NHS Lothian
University Hospitals Division
Directorate of General Surgery
Royal Infirmary of Edinburgh
Advanced specialty training opportunity in Colorectal Surgery
1.
Outline of the post
This post is suitable for a year 6 or equivalent specialist registrar who wishes to gain
experience in advanced open and laparoscopic management of complex colorectal
conditions, benign and malignant. Candidates should therefore have had significant previous
training in colorectal and laparoscopic surgery, including endoscopy. The post will comprise
both emergency duties on the registrar rota (which is non-resident) and elective sessions at
the Western General Hospital. At present the rota for emergency on-call is 1 in 7 for days and
1 in 9 for nights. The Colorectal Unit is one of Europe’s biggest. The Department of
Coloproctology was established in August 2002 and offers tertiary referral colorectal surgical
services for all aspects of benign and malignant colorectal conditions, both elective and
emergency. Elective and emergency upper gastro-intestinal surgery is provided in the New
Royal Infirmary with the two units working closely together in the first major totally specialist
emergency surgical service for all upper and lower gastro-intestinal surgical emergencies in
the UK.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental
health and hospital services. Mr Tim Davison is Chief Executive and Dr David Farquharson is
Medical Director.
The NHS Board determines strategy, allocates resources and provides governance across
the health system. Services are delivered by Lothian University hospitals division, the Royal
Edinburgh hospital and Associated mental health services, 4 community health (and social
care) partnerships (CH(C)Ps) in City of Edinburgh, West Lothian, East Lothian and
Midlothian, and a Public Health directorate.
NHS Lothian serves a population of 850,000.
The Department of Plastic Surgery provides a supraregional service to Fife, the Borders and
Highland regions and serves a population of 1.4 million
2.1 University Hospitals Division
The University Hospitals Division provides a full range of secondary and tertiary clinical
services to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The
Division is one of the major research and teaching centres in the United Kingdom.
Hospitals included in the Division are:
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The Royal Infirmary of Edinburgh
The Western General Hospital
The Royal Hospital for Sick Children, Edinburgh
St Johns Hospital
Royal Victoria Hospital
Liberton Hospital
The Princess Alexandra Eye Pavilion.
The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South
East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24
operating theatres, and is equipped with modern theatre and critical care equipment and
monitoring. Within the main building is a dedicated, multidisciplinary, 5 theatre day
surgery complex. The hospital provides for most specialities and is the centre for:
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General surgery with a focus on the upper GI tract
Vascular surgery
Hepato-biliary and Transplant medicine and surgery
Cardiac and Thoracic surgery
Elective and trauma Orthopaedics surgery
Neonatology
Obstetrics & Gynaecology
Cardiology
Renal Medicine
Sleep Medicine
Regional major Accident and Emergency centre.
There is a Combined Assessment Unit which takes unselected GP or direct emergency
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 and NM and PET scanning
will be available in 2008). There is a full range of lecture theatres, a library and AV
facilities.
The Western General Hospital (WGH) has 600 beds and 5 operating theatres and is
equipped with modern theatre and critical care equipment and monitoring. The Anne
Ferguson building was completed in 2001. The hospital provides for most specialties and
is the centre for:
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Neurology, Neurosurgery and neuropathology
UK CJD unit
Colorectal Surgery
Urology and Scottish Lithotriptor Centre
Breast Surgery and Breast screening
• Gastro-Intestinal disease
 Rheumatology
 Infectious Diseases
 Haematology Oncology
 Medical Oncology
 Radiation Oncology (including 6 LINACs)
 Dermatology (Inpatient)
 Medicine of the Elderly/Stroke Medicine
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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.
St John’s Hospital opened in 1989 and is located in the centre of Livingston, a new town
about 30 minutes drive west from Edinburgh. The hospital provides for most common
specialties but does not have emergency general surgery or orthopaedic trauma
operating. The hospital has a paediatric ward and is the centre for:
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General Medicine with specialists in Cardiology, Diabetes & Endocrinology,
Gastroenterology, Respiratory Medicine and Care of the Elderly
Obstetrics & Gynaecology
Child Health including Paediatrics and community child health
The supraregional Burns and Plastic Surgery unit.
Oral and Maxillofacial Surgery
ENT
Critical Care (ITU, HDU and CCU)
Accident and Emergency
General Surgery
Orthopaedics
Anaesthetics
Mental Health including ICCU and ICPU
Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian
with SJH being developed as a major elective centre for the region. Lothian’s ENT service
was relocated to SJH to create an integrated head and neck unit with OMFS and Plastic
Surgery.
Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric
Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite
renal dialysis unit and a £2.75m reprovision of A&E. There are full supporting Laboratory
and Diagnostic Radiology Services (including CT, Ultrasound and NM).
The hospital has been accredited full teaching hospital status by the University of
Edinburgh. There is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing
general and specialist services for children. The hospital is situated in a residential area
close to the centre of Edinburgh and is approximately 3 miles from the site of the New
Royal Infirmary and the co-located University of Edinburgh Medical School and 3 miles
from the Western General Hospital. The RHSC is a 151-bedded Hospital, and is the main
paediatric teaching hospital for the South-East of Scotland providing general and
specialised services on a local, regional and national basis. It acts as the local paediatric
referral centre for the children of Edinburgh and surrounding areas, and as a tertiary
referral centre for intensive care patients; gastroenterology, hepatology & nutrition;
respiratory medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal
surgery; plastic surgery; orthopaedic surgery; urological surgery and aspects of general
surgery.
Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8
bedded Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3
bedded Neonatal Intensive Care Unit. There is an excellent library facility and a modern
lecture theatre with a full range of audio-visual equipment.
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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
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.
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
The unit is currently staffed by four University appointments, Professor M G Dunlop, Professor K C
Fearon, Mr H M Paterson and Miss F V M Din and nine NHS Consultants, Mr R G Wilson, Mr B J
Mander, Mr M A Potter, Mr D N Anderson, Mr C Reddy, Miss M H S Collie Mr AJ Clark Mr D Speake and
Mr M Duff.
The appointee will be part of a team consisting of 13 consultants, 7 SPRs (with 2 Breast SPRs making a
middle grade rota of 1.9) with plans to increase this tier by two , 4 FY2s/2CTs and 12 Fy1s providing
emergency, in-patient and day case service to the population of Lothian. The successful candidate will
be expected to provide a full commitment to the middle-grade rota on a 1.9 (1:7days / 1:9 nights) basis.
The post holder will be based at the Western General Hospital, which is the main centre of adult
colorectal services in Edinburgh and one of Europe’s busiest Colorectal Units. The unit also provides a
colorectal service to West Lothian at St Johns Hospital, East Lothian at Roodlands Hospital and at Leith
Community Treatment Centre. Elective colorectal short stay Surgery is carried out at the Western
General, St Johns and Roodlands Hospitals. Emergency and in-patient colorectal surgery is carried out
at the Western General Hospital.
The Western General Hospital has a long history as a major teaching hospital and is the site of major
research laboratories funded by MRC, CRC and by ICRF. The present bed compliment is 850 beds.
The hospital has all of the major acute medical specialities and has supra-regional services for
Oncology, Urology, Neurosciences, Infections Diseases and Rheumatology. There is a well-established
Gastroenterology Unit at the Western and a long tradition of close working with the surgeons. A full
range of on site laboratories and imaging supports the hospital.
The Colorectal Surgical Unit has a complement of 72 elective beds, including a 25-bedded acute
admissions ward. Critical care comprises 10 level one surgical high dependency beds; 6 level 2/3 beds
and a 10-bedded intensive care unit. The new development (the Anne Ferguson building) opened in
August 2001 and provides a new theatre suite, including a dedicated CEPOD theatre, day bed and GI
endoscopy facilities as well as out patients. The GI endoscopy service supports a full range of
interventional modalities including laser therapy, argon plasma coagulation and endoscopic ultrasound.
Colonoscopy is supported by the Scope Guide system and a dedicated colorectal emergency session. A
full bowel screening service is undertaken on site. Endoanal ultrasound and anorectal physiology are
available on site. The Unit performs over 700 major colonic resections annually including approximately
200 Laparoscopic procedures. Approximately 50 Ileoanal-pouch procedures are performed annually.
TEMS, Sacral Nerve Stimulation, Ventral Rectopexy and other advanced Colorectal procedures are also
undertaken.
The colorectal unit admits 6 – 12 emergency colorectal patients daily. Consultant on-call is based on a
rotating cycle of long weekends (Friday am-Monday am) followed by a week of daytime cover (Monday
am – Friday am) alternating with a week of evening shifts (Monday – Thursday) during which all elective
sessions are cancelled. The middle grade rota is 1A compliant.
The unit also accepts tertiary referrals from other Scottish centres; activity data confirms that the unit
received in the last year 6,300 new patient referrals, 2356 emergencies. The unit also carried out 1239
elective in-patients episodes and 1214 day case /23 hour stay patients.
There is a weekly multidisciplinary Oncology team meeting, at which all cases of colorectal cancer are
discussed pre and post operatively. There are weekly unit meetings, which include morbidity and
mortality meetings and also a weekly Radiology meeting. The Multi-disciplinary IBD team meets every
Friday Lunchtime. There is an active Post Graduate Medical Educational Programme on a Friday
afternoon both in house and at the Lister Post Graduate Institute.
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6.
Research and Development
There is an active clinical and laboratory research programme within the unit and the
successful candidate will be encouraged to take an active role in ongoing clinical research.
7.
Teaching
There is a busy undergraduate and postgraduate training programme within the unit to which
the successful applicant will be expected to take a full part.
8.
Contact Details
Informal enquiries to Mr James Mander, Consultant Colorectal Surgeon,
james.mander@luht.scot.nhs.uk
The
NHS
Structured
Application
can
be
obtained
by
e-mailing
medical.personnel@nhslothian.scot.nhs.uk. The completed NHS Structured Application and the
names, email and postal addresses of three referees should be sent to the above email address by
the closing date of, no applications will be considered after this time. Please quote reference
Please note that we no longer accept application by CV.
All suitable applicants are encouraged to apply for this post. However, in accordance with UK Border
Agency guidance, those requiring sponsorship under a Tier 2 visa can only be appointed to a post if
there are no suitable UK/EEA applicants or applicants not requiring sponsorship (e.g. those on a Tier
1 visa). For more information go to http://www.ukba.homeoffice.gov.uk/workingintheuk/
We are working towards Equal Opportunities.
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9.
Person Specification
PERSON SPECIFICATION
Fixed term ST post in Colorectal Surgery
REQUIREMENTS
Qualifications and
Training
Experience
Ability
ESSENTIAL
Full GMC registration
FRCS or equivalent
DESIRABLE
Higher degree ( MD, PhD)
Broad experience in elective and
emergency general surgery including
trauma.
Competence in elective and emergency
colorectal surgery including the
management of colorectal malignancy
Advanced laparoscopic skills
Able to work in complex team and provide
leadership
Able to work flexibly
Academic
Achievements
Evidence of a complex service in a
changing environment and how to develop
service
Commitment to research, publications and
presentations.
Evidence of close working
with and understanding of
needs of other departments
Able to organise time
efficiently and effectively
Higher degree and publications in
peer-reviewed journals
Previous experience of participation in
research
Teaching
And Audit
Experience in supervision and training of
undergraduates and postgraduates
Evidence has conducted a complete audit
cycle.
Motivation
Patient safety
Team working within complex MDT setting
Evidence of participation in maintaining
clinical governance standards
Personal
Attributes
Enthusiastic, good communication skills
Committed to flexible working
Maturity, openness and flexibility
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Enthusiasm and commitment to
improving teaching
Commitment to ongoing audit of
departmental practice
Able to motivate departmental
colleagues