HEALTH EDUCATION THAMES VALLEY - SPECIALTY
TRAINING PROGRAMME IN REHABILITATION MEDICINE
About Health Education Thames Valley
We are the Local Education and Training Board (LETB) for Thames Valley covering
Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of
effective workforce planning and excellent education and training to develop a highly
capable, flexible and motivated workforce that delivers improvements in health for
the population of Thames Valley. Thames Valley LETB is responsible for the training
of some 1500 trainees
Health Education Thames Valley is a relatively small organisation with a defined
geographical area which serves as a single unit of application. In the majority of
cases successful candidates will be asked to preference their choice of location for
either one or two years. Some programmes will require successful candidates to
indicate a location and specialty. Future placements will usually be based on
individual training and educational needs. Please note that applications are to the
Health Education Thames Valley as a whole. This may mean that you may be
allocated to any geographic location within the deanery depending on training
needs.
The Rehabilitation Medicine Training Programme
This document outlines the training programme for Specialist Registrars who wish to
obtain further training towards a consultant post in Rehabilitation Medicine. The
programme has six trainees who are based in two main centres – the Department of
Rehabilitation, Royal Berkshire Hospital in Reading and the Oxford Centre for
Enablement (OCE), Oxford University Hospitals NHS Trust in Oxford.
The programme covers all domains of the training programme, and allows further
specialist training in most domains including Spinal Cord Injury rehabilitation at the
National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury. It is a four
year programme – starting at ST3 - with sufficient flexibility and opportunities to allow
specialised experience in a wide variety of areas including Trauma rehabilitation in a
Major Trauma Centre, at the John Radcliffe Hospital, Oxford. During this time, the
trainee's work will be monitored for satisfactory progress and subject to annual
reviews in the form of ARCPs. Progression on the programme will be dependent
upon these reviews.
The posts on this rotation have been approved for Specialist Training by the Royal
College of Physicians. The posts attract National Training Numbers and provide
training towards a Certificate of Completion of Training (CCT).
The Postgraduate Dean has confirmed that this post has the necessary educational
and staffing approvals.
Summary of Programme
This outlines the programme, but it must be stressed that the small number of
trainees on the programme coupled with varying numbers recruited in a particular
year means that the order may vary from this programme. A list of training
opportunities is at the end.
Months
Location
Comment
0-6
Royal Berkshire Hospital, Induction, which might include 1-2 weeks in
Reading
Oxford.
Neurological Rehabilitation (all aspects)
7 - 12 Royal Berkshire Hospital, Neurological Rehabilitation. Opportunities for
Reading
experience of palliative care, pain
management, shoulder problems, foot & ankle
problems, paediatric transition, environmental
control assessments.
13 – 18 Royal Berkshire Hospital, Neurological Rehabilitation. Opportunities for
Reading
audit, service management, clinical
governance, community rehabilitation,
neurogenic bladder management
19 – 21 Stoke Mandeville
Spinal Cord Injury rehabilitation at the National
Hospital, Aylesbury
Spinal Injuries Centre. Sub-acute and longer
term rehabilitation. Will specifically learn about
respiratory management for high cord injury,
baclofen pumps, skin care, autonomic
dysreflexia and expected impairments at
common levels of injury
22 – 24 Oxford Centre for
Neurological Rehabilitation (IP) and
Enablement, Oxford
Prosthetics. Opportunities for spasticity and
botulinum toxin clinics, wheelchair and
specialist equipment clinics
24 – 30 Oxford Centre for
Neurological Rehabilitation (IP), prosthetics,
Enablement, Oxford
spinal pain, specialist orthopaedic joint clinics.
Opportunities for audit, management projects,
orthoptic clinics, pain management, neuropsychiatry, orthotics
30 – 36 John Radcliffe Hospital,
Trauma and acute in-patient rehabilitation
Oxford
linking to OCE.
36 – 48 Various
This last year is an opportunity to gain
experience in a wide variety of areas. It will
have as its base long-term community-based
neurological rehabilitation but allows the
trainee to visit other centres and see
specialised services and clinics
Rotation Information
The rotation is subject to continuing change as rehabilitation services are changing
and developing in all parts of the Region, and as the organisation of the NHS
changes. The information given reflects the present situation. Changes are unlikely
to affect the general content or location of training posts but may affect some details.
Generally the changes will lead to a greater opportunity for trainees to gain
experience.
Furthermore the rotation is designed to allow individual trainees to develop their
own areas of interest and specialisation as far as this is possible and compatible
with service and training requirements.
Thirdly an academic rehabilitation unit is being developed primarily with Oxford
Brookes University. Trainees are encouraged to take opportunities to be involved in
academic activities (teaching, attending research meetings etc) and may become
involved in projects involving Oxford Brookes University, the University of Oxford and
other collaborating universities.
The general rehabilitation training rotation is given below, and applies to all
trainees. The precise order and durations of each part necessarily vary because the
small numbers of trainees and irregular arrival and departure of trainees makes
prediction impossible.
All trainees are expected to gain extra (specialist) experience in at least one part of
rehabilitation, and this is possible within the four year programme for the recognised
specialities (neurological rehabilitation, prosthetics, trauma and musculo-skeletal
rehabilitation, spinal injury rehabilitation) and indeed would be considered in other
specialities (e.g. paediatric rehabilitation) after discussion with the Training
Programme Director.
Note on spinal injury training
Trainees may, if they wish, decide to spend up to twelve months at the National
Spinal Injuries Centre within the four year programme, gaining considerable
experience that would be quite sufficient to take on a post involving spinal injury
rehabilitation.
Trainees should be aware that the British Association of Spinal Cord Injury
Specialists (BASCIS) suggests that a total of 36 months is needed in spinal
injury rehabilitation for someone to be a full specialist in spinal injury
rehabilitation. However this is not an official requirement, and has no
statutory basis, and consultants have been and will be appointed into spinal
injury rehabilitation posts without fulfilling this extent of experience.be sufficient
to take a job that is exclusively in spinal injury rehabilitation.
Any trainee who wished to complete the unofficial BASCIS curriculum would
need to take an additional two years of out-of-programme-experience based
at the National Spinal Injuries Centre, Aylesbury in order to achieve this. Any
trainee who wished to do this would need to discuss the option with the Training
Programme Director. One option would be to obtain a CCT and then take on a
training fellowship. For a trainee educational agreement might be given, but
funding agreement would be needed from the National Spinal Injures Centre.
Anyone wishing to discuss this should contact the Training Programme Director.
For most trainees the general pattern of the rotation is as follows:
Time
Eighteen
months
Location
Royal Berkshire Hospital,
Reading
Fifteen
Months
Oxford Centre for
Enablement,
Nuffield Orthopaedic
Centre, Oxford
Nine
months
Oxford Centre for
Enablement, Nuffield
Orthopaedic Centre, John
Radcliffe Hospital
National Spinal Injuries
Centre
Stoke Mandeville Hospital,
Aylesbury
Oxford Centre for
Enablement
Three
months
Three
Months
Content/comment
Neurological Rehabilitation and disability
management, Palliative care, Pain
management, Spasticity management,
Environmental Control Assessment,
Community-based rehabilitation,
specialist care for people with Motor
Neurone Disease, Multiple Sclerosis,
Parkinson’s Disease. Also paediatric
transition to adult services, acute stroke
care, bladder management with urology
department and close links to and
working with neurology department.
Neurological Rehabilitation, Communitybased rehabilitation, spasticity
management and intra-thecal baclofen,
low awareness states, acute and longterm rehabilitation, stroke care,
psychiatric and psychological aspects,
specialist clinics at John Radcliffe,
specialist seating, environmental controls
and almost all aspects of neurological
rehabilitation.
Trauma rehabilitation, musculo-skeletal
rehabilitation, Prosthetic Rehabilitation,
Chronic Pain,
Spinal injury rehabilitation,
Also covering general parts of the
curriculum including specialised seating,
environmental controls, and orthoses
Any specialist modules or experience
wanted or needed: psychiatry, palliative
care; respiratory care; community head
injury service and vocational
rehabilitation (Aylesbury)
Trust Information
There are two primary hospitals involved in Oxford and Reading, but trainees may
also spend time in other hospitals and Trusts as part of their training.
The two main hospital Trusts are:
Oxford University Hospitals NHS Trust, Oxford
Training in this Trust occurs in the following named hospitals:
 John Radcliffe Hospital: trauma rehabilitation and in-patient referrals, with
other specialities seen as appropriate
 Nuffield Orthopaedic Centre; the Oxford Centre for Enablement which cover
almost all other rehabilitation training, especially neurological rehabilitation,
prosthetics, and musculo-skeletal
 Churchill Hospital; pain, palliative care and other specialities
The hospital (Trust) website is http://www.ouh.nhs.uk/
Royal Berkshire Hospital, Reading
Training in this Trust is based in the single hospital, but extends into various
community hospitals and settings.
The hospital (Trust) website is http://www.royalberkshire.nhs.uk/
Other hospital Trusts where trainees will or may go are:
Buckinghamshire Healthcare NHS Trust
The primary training in this trust is in spinal injury rehabilitation, which occurs in
the National Spinal Injury Centre, Stoke Mandeville Hospital, Aylesbury. Most
trainees will undertake ther necessary training in spinal injuries here in an
attachment of three months; trainees wanting to specialise in this may be able to
spend up to one year here.
In addition trainees may spend short times working in other services within the
Trust, usually attending out-patient clinics but also potentially visiting to see other
models of care:
 Amersham hospital, where there is an in-patient service (Buckinghamshire
Neurological Rehabilitation Service). This is not currently a part of the training
programme, but could be visited.
 Rayner’s Hedge, Aylesbury, which is a community neurological rehabilitation
service with no medical input. This is not currently a part of the training
programme.
 Bedgrove Health Centre, Aylesbury which runs both a Community Head Injury
Service and a vocational Rehabilitation service (“Working Out”). Training
clinics occur here.
The hospital (Trust) website is http://www.buckshealthcare.nhs.uk/
In Reading, the Royal Berkshire Hospital has a 16 bedded in-patient rehabilitation
unit within an acute general hospital, and includes close liaison with and out-reach to
acute stroke care, intensive care unit, and neurology. It is a recognised Level IIa
specialist service. Furthermore the department has access to West Berkshire
Community Hospital, Newbury where about 5-6 inpatients have longer-term
rehabilitation for neurological conditions.
There are two consultants, Dr Hamid Sultan and Dr Faraz Jeddi and one Associate
Specialist, Dr Peter Tun. There will be a dedicated senior house officer. There are
usually two but sometimes one and rarely three specialist registrars present at any
one time. There is a full rehabilitation team in the hospital with a community team;
both have clinical psychology input. Access to orthotics, orthoptics and a local
wheelchair service is available in the hospital. There are clinical nurse specialists for
rare neurological conditions, Parkinson’s Disease and Multiple Sclerosis who work
closely with the rehab team. The service is closely integrated with the neurology
service with training opportunities within neurology. Trauma rehabilitation services
are developing.
In Oxford, the Oxford Centre for Enablement has 26-30 inpatient beds primarily
for acute phase but including some slow-stream neurological rehabilitation. It is a
recognised Level I specialist service. Inpatients mainly come from Oxfordshire
(population 700,000) and Buckinghamshire. It is part of the Regional Trauma
service and this involves providing specialist rehabilitation input into the Trauma
wards for patients immediately after admission. There are a large number of outpatients and day patients.
It has four full-time consultants (Dr Wade, Dr Kischka, Dr Henderson Slater, Dr Jo
Hillan), usually two but sometimes three specialist registrars, and one GP trainee
senior house officer. It has very many therapists, nurses, and other specialists
including clinical neuropsychologists, clinical engineers, orthotists, prosthetists, an
orthoptist, etc. Recently a formal academic link with Oxford Brookes University has
formed, with many research projects being run jointly.
The specialist registrars are currently is on-call one in four for the centre, but this will
be subject to review by the Trust and it seems probable that registrars will join the
acute medical on-call rota at a level that does not disrupt training.
Aylesbury/Buckinghamshire
The National Spinal Injuries Centre has 110 beds in five adult wards and one
paediatric ward, in a building complex that is joined to but separate from the main
acute general hospital (Stoke Mandeville Hospital). The Centre is a self-contained
specialist rehabilitation centre that can provide exposure to every aspect of spinal
injury rehabilitation.
The centre provides acute phase rehabilitation, including for people with very high
spinal cord injuries who need ventilatory support. It also provides elective admissions
for further rehabilitation, and assessment of later problems related to the spinal
injury. The centre has a significant out-patient department for long-term follow-up
and management of complications. It does not admit children acutely, but provides
inpatient rehabilitation and life-long follow-up for children with spinal cord injuries
from birth onwards.
There are six consultants, an associate specialist, and 5 SHOs. There is a full
rehabilitation team including especially peripatetic nurse specialists. It is likely that
there will be no more than one registrar present at any one time.
Teaching
Most teaching is on a one to one basis by the consultants, either in relation to a
specific case or in relation to a process (e.g. assessing mental capacity) or technique
(e.g. botulinum toxin injection).
Trainees are encouraged to attend the Neurology Grand Round at the John Radcliffe
hospital (held weekly), and the monthly Rehabilitation Grand Round at the Oxford
Centre for Enablement. There are monthly neurology trainee teaching sessions
open to rehabilitation trainees, held alternately in Oxford and Southampton.
Trainees have organised teaching meeting in conjunction with London Trainees, and
have organised one-off meetings.
There are regular in-house teaching sessions for the whole rehabilitation team in all
settings, and the trainees should attend these when appropriate and will also be
asked to teach at them from time to time.
Duties of Post
The trainee is expected to fulfil the clinical, service duties specific to each post which
will include aspects of:
 managing inpatients medically: clerking admissions, supervising junior
medical staff, seeing patients regularly, checking diagnoses, diagnosing and
managing intercurrent illness etc
 managing inpatients in their rehabilitation: setting goals as part of the team,
participating in and leading team meetings, liaising with the team, and with
many other professions and organisations, seeing family and others etc
 seeing new referrals in other settings from intensive care to nursing home and
the patient’s own home
 seeing out-patients, both new and follow-up
 participating in specialist clinics and services (e.g. spasticity clinics)
 responding to and managing any acute, new clinical problems in patients
known to the service
 liaising with other professionals who seek advice
They will also be expected to fulfil the normal supporting clinical activities such as:
 participating in, or organising and undertaking departmental or service audit
 using any pathways, procedures and protocols that may be in place



facilitating any research being undertaken within or in association with the
service
teaching – students, other professions, other doctors, the public
taking part in any service development projects being carried out
And, of course, they will be expected to further their own training in consultation with
their educational and clinical supervisors.
Main Conditions of Service
Appointments to this programme are subject to the Terms and Conditions of Service
(TCS) for Hospital Medical and Dental Staff (England and Wales). In addition
appointments are subject to:
 Applicants having the right to work and be a doctor or dentist in training in the
UK
 Registration with the General Medical Council
 Pre-employment checks carried out by the Trust HR department in line with
the NHS employment check standards, including CRB checks and
occupational health clearance.
The employing Trust’s offer of employment is expected to be on the following
nationally agreed terms:
Hours – The working hours for junior doctors in training are now 48-hours (or 52hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors
in training also have an individual right to opt-out if they choose to do so, but they
cannot opt-out of rest break or leave requirements. However, the contracts for
doctors in training make clear that overall hours must not exceed 56 hours in a
week (New Deal Contract requirements) across all their employments and any
locum work they do.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/EWT
D/Pages/EWTD.aspx
Pay – you should be paid monthly at the rates set out in the national terms and
conditions of service for hospital medical and dental staff and doctors in public health
medicine and the community health service (England and Wales), “the TCS”, as
amended from time to time. The payscales are reviewed annually. Current rates of
pay may be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircular
sMedicalandDental.aspx Part time posts will be paid pro-rata
Pay supplement –depending upon the working pattern and hours of duty you are
contracted to undertake by the employer you should be paid a monthly additional
pay supplement at the rates set out in paragraph 22 of the TCS. The current
payscales may be viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircular
sMedicalandDental.aspx . The pay supplement is not reckonable for NHS pension
purposes. The pay supplement will be determined by the employer and should be
made clear in their offer of employment and subject to monitoring.
Pension – you will be entitled to join or continue as a member of the NHS Pension
Scheme, subject to its terms and rules, which may be amended from time to time. If
you leave the programme for out of programme experience you may have a gap in
your pension contributions. More information can be found at
http://www.nhsbsa.nhs.uk/pensions
Annual Leave – your entitlement to annual leave will be five or six weeks per annum
depending on your previous service/incremental point, as set out in paragraphs 205206 of the TCS. The TCS may be viewed at
http://www.nhsemployers.org/PayAndContracts/MedicalandDentalContracts/JuniorD
octorsDentistsGPReg/Pages/DoctorsInTrainingJuniorDoctorsTermsAndConditions150908.aspx
Sick pay – entitlements are outlined in paragraph 225 of the TCS.
Notice –you will be required to give your employer and entitled to receive from them
notice in accordance with paragraphs 195-196 of the TCS.
Study Leave –the employer is expected to offer study leave in accordance with
paragraphs 250-254 of the TCS. Local policy and procedure will be explained at
induction.
Travel Expenses – the employer is expected to offer travel expenses in accordance
with paragraphs 277-308 of the TCS for journeys incurred in performing your duties.
Local policy and procedure should be explained at induction.
Subsistence expenses – the employer is expected to offer subsistence expenses in
accordance with paragraph 311 of the TCS. Local policy and procedure should be
explained at induction.
Relocation expenses – the employer will have a local policy for relocation expenses
based on paragraphs 314 – 315 of the TCS and national guidance at
http://www.nhsemployers.org/PayAndContracts/MedicalandDentalContracts/JuniorD
octorsDentistsGPReg/Pages/DoctorsInTrainingJuniorDoctorsTermsAndConditions150908.aspx
You are advised to check eligibility and confirm any entitlement with the employer
before incurring any expenditure.
Pre-employment checks – all NHS employers are required to undertake preemployment checks. The employer will confirm their local arrangements, which are
expected to be in line with national guidance at
http://www.nhsemployers.org/RecruitmentAndRetention/Employmentchecks/Pages/Employment-checks.aspx
Professional registration – it will be a requirement of employment that you have
professional registration with the GMC/GDC for the duration of your employment.
Though the post is covered by NHS Indemnity, you are strongly advised to register
with the MPS for professional indemnity.
Health and Safety – all employers have a duty to protect their workers from harm.
You should be advised by the employer of local policies and procedures intended to
protect your health and safety and expected to comply with these.
Disciplinary and grievance procedures – the employer will have local policies and
procedures for dealing with any disciplinary concerns or grievances you may have.
They should advise you how to access these, not later than eight weeks after
commencement of employment.
Educational Supervisor – the employer or a nominated deputy (usually the Director
of Medical Education) will confirm your supervisor on commencement.
General information on the LETB’s management of Specialty Training
programmes, including issues such as taking time out of programme and dealing
with concerns or complaints, is available at www.oxforddeanery.nhs.uk and in the
national ‘Gold guide’ to Specialty Training at http://specialtytraining.hee.nhs.uk/.
Please ensure that you inform Health Education Thames Valley of any changes to
your contact details.
February 2014