NHS Lothian
Division/CH(C)P
Directorate of Surgery
Initial Hospital Base: Royal Infirmary Edinburgh
Advanced specialty training opportunity IN HPB AND TRANSPLANT 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 hepaticopancreatico-biliary conditions, benign and malignant, and intra-abdominal transplantation.
Candidates should therefore have had significant previous training in HPB and/or transplant
surgery. The post will comprise both emergency duties on the transplant registrar rota,
covering multiorgan retrieval and transplantation as well as elective sessions at the Royal
Infirmary.
1.
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 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.
1.1 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.
November 2012
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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:
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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, 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.
November 2012
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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:
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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
Imaging, CT Scanning, nuclear scanning and ultrasound. On site laboratories provide
biochemistry, haematology, pathology and neuropathology services
November 2012
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2.
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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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.
November 2012
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4.
Departmental Information:
HPB Unit
The specialist HPB unit acts as a regional / supraregional referral centre for all aspects of benign and
malignant HPB pathology. There are approximately 100 liver resections, 40-50 Whipple’s operation,
plus additional major biliary and pancreatic procedures performed annually. There are weekly clinics,
multi-disciplinary team and X ray meetings.
Consultant HPB surgeons
Prof. OJ Garden
Prof. RW Parks
Prof. SJ Wigmore
Mr JJ Powell
Mr R Ravindran
Ms Anya Adair
Mr JJ Casey
Mr E. Harrison
Mr D. Mole
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 is
also commissioned to provide a national service for isolation and transplantation of pancreatic islets
for the population of Scotland since 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.
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 two consultants are
routinely on call (first and second tier).
November 2012
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Names of Clinical staff and any specialist interests
(a) Consultant Transplant Surgeons
Ms 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
(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 Paddy Gibson
Dr Jane Goddard
Dr Lorna Henderson
Prof Jeremy Hughes
Dr David Kluth
Dr Wendy Metcalfe
Dr John Neary
Dr Paul Phelan
Dr Richard Phelps
Prof. Neil Turner
Dr Simon Watson
Dr Caroline Whitworth
(d) Transplant Anaesthetists
Dr David Cameron
Dr Brian Cook
Dr Rory Mayes
Dr Alistair Lee
Dr Dermot McKeown
Dr Anthony Pollok
Dr Ewan Thompson
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 and ward rounds,)
November 2012
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5.
Details of the Post
There are four Higher Surgical trainees rotating through HPB surgery and the transplant unit. Duties will
include an elective commitment to the non-operative and operative management of HPB patients,
including complex HPB surgery, and to all aspects of multi-organ retrieval and intra-abdominal
transplantation.
6.
Research and Development
As noted above, the HPB and transplant units are fully involved in both laboratory and clinical
research. Opportunities therefore will be available.
7.
Teaching
The unit is involved in under graduate and postgraduate teaching training and examinations.
8.
Contact Details
Prof Wigmore
Consultant Transplant Surgeon
Tel: 0131 242 1714
E-mail: s.wigmore@ed.ac.uk
Mr Gabriel Oniscu
Consultant Transplant Surgeon
E-mail: Gabriel.Oniscu@nhslothian.scot.nhs.uk
November 2012
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9.
Person Specification: Fixed term ST post: Transplant/HPB
REQUIREMENTS
Qualifications
Training
and
ESSENTIAL
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DESIRABLE
GMC
registered
medical
practitioner
Be on, or be eligible for inclusion
on within 6 months of interview,
the GMC Specialist Register
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Additional
postgraduate qualifications,
e.g. MD or PhD
Post
Specific
Experience
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Applicant should have some
experience in HPB or transplant
surgery
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Experience of all areas
of abdominal organ
transplantation
Ability
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Evidence of ability to take full
responsibility for independent
management of patients.
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Ability to
redesign
clinical
service
or
process
Academic
Achievements
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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
 Evidence of teaching
 Evidence of audit activity
Teaching and Audit
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Motivation
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Evidence of commitment to:
o Patient focused care,
o Effective and efficient use
of resources
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Evidence
of
development
of
services for patients
Team Working
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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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Able
to
motivate
colleagues
Evidence of ability to
lead service re-design
for the benefit of
patients
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