OXFORD DEANERY SPECIALTY TRAINING PROGRAMME
IN REHABILITATION MEDICINE
About Oxford Deanery
The Oxford Deanery covers the counties of Oxfordshire, Berkshire and
Buckinghamshire, with Banbury and Milton Keynes in the North, to Reading and
Slough in Berkshire and High Wycombe and Aylesbury in the West.
The Oxford Deanery is part of NHS South of England which comprises South
Central, South West and South East Coast Strategic Health Authorities. The Oxford
Deanery is responsible for the training of some 1500 trainees.
The Oxford Deanery is a relatively small deanery 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 Oxford Deanery as a
whole. This may mean that you may be allocated to any geographic location
within the Oxford Deanery depending on training needs.
The Rehabilitation Medicine Training Programme
The Rehabilitation Medicine training programme is a four year programme, starting
at ST3. 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.
Anyone who wishes to discuss the nature of rehabilitation medicine and why it is one
of the most satisfying and challenging medical specialities to be in should contact
Professor Derick Wade at the Oxford Centre for Enablement (tel: 01865-737306;
email: derick.wade@ouh.nhs.uk). He is the Training Programme Director; he can
give further specific information about the training programme, and he is happy to
answer any questions and to discuss why rehabilitation is a good career choice..
The training programme covers the whole curriculum and allows trainees to gain
experience in any of the four specialisations recognised in the Curriculum
(neurological rehabilitation, spinal injury rehabilitation, prosthetics, and musculoskeletal rehabilitation). However it must be noted that to fulfil the requirements
needed to specialise exclusively in spinal injury rehabilitation, the trainee will
usually need to take up to an additional two years in out-of-programme-experience
to gain the suggested three years of spinal injury rehabilitation experience. This
should be discussed with the Training Programme Director once a trainee has
decided that he or she wishes to consider it.
The training programme for Rehabilitation Medicine is based in several different
Trusts throughout the Oxford Deanery so trainees may find themselves employed by
any of the following Trusts and placed in any of the following hospitals:
Trust
Oxford University Hospitals NHS
Trust
Hospitals and Locations
Nuffield Orthopaedic Centre, Oxford
http://www.ouh.nhs.uk/
John Radcliffe Hospital, Oxford
http://www.ouh.nhs.uk/
Royal Berkshire NHS Foundation
Trust
Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
West Berkshire Community Hospital, Newbury
http://www.royalberkshire.nhs.uk/
Buckinghamshire Healthcare NHS
Trust
Stoke Mandeville Hospital, Aylesbury
http://www.buckshealthcare.nhs.uk/
Amersham hospital, Amersham
http://www.buckshealthcare.nhs.uk/
Rayner’s Hedge, Aylesbury
http://www.buckshealthcare.nhs.uk/
Bedgrove Health Centre, Aylesbury
http://www.buckshealthcare.nhs.uk/
However it must be noted that the only fixed bases (i.e. where the trainee will be
based for more than a day’s work) are:
 Nuffield Orthopaedic Centre, Oxford (possibly extending to the John Radcliffe
Hospital, Oxford)
 Stoke Mandeville Hospital, Aylesbury
 Royal Berkshire Hospital, Reading
It should also be noted that trainees may (a) choose to work in other local hospitals
and services to gain experience in specialist areas (e.g. in the Ridgeway Trust to
gain experience of Learning Disability) and (b) be asked to see patients in any local
or Regional hospital, for example to assess patients for admission.
Rotation Information
The rotation is currently undergoing change as rehabilitation services are changing
and developing in all parts of the Region. 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 specialist experience in one part of rehabilitation,
and this is possible within the four year programme for three of the recognised
specialities (neurological rehabilitation, prosthetics, musculo-skeletal rehabilitation)
and indeed in other specialities (e.g. paediatric rehabilitation) after discussion with
the Training Programme Director.
For spinal injury rehabilitation the situation is different. 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. However this will not,
according to the curriculum suggested by the British Association of Spinal Cord
Injury Specialists (BASCIS), be sufficient to take a job that is exclusively in spinal
injury rehabilitation.
The BASCIS curriculum suggests that a total of 36 months is needed in spinal injury
rehabilitation for someone to be a full specialist in spinal injury rehabilitation.
Consequently the trainee would need to take an additional two years of out-ofprogramme-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. Educational agreement will normally
be given, for at least two trainees at any one time. Funding agreement would be
needed from the National Spinal Injures Centre.
Thus the programme can be adapted to follow the particular interests of most
trainees, provided that the adaptation is consistent with the educational and service
components of the programme. For most trainees the general pattern of the
rotation is as follows:
Time
Two weeks
Location
Oxford Centre for Enablement
Eighteen
months
Royal Berkshire Hospital,
Reading
Eighteen
Months
Oxford Centre for Enablement,
Nuffield Orthopaedic Centre,
Oxford
Six months
Oxford Centre for Enablement
& Nuffield Orthopaedic Centre
Three
months
National Spinal Injuries Centre
Stoke Mandeville Hospital,
Aylesbury
Three
Months
Oxford Centre for Enablement
Content/comment
Brief induction period to become
familiar with Oxford
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,
Community-based rehabilitation,
spasticity management and intrathecal baclofen, low awareness
states, acute and long-term
rehabilitation, stroke care, psychiatric
and psychological aspects, specialist
clinics at John Radcliffe, specialist
seating, environmental controls and
almost all aspects of neurological
rehabilitation. Acute trauma
rehabilitation will become part of the
training in 2012.
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
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. 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; one Associate
Specialist, Dr Peter Tun; and one 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 second 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.
The Oxford Centre for Enablement has 30-33 inpatient beds primarily for acute
phase (24) or slow-stream (8) neurological rehabilitation patients that mainly come
from Oxfordshire (population 700,000). It will be part of the Regional Trauma service
to be started in April 2012 and this will involve providing specialist rehabilitation input
into the Trauma wards for patients immediately after admission.
It has three full-time consultants (Dr Wade, Dr Kischka, Dr Henderson Slater),
usually two but sometimes three or only one specialist registrar, and one GP trainee
senior house officer and 0.1 WTE doctor interested in psycho-social medicine. 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 large research projects being run jointly.
The specialist registrar currently is on-call one in four, but this will be subject to
review as the Trust restructures in early 2012.
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, one or two specialist registrars at
most times, two staff grades and 5 SHOs. There is a full rehabilitation team
including especially peripatetic nurse specialists.
.
 http://www.buckshealthcare.nhs.uk/NSIC%20Home/spinal
 http://www.royalberkshire.nhs.uk/wards__departments/n/neurological_rehabili
tation.aspx
 http://www.noc.nhs.uk/oce/default.aspx
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/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.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/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.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 Deanery’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://www.mmc.nhs.uk Please ensure
that you inform Oxford Deanery of any changes to your contact details.
February 2012