WESSEX RENAL & TRANSPLANT UNIT
Job Description for a
CONSULTANT NEPHROLOGIST
(10 PAs)
Portsmouth Hospitals Trust
July 2012
CONTENTS
INTRODUCTION TO PORTSMOUTH HOSPITALS NHS TRUST ... 1
THE WESSEX RENAL AND TRANSPLANT SERVICE ................... 2
RESEARCH AND DEVELOPMENT WITHIN WRTS ....................... 5
THE POST ...................................................................................... 6
JOB PLAN ..................................................................................... 10
PORTSMOUTH HOSPITALS NHS TRUST
INTRODUCTION
Portsmouth Hospitals NHS Trust is one of the largest acute hospital trusts in the country.
It provides a full range of services to more than 650,000 people across Portsmouth, South
East Hampshire and West Sussex. Most services are provided at Queen Alexandra
Hospital but a range of outpatient and diagnostic facilities are also offered closer to
patients’ homes. It has one of the busiest Emergency Departments with around 130,000
attendances a year and has the busiest maternity department on the South Coast. The
Trust employs around 6,000 staff and is the second largest employer in Portsmouth. The
Trust is expecting to be successful in its FT application early next year.
The Trust’s catchment area is bordered by the Solent and English Channel and includes
the City of Portsmouth and the Boroughs of Gosport, Fareham and Havant, extending
from Warsash in the west to Emsworth on the Sussex border and including Petersfield
and Liss to the north. Portsmouth has grown up around the Royal Naval establishments in
Portsmouth and Gosport. It now provides a wide range of modern high-tech industry and
facilities. Both Southsea and Hayling Island are holiday resorts.
Portsmouth is situated on the South Coast of England within easy reach of London (just
over an hour to Waterloo), and the historic towns and cities of Chichester, Winchester and
Salisbury to name a few. The South Downs National Park, the Isle of Wight and the New
Forest are within short journeys. The South Coast boasts the highest annual sunshine of
mainland England and attracts very little snow! The coast provides excellent opportunities
for sailing and many other water sports. There are some excellent schools both within the
island of Portsea and on the mainland. Portsmouth and Southampton have large shopping
facilities and good theatre, restaurants and other excellent entertainments.
The Trust is based at Queen Alexandra Hospital (QAH) at Cosham, a £120m PFI
development with the Carillion Company with the following facilities: 
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1072 inpatient beds
117 day case beds
20 main state of the art operating theatres
7 day surgery theatres with plans for robot-assisted surgery
3 endoscopy suites
excellent clinical support facilities: 2 MRI scanners, SPECT CT etc.
dedicated outpatient facilities
excellent academic, education and research facilities
an administrative headquarters to support the Ministry of Defence Hospital Unit
(MDHU)
The Trust is a centre of excellent for cancer, cardiology, intensive care, colorectal and
upper-GI surgery and an innovative and nationally recognised diabetic service. It has links
with the Royal Free Hospital for liver transplantation and has recently started bariatric
surgery services.
The QA site provides all acute services. Some outpatients facilities are provides in St
Mary’s Hospital on Portsea Island, Gosport War Memorial Hospital, Fareham Community
Hospital and Petersfield Community Hospital.
1
THE WESSEX RENAL AND TRANSPLANT SERVICE
The Wessex Renal & Transplant Service (WRTS) is centred in recently commissioned
premises at Queen Alexandra Hospital. The WRTS provides a comprehensive renal
service to an adult population of approximately 2.2 million, covering the majority of
Hampshire, the Isle of Wight and the adjacent parts of Wiltshire, West Sussex, Berkshire
and Surrey. There are 620 patients in the dialysis programme (520 on haemodialysis
(including 10 at home) and 100 on CAPD), and around 750 patients with functioning
transplants. The Unit takes on around 100 new patients with end stage renal failure per
million adult population per year, and undertakes approximately 70 renal transplants per
year, including ABO-incompatible transplants. It refers patients for pancreas-kidney
transplantation to the Oxford Transplant Centre, which performs monthly assessment
clinics within the outpatient department on the Renal Unit.
There are three dedicated Inpatient wards. The current bed complement is 42, with an
additional 6 day-treatment beds. There is an out-patient dialysis ward with 25 stations, a
Community PD unit and home HD team. The WRTS has its own integral out-patient
department and the facility to see programme patients as emergencies during the day.
The majority of nursing staff on the Wards are nephrology trained and there is a locally
run Nephrology Nursing Course. The Unit employs 2 wte Living Donor Transplant Coordinators, 2 wte Recipient Transplant Coordinators, 3.6 wte Dietitians and a full-time
Renal Pharmacist. There are excellent, committed nurse specialists in vascular access,
transplantation, pre-dialysis care, home haemodialysis, peritoneal dialysis and anaemia
management.
Out-patient nephrology clinics (including general nephrology, haemodialysis, CAPD and
transplant/vascular access review) run on every day of the week. In addition, the
Consultant Nephrologists are responsible for peripheral clinics in the hospitals in
 Chichester,
 Bognor Regis,
 Basingstoke,
 Gosport,
 the Isle of Wight,
 Southampton,
 Winchester and
 Salisbury.
This post will develop the responsibility for Andover Hospital (North Hampshire). The
service has plans to cover Bordon and Lymington Community Hospitals in the near future.
The WRTS has eight satellite dialysis units:
 Bognor Regis (14 stations),
 Totton in Southampton (9) and
 the Isle of Wight (10) are NHS rented and staffed.
The remainder are privately run and subcontracted:
 Basingstoke (16) and
 Chandlers Ford, Southampton (18) with Fresenius.
 Havant, Portsmouth (22),
 Salisbury (10) and
 Milford-on-Sea, New Forest (7) with Renal Services.
The current five-year development plan with commissioning partners will deliver full
capacity by 2013. The consultant team is responsible for satellites units, individually or
shared, and hold regular dialysis clinics within the units. Peritoneal dialysis, home
haemodialysis and transplant patients beyond the first three months are all seen as close
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to home as possible. At least 60% of outpatient activity occurs away from the Portsmouth
hub.
WRTS provides home haemodialysis with a dedicated training area and support staff. This
is a recent development and the aim is to double home HD numbers by 2013. The
nXstage machine marketed by Kimal is currently being used as this minimises home
conversion while still providing effective dialysis, and being relatively portable.
The Peritoneal Dialysis Team is nationally and internationally known for acute start PD,
medical PD catheter insertion, nurse-led education and training and conscious sedation
protocols. This post holder would be expected to participate in the insertion of double-cuff
tunnelled Tenchoff peritoneal dialysis catheters and the training and supervision of the
nephrology juniors in this technique.
The service also hosts and runs a Tertiary Hypertension service, with investigation,
diagnosis, monitoring and management of simple and complex hypertensives. The Trust
is considering renal denervation in addition.
The Trust and the renal service actively participate in undergraduate and postgraduate
medical and nursing training. Medical students are hosted from the nearby University of
Southampton medical school and medical staff from the service participate in regular
university teaching. Final year students are placed on the renal unit as part of their
medical attachments. Interest and expertise in undergraduate teaching would be an
advantage for this post holder. The service is the only nephrology training facility in the
region and has 7 numbered ST3+ posts. The clinical experience is excellent, with acute
transplantation, a large population and dialysis cohort and multiple feeding acute
hospitals. There is a significant service commitment and the middle-grades provide a 24/7
non-resident second on-call rota, coverage of the dialysis unit and day unit and a
significant support of clinics, both on- and off-site. There are also 7 dedicated SHO-grade
(FY2-CT2) juniors who provide first on-call solely for the renal unit. The vast majority of
nephrological procedures are performed by the ST3+ juniors. This postholder will have
joint responsibility for the training and supervision of the renal juniors in these procedures.
The service provides acute and chronic transplantation services for the region, including
all work up, surgical, nephrological and nursing care, dedicated anaesthetic staff,
transplant coordinators (living donor, recipient and post-transplant), surgery and
immediate, middle- and longer-term post-transplant management for donors and
recipients. Hand-assisted laparoscopic nephrectomy is the donor operation of choice.
There are a good number of local DCD donations and a dynamic and increasing living
donor programme, with one of the highest number of non-directed altruistic donations in
the country. The local commissions favour transplantation, particularly pre-emptive. The
H&I laboratory is off-site but provides an excellent cross-match service. Virtual crossmatching reduces cold-ischaemic time. ABO-incompatible transplantation is provided and
HLA-incompatible transplantation is being considered for the near future. Extensive
experience of acute transplantation, preferably with ABOi and/or HLAi transplantation, is
vital for this post.
The four transplant surgeons also provide a dedicated vascular access service, with good
links to vascular imaging and interventional radiology, and excellent primary and
secondary patency rates. This is evidenced by more than 80% of the service’s patients
dialysing via a native fistula or graft, with the intention of exceeding 85% by the end of the
year. The vascular access nurse specialist provides and coordinates fistula and graft
monitoring with pre-emptive investigation and treatment, further maintaining good access
quality.
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EXISTING MEDICAL STAFF ESTABLISHMENT (Portsmouth)
Nephrology
Dr T D Leach
Consultant Nephrologist and Clinical Director
Dr K A Armstrong
Locum Consultant Nephrologist
Dr A F Hughes
Consultant Nephrologist and Clinical Lead for Anaemia
Dr R J Lewis
Consultant Nephrologist and Clinical Lead for Low Clearance
Dr J Macanovic
Consultant Nephrologist and joint Clinical Lead for Transplantation
Dr J C Mason
Consultant Nephrologist and Clinical Lead for Haemodialysis
Dr J M Stevens
Consultant Nephrologist and Clinical Lead for Peritoneal Dialysis
Dr G Venkat Raman
Consultant Nephrologist and Governance Lead
Junior Staff:
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10 Specialist Registrar-grade juniors in Nephrology (including 1
on rotation to Southampton & 2 rotational with General
medicine at QAH)
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7 Senior House Officers or equivalent
Surgery
Mr P Gibbs
Consultant Transplant and Vascular Surgeon & Clinical Director for
Transplantation
Mr S Dutta
Consultant Transplant and General Surgeon and Clinical Lead for
Living Donation
Mr K Graetz
Consultant Transplant and General Surgeon and Trust Lead for
Emergency Surgery
Miss S Wakelin
Consultant Transplant and General Surgeon
Junior Staff:
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2 Specialist Registrars on surgical rotation
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1 Senior House Officer rotating with General Surgery
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RESEARCH AND DEVELOPMENT WITHIN WRTS
The research interests of WRTS cover many areas of Nephrology, including:
 Cultured primary human tubular epithelial cells
 Nutrition in chronic kidney disease and CAPD
 Familial nephropathies
 Transplant immunosuppression and pharmacogenetics
 Epidemiology of CKD
 Acute kidney injury (AKI) and chronic kidney disease (CKD)
 Home haemodialysis
Research is encouraged within the Universities of Southampton and Portsmouth. The post
holder is strongly encouraged to develop his/her own interest and facilitate research for
medical juniors and other healthcare professionals. The Renal and Transplant Research
Charitable Fund is well endowed by public donations and currently supports a number of
research projects, three Research Fellows and support staff. There are regular research
and clinical seminars within the Wessex Renal and Transplant Service in Portsmouth.
Basic science research is carried out within the Renal Group, working jointly between the
Renal Unit and the University of Southampton. There are on site laboratory facilities for
cell-based research within the department in Queen Alexandra Hospital. In Southampton
University, the Renal Group is part of the Division of Infection, Inflammation and Repair,
with Prof Iain Cameron as overall Research Director for the Medical School. Dr Jane
Collins is Senior Lecturer and Mrs Sara Campbell senior. Recently the Group developed a
novel preparation of cultured human renal tubular epithelial cells, the subject of a recent
successful MD student. Current research interests include the role of these cells in renal
inflammation and fibrosis, with focus on mesenchymal transformation, changes in
epithelial permeability and the effect of immuno-modulating compounds and drugs. This
work is facilitated by close cooperation with the University Bio-imaging Unit and specialist
Immuno-histochemistry Laboratory and was the subject of a recent PhD study.
The unit is also conducting two PhD studies in collaboration with Guy’s and St Thomas’s
one exploring the pharmacogenetics of mycophenolate metabolism in transplanted
patients and the other studying the incidence and detection of familial nephropathies.
A partnership has been established with Prof. Paul Roderick of the Clinical Epidemiology
Department in Southampton University. An MD project studying the relationship between
AKI and CKD has recently been completed. There is great potential for further renal
epidemiological studies using a huge established community-centred database.
The Unit has its own dedicated research facility for contributing to national and
multinational studies. This is staffed by two dedicated Research Nurse Specialists and a
part-time Research Assistant. The renal specialty lead for the Hampshire and Isle of Wight
CLRN is on site and is supported by additional regional research expertise. The holder of
this advertised post is expected to make him/herself available to be principle investigator
for studies undertaken by the unit. Additional funding may be available to facilitate this.
The unit is currently involved in 10 portfolio studies investigating diverse aspects of
nephrology, dialysis and transplantation. The recruitment record of the unit is excellent.
The Trust hosts a well staffed and proactive Academic Research & Development Support
Unit which has been set up to develop and facilitate health service-orientated research.
Expert help is therefore on site for developing grant proposals and designing future
research projects
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THE POST
Direct Clinical Care
The post holder will be responsible for nephrology, dialysis and acute/chronic transplant
care in in-patient and out-patient environments as well as in the satellite facilities. The
post holder will also be required to perform nephrological procedures (line insertions, renal
biopsies) and to teach and supervise the Unit’s junior doctors in these procedures. The
unit is keen to develop an acute kidney injury (AKI) network and to expand the scope of
acute transplantation in future; a particular interest in one or other of these fields would
therefore be desirable.
The service, given its large geographical area, is currently divided by sub-region (based
around each of the 7 satellite acute trusts) with an individual nephrologist for each to
maintain patient continuity as much as possible. Reorganisation is currently ongoing with
the aim of the addition of one or two sub-regions, making each area geographically
smaller and therefore more manageable in the face of a continued growth in renal patients
in this region.
Physicians from WRTS run nephrology and renal replacement (RRT) clinics at all of the
satellite acute trusts and RRT clinics at the satellite dialysis units. Temporarily this post
will assume responsibility for some nephrology and some of the renal replacement
therapy patients in Southampton, and nephrology and RRT for patients in Andover
(currently travelling to Winchester, Salisbury or Basingstoke).
At the outset, the post holder will take part in the on-call rota for nephrology:
 1:8 on the QAH site, where on-call is currently organised into a ‘physician of the
week’ (PoW) system.
 In time, there may be a change to this commitment depending on the appointment
of further colleagues and/or service developments in Southampton.
In the PoW system, the consultant is on call for a full week, overseeing new admissions
before handing them back to their respective consultant the next day. New admissions
previously unknown to the unit usually remain under the PoW until discharge.
It is intended that current work patterns will change in the near future and that this postholder will be one of a smaller group of consultants closely involved in acute
transplantation. They will be required to work closely with surgical colleagues and to
attend daily ward rounds and twice-weekly clinics overseeing newly-transplanted patients.
Out-patient clinics will be held at PHT and peripheral sites as indicated in the
accompanying job plan.
The post is initially 10 PAs but there is potential for a subsequent increase to 11 on mutual
agreement.
Supporting Professional Activities
Sufficient SPA and administration time is included to fulfil the role (2 PAs).
SECRETARIAL SUPPORT AND OFFICE ACCOMMODATION
Secretarial support (0.5 WTE) will be available in adjacent office accommodation.
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RESIDENCE
Residence within 30 minutes travel by road from Queen Alexandra Hospital is required
unless alternative arrangements are agreed with local management and consultant
colleagues. The post holder must normally have a current driving license and their private
residence must be maintained in contact with the public telephone service.
GENERAL PROVISIONS
The post holder will be expected to work with local managers and professional colleagues
in the efficient running of services and will share with consultant colleagues in the medical
contribution to management. Subject to the provisions of the Terms and Conditions of
Service, the post holder is expected to observe agreed policies and procedures, drawn up
on consultation with the profession on clinical matters, and follow the standard orders and
financial instructions of the Portsmouth Hospitals NHS Trust. In particular, managers of
employees of the Portsmouth Hospitals NHS Trust are expected to follow the local and
national employment and personnel policies and procedures. The post holder will be
expected to ensure that there are adequate arrangements for hospital staff involved in the
care of patients to be able to contact him/her when necessary.
All medical and dental staff are expected to comply with the Portsmouth Hospitals NHS
Trust Health and Safety Policies, including compliance with essential/mandatory training.
All Consultant posts are subject to annual appraisal, in accordance with Trust policies.
SAFEGUARDING
All staff are expected to act in such a way that at all times the health and well being of
children and vulnerable adults is safeguarded. Familiarisation with and adherence to the
Safeguarding Policies of the Trust is an essential requirement for all employees. In
addition all staff are expected to complete essential/mandatory training in this area.
INFECTION CONTROL
In compliance with the Trust's practices and procedures associated with the control of
infection, you are required to:
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Adhere to Trust Infection Control Policies assuring compliance with all defined
infection control standards at all times.
Conduct hand hygiene in accordance with Trust policy, challenging those around
you that do not.
Challenge poor practice that could lead to the transmission of infection.
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STUDY LEAVE
Study leave is granted within the maximum of 30 days in any 3 years for professional
purposes in accordance with National and local guidelines on study leave. A Trust grant of
c£1,250 per annum (pro rata) is payable towards CME expenses to those consultants who
have satisfactorily completed their annual appraisal. Study leave is subject to annual
appraisal and completion of an agreed job plan.
HAND HYGIENE POLICY
The Trust has adopted "Naked Below the Elbow" strategy which means that when
involved in patient care and direct physical contact with patients, you must wash or
decontaminate your hands as per the Hand Hygiene Policy.
Compliance with the Hand Hygiene Policy is mandatory; you must wear short sleeved
shirts/blouses/uniform, remove any out jackets and roll up your sleeves. No jewellery
should be worn below the elbow (except a plain wedding band) and wrist watches must be
removed.
Compliance with this policy will be monitored and any non compliance may be subject to
disciplinary action.
REHABILITATION OF OFFENDERS
Because of the nature of the work for which you are applying, this post is exempt from the
provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974 by virtue of the
Rehabilitation of Offenders Act, 1974 (exceptions) order 1975. Applicants are therefore
not entitled to withhold information about convictions. This could result in dismissal or
disciplinary action from the Trust.
Any information given will be completely confidential and will be considered only in
relation to an application for positions to which the order is applied.
MEDICAL CLEARANCE
Appointment to this post is subject to satisfactory medical clearance. If short listed for
interview you may be required to complete a simple medical questionnaire.
POST VACANT
The post will be occupied temporarily ahead of substantive appointment. The appointee
will be required to take up the post within around three months from the date of the offer of
an appointment, but the exact date of commencement can be agreed between the
appointee and Portsmouth Hospitals NHS Trust.
If you consider it unlikely that you will be able to take up the appointment within about
three months of an offer, you are advised to point this out at the time of your application.
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VISITING
Intending applicants may obtain further information and/or arrange a visit by contacting Dr
Tim Leach, Clinical Director, on telephone 023 9228 6000 ext 1001.
Please note the Trust will reimburse expenses for one pre-interview visit in respect of
short listed candidates.
Due to the high volume of recruitment and our desire to treat all applicants fairly it is not
possible to meet with the Chief Executive, Miss Ursula Ward, prior to the Appointments
Advisory Committee.
However, arrangements to meet with Mr Simon Holmes, Medical Director, can be made
by contacting Liz Malo on 023 9228 6959.
Both Mr Holmes and Ms Ward are extremely committed and supportive of this
appointment and to appointing the right candidate and, as part of the induction
programme the successful applicant will have an opportunity to meet with them.
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JOB PLAN
Day
Monday
Tuesday
Wednesday
Thursday
Friday
Additional
agreed activity
to be worked
flexibly
Additional
work as
physician of
the week QAH
(1:8)
Time
09.00-11.00
14.00-17.00
09.00-13.00
14.00-17.00
09.00-13.00
14.00-15.00
15.00-16.00
08.30-10.00
14.00-17.00
10.00-13.00
Location
QAH
Peripheral Clinic
QAH
Peripheral Clinic
QAH
QAH
Peripheral Clinic
QAH
QAH
Work
MDT
OPD (1:2)
Procedures (1:2)
OPD (1:2)
OPD
MDT (Tx/Bx)
CME/Management
Xray MDT
OPD (1:2)
Ward Round
Patient Admin
Travel
Individual CME
Ed supervision
Management
Appraisal/diaries
Ward rounds/
Tx clinics/
Calls/attendances
out of hours
QAH
Categorisation
DCC
DCC
DCC
SPA
SPA
SPA
SPA
Hours
2
1.5
2
1.5
4
1
1
1.5
1.5
3
9
2
1
1
4
1
DCC
3
DCC
DCC
DCC
DCC
SPA
DCC
Total Hours
40
Total PAs
10
SUMMARY OF PROGRAMMED ACTIVITY
Supporting Professional Activities
Direct Clinical Care (including unpredictable on-call)
Other NHS Responsibilities
External Duties
Number
2
8
TOTAL PROGRAMMED ACTIVITIES
10
ON-CALL AVAILABILITY SUPPLEMENT
1 in 8
Agreed on-call rota (e.g. 1 in 5):
Agreed category (A or B) :
A
On-call supplement (%):
5%
10