OXFORD DEANERY: Academic Clinical Fellow in
Immunology (ST3)
Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to
University/NHS Trust/Deanery partnerships nationally through a formula mechanism and by
competition. These posts form part of the NIHR Integrated Training Pathway, further details
of which can be found on the NIHR TCC website http://www.nihrtcc.nhs.uk. All NIHR ACF
posts attract an NTN-A.
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 around 2000 Foundation and Specialty 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 Immunology Training Programme
The Immunology training programme is a 5-YEAR year programme, starting at ST3. The
ACF post is for 3 years starting at ST3 after which the trainee is expected to progress to a
PhD or an Academic Clinical Lectureship post. 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.
Please note: for 2016, in addition to the academic interviews, candidates will be required to
attend and pass a clinical interview for the specialty they are applying to for academic
training, if appropriate. Offers made will therefore be conditional upon meeting the required
standard in the clinical interview.
Please check the FAQs (http://www.oxforddeanery.nhs.uk/pdf/2015 Applicant NIHR ACF
FAQs.pdf) on the HETV website for more information.
The posts in this programme have been approved for Specialist Training by the Joint
Committee of the Royal College of Physicians and the Royal College of Pathologists. 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.
The programme is based in one Trust in the Oxford Deanery, though trainees will find
themselves on secondment for specific training in other hospitals in the country. These
include:
Hospitals and Locations
Great
Ormond Street
http://www.gosh.nhs.uk/
or
Newcastle
General
http://www.newcastlehospitals.org.uk/
Hospital 4-6 weeks for specialist paediatrics
Hospital
St
Mary’s
Paddington 4 weeks for specialist allergy
http://www.imperial.nhs.uk/stmarys
or
Heartlands Hospital, Birmingham
http://www.heartofengland.nhs.uk/
Or other specialist departments or locations as needed to complete an individual’s training.
Rotation Information
There are no formal rotations as the programme is based within a single Trust in the
Deanery (The Oxford Radcliffe Hospitals NHS Trust), where trainees will be employed for
the duration of their training. However, secondment opportunities exist at the locations
specified above to allow a trainee to complete their training.
Trust Information
The Oxford Radcliffe Hospitals NHS Trust http://www.oxfordradcliffe.nhs.uk/home.aspx
The services of the Trust are provided from three sites:
 The John Radcliffe Hospital, which is the main accident and emergency hospital,
also provides general and specialist medical, surgical, trauma, cardiac, women’s
services and geratology. This site now includes the newly completed West Wing
and Children’s Hospital. The West Wing provides a regional head and neck
services that includes neurosciences and specialist surgical service including
neurosurgery and neurology, cranio-facial surgery, plastic and reconstructive
surgery, ENT and ophthalmology. The Children’s Hospital provides paediatric
services.
 The Churchill, which has a number of specialist services including renal and
urology, medical and clinical oncology, palliative care, dermatology, chest
medicine, infectious diseases, geratology, diabetes, endocrinology and metabolic
services, medical and clinical genetics, laboratory immunology and genito-urinary
medicine.
 The Horton Hospital in Banbury, which provides district general hospital services,
including accident and emergency services, to its local population in the north of
the county and in surrounding counties.
The Trust has nearly 1,500 beds and it is anticipated that 260,000 people will attend as
outpatients, over 97,000 patients will be admitted, 90,000 will attend the accident and
emergency department, and more than 7,000 babies will be delivered during the current
year. The Trust continues to build on its alliances with its key partners: Health Authorities,
Primary Care Groups, General Practitioners and other Trusts. These help both service
delivery throughout the health care system and ensure that the quality and effectiveness of
services can be improved. These alliances are particularly important in the development of
specialist services and the availability of these services to a wide population. The continued
support of the Community Health Council is much valued and we will continue to work with
the CHC to the benefit and the services.
The Trust works particularly closely with the University of Oxford Medical Sciences Division.
The Trust values these links and is exploring with the University how best to secure closer
ties in the coming years.
Immunology in Oxford is responsible for all immunological referrals, clinical and laboratory,
for Oxfordshire, Berkshire, Buckinghamshire and Northamptonshire. It comprises two
sections:
Clinical Immunology based at the John Radcliffe Hospital, is part of the Medicine Clinical
Centre along with other specialist services. Children and adults with suspected immune
deficiencies, severe autoimmune diseases or other immunological diseases are seen in
Immunology clinics. Multi-specialist clinics are run for autoimmune diseases and for patients
with allergic problems. In-patient referrals, for the diagnosis and management of patients
with immunological diseases, are seen in all the central Oxford hospitals, though there are
no admitting facilities for Immunology.
The regional Immunology Laboratory is based at the Churchill Hospital and is part of the
Laboratory Medicine Centre. Approximately 60,000 specimens a year are received from
Oxfordshire (population 0.56 and local hospitals (2.5 x 106) population. Tests range from
autoantibodies and immuno-chemistry to specific cellular and humoral tests of immune
function. Flow cytometry is used for immunophenotyping for monitoring of patients with HIV
disease and primary immune deficiency diseases
Duties of Post
Principal Responsibilities: The ACF is expected to take part in clinics, in conjunction with the
other senior and junior medical staff. He/she will be involved in the laboratory and will be
responsible for interpretation and authorisation of laboratory results. This includes liaison
with clinical staff, general practitioners, clinical nurse specialists, technical and clerical staff,
both by telephone, by email and in the wards.
Daily Commitment: Variation of the above depending on stage of training. Daily attendance
at the various immunological clinics are discussed and fixed at regular (3 monthly) meetings
with the Clinical Immunology lead clinician.
Description of Working Pattern: To cover days only; there is no on-call.
induction pack on arrival
Timetable &
Teaching: Ad hoc teaching opportunities to undergraduates, postgraduates and nursing
staff, are available and depend on the level of training being undertaken.
Administration/Management:
programme
Experience in management forms part of the training
Training
AIM
To gain the appropriate skills and competences, including the Fellowship in Immunology of
the Royal College of Pathologists by examination, for eligibility for a CCT in Immunology.
TRAINING OBJECTIVES: include the acquisition of:
 Appropriate skills required for the pursuit of a clinical career as a consultant, namely
assessment of patients with immunological diseases, relevant investigative methods and
their interpretation, appropriate treatments for immunological diseases.
 Understanding and writing scientific papers in peer reviewed journals, mechanisms for
publication of scientific papers/case reports, oral presentation of cases, reports on risk
assessments for individual patients, mechanisms for submission to ethics committees &
basic medical statistics.
 Understanding of feasibility and relevance assessment of laboratory methods, audit and
research design.
 Particular knowledge of the clinical presentation of patients with immunologically related
conditions, including primary immune deficiencies, systemic & organ specific
autoimmune diseases, rheumatological conditions including vasculitis, severe allergy and
complications of immune compromised patients and their management.
 The immunological principles underlying the laboratory investigation of disease, in
particular suspected immunological conditions. Interpretation of imaging and laboratory
tests and indications for their use.
 Completion of a project of bench research in translational immunology, to give real
experience of hands on research. The trainee will present the results for peer-review and
possibly publication of one of them.
 Continuation of learning of principles of pathogenesis, diagnosis and management of all
medical conditions, medical ethics and holistic understanding of patients as gained in
CMT.
Research
Allocation of protected academic time in blocks will allow trainees to complete two research
projects in the 3 years, to enable submission of an application for MRC or other clinical
training fellowship at end of second year. There will be two pilot Research Projects of 15
weeks. To ensure flexibility, there will be a chance to change projects if appropriate, but only
after consultation with the ACF panel.
Each project will have a named supervisor, who will be responsible, on a day to day basis,
for ensuring that project is completed and submitted. Both projects will be presented at lab
meetings & the second project will be written up in report form for the ACF panel. The
second project enables time for bench/animal work, training course (ethics, animal licence,
practical bench work).
COLLABORATIVE LINKS are important and joint supervision is encouraged to facilitate
translational research. The systemic functioning of immune systems gives opportunities for
collaboration with organ-based specialists as well as clinician-scientists. The following
principal investigators have offered translational projects but there is opportunity to make
arrangements with other investigators across the Medical Sciences Division and assistance
can be given to make a choice in this:
Prof Georg Hollander (Immunodeficiency)
Prof Andrew McMichael’s/Rodney Phillips’ teams (HIV),
Prof Graham Ogg (Allergy),
Prof Paul Klenerman (T cell responses to viruses)
Prof Lars Fugger (Autoimmunity)
Prof Angela Vincent (Neuroimmunology)
Dr Alison Simmons (Gastroenterology)
Prof Richard Cornall (Genetic models of immunodeficiency)
Prof Enzo Cerundulo (Cancer)
Dr Smita Patel (Primary immune deficiencies)
Dr Paul Bowness (Rheumatological diseases)
Prof David Jackson (Endothelial pathology)
Dr Julian Knight (Genetics of immunodeficiency and autoimmunity).
Prof. Adrian Hill (Vaccines)
In addition, collaborations abroad (Karolinska Institute; Necker Hopital, Paris; University of
Freiberg, National Institutes of Health, Bethesda) provide opportunities for secondment
during a clinical training fellowship.
Timetable/rotation over 3 years
Entry into the program is at ST3. During the 3 years the allocation of time will be as shown
in the table. Allocation for academic time is in blocks of protected time.
Trainees are expected to complete core medical training and the equivalent of the first year
of CCT Immunology training in addition to the academic project.
Allocation of time – in weeks in each year:
Aim
Year 1
Project experience
0
MSc lectures
10
Clinics
24
Secondments for training
0
Immunopathology laboratory
12
Year 2
15
10
11
4
6
Year 3
15
0
23
4
4
During year 1 the focus is on acquiring a sound grounding in fundamental immunology by
attending the MSc lectures and learning by apprenticeship in routine immunodeficiency,
allergy and autoimmunity clinics. In addition, the trainee will spend 12 weeks in the
immunopathology laboratory understanding the immunological principles underlying the
laboratory investigation of disease.
Time is set aside during the MSc weeks for trainees to visit these potential supervisors and
laboratories with the aim of identifying two projects in different areas. There are many labs
looking at immunologic aspects of disease with links outside clinical immunology, where a
secondment would be very suitable, these include Gastro (Fiona Powrie), Cancer
Immunology (Cerundolo), Infectious Diseases (McMichael, Goulder, Phillips, Klenerman)
Auto-immunity (Hollander, Cornall), Transplantation (Wood), Vaccines (Hill) and Allergy
(Ogg).
During years 2 and 3 the emphasis is on developing their clinical skills and increasing the
clinical exposure to include rotations to Haematology, Nephrology, Infectious Diseases and
Dermatology. The projects are carried out in years 2 and 3, and each will be completed in 15
weeks. This should facilitate the submission of an application for MRC or other clinical
training fellowships. If the ACF already holds a PhD then support for appropriate postdoctoral research and funding applications will be given.
Throughout the 3 years the trainees are expected to attend weekly clinical meetings and
teaching sessions as well as the national training days organised by the ACP.
Support for training fellowship/award application
In addition to the relevant scientific and background information, practical skills and handson experience, the trainees will get full support from NDM administrative staff for their clinical
training fellowship application. An academic supervisor will be identified for the duration of
their Academic Clinical Fellowship. A mentor, distinct from the project supervisors & the
educational supervisors, will be also be appointed.
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, 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/EWTD/P
ages/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/PayCircularsMedica
landDental.aspx
Pay supplement –there is no on-call requirement or supplement
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 205-206 of
the
TCS.
The
TCS
may
be
viewed
at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTSGPRE
G/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/JUNIORDOCTORSDENTISTSGPRE
G/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 pre-employment
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 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
September 2015