NHS Lothian
Lothian University Hospitals Division
Directorate of Critical Care
Hospital Base: Royal Infirmary of Edinburgh
Speciality Doctor: Transplant Anaesthesia and Critical Care
1. Outline of the post
This is a full time Speciality doctor post in Transplant Anaesthesia and Critical Care at the Royal
Infirmary of Edinburgh. It is available immediately. The post holder will have the opportunity to work
within a Consultant delivered service providing patient care for a number of different surgical subspecialities including: National Transplant Programmes for Liver, Kidney & Pancreas, Hepatobiliary,
Upper GI, Endocrine and Bariatric surgery. There is a close working relationship with Critical Care.
The post is configured to provide progressive development in anaesthesia/critical care for the
management of complex peri-operative major surgery. The post would be most suitable for a senior
trainee post CCT wishing to develop further skills before full independent practice.
Consideration could be given for a candidate in training where appropriate College, Deanery and
Departmental objectives were individually negotiated and agreed in advance.
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:
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.
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The Royal Infirmary Edinburgh
The Royal Infirmary Edinburgh (RIE) is a major teaching hospital on a green field site in the South
East of the city 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 Surgery
Gastroenterology
The Scottish Liver Transplant Programme
Cardiac and Thoracic surgery
Elective and Trauma Orthopaedics surgery
Neonatology
Obstetrics & Gynaecology
Cardiology
Renal Medicine
Respiratory and Sleep Medicine
Emergency Department and Regional Trauma 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.
It is envisaged that neurosciences and the Royal Hospital for Sick Children will be co-located at the
Royal Infirmary site in 2015.
Western General Hospital
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.
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St John’s Hospital
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
Obstetrics & Gynaecology
Child Health including Paediatrics and community child health
The supraregional Burns and Plastic Surgery unit.
Oral and Maxillofacial Surgery
ENT
Critical Care (ITU, HDU and CCU)
Accident and Emergency
General Surgery
Orthopaedics
Anaesthetics
Mental Health including ICCU and ICPU
Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH
being developed as a major elective centre for the region. Lothian’s ENT service was relocated to
SJH to create an integrated head and neck unit with OMFS and Plastic Surgery.
Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a
digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a
£2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology Services
(including CT, Ultrasound and NM).
The hospital has been accredited full teaching hospital status by the University of Edinburgh. There
is a full range of lecture theatres, a library and AV facilities.
The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and
specialist services for children. The hospital is situated in a residential area close to the centre of
Edinburgh and is approximately 3 miles from the site of the New Royal Infirmary and the co-located
University of Edinburgh Medical School and 3 miles from the Western General Hospital. The RHSC
is a 151-bedded Hospital, and is the main paediatric teaching hospital for the South-East of Scotland
providing general and specialised services on a local, regional and national basis. It acts as the local
paediatric referral centre for the children of Edinburgh and surrounding areas, and as a tertiary
referral centre for intensive care patients; gastroenterology, hepatology & nutrition; respiratory
medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal surgery; plastic
surgery; orthopaedic surgery; urological surgery and aspects of general surgery.
Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8 bedded
Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3 bedded Neonatal
Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full
range of audio-visual equipment.
All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy
services. The local radiology department provides on site Magnetic Resonance Imaging, CT
Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry, haematology,
pathology and neuropathology services
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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 CHPs include:
The Astley Ainslie Hospital in Edinburgh
Rosslynlee Hospital in Midlothian
Herdmanflat Hospital
Roodlands Hospital in East Lothian.
The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian Councils
bringing together those responsible for planning, managing and providing community-based health
services for the population of Edinburgh and the Lothians.
There are 7,500 members of staff. In addition, there are approximately 1,000 independent
contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A
population of 850,000 people is served across health board area. The range of services care of the
elderly, medical rehabilitation, community mental health, substance misuse and learning disability,
district nursing and health visiting, family planning, well woman, , comprehensive dental care and
those provided by Professions Allied to Medicine, such as physiotherapy, pharmacies and
optometrists. Specialist services provided include brain injury rehabilitation, bio-engineering and
prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and Family
Psychiatric Services.
2.3 Royal Edinburgh Hospital and Associated Services
The Royal Edinburgh and Associated Services provides a range of Mental Health services to the
population of Lothian and other Boards within Scotland.
The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises
some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the following
range of specialities:
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Acute Mental Health
Rehabilitation
Psychiatric Emergency Team 24/7
Outpatients
Assessment Phychiatry of Old Age
Forensic Medium Security Unit
Inpatient facilities for under 18s
Psychotherapy Service
Psychology Services
Services for Eating Disorders
Day Hospitals – Psychiatry of Old Age
There are an additional 46 bed and 1 day hospitals for Psychiatry of Old Age in the north of the city
at the Royal Victoria Hospital.
The hospital is currently housed in a mix of accommodation ranging from 19th century to present.
There is a major project now in place to take forward a reprovisioning programme in line with the
strategic vision with the “Delivery for Mental Health” Scottish Executive 2006.
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2.4 Department of Public Health Medicine
The Department of Public Health improves the health of the people of Lothian in collaboration with
many other partners including the University of Edinburgh and uses a range of knowledge,
experience and networking capability to monitor and improve health and collate and interpret health
related information.
To enable efficient management of the Department: there are at present four groups in the
Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health Information.
3. University of Edinburgh
The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom
located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research
University and within the top 5 Universities in Europe for its Biomedical Sciences.
The University of Edinburgh’s College of Medicine and Veterinary Medicine (CMVM; Head Professor
Sir John Savill) is an internationally leading force in basic-to-clinical translational research. The
College has a consistent 30-year strategy of interdisciplinarity and integration of basic and clinical
sciences. In the most recent Research Assessment Exercise (2008), the University of Edinburgh was
top in the United Kingdom within the UoA4 category of Hospital-based Clinical Subjects. In 2008/9,
CMVM attracted over £120 million in external peer-reviewed grant funding.
It has established several major interdisciplinary research Centres:
i. MRC Centre for Inflammation Research (Director, Professor John Iredale)
ii. Centre for Cardiovascular Science (Director, Professor Brian Walker) incorporating the BHF
Centre of Research Excellence (Director, Professor John Mullins)
iii. Centre for Reproductive Biology (Director, Professor Phillipa Saunders) and MRC Human
Reproductive Sciences Unit (Director, Professor Robert Millar) including the Tommy’s Centre
(Director, Professor Jane Norman).
iv. MRC Centre for Regenerative Medicine (Director, Professor Sir Ian Wilmut)
v. Centre for Molecular Medicine (Director, Professor David Porteous)
vi. Centre for Cancer Research (Director, Professor David Harrison)
vii. Centre for Population Health Sciences (Director, Professor Harry Campbell)
viii. MRC Human Genetics Unit (Director, Professor Nick Hastie)
These Centres are predominantly based at two sites: the Queen’s Medical Research Institute at the
Royal Infirmary, and the Institute of Genetics and Molecular Medicine at the Western General
Hospital. The 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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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
An Academic Department of Critical care Medicine was established within the University of
Edinburgh in 2011 and is led by Professor Timothy Walsh.
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NHS Library and Postgraduate Facilities
There are excellent facilities on all sites.
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5. Departmental Information
Facilities
The Critical Care Directorate is responsible for patients requiring general critical care on all 3 Lothian
acute hospital sites. The Critical Care Directorate encompasses:
Ward 118 Royal Infirmary of Edinburgh:
Ward118 is a 19 bedded mixed level 2/3 general ICU and is a regional referral centre for liver failure
and liver transplantation. It offers a full range of organ support. There are approximately 1100
admissions per year.
Ward 116 Royal Infirmary of Edinburgh:
Ward 116 is a 12 bedded Level 2 mixed Medical/Surgical HDU. There are approximately 1500
admissions per year.
Ward 20 Western General Hospital
Ward 20 is a 16-bedded mixed 2/3 facility. It provides general and neuro critical care and the home
ventilation service. There are approximately 750 admissions per year.
Ward 58 Western General Hospital
Ward 58 provides surgical Level 1-2 HDU facilities on the Western site.
ICU St Johns Hospital
A 4 bedded mixed level 2-3 Unit, includes postoperative maxillofacial and plastics work and regional
burns unit.
Critical Care Directorate at the Royal Infirmary of Edinburgh
The directorate provides anaesthetic consultants to theatres for a fully internal prospective rota to
cover areas of elective and out of hours work. Elective surgical sub-specialities currently within the
group are : Hepatobiliary , Upper GI , Endocrine ,Bariatric in conjunction with National Transplant
Programmes for Liver , Kidney and Pancreas anaesthesia. There is a commitment to patient
assessment , participation in MDT evaluation and cardio-pulmonary exercise testing.
The Scottish Liver Transplant Unit performed 104 Liver Transplants in 2014 with a current waiting list
of 35-40 patients.
The Renal Transplant Programme includes an active live donor programme with approx 120 kidney
and 15 pancreatic procedures per year. The group has an active quality improvement and audit
profile. Specific interests in developing clinical and project skills would be encouraged and
supported.
The Royal Infirmary has the largest and busiest Critical Care department in Scotland and one of the
busiest in the UK with over 2500 admissions per annum. The workload is mixed reflecting the acute
nature of the hospital. The hospital is the regional trauma centre, houses the Scottish Liver
Transplant Unit, Pancreatic Transplant and Regional Renal Transplant Unit and is the Scottish centre
for thoraco-abdominal aortic aneurysm repair. The Critical Care Directorate works closely with all of
these specialities, particularly the transplant and acute liver failure services.
There is a separate Cardiothoracic surgical ICU and HDU.
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Medical Staff
Dr Stuart McLellan is the Clinical Director for the Directorate of Critical Care in NHS Lothian.
In total there are 28 Critical Care Consultants within the Directorate.
The current critical care consultant establishment at the Royal Infirmary of Edinburgh is:
Dr Kenneth Baillie (Critical Care)
Dr Monika Beatty (Critical Care)
Dr David Cameron (Critical Care and Transplant Anaesthesia)
Dr Brian Cook (Medical Director, Critical Care )
Dr Mark Dunn (Critical Care)
Dr Michael Gillies (Associate Medical Director , Critical Care)
Dr David Griffiths (Critical Care and Anaesthesia)
Dr Alasdair Hay (Critical Care)
Dr Kalliroi Kefala (Unit Professional Lead, Critical Care and Respiratory Medicine)
Dr Dean Kerslake (Critical Care and Emergency Medicine)
Dr Alistair Lee (Critical Care and Transplant Anaesthesia)
Dr Nazir Lone (Critical Care)
Dr Sam Moultrie (Critical Care and Anaesthesia)
Dr Grant Price (Critical Care and Anaesthesia)
Dr David Ray (Critical Care and Anaesthesia)
Dr David Semple (Critical Care and Anaesthesia)
Dr David Swann (Critical Care and Anaesthesia)
Professor Tim Walsh (Research Lead, Critical Care)
Dr Elizabeth Wilson (Critical Care and Anaesthesia)
Dr Neil Young (Critical Care and Anaesthesia)
In addition the following consultants in transplant anaesthesia form part of the Critical Care
Directorate.
Dr Craig Beattie (Transplant Anaesthesia)
Dr Philip Docherty (MoD Consultant and Honorary NHS Consultant, Transplant Anaesthesia)
Dr Mortimer Kelleher (Transplant Anaesthesia)
Dr Rory Mayes (Transplant Anaesthesia)
Dr Dermot McKeown (Transplant Anaesthesia)
Dr Antony Pollok (Transplant Anaesthesia)
Dr Euan Thomson (Transplant Anaesthesia)
At the Royal Infirmary of Edinburgh there are two consultants on duty for ICU each day and a third
on for HDU. There is one consultant on call at night for critical care and usually 3 consultants on call
at the weekend.
Trainees work on two rotas: a junior rota staffed by FY2, ST1-2 medical staff (drawn from ACCS,
Anaesthesia and EM) and ACCPs; the senior rota is staffed by ST3+ level trainees in Anaesthesia
and Critical Care Medicine.
The Edinburgh Critical Care Research Group
The department has an active research programme with particular interests in blood transfusion,
healthcare associated infection, sedation, acute lung injury and perioperative intensive care. There is
a full portfolio of research including several NHIR multi-centre trials. The research group is led by
Professor Timothy Walsh and includes a clinical lecturer, research fellow and a dedicated group of
research nurses. For more information visit: http://www.eccrg.org.uk/
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6. Details of the Post
The post is based at the Royal Infirmary of Edinburgh. The appointee will be part of the Directorate of
Critical Care, Lothian University Hospitals Division, and accountable to the Clinical Director Dr Stuart
McLellan.
The successful applicant will be responsible for providing anaesthesia for the services listed above.
Although the job is based at the Royal Infirmary, prospective appointees should be prepared to work
across all sites in NHS Lothian. This is an Exposure Prone Procedure Post.
The appointee will be expected to contribute appropriately to administration within the Directorate
and to participate in audit
7. Research and Development
The successful applicant will have the opportunity to pursue and develop any personal interest in
clinical research subject to suitable arrangements and mutual agreement with their colleagues.
8. Teaching
The appointee will be expected, within his or her NHS responsibilities, to undertake and to participate
in undergraduate and post-graduate teaching as required.
9. TIMETABLE
This is for illustration purposes only.
Annualised Hours are calculated as follows and a sample timetable is shown below.
On Call
7 x On-Call Weekends per year = 7 x 33.33hours
= 233.5 hours per year
24 x 16h (weekday nightshift) = 384 hours per year
Direct Clinical Care
Theatre / ICU / Pre-assessment /Transplant Meetings
22h x 42 = 924 hours per year
Total Annual Hours 1541.5
Weekly Hours (based on 42 weeks) equals 1541.5 = 36 hours = 9Pas
Further EPAs could be offered by mutual agreement.
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9 (Continued ) ILLUSTRATION ONLY
DAY
TIME
TYPE OF WORK
Monday
RIE
0800-1800
DCC
Theatre
10hr
On Call
4hr
Tuesday
RIE
1300-1600
Cardio-pulmonary Exercise
Testing
Patient Assessment
3hr
Wednesday
RIE
0800-1800
Theatre
Liver Transplant Ward
Round/Pre-assessment for
surgical and transplant
patients
Theatre/Radiology Dept
10h
Thursday
RIE
Friday
RIE
Saturday
RIE
ICU or
Transplant
On Call
Sunday
ICU or
Transplant
On Call
SPA
5.5hr
0800-1330
0800 – 1200
ICU Meeting
Teaching/Research
CPD
1400-1600
Liver Transplant
Meeting/Ward Round
ICU or Theatre
0830 – 2100
or
2030 - 0900
0830 – 2100
or
2030 - 0900
1 in 6
ICU or Theatre
1 in 6
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4h
2h
12.5h
(all
premium
time)
12.5h(all
premium
time)
EPA
Other
Categories
AD OR ED
10. PERSON SPECIFICATION
Consultant Critical Care
REQUIREMENTS
Qualifications and
Training
ESSENTIAL
GMC registered medical practitioner
FRCA or equivalent
DESIRABLE
Experience in Liver Transplant
Anaesthesia. Intermediate Critical
Care Training or equivalent
Experience
Wide experience in anaesthesia and
critical care
Overseas experience.
Other experience relevant to
needs of the department e.g.
Liver ICU, Echocardiography
Ability
Ability to take full responsibility for
developing independent
management of patients.
Commitment to research,
publications and presentations
Academic
Achievements
Teaching and Audit
Committed to formal and informal
teaching and training of SpRs, junior
doctors and medical students.
Participation in audit projects
Personal Attributes
Committed to patient focused care
Good team player, good
communication skills, experience of
working in multidisciplinary teams
Able to organise time efficiently and
effectively
1 in 6 weekends prospectively
covered as per job timetable above. 1
in 10 weekday nights
Circumstances of
Job
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Evidence of previous research
and publication.
Higher Degree e.g. MSc/MD/PhD
Previous experience of teaching
and designing and effecting audit
programmes. Development of
Educational Programmes.
Postgraduate Qualification in
Education.
Able to motivate colleagues.
Previous managerial training and
experience
9. Contact Details
Dr Michael Gillies, Associate Divisional Medical Director
Theatres, Anaesthesia and Critical Care
Department of Anaesthesia, Critical Care and Pain Medicine
Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA.
Tel: 0131 242 3193
Email: Michael.Gillies@nhslothian.scot.nhs.uk
Dr Stuart McLellan, Critical Care Clinical Director
Western General Hospital Edinburgh EH4 2XU
Email Stuart.McLellan@nhslothian.scot.nhs.uk
Dr David Cameron
Department of Anaesthesia, Critical Care and Pain Medicine
Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA.
Tel 0131 242 1186
Email: David.D.Cameron@nhslothian.scot.nhs.uk
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