partner, Brighton and Sussex Medical School (BSMS), the Kent, Surrey and Sussex Postgraduate
Deanery and our local Universities.
We also work in close partnership with our local GPs and commissioners to ensure that local health
services are provided and improved in ways which best meet the needs of our patients and their families.
The Department of Infection and Microbiology is based at the Royal Sussex County Hospital, Brighton
and provides services across the Trust which comprises the Royal Sussex County Hospital in Brighton
and the Princess Royal hospital in Haywards Heath.
2.2 Our Partner Medical School
The school's first 128 students started their five-year course in October 2003 and it has proved an
outstanding success, typically receiving more than 15 applications per place and consistently among the
most competitive medical schools in the country. Students spend the first two years based mainly at the
University campuses at Falmer, but with significant clinical exposure throughout the period, particularly in
primary care. During year 3 the main focus is hospital based specialties at the RSCH, while years 4 and 5
are spent obtaining further basic science training and gaining experience in other medical disciplines.
Year 5 is mainly based around regional attachments and will provide experience in shadowing house
officers. The School aims to teach a research-rich curriculum in which basic and clinical science are
prominent. In addition, we have developed an imaginative teaching programme that incorporates new
technology (such as the innovative PDA project, MoMED) and the use of imaging alongside anatomy
teaching, which has been a particular success. Feedback from the National Student Survey has
demonstrated an exceptionally high level of student satisfaction. Close links have been developed with
many NHS consultant colleagues and honorary academic titles are conferred for those who have a
particular engagement with the School. BSMS is also closely involved with postgraduate education.
BSMS has produced a new 5 year strategic plan (2009 – 14) that places growing its research capacity as
the number one priority. We have made significant investments in research infrastructure, including a
world-class Clinical Imaging Sciences Centre (CISC) and a Clinical Investigation & Research Unit (CIRU)
dedicated to patient orientated research and early clinical trials. There has been a rapid increase in
postgraduate research students and research income has more than doubled over the last five years.
The research programme of the School is growing rapidly. It is focused around major themes that include
neuroscience, oncology, and infection and inflammation. Within these we have particular strengths in
elderly care medicine, primary care and epidemiology and in imaging. There is a joint Research Office
that handles NHS R&D contracts and strong links between BSMS research faculty and NHS colleagues.
7
2.3 The Infectious Diseases Unit
The infectious diseases clinical team runs Grant ward, an 11-bedded infectious diseases isolation and
cohorting ward and is directly responsible for inpatient care of between 6-12 patients at any one time. Inpatient work comprises a mixture of healthcare associated infection, community acquired and imported
infection. In addition the infectious diseases team receives an average of 30 consultation requests per
month from other teams. The consultant on duty runs a weekly out-patient clinic with the ward specialist
registrar. A new twice weekly Rapid Access Infectious Diseases clinic has recently been set up, and takes
place on Wednesday afternoons and - in parallel with the routine ID clinic - on Friday afternoons.
The Microbiology and Infectious diseases consultants work closely together to provide an integrated
Clinical Microbiology and Infection Service, to support teaching of medical students from the Brighton and
Sussex Medical School and to support a training programme for joint trainees in Microbiology and
Infectious Diseases. We currently have seven trainees rotating through a scheme involving Worthing,
Chichester and Surrey and Sussex Hospitals.
New initiatives include plans to develop a Travel Medicine Clinic and an integrated OPAT service.
There are also close links with a busy HIV/GUM service and with the Health Protection Unit based in
Lewes including a weekly joint clinical meeting.
2.3.1 Consultant infectious diseases staff
Prof Jon Cohen
Honorary consultant in Infectious diseases (Dean of BSMS)
Dr Dan Agranoff
Consultant in Infectious Diseases and Acute Medicine
Dr Martin Llewelyn
Honorary consultant in Infectious diseases (Senior lecturer)
Prof Melanie Newport
Honorary consultant in infectious diseases
2.4 The Microbiology laboratory
The laboratory in Brighton is a former Public Health Laboratory which transferred to the NHS in 2003,
although it remains a Health Protection Agency (HPA) collaborating laboratory. There is a service level
agreement between the Trust and the HPA. The Food, Water and Environmental (FWE) Microbiology
services are now under Trust management. The budget holder is the Head BMS for microbiology and the
budget manager is the Pathology Services Manager. The overall budget is £6.7 million; income £1.5
million, pay £2.5 million, non-pay £2.7 million. CPA status is conditional accreditation. The laboratory is
accredited under the IBMS as a training laboratory for Bacteriology and Virology. The laboratory
participates in a comprehensive range of quality control schemes (UKNEQAS). The department provides
routine bacteriology and mycology services to Brighton and Sussex University Hospitals (BSUH) NHS
Trust and general practices in the Brighton and Hove PCT and the Mid-Sussex PCT catchment areas. In
addition virology and food/water/environmental work is undertaken for East and West Sussex, together
with the southern part of Surrey. Virology and serology work is undertaken at the Brighton site. The
laboratory serves a population of 460,000. Approximately 35% samples come from general practice. The
laboratory provides specialist services for neurosciences, paediatrics, cardiac surgery, cancer, renal and
HIV medicine. BSUH provides regional services for molecular virology and serology. Other laboratories
served with specialist tests include Maidstone and Tunbridge Wells, Eastbourne and Hastings, Crawley
and Redhill, Worthing, Ashford (Kent), Chichester, East Grinstead and Nuffield Hospitals.
With the future development of managed pathology networks, there may be opportunities to work in other
laboratories across Sussex.
Current annual workload figures are as follows:
Bacteriology
Virology/Molecular/Serology
Food/water/environmental
250,000
160,000
18,000
8
The laboratory includes a recently commissioned and fully equipped molecular suite. This has allowed
the phasing out of tissue culture methods and their replacement by PCR-based tests (e.g. for Herpes
simplex) and the introduction of PCR-based tests for other agents such as influenza and cytomegalovirus.
A Consultant Virologist has recently been appointed. This is a new post working alongside other clinical
members of the service. Equipment includes: Abbott Architect, Diasorin Liaison, Rotagene 3,000, Roche
Light-cycler 2.0 and 480, Magnapure Classic and Compact, Abbott M2000 and M2000 RT, BD Viper,
Biomerieux BacTalert, BacTalert 3D,Vitek and Menarini Sedimax. Future developments include Abbott
HIV protease sequencing, BD Bactec FX, Midgit and Phoenix plus BD Epicentre. The laboratory
information management system is Clinisys for Clinical Microbiology and GP Order Comms (Anglia Ice) is
being rolled out. There is electronic reporting to wards and general practice. Future links to other Trusts
are possible. For food and environmental work we use QSYS LIMS with web-based reporting of results.
Kiestra automation is being procured for automation and regionalisation of bacteriology work.
2.4.1 Consultant Medical Microbiology staff
Dr Marc Cubbon
Lead consultant in Microbiology and infection control doctor
Dr Eliza Alexander
Consultant microbiologist and lead for antimicrobial governance
Dr Stephen Mepham
Consultant in Microbiology and Infectious Diseases
Dr Mohammed Hassan-Ibrahim Consultant virologist
Dr Stephen Mepham
Consultant in Microbiology and Infectious Diseases
Dr John Paul
Honorary Consultant Microbiologist
2.5 Junior medical staff
The number of posts is as follows:
NTNs
Academic F2
F1 trainee
2 Infectious Diseases, 2 Microbiology
0.6 WTE (rotating post) - ID
1 - ID
2.6 Infection Control
The Director of Infection Prevention and Control is Mr Des Holden who is also a consultant obstetrician
and Medical Director. He is supported by Dr Marc Cubbon, consultant microbiologist and infection control
doctor, and Yvette Pickford, nurse consultant in infection control. The rest of the infection control team
consists of
Senior Infection Control Nurses
Infection Control Nurses
Surveillance and Audit Nurse
Personal Assistant
2.0 WTE
2.0 WTE
0.9 WTE
1.8 WTE
There are service level agreements to provide support to the infection control teams at several
neighbouring non-acute trusts (Southdowns, East Sussex Downs and Weald PCT, Mid Sussex PCT,
Brighton and Hove PCT) and there are close links with the local Health Protection Unit in Lewes. There is
wider communication with infection control staff and environmental health officers via the East Sussex,
Brighton and Hove Community Health Protection Committee.
2.7 Clinical Service Routine:
The trainee is expected to take part in all aspects of the work of the department.
A timetable of responsibilities will be drawn up to allow for the training requirements of the appointee.
Sufficient time will be allocated for personal study and scientific research. Where necessary, the timetable
will allow for training at other sites in order that the appointee is able to fulfil College training requirements.
9
An appropriate timetable of service duties will be drawn up ensuring a balanced exposure to the full range
of diagnostic reporting, clinical ward rounds, and Infection Control and Management activities. Fixed
timetabling is not in line with current work patterns and does not take into account the flexibility required of
a reactive speciality.
2.7.1 Outline work plan (ID):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
Microbiology
weekend
handover
Clinical referrals
Consultant ID
ward round
SpR Teaching
Clinical referrals
12pm
1pm
C. diff. mtng
Infection
radiology
meeting
Grand
round
Ward round
Clinical
infection
meeting
Consultant ward
round
Lab/Clinical 1:5
Lab/Clinical 1:5
PM
Ward/ clinical referrals
Teaching medical
students
Rapid Access ID clinic
ID outpatients clinic
Rapid Access ID clinic
2.7.2 Outline work plan (Microbiology)
Tuesday
AM
Microbiology
weekend
handover
Clinical referrals
Renal round
Wednesday
SpR Teaching
Thursday
HIV MDT (9.30)
ITU round
(11.30)
Clinical
infection
meeting
Monday
Friday
Saturday
Sunday
11am
Haem-Onc MDT
1pm
PM
Bench round
ITU round
TB MDT (11.45)
ITU round
(11.30)
ITU round
(11.30)
Infection
radiology (12)
Paeds MDT (12)
Renal round
ITU round
Grand
round
Teaching medical
students
Bench round
TMBU round
Bench round
Lab/Clinical 1:5
Lab/Clinical 1:5
2.7.3. Clinical on-call commitments:
10
Once appropriately trained in microbiology, the SpR will be first on call on average 1:5 over the year’s
appointment. Calls will be received directly from clinicians or BMS staff. The SpR will be expected to work
on-site on weekend daytime when on-call. Consultant cover will be provided.
The work intensity has been calculated at Band 1A, but will be confirmed by diary card within 6 weeks of
commencing the post.
2.8 Research
The trainee will have opportunities to follow research interests in Brighton or elsewhere. Current
departmental research interests in Brighton include involvement in multicentre studies on Staphylococcus
aureus and Clostridium difficile.
2.9 Audit
Specialist trainees are required as part of their training to be able to perform audit projects. A list of audit
projects is available for specialist trainees or they may elect to look at a subject of their own choice if
approved by their educational supervisor. A monthly research and audit meeting is jheld on the last
Wednesday of the month.
2.10 Useful websites
BSUHT
University of Brighton University of Sussex
BSMS
For further information
about the City of Brighton
and Hove and surrounding
area
-
http://www.bsuh.nhs.uk
http://www.brighton.ac.uk
http://www.sussex.ac.uk
http://www.bsms.ac.uk
http://www.thisisbrighton.co.uk
3. Medical Microbiology at Surrey & Sussex Healthcare NHS Trust
(SaSH)
East Surrey Hospital, Redhill and Crawley Hospital
3.1 Educational Supervisor:
Dr Karen Knox
01293 600300 x3109 (secretary)
Direct line 01293 600300 x3028
karen.knox@sash.nhs.uk
The trainee will spend their time divided between laboratory based training at Crawley Hospital and
the acute clinical site at East Surrey Hospital in Redhill.
 Laboratory base at Crawley Hospital
The Department of Medical Microbiology is sited at Crawley Hospital and is 10-15 minutes walk to the
centre of Crawley and rail links. It is approximately 10 miles from East Surrey Hospital in Redhill, the
acute hospital site (see below). Crawley Hospital is a community hospital under the domain of West
Sussex PCT. The laboratory and its staff remain under SaSH.
 Acute Trust Hospital: East Surrey Hospital, Redhill
East Surrey Hospital is sited a short distance south of Redhill town centre and approximately 10 miles
from the Crawley hospital laboratory base.
Population, number of beds and specialties:
East Surrey Hospital is a 400-bedded acute general hospital and designated trauma centre serving a
catchment area of around 400,000 population. It is a very busy hospital with expanding departments
11
in Emergency Medicine, Trauma & Orthopaedics, Cardiology, Paediatrics and Maternity. It has a 10bedded ICU, 6-bedded HDU, 8-bedded CCU with angiography suite, and a level 2 Neonatal Unit.
East Surrey Hospital provides a wealth of interesting cases for training, including infectious diseases,
some of which are admitted by virtue of the hospital’s proximity to Gatwick Airport.
3.2 Induction:
The educational supervisor will be responsible for initial induction of the trainee, introducing him/her to
departmental arrangements and staff.
The StR is expected to attend the Trust’s Induction programme which consists of a whole day.
Departmental induction will include a session with the OMM or Chief BMS and covers Laboratory
orientation and health & safety.
3.3 University links:
East Surrey Hospital is recognised for undergraduate teaching by the new medical school at the
University of Brighton.
3.5 Pathology departments:
The Medical Microbiology laboratory was refurbished in 2005 as part of the reconfiguration of acute
services within SaSH NHS Trust. It remains the single Pathology discipline sited off the acute East Surrey
hospital site at Crawley Hospital. There is StR office space at both the Crawley and East Surrey Hospital
sites.
Accreditation status:
The Microbiology department currently holds conditional CPA(UK) Accreditation.
3.5.1 PERSONNEL
The Department has a very friendly atmosphere and encourages team-working.
Senior Medical Staff:
Dr Bruce Stewart, Consultant Medical Microbiologist (CMM), Clinical Support Services Director and
Laboratory Lead
Dr Donald Lyon, CMM and Antibiotic Lead
Dr Karen Knox, CMM and Lead Infection Control Doctor
Infection Prevention and Control and Antibiotic Stewardship Team (IPCAS team - based at East
Surrey Hospital):
Ashley Flores, Lead Infection Prevention and Control Nurse (IPCN) and Deputy DIPC
Ruth Bradburn, Senior IPCN
Suzanne Rapley, IPCN
Jill Clarke, Infection Control Practice Development and IV line Nurse
Colin Pink, Infection Control Programme Manager
Amy Lee, Antibiotic Pharmacist
Senior Laboratory Staff:
Mr Michael Rayment, Pathology Services Manager (PSM)
Mr Peter Webber, Operational Manager for Microbiology (OMM)
Mrs Rosalind Phipps, Lead Biomedical Scientist (BMS)
The laboratory staff further consists of 5 Senior BMS, 15 BMS, 1 trainee BMS, 10 MLAs, 1 A&C.
Administrative Staff:
2 WTE senior medical secretaries (Mrs Janis Trim and Ms Lucy Gritton)
12
3.6 Departmental workload:
The Microbiology Laboratory is fully computerised (Isoft APEX Laboratory Information Management
System) and provides a comprehensive service covering all aspects of general microbiology to the
acute Trust Hospital and community hospitals and GPs in the east Surrey and northern patch of West
Sussex.
The Department processes approximately 200,000 samples per annum, split roughly 50:50 between
the Trust and direct access (GP work).
The work of the laboratory comprises a full range of general microbiology including mycology,
mycobacterial detection, parasitology and basic serology. A programme of introduction of technology
and automation has continued since 2004 which has seen the establishment of BD ProbeTec for
Chlamydia PCR, Bactec MGIT for liquid TB culture, Norovirus molecular detection platform and ILSprint for automated urine microscopy. The serology platform has recently been replaced with a
random access system (Abbott Architect). Further planned developments include the introduction of
automated organism ID/susceptibility testing (e.g. Vitek, Phoenix).
The Infection Control service encompasses Surrey and West Sussex PCT but the community
premises (GP practices, nursing homes and community hospitals) are primarily covered by the local
PCT employed IPCNs the hospital IPCAS team have good communication.
3.7 Meetings:
Senior Management Meeting (monthly): OMM, CMMs and PSM
Senior BMS Meeting (monthly): OMM and senior BMS staff
Laboratory Staff meetings (monthly): OMM, CMMs and all laboratory staff
Laboratory educational meetings – as announced
IPCAS team meeting (bimonthly)
Infection Control Taskforce meetings biweekly
Medical Grand Round at PGMEC East Surrey Hospital weekly
3.8 Liaison with major clinical units:





ITU MDT meetings (ESH) on Monday and Thursday mornings. Daily telephonic communication is
expected as a minimum outside of this.
Attendance on wards Monday and Thursday afternoons as clinically indicated by significant cultures
or as part of a consult service.
Paediatric Grand Round Tuesday afternoon – opportunity to attend.
Close working relationship with all clinical specialties is expected.
Close working relationship with CCDC and Community Infection Control teams.
There are opportunities to develop enhanced links with other departments e.g. GUM, Orthopaedics,
SCBU.
3.9 Accommodation:
At Crawley Hospital the trainee has a dedicated office with a PC, desk, filing cabinet and telephone.
This is situated adjacent to the laboratory.
At East Surrey Hospital the trainee has a desk space with PC access telephone within the shared
clinical office.
Laboratory facilities can be allocated as required for project or other work (examination preparation).
3.10 Educational arrangements
3.10.1Training agreement:
The Educational Supervisor will discuss and agree a training programme with the StR within the first
week of commencing the appointment. The training agreement and objectives will be reviewed and
revised.
3.10.2 Appraisals:
13
Protected time will be set aside on a 3 monthly basis for formal documented appraisal of the StR by
the Educational Supervisor. There is ample opportunity for non-formal discussion outside of these
times.
3.10.3 Postgraduate educational facilities:
The post-holder will have access to the Trust’s Post-graduate Medical Centre, with a lecture theatre and
modern audiovisual equipment at East Surrey Hospital. A Medical Grand Round is held on Thursday
lunchtimes.
 Library facilities:
There is a library on each of the hospital sites, which host a range of English, European and American
postgraduate journals and textbooks. The post-holder will have their own office at Crawley Hospital
and a shared office at East Surrey Hospital with access to a computer and the Internet.
 IT Facilities:
The trainee has access to a PC at both sites (dedicated PC at Crawley site; shared PC at East Surrey
site). All PCs are connected to the hospital mainframe and provide full email facilities, access to the
Trust intranet and to the internet (www) and library search facilities. They are also linked to the
laboratory reporting system, hospital PAS (Cerner) and radiology system.
3.10.4 Timetable of Educational events:
The StR may, if appropriate to level of training, attend an MSc course on a protected day release
basis at the Royal London hospital depending upon level of training.
The StR is encouraged to attend the Medical Grand Round at East Surrey Hospital on Thursday
lunchtime.
There is opportunity for the StR to attend the Friday morning ID/Micro clinical meeting at the Royal
Sussex Hospital (Brighton).
3.11 Principal service responsibilities
Clinical Service Routine:
The trainee is expected to take part in all aspects of the work of the department appropriate to their
level of training and experience.
Depending on experience previously gained, the post-holder will undertake dedicated time on a bench
rotation before participating fully, as directed by the CMMs, in all aspects of diagnostic and clinical
microbiology. This includes responsibilities in: laboratory supervision; the verification, interpretation
and authorisation of microbiology results; the clinical management of patients with infectious diseases
including telephone advice, ward review of patients and participation in multi-disciplinary team
meetings; and infection prevention and control work. These services support the acute clinical
services based at East Surrey Hospital as well as being provided to the community hospitals and GPs
(some 50 practices) of West Sussex and Surrey PCTs.
The post-holder will be expected to carry out these clinical duties as part of a team with the three
Consultant Medical Microbiologists who work a one-week-in-three clinical duty roster. The post-holder
will also be expected to participate in audit, governance, educational and research activities as a key
member of the department. In addition, the post-holder will be expected to maintain a log book of
cases in which s/he has been directly involved.
 Clinical on-call commitments
Currently, once appropriately trained, the post-holder will undertake non-residential out-of-hours oncall duties on a rotational basis, including weekend working (average 1:7). There is always an on-call
Consultant timetabled to provide support. The on-call service is to provide clinical microbiology and
infection control advice to the on-call teams within the Trust (and very occasionally to the community
services). There is always an on-call BMS to provide the technical service. The work intensity has
been calculated at Band 1B which will require diary card confirmation during the year.
14
 Teaching responsibilities:
Where the opportunity arises, the post holder will be encouraged to participate in undergraduate
teaching and the training of nurses, BMS and junior medical staff as appropriate.
3.12 Research possibilities:
StRs will be encouraged to pursue research into areas of interest and will be supported in work
required for an MSc, MRCPath or MD if appropriate. If the necessary facilities or specialist support
and supervision is not available on site, time will be allocated to enable this to be sought elsewhere.
3.13 Clinical audit:
The Trust has an active audit department available to help in design and analysis of individual audits.
The StR will participate in local and regional audits and is encouraged to design and run audits
projects according to his/her own interest.
There is a regular programme of antibiotic audits supported by an antibiotic pharmacist.
3.14 Management training:
According to stage of training, the StR will be exposed to laboratory management through discussion
and tutorials with the CMMs and is encouraged to attend laboratory and other appropriate Trust
meetings.
4. Medical Microbiology at St Richard’s Hospital, Chichester
4.1 Educational Supervisor:
Dr Susan Jerwood
01243 831631 or ext 3547
Susie.Jerwood@wsht.nhs.uk
4.2 Setting
St Richard’s Hospital is a busy DGH where trainees will get a good grounding in practical microbiology. All
trainees will spend time on the benches, the length of time depends on previous experience. There are
daily ward rounds in ITU, for bacteraemias and hot cases. There is a weekly medical grand round which
trainees are encouraged to attend, and can present if they wish. Day to day activities will be tailored to the
stage of training, for example prior to exams more time can be spent in the laboratory or towards the end
of training more time can be spent on managerial tasks. All trainees will be actively encouraged to take
part in departmental audits and time off clinical work is set aside for these and other training activities.
4.3 Staffing
At consultant level there are 2 microbiologists at St Richard’s (Dr Jerwood and Dr Greig). The trainee
usually works a standard 9am-5pm working day.
4.4 Education
Trainees participate in a programme of training days currently organised by the London
deanery. Tutorials and seminars are arranged on a regular basis at the different centres and trainees are
also welcome to attend the Friday meetings in Brighton when not on clinical cover. Most MMV trainees
have undertaken an MSc in Microbiology and trainees are encouraged to submit abstracts and attend
MMV/ID meetings such as the Federation of Infection Societies annual meeting.
4.5 On-call
SpRs contribute to a microbiology on call rota on a 1:5 basis with consultant cover. On-call is off site,
though the on-call person needs to go into the laboratory on Saturdays and bank holidays (approximately
10am-4pm) to deal with authorising, new blood culture results and any other matters that cannot wait.
15
5. Medical Microbiology at Worthing Hospital
5.1 Educational Supervisor:
Dr Jo Legg
01903 285088
Joanne.Legg2@wsht.nhs.uk
5.2 Setting
Worthing Hospital is a large district general hospital covering a population of approx. 250,000. The
hospital provides a range of core services with a renal dialysis unit, large interventional Cardiology unit, a
6 bed ITU / 6 bed HDU, and a 30 bed Medical admissions ward. It is a busy hospital with a high proportion
of elderly patients. Worthing and St Richard’s Hospitals (Chichester) have recently merged as a Trust
(Western Sussex Hospitals NHS Trust) and services are currently undergoing reconfiguration across the 2
sites. The hospital is a recognised undergraduate teaching site for Brighton Medical School and
Guys/Kings/Thomas’s Medical School.
5.3 Staffing
There are 3 Consultant Microbiologists at Worthing: Dr’s Legg, Bates and Child, and one Specialist
Trainee. The Infection control team comprises 1 Nurse Consultant and 3 Infection Control Nurses. The
department is also supported by a full time Antimicrobial Pharmacist.
5.4 Microbiology Laboratory
Worthing Hospital has a large modern Microbiology Laboratory which has full CPA accreditation. It is
provides a comprehensive service to the hospital and GP’s in the Worthing area. The work of the
department comprises a full range of general microbiology, including mycology, parasitology, and basic
viral serology. A fuller virology service is purchased from Brighton, and TB work provided by St Richard’s
Hospital.
5.5 Clinical Microbiology Service
The Microbiology team provide a very clinically focussed service to the hospital and to the local
community. There is a daily laboratory bench round followed by a clinical ward round to review patients on
ITU and any patient with a bacteraemia or other significant infection. In addition, a member of the team
undertakes regular orthopaedic ward rounds and attends a weekly Diabetic foot MDT.
5.6 Microbiology Training
This depends on the previous experience of the trainee. For new trainees a period of 2-3 months is spent
in the laboratory, followed by training in the clinical authorisation of results. The trainee then takes part in
clinical ward rounds, and provides clinical microbiology advice to the hospital and GP’s with consultant
supervision. For those trainees in later stages of training, in addition to clinical consults, experience in
management roles are organised including infection control and outbreak management, antimicrobial
stewardship, and laboratory management.
Trainees are expected to participate in audit projects and are given protected time to complete these, and
other research projects if appropriate.
5.7 Education
Trainees participate in a programme of training days currently organised by the London deanery. Most
trainees attend the 2 year MSc in Medical Microbiology in London (1 day/ week day release) and also
attend the Friday morning Clinical Infection meetings in Brighton.
Trainees are also encouraged to attend and or present at national meetings such Federation of Infection
Societies and British Infection Association.
5.8 On-call
Trainees take part in a 1 in 5 on call rota with consultant cover. Weekend cover includes on site
authorisation and clinical ward round on a Saturday.
16
6. Medical Microbiology at Frimley Park Hospital and The Royal
Surrey County Hospital
6.1 Educational Supervisor:
Dr David Garner
01276 423501
david.garner@fph-tr.nhs.uk
6.2 Setting
Frimley Park Hospital NHS Foundation Trust is a major general hospital located in Surrey, close to the
Hampshire and east Berkshire borders. It provides a full range of district general hospital services for the
population of north east Hampshire, west Surrey and east Berkshire with a catchment population of
approximately 400,000. The Royal Surrey County Hospital NHS Foundation Trust NHS Foundation Trust
is a leading modern general hospital and specialist centre for cancer services and treatment, based in
Guildford. The RSCH serves a population of 320,000 for emergency and general hospital services, mainly
from West Surrey, East Hampshire and North Sussex and 1.2 million people for cancer services.
6.3 Staffing
There are 3.6 Consultant Microbiologists at Frimley Park Hospital and 2 Consultant Microbiologists at the
Royal Surrey County Hospital, who form part of a single department serving both acute Trusts. The two
Trusts have their own Infection Control Teams and Antimicrobial Pharmacists.
6.4 Microbiology Laboratory
Frimley Park Hospital has a cutting edge, modern Microbiology Laboratory including Kiestra, MaldiTOF
and automated urinalysis. It has full CPA accreditation. It is provides a comprehensive service to both
Frimley Park and Royal Surrey County hospitals and GP’s in the Surrey, Hampshire and East Berkshire
areas. The work of the department comprises a full range of general microbiology, mycology and
parasitology, as well as a specialist virology service. The current laboratory workload is in excess of
600,000 specimens per annum.
6.5 Clinical Microbiology Service
The Microbiology team provide a clinically focussed service to the both hospitals and to the local
community. There is a daily laboratory bench round followed by a clinical ward round to review patients on
ITU and any patient with a bacteraemia or other significant infection. In addition, a member of the team
undertakes regular orthopaedic ward rounds and attends a weekly Haematology MDT.
6.6 Microbiology Training
This would depend on the previous experience of the trainee. For new trainees a period of 3 months is
spent in the laboratory. The trainee would then be expected to participate in the provision of the clinical
microbiology service to both hospitals and GPs including oncall, whilst under the supervision of one of the
Consultant Microbiologists. In addition the trainee will be given experience in management roles such as
network laboratory management, infection control and antimicrobial stewardship. Trainees will also be
expected to participate in clinical audit and teaching of junior medical staff and laboratory staff.
6.7 Education
Trainees participate in a programme of training days currently organised by the London deanery. Most
trainees attend the 2 year MSc in Medical Microbiology in London (1 day/ week day release). Trainees are
also encouraged to attend and or present at national meetings such Federation of Infection Societies and
British Infection Association.
6.8 On-call
Trainees take part in a 1 in 5 on call rota with consultant cover. Weekend cover includes on site
authorisation on Saturday with the potential for off site authorisation on Sunday.
17