NHS Lothian
Division/CH(C)P
Directorate of Surgery
Initial Hospital Base: Royal Infirmary Edinburgh
FIXED TERM SPECIALTY DOCTOR IN TRANSPLANTATION
(10PAs, fixed term 12 months)
1.
Outline of the post
The Transplant Unit at The Royal Infirmary of Edinburgh would like to advertise a
Specialty Doctor post to compliment four existing posts. This post will provide on call
support for the Scottish Organ Retrieval Team and activities of the Edinburgh
Transplant Unit and will also offer the opportunity for a period of advanced clinical
training in transplant surgery. The post will be vacant from the 24th of April 2015.
The Transplant Unit will fund the post.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community,
mental health and hospital services. Dr David Farqhuarson 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.
2.1 University Hospitals Division
The University Hospitals Division provides a full range of secondary and tertiary
clinical services to the populations of Edinburgh, Midlothian, East Lothian and
West Lothian. The Division is one of the major research and teaching centres in
the United Kingdom.
Hospitals included in the Division are:
The Royal Infirmary of Edinburgh
The Western General Hospital
The Royal Hospital for Sick Children, Edinburgh
St Johns Hospital
Royal Victoria Hospital
Liberton Hospital
The Princess Alexandra Eye Pavilion.
April 2008
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The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the
South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869
beds, and 24 operating theatres, and is equipped with modern theatre and critical
care equipment and monitoring. Within the main building is a dedicated,
multidisciplinary, 5 theatre day surgery complex. The hospital provides for most
specialities and is the centre for:
 General surgery with a focus on the upper GI tract
 Vascular surgery
 Hepato-biliary and Transplant medicine and surgery
 Cardiac and Thoracic surgery
 Elective and trauma Orthopaedics surgery
 Neonatology
 Obstetrics & Gynaecology
 Cardiology
 Renal Medicine
 Sleep Medicine
 Regional major Accident and Emergency centre.
There is a Combined Assessment Unit which takes unselected GP or direct
emergency referals, 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, NM
and PET scanning). 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 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.
April 2008
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St John’s Hospital opened in 1989 and is located in the centre of Livingston, a
new town about 30 minutes drive west from Edinburgh. The hospital provides for
most common specialties but does not have emergency general surgery or
orthopaedic trauma operating. The hospital has a paediatric ward and is the
centre for:
 General Medicine with specialists in Cardiology, Diabetes & Endocrinology,
Gastroenterology, Respiratory Medicine and Care of the Elderly
 Obstetrics & Gynaecology
 Child Health including Paediatrics and community child health
 The supraregional Burns and Plastic Surgery unit.
 Oral and Maxillofacial Surgery
 ENT
 Critical Care (ITU, HDU and CCU)
 Accident and Emergency
 General Surgery
 Orthopaedics
 Anaesthetics
 Mental Health including ICCU and ICPU
Since 2005 general surgery and orthopaedics have been reconfigured in NHS
Lothian with SJH being developed as a major elective centre for the region.
Lothian’s ENT service was relocated to SJH to create an integrated head and
neck unit with OMFS and Plastic Surgery.
Recent developments at SJH include a new endoscopy suite, an Intensive
Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day
centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are
full supporting Laboratory and Diagnostic Radiology Services (including CT,
Ultrasound and NM).
The hospital has been accredited full teaching hospital status by the University of
Edinburgh. There is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing
general and specialist services for children. The hospital is situated in a
residential area close to the centre of Edinburgh and is approximately 3 miles from
the site of the New Royal Infirmary and the 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 SouthEast of Scotland providing general and specialised services on a local, regional
and national basis. It acts as the local paediatric referral centre for the children of
Edinburgh and surrounding areas, and as a tertiary referral centre for intensive
care patients; gastroenterology, hepatology & nutrition; respiratory medicine;
cardiology; nephrology; neurology; oncology; haematology; neonatal surgery;
plastic surgery; orthopaedic surgery; urological surgery and aspects of general
surgery.
Hospital accommodation encompasses five theatres, a critical care unit
comprising a 6/8 bedded Paediatric Intensive Care Unit, 4/6 bedded High
Dependency Unit and a 3 bedded Neonatal Intensive Care Unit. There is an
excellent library facility and a modern lecture theatre with a full range of audiovisual equipment.
April 2008
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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
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
RoodlandsHospital 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: Acute Mental Health
 Rehabilitation
 Psychiatric Emergency Team 24/7
 Outpatients
 Assessment Phychiatry of Old Age
 Forensic Medium Security Unit
 Inpatient facilities for under 18s
April 2008
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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:
 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.
April 2008
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3.
University of Edinburgh
The University of Edinburgh was established in 1582 and is one of the largest in the United
Kingdom located on a number of prominent sites in Scotland’s capital city. It is Scotland’s
premier research University and within the top 5 Universities in Europe for its Biomedical
Sciences.
The University of Edinburgh’s College of Medicine and Veterinary Medicine (CMVM; Head
Professor Sir John Savill) is an internationally leading force in basic-to-clinical translational
research. The College has a consistent 30-year strategy of interdisciplinarity and integration
of basic and clinical sciences. In the most recent Research Assessment Exercise (2008), the
University of Edinburgh was top in the United Kingdom within the UoA4 category of Hospitalbased Clinical Subjects. In 2008/9, CMVM attracted over £120 million in external peerreviewed grant funding.
It has established several major interdisciplinary research Centres:
i. MRC Centre for Inflammation Research (Director, Professor John Iredale)
ii. Centre for Cardiovascular Science (Director, Professor Brian Walker) incorporating the
BHF Centre of Research Excellence (Director, Professor John Mullins)
iii. Centre for Reproductive Biology (Director, Professor Phillipa Saunders) and MRC Human
Reproductive Sciences Unit (Director, Professor Robert Millar) including the Tommy’s
Centre (Director, Professor Jane Norman).
iv. MRC Centre for Regenerative Medicine (Director, Professor Sir Ian Wilmut)
v. Centre for Molecular Medicine (Director, Professor David Porteous)
vi. Centre for Cancer Research (Director, Professor David Harrison)
vii. Centre for Population Health Sciences (Director, Professor Harry Campbell)
viii. MRC Human Genetics Unit (Director, Professor Nick Hastie)
These Centres are predominantly based at two sites: the Queen’s Medical Research Institute
at the Royal Infirmary, and the Institute of Genetics and Molecular Medicine at the Western
General Hospital. The co-location of basic science and clinical groups within state-of-the-art
infrastructure and technology provides an excellent and exciting opportunity to conduct
translational research at the highest level.
This academic power base is supported by clinical research infrastructure that includes:
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4.
April 2008
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
NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
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5.
Departmental Information: Transplant Unit.
The Transplant Unit provides medical care at a national level for the whole of Scotland
through the Liver and Pancreas programs as well as supraregional cover for kidney
transplantation. The unit has also been commissioned to provide a national service for
isolation and transplantation of pancreatic islets for the population of Scotland from April
2009.
The Scottish Liver Transplant Unit opened in 1992 and the annual contract for liver
transplant numbers has gradually increased. In 1995 the Renal Transplant Unit moved from
the Western General Hospital so that the Royal Infirmary Transplant Unit became a
combined unit. The number of patients transplanted has gradually increased as well as their
complexity, with the opening of a pancreas program and the development of Living donor
transplantation, for kidney and liver recipients.
Following significant national concerns about the organ donation rate, a UK-wide advisory
committee was setup to advise all departments of health regarding action, which should be
taken to improve the situation. Several recommendations were made to increase the
donation rate and in fact some of them have already been implemented with a significant
effect on the transplant activity. We therefore appointed two specialty doctors (transplant
clinical fellows) last year to provide cover for the transplant unit. This has been successful in
order to cope with the increasing transplant activity. We are now advertising for two
additional Specialty Doctor posts, of which this is one.
The combined renal, pancreas and liver transplant ward has 18 in-patient beds in addition to
a dedicated transplant high dependency unit with 5 beds. Further beds are funded by the
transplant service in the intensive care unit. The Transplant Unit also contributes to the
fulminant hepatic failure service, which is a further nationally designated service for the
population of Scotland.
The Transplant Unit in the RIE provides a national organ retrieval service throughout
Scotland and also in Northern Ireland. Recent changes in organ allocation based on the
Donor task force recommendations and the commissioning of the National Organ Retrieval
Service (NORS), the transplant unit through the Scottish Organ Retrieval Team (SORT)
provides second on call cover for the north of England, in cooperation with Newcastle and
Leeds Transplant Units. This, similar to liver, pancreas and islet transplantation, is a supra
regionally funded service currently commissioned by National Service Division.
The number and complexity of retrievals has increased considerably being now routinely two
consultants on call (first and second tier).
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Names of Clinical staff and any specialist interests
(a) Consultant Transplant Surgeons
Miss Anya Adair
Mr Murat Akyol
Mr John Casey
Mr Ian Currie
Prof John Forsythe
Mr Ewen Harrison
Ms Lorna Marson
Mr Gabriel Oniscu
Mr James Powell
Prof. Steve Wigmore
April 2008
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(b) Transplant Hepatologists
Dr Andrew Bathgate
Dr Carol Blair
Prof. Stuart Forbes
Prof. Peter Hayes
Dr Alastair MacGilchrist
Dr Ken Simpson
(c) Transplant Nephrologists
Dr Brian Conway
Dr Bean Dhaun
Dr Paddy Gibson
Dr Jane Goddard
Dr Lorna Henderson
Dr Jeremy Hughes
Dr David Kluth
Dr Wendy Metcalfe
Dr John Neary
Dr Richard Phelps
Prof. Neil Turner
Dr Simon Watson
Dr Caroline Whitworth
(d) Transplant Anaesthetists
Dr Craig Beattie
Dr David Cameron
Dr Brian Cook
Dr Rory Mayes
Dr Alistair Lee
Dr Dermot McKeown
Dr Anthony Pollok
Dr Ewan Thompson
Yet again we can report a record year for transplantation activity in the Royal Infirmary of
Edinburgh in this last financial year. This year there have been more assessments, more
retrievals, more transplants (both liver and kidney) and more outpatient consultations than ever
before.
In 20011/2012 financial year 115 retrievals were performed; 109 kidney transplants, 20
pancreas transplants and 96 liver transplants were performed in the Transplant Unit.
(This summary only reflects part of the transplant unit activity, not including outpatient
clinics, assessments, ward rounds.
April 2008
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6.
Details of the Post
There are three Specialty doctors attached to the transplant unit, who work together with the
trainees and the two new posts will complement this. Their main commitment will be to provide
cover to the transplant on call rota, and secondly to participate in the transplant ward duties.
There will be also an element of work at the HPB unit.
The combination of trainees and specialty doctors has contributed largely to develop a rota that
is compliant with EWTD and New Deal and has been a big benefit for the unit and NHS
Lothian.
Applicants should be ST3-7 grade or equivalent and as noted before, the post is part of a
national transplant program. This is an Exposure Prone post.
7.
Research and Development
As noted above, the transplant unit is fully involved in both laboratory and clinical research.
Opportunities therefore will be available.
8.
Teaching
The unit is involved in under graduate and postgraduate teaching training and examinations.
No formal teaching duties required of this unit.
April 2008
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9.
Job Plan
NHS Lothian - Job Plan Format
Name: SPECIALTY DOCTOR
Specialty: TRANSPLANT UNIT
Principal Place of Work: RIE (ward 206).
Contract:
Full Time
Programmed Activities: 10.
EPAs: not applicable.
Availability Supplement: 6%
Salary will be defined in accordance with the provisions in Schedule 14 of the Terms &
Conditions, appropriate for the individual experience.
Managerially responsible to: Prof Wigmore
Responsible for: see attached job description (appendix 1)
a)
Timetable of activities which have a specific location and time (appendix 2)
See attached job description. In summary, main commitment will be to provide cover
to the transplant on call rota.
9.
Contact Details
Prof Wigmore
Consultant Transplant Surgeon
Lead Clinician Transplant Unit
Royal Infirmary of Edinburgh
51 Little France Crescent
EDINBURGH
EH16 4SA
Mr Gabriel Oniscu
Consultant Transplant Surgeon
Transplant Unit
Royal Infirmary of Edinburgh
51 Little France Crescent
EDINBURGH
EH16 4SA
Tel: 0131 242 1714
Fax: 0131 242 1739
Tel: 0131 242 1715
Email: s.wigmore@ed.ac.uk
Email: gabriel.oniscu@ed.ac.uk
April 2008
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10.
Person Specification: Specialty Doctor. Transplant Unit
REQUIREMENTS
Qualifications
Training
and
ESSENTIAL
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Post
Specific
Experience
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DESIRABLE
GMC
registered
medical
practitioner
Be ST3-8 grade or equivalent
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Additional
postgraduate qualifications,
e.g. MD or PhD
Applicant should have experience
in organ retrieval procedures.
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Experience of all areas
of abdominal organ
transplantation
Experience
in
assessment of patients
for inclusion on the
active waiting list for
organ transplantation
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Ability
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Academic
Achievements
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Evidence of ability to take full
responsibility for independent
management of patients.
Independent during organ retrieval
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Ability to
redesign
clinical
service
or
process
Evidence of commitment to
research,
publications
and
presentations
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Evidence of previous
experience
in
successful
research
funding, review and
publication
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Evidence of teaching
qualification or learning
Designing
and
effecting
audit
programmes
Teaching and Audit
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Motivation
Team Working
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April 2008
Evidence of commitment to:
o Patient focused care,
o Effective and efficient use
of resources
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Evidence of teamwork with
colleagues in own and other
disciplines
Able to organise time efficiently
and effectively
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Evidence
of
development
of
services for patients
Clear commitment to
developing
role
in
transplantation/ organ
donation
Able
to
motivate
colleagues
Evidence of ability to
lead service re-design
for the benefit of
patients
APPENDIX 1. TIMETABLE
a) Timetable of activities Predictable
DAY
Monday
08-12
HOSPITAL/ LOCATION
TYPE OF WORK
Transplant Rounds
Patient Administration
DCC
1
SPA
1
DCC
1
07pm-07am
Tuesday
07pm-07am
Emergency Work from on call duties (PEW)(1:5 rota)
Transplant Rounds
Clinic
Patient Administration
Wednesday
07pm-07am
RIE, transplant Unit
Thursday
07pm-07am
Transplant Rounds
PA
1.5 (1 PEW)
DCC
1
RIE, List th 15
SLTU Meeting
DCC
2
RIE, Ward rounds
transplant Unit
DCC
1.25 PA (PEW)
RIE, Ward Rounds
transplant Unit
DCC
1.25 PA (PEW)
Clinic
Friday
07pm-07am
Saturday
09-13h
Sunday
09-13h
10 (9+1)
Total number of PA *
* : Predictable on call work (PEW) is shown as 3.5 PA (1:5 rota).
April 2008
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