NHS Lothian
University Hospitals Division
Cancer Services Directorate
Western General Hospital, Edinburgh
Advanced Specialty Training post in Breast Surgery
Edinburgh Breast Unit
February 2016 for 6 months
1.
Outline of the post
This post is suitable for a year 6 or above specialist registrar who wishes to gain experience
in advanced management of complex breast conditions, benign and malignant, including
oncoplastic surgery. Candidates should therefore have had significant previous training in
breast surgery. The post will comprise both emergency duties on the registrar rota (which is
non-resident and largely involves covering colorectal emergencies overnight) and elective
sessions at largely at the Western General Hospital. At present the rota for emergency on-call
is 1 in 9 for nights. The Edinburgh Breast Unit is probably the largest breast surgery unit in
the UK and manages the spectrum of benign and malignant breast disorders in close
collaboration with colleagues from radiology, oncology, pathology and plastic surgery.
Screening assessment cases are managed across Lothian, Borders, West Fife and Forth
Valley.
2.
NHS Lothian
NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental
health and hospital services. Tim Davison is Chief Executive and 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
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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
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
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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.
All services are supported by comprehensive radiology, neurophysiology, laboratory and
therapy services. The local radiology department provides on site Magnetic Resonance
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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.
5.
Departmental Information
This post is aimed at general surgical trainees towards the end of their training with a
specialist interest in breast surgery (ST6-8). Plastic surgical trainees may be considered if
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ultimately considering a role in the management of symptomatic and screening breast
referrals but general surgery experience will be required to cover on call. The post will
include emergency general surgery on-call (currently 1 in 9) and will involve the management
of breast surgical emergencies within normal working hours. Breast training will be based on
the requirements of the ISCP General Surgery Curriculum and will include exposure to
specialist breast new patient clinics with emphasis on appropriate use of diagnostic
procedures, communication with patients and initial management of benign (including
inflammatory) and malignant conditions. Training will be given in performance of needle
biopsies and the use of ultrasound. Management of malignant breast disease in symptomatic
and screening patients (including adjuvant treatment and follow up) will be guided through the
multidisciplinary team structure. Training will be provided in the surgical management of
benign and malignant conditions with an emphasis on an oncoplastic approach (including a
high proportion of image guided procedures) and there will be extensive exposure to
reconstructive techniques with input from the plastic surgical team. Participation in audit will
be expected. The large workload, well developed multidisciplinary team structure and
regional nature of the Edinburgh Breast Unit coupled with a relatively small number of
trainees allows the provision of comprehensive experience.
The Edinburgh Breast Unit has an international reputation in excellence in service and
research located in the Western General Hospital.
It has dedicated outpatient, inpatient and theatre facilities for breast disease. Over 7000
symptomatic breast referrals and over 700 new breast cancer cases are dealt with in the unit
per year. There are eight consultant breast surgeons (Miss Elaine Anderson (Clinical
Director), Prof Mike Dixon, Mr Glyn Neades, Mr Matthew Barber, Mr Ian Young, Mr Oliver
Young (Clinical Lead), Mr Dhananjay Kulkarni and Mr Talha Saleem). Mr Neades and Mr
Young provide breast surgical services at a linked satellite centre at Queen Margaret Hospital
in Dunfermline. Mr Barber provides breast surgical services for West Lothian at St John’s
Hospital. The unit has close links with breast services in Borders, Dumfries and Galloway
and Forth Valley. Across the region over 10000 new patients and over 1000 cancers are
managed annually. We work closely with 2 consultant plastic surgeons, one of whom attends
the pre-operative multidisciplinary planning meetings. We offer immediate and delayed breast
reconstruction and an emphasis on oncoplastic surgical techniques for all cases.
The breast unit works closely with the South-east of Scotland Breast Screening Centre
situated at Ardmillan Terrace, Edinburgh, which provides 3 yearly breast screening to
167,000 women and diagnosed around 400 cancers last year.
The unit is currently supported by 2 full-time and 4 part-time specialty doctors, 3 trainees
(including this post) and 1FY1. The unit often has visiting fellows.
There is close multidisciplinary working between five consultant clinical oncologists and four
medical oncologists. The academic standing of the unit has been strengthened by the recent
appointment of Professor David Cameron as Professor of Oncology and Director of Cancer
Services. The Unit is supported by nine consultant radiologists and five consultant
pathologists. Multidisciplinary meetings are held to advise on adjuvant therapy and
management of newly referred cases.
The unit has a recently refurbished, self-contained 17-bedded breast ward, including its own
day bed area, two adjacent, recently rebuilt theatres, mammography department and a 10roomed outpatient department. Major improvement works to the mammography unit have
recently been completed. The unit has its own newly refurbished and expanded
administrative and records department.
The department also has close links with the clinical genetics department and the Familial
breast clinic.
The Breast Unit has a portfolio of laboratory, translational and clinical studies.
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The Breast Cancer Institute is a charity based in the Unit, is very effectively working with the
Health Board to improve facilities for breast services and supports locally based breast
research.
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 audit and
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.
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Contact Details
Informal enquiries to Mr Matthew Barber, Consultant Breast Surgeon, 0131 537 2468/
matthew.barber@nhslothian.scot.nhs.uk
It is anticipated that the interviews will be held on
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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8.
Person Specification
PERSON SPECIFICATION
Advanced Speciality Trainee in Breast 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
Competence in general breast surgery
Breast reconstructive skills
Able to work in complex team and provide
leadership
Evidence of close working with
and understanding of needs of
other departments
Able to work flexibly
Evidence of a complex service in a
changing environment and how to develop
service
Academic
Achievements
Commitment to research, publications and
presentations.
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