HEALTH EDUCATION THAMES VALLEY – SUB-SPECIALTY
TRAINING PROGRAMME IN STROKE 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 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 Stroke Medicine Training Programme
The Stroke Medicine training programme is a one-year programme, starting at minimum level
of ST3. During this time, the trainee's work will be monitored while in post culminating in an
SYA performed by the Specialist Advisory Committee to determine satisfactory progress.
Progression on the programme will be dependent upon these reviews.
The posts on this rotation have been approved for Specialist Training by the JRCPTB.
Applicants must hold a national training number (NTN) in one of the recognised parent
specialties of geriatric medicine, general (internal) medicine, acute medicine, rehabilitation
medicine, clinical pharmacology and therapeutics, cardiology or neurology.
The Postgraduate Dean has confirmed that this post has the necessary educational and
staffing approvals.
The programme is based in the following trusts within the Health Education Thames Valley
region:
Trust
Oxford University Hospitals NHS
Trust
Hospitals and Locations
John Radcliffe Hospital, Oxford
http://www.ouh.nhs.uk/
Royal Berkshire NHS Foundation
Trust
Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Stroke medicine has recently been recognized as a sub-specialty of geriatric medicine,
general (internal) medicine, acute medicine, rehabilitation medicine, clinical pharmacology
and therapeutics, cardiology and neurology. A curriculum has been approved by the
postgraduate medical education and training board (PMETB).
The trainee will have the same Educational Supervisor for the full 1 year of post: Dr James
Kennedy for the appointee starting in Oxford and likewise for the appointee in Reading the
Educational Supervisor role would rotate yearly between the local Clinical Supervisors.
This one-year programme aims to provide a comprehensive training programme in all
aspects of stroke medicine, including stroke prevention, acute stroke care, including all
aspects of tertiary acute stroke care, and rehabilitation. Teams at the Royal Berkshire
Foundation NHS Trust and the Oxford University Hospitals NHS Trust have joined together
to provide such a programme. The appointees will each spend six months in either Oxford or
Reading, before rotating to the other centre for the remainder of the year.
The John Radcliffe Hospital in Oxford is home to an established Consultant-led hyperacute
stroke programme. The clinical activity is coupled to increasing research activity with the
development of an Acute Vascular Imaging Centre in close proximity to the Emergency
Department. There is ample opportunity to gain experience of neuroradiology, including a
dedicated stroke radiology conference each week.
In addition, Oxford has a strong record in the arena of stroke prevention. The appointee will
regularly attend rapid access TIA clinics in Oxford and/or Banbury.
During the six months based in Reading, the trainee will experience working on the hyper
acute Stroke unit, with a combined stroke and further extended stroke unit beds and ESD.
This provides a comprehensive and seamless stroke rehabilitation pathway at the Royal
Berkshire NHS Foundation Trust. The acute stroke unit offers distinct ‘acute’ and ‘early
rehab’ phases, with specialised neurorehabilitation and services such as spasticity
management provided for selected patients.
Educational opportunities are numerous and include a weekly stroke medicine seminar
organised by the University of Oxford Acute Stroke Programme.
Time may be made available during the year for the appointee to gain experience in fields
such as vascular surgery and neurological intensive care, according to their training needs.
Dr Kennedy will assist the appointee in arranging these placements.
OXFORD UNIVERSITY HOSPITALS NHS TRUST
Job description for the OXFORD part of this rotation
Stroke Trainee (Oxford/Reading)
2
With the exception of section 10, this job description describes the Oxford component of the
rotation, primarily based at the John Radcliffe Hospital. The appointee will also be expected
to undertake duties at the Horton General Hospital in Banbury
1.
JOB TITLE:
Specialist Registrar / Specialty Registrar in Stroke Medicine.
2.
GRADE:
Specialist Registrar / Specialty Registrar
3.
SPECIALTY:
Stroke Medicine
4.
REASON FOR VACANCY
New posts (1 year, fixed-term)
5.
SUPERVISING CONSULTANTS:
Dr James Kennedy
Dr Philip Mathieson
Dr Ian Reckless
Dr Ursula Schulz
6.
EDUCATIONAL SUPERVISOR
Dr James Kennedy
7.
PROGRAMME DIRECTOR & REGIONAL SPECIALTY ADVISOR:
Dr James Kennedy
8.
ANNUAL AND STUDY LEAVE
All leave must be planned in advance and agreed with the supervising consultants. One
other specialist registrar (Geratology and GIM) provides cover on the stroke unit and at least
one specialist registrar must be available every weekday. Annual leave entitlement will be 5
or 6 weeks dependent on the appointee’s seniority.
9.
SALARY
Salary will be calculated according to the Specialist Registrar / Specialty Registrar Scale. The
post-holder’s point on the scale will be defined according to seniority in the parent specialty.
A banding supplement will be paid in relation to the on-call commitment to geratology. This
post will be subject to intermittent hours monitoring.
10. DUTIES OF THE POST
a)
Principal Responsibilities:
In conjunction with the other two registrars attached to the stroke unit (from geratology and
GIM), the post-holder will be responsible for the day to day care of all patients referred to and
managed by the stroke team. This will include initial assessment of referrals, ward rounds
Stroke Trainee (Oxford/Reading)
3
and outpatient clinics. The post-holder will form part of the acute stroke response team,
assessing patients in the Emergency Department (and elsewhere within the hospital) for
thrombolytic treatment immediately following stroke onset. An F2/ST1/ST2 doctor is also
attached to the stroke unit on a rolling 5-week rota.
b)
Description of Working Pattern
The standard working day is 0830 until 1800. The post-holder will participate in the on-call
geratology rota (1 in 7), with prospective cover for annual and study leave. Whilst on-call,
the post-holder will form part of the out-of-hours acute stroke response. In addition, the postholder will provide support to the on-call house staff (F1/F2/ST1/ST2) covering patients on
the acute stroke unit, and Level 4 (geratology). There are no direct admissions to geratology
out-of -hours. The post-holder will be expected to be within 30 minutes of the Emergency
Department at the John Radcliffe Hospital at all times when on-call. It may be possible to
assist the candidate in identifying accommodation on site, where necessary.
c)
Teaching
The post-holder will be expected to teach junior colleagues and medical students on a dayto-day basis. The post-holder will play an active part in regional stroke seminars, journal club,
grand round presentations and training sessions for allied health professionals.
d)
Administration/Management
The post-holder will be expected to ensure that accurate clinical records are kept and that
timely discharge summaries are produced for patients under the care of the stroke team. In
addition, the post-holder may be expected to assist in the organization of the acute stroke
response rota.
e)
Audit and data collection
The post-holder will be expected to contribute to ongoing data collection and audit within the
stroke service. Novel systems of data collection are currently being developed by the acute
stroke programme in Oxford.
f)
Research
The post-holder will be expected to take an interest in ongoing clinical trials that have been
adopted from the Stroke Research Network portfolio and Oxford Biomedical Research
Centre related research projects. The post-holder will be encouraged to participate in the
design and conduct of new research projects wherever possible.
g)
Study and Training
The post-holder will be encouraged to attend relevant stroke conferences in the United
Kingdom and Europe. Where possible, the appointee will attend the Oxford regional training
days in their parent specialty. Excellent Library facilities are available at the John Radcliffe
Hospital. The study leave budget is currently £550 per annum.
12. STRUCTURE OF THE STROKE SERVICE AND KEY PERSONNEL
The stroke service is not a distinct administrative department. Rather, it has close links with
general medicine, emergency medicine, geratology, neurology and neuro-radiology.
Managerial responsibility for most of the stroke services provided within the Oxford University
Hospitals NHS Trust is illustrated below:
Stroke Trainee (Oxford/Reading)
4
Division A
↑
Directorate of Acute and Emergency Medicine with Geratology
↑
Department of Geratology
↑
Acute Stroke Service
In addition, further stroke services are provided through the NHS Department of Neurology.
Clinicians from the University Departments of Clinical Geratology and Clinical Neurology
make a significant contribution to patient care.
Medical Staff - Consultants
NHS
Dr Philip Mathieson (Stroke, GIM)
Dr Ian Reckless (Stroke, GIM)
Dr Ursula Schulz (Stroke, Neurology)
Dr Simon Winner (Geratology)
Dr Sudhir Singh (Geratology, GIM)
Dr Neil Stewart (Geratology, GIM – Horton Hospital)
Dr Mike Ward (Geratology, GIM – Horton Hospital)
Dr Wilhelm Kueker (Neuro-radiology)
Dr Dennis Briley (Neurology)
University
Professor Alastair Buchan (Acute Stroke, Neurology)
Dr James Kennedy (Acute Stroke, GIM)
Medical Staff - Other
NHS
2 Specialist Registrars (Geratology, GIM – by rotation, six months)
1 F2 / ST1 / ST2 (Core Medical Training – by rotation, 5 weeks)
University
Clinical Research Fellows, Radcliffe Department of Medicine
Senior Nursing Staff
NHS
Sarah Wheeler (Matron, Geratology and Stroke)
Geraldine Yebra (Charge Nurse, Acute Stroke Unit)
13. TIMETABLE
The timetable below represents a typical working week. It is for illustrative purposes and
actual activities may vary following discussion with the appointee.
Stroke Trainee (Oxford/Reading)
5
Monday
A.M.
Acute Stroke Unit
P.M.
Rapid Access TIA clinic
Tuesday
Acute Stroke Unit
Ward referrals
Stroke case presentation / seminar
Neuro-radiology review meeting
Acute Stroke Unit
Wednesd
ay
Acute Stroke Unit
Acute Stroke Unit
Thursday
NDM case
seminar
presentation
/
Medical Grand Round
Clinical Audit & Private Study *
Acute Stroke Unit
Friday
Acute Stroke Unit
Acute Stroke Unit
Ward referrals
Student teaching *
* The timing of these 5 sessions may change by to ensure maximal clinical exposure and
educational benefit.
The appointee will be on-call for acute stroke response during the day on Tuesdays and
Fridays. The appointee will participate in the Geratology on-call rota (including acute stroke
response) on a 1 in 7 basis (with prospective cover).
OXFORD UNIVERSITY HOSPITALS NHS TRUST
PROFILE
1.
OXFORD UNIVERSITY HOSPITALS NHS TRUST
Overview
The Oxford University Hospitals (OUH) is one of the largest teaching trusts in the country,
with a national and international reputation for the excellence of its services and its role in
teaching and research.
The Trust, which is based on two sites in Oxford and one in Banbury, provides general
hospital services for the local population in Oxfordshire and neighbouring counties, and more
specialist services on a regional and national basis. It employs about 9,500 staff.
The Trust works in close co-operation with the University of Oxford, and is a leading centre
for research programmes in cancer, neurosciences, diabetes, genetics and many other
fields. The Trust, jointly with the University of Oxford, was recently awarded biomedical
Stroke Trainee (Oxford/Reading)
6
research centre status, by the Department of Health, making it one of the five pre-eminent
centres in the country for translational medical research.
The Trust hosts trainees from the Oxford Deanery, the University of Oxford’s Department of
Postgraduate Medical and Dental Education, which is jointly funded by the University and the
NHS. The Trust works with the Deanery to provide one of the country’s pre-eminent centres
for the training of doctors. It also works in close co-operation with Oxford Brookes University,
and hosts nurse and other healthcare professional training.
Performance and activity
The Trust has an annual turnover of £0.5 billion. It provides a district general hospital service
for around 700,000 people in Oxfordshire and the neighbouring counties. The Trust’s
specialist services serve a population of around 2.5 million in Oxfordshire, Buckinghamshire,
Berkshire, Wiltshire, Gloucestershire and Northamptonshire. In addition to the normal range
of specialist services, the Trust also provides other highly specialised treatment and care for
a still wider catchment area.
Demand for Trust services has risen steeply in recent years and in 2005/6:





511,000 people attended outpatient appointments
117,000 people attended the emergency departments
48,300 people were admitted as inpatients for emergency treatment
20,200 people were admitted as inpatients for planned surgery
7,850 babies were delivered
The Trust was awarded two stars in the Healthcare Commission’s 2005 performance
ratings. In 2006, the first year of the Healthcare Commission’s ‘annual health check’, the
Trust achieved an overall rating of ‘Good’ for Quality of Services, placing it in the top half of
all acute trusts, and top 40% of all NHS trusts. The Trust has also, consistently, been one
of the 40 top hospitals as judged by the CHKS benchmarking service.
Financial situation
The Trust sits within an area which receives a lower level of health funding than many other
health economies, based on the relative health of its population. In the past three years,
strong financial control has enabled the Trust to reduce reference costs from 8% above to
6% below the national average. In order to ensure that the Trust stays within its financial
constraints it has, over the passed year, pioneered a number of performance improvement
initiatives designed to ensure that it is making best use of its resources. These have
included extending the proportion of day case operations and cutting the average length of
stay for patients. Payment by Results will put the ORH in a relatively strong position in the
future
New developments
In January 07 the Trust opened an extensive new wing for adult services at the John
Radcliffe Hospital, and the Children’s Hospital, Oxford. The new wing for adults, known as
the West Wing, houses head and neck and other services which were previously based in
the Radcliffe Infirmary in the centre of Oxford. The new Wing offers state of the art facilities
for patients and for staff. It includes additional capacity or improved facilities for a number
Stroke Trainee (Oxford/Reading)
7
of services, including specialist surgery, neurosciences and the Oxford Eye Hospital. In
addition to clinical space, it provides a base for University teaching and research. The
Radcliffe Infirmary building, which has housed medical services, teaching and research,
since the 18th century, has been passed to the University of Oxford.
The Children’s Hospital, Oxford, brings together paediatric services which were previously
spread across three sites in Oxford. It is a purpose-built building which provides general
paediatric services for local children, and a range of specialist services, for children on a
regional and national basis. The new Hospital was funded through the Private Finance
Scheme which also funded the West Wing, supported by a £15 million fundraising
campaign which allowed for the development of additional facilities for children and families,
such as play areas, class rooms, and relative rooms.
Work has also begun on a new Cancer Centre on the Churchill Hospital site, in conjunction
with PFI partners, OCHRE Solutions. This development will include additional medical and
surgical beds, a new radiology department, head and neck cancer surgery centre, linear
accelerators for radiotherapy and additional accommodation for chemotherapy patients.
In addition to cancer services, the development will also provide facilities to support other
services on the Churchill site. These include physiotherapy, a high dependency unit, ten
operating theatres and a private patients’ unit. The centre will open in 2008.
The Trust is also planning to expand its cardiac centre on the John Radcliffe site, in order to
provide facilities for a predicted rise in cardiology patients over the coming years. The new
facilities include four additional catheter labs, for diagnosing heart problems, and for
monitoring patients undergoing cardiology treatment, a recovery unit, additional beds and
new facilities for staff. It is hoped that the new facilities will open in 2009.
Hospital Profiles
The John Radcliffe Hospital
Headley Way, Headington, Oxford, OX3 9DU
Tel 01865 741166
The John Radcliffe Hospital, in Headington is the main emergency site. It also provides
acute medical and surgical services, trauma, intensive care, cardiac, women’s services and
children’s services (now based in the Children’s Hospital on the site). Following the
relocation of services from the Radcliffe Infirmary in January this year, the range of services
has been extended to include neurosciences (neurology and neurosurgery), specialist
surgery (ophthalmology; ear, nose and throat; plastic surgery), critical care facilities for
specialist surgery and neurosurgery and a new day surgery unit.
The Hospital currently has 700 inpatient beds.
The Churchill Hospital
Old Road, Headington, Oxford, OX3 7LJ
Tel 01865 741841
The Churchill Hospital, which opened in 1942, is also in Headington and provides mainly
non-emergency specialist services, including renal medicine and transplant, clinical and
medical oncology, dermatology, chest medicine, infectious diseases and the recently
extended palliative care centre. The Hospital has 317 beds. Work is well underway on the
new Cancer Centre and associated surgical and diagnostic facilities, which will be
completed in 2008.
Stroke Trainee (Oxford/Reading)
8
The Horton General Hospital
Oxford Road, Banbury, Oxfordshire, OX16 9AL
Tel 01295 275500
The Horton General Hospital, which opened in 1872, is located in Banbury and provides
general hospital services, including accident and emergency services, maternity and
paediatric services, to the growing local population in the north of Oxfordshire and
surrounding areas. The Hospital has 277 beds.
Strategic Review
The Trust has almost completed a wide-ranging Strategic Review, which has been
considering the range of services offered by the Trust and their clinical and financial
viability, the role of the Trust in the current healthcare market place, and its future strategic
direction. A status report, Strategic Review: Emerging Themes, was published in 2005. The
Review team will present its final findings and recommendations to the Board later in 2007.
Organisational structure
The Trust is managed by a Board of Directors which includes:






Chairman
Six Non-executive Directors
Chief Executive
Director of Finance and Procurement
Medical Director
Chief Nurse,
An Executive team includes the Directors of Operations, Divisional Medical Directors, and
Directors of Planning and Information, Human Resources, Estates and Facilities, and the
Horton General Hospital.
Trust services are grouped into three divisions, each with a number of directorates. The
divisions are responsible for the day-to-day management and delivery of services.
The Divisions are:
Division A
Division B
Division C


Cancer services
– medical and clinical
oncology, clinical
haematology, pain relief
unit, and palliative care.
 Children’s services
and clinical genetics
– paediatric medicine,
paediatric surgery,
specialist
children’s services,
community paediatrics,
neonatal, paediatric
intensive care, and
clinical genetics.
Acute and
emergency
medicine and
geratology
– acute general medicine,
emergency departments
in
Oxford and Banbury, and
geratology.
 Emergency access
– operational managers,
emergency admissions,

General surgery,
vascular and trauma –
emergency surgery,
gastrointestinal medicine
and surgery, endocrine
surgery, breast surgery,
trauma surgery, and
Stroke Trainee (Oxford/Reading)
 Women’s and sexual
health – obstetrics
9
and emergency access
teams.
 Cardiac services
– cardiology,
cardiothoracic surgery,
and cardiac investigative,
and diagnostic services

Renal services –
urology, renal medicine
and dialysis, and
transplantation.
 Specialist medicine
– dermatology services,
Oxford Centre for
Diabetes, Endocrinology
and Metabolism,
haemophilia unit, clinical
immunology, infectious
diseases, and respiratory
medicine.
1.2
orthopaedic surgery.

Critical care,
anaesthetics and
Theatres – intensive care
unit, neuro-intensive care
unit and Horton critical
care unit. Anaesthetics
provide a service not only
within the Trust but also
to all other
Trusts in Oxford.

Specialist surgery
and
neurosciences – ENT,
cleft lip and palate
surgery,
plastics and
reconstructive
surgery, ophthalmology,
oral and maxillofacial
surgery, neurosurgery,
neurology,
neuropathology,
neuropsychology, and
neurophysiology.
and maternity services,
gynaecology, and genitorurinary medicine

.Laboratory
medicine and
clinical sciences –
cellular pathology,
biochemistry,
haematology,
microbiology,
immunology, and
genetics.

Radiological
sciences
– general radiology, CT,
MRI, medical physics &
clinical engineering,
neuroradiology, and
nuclear radiology.

Pharmacy and
therapies
– pharmacy,
physiotherapy,
dietetics, speech and
language therapy, and
occupational therapy.
Trust Organization
The Trust has organized its clinical and clinical support services into the three
divisions, each containing several directorates as indicated above. Clinical Service
Units (CSUs) or clinical teams are then grouped into these directorates. Each CSU
has a lead clinician (typically a consultant) and a clinical manager. All directorates
have a chair and a directorate manager. In addition, corporate services are
provided through the Executive Directorates as indicated below.
The Trust also has a Medical Staff Council to which all consultants, associate
specialists and consultant scientists belong. Individual directorates will also have
consultant groups which will meet on a regular basis.
1.3
Trust Board
Non-Executive Directors
Sir William Stubbs, Chairman
Mr Adrian Towse
Dr Ken Fleming
Ms Caroline Langridge
Dame Fiona Caldicott
Mr Brian Rigby
Stroke Trainee (Oxford/Reading)
10
Executive Directors
Chief Executive
Director of Finance & Procurement
Medical Director
Director of Nursing & Clinical Leadership
Mr Trevor Campbell Davis
Mr Chris Hurst
Dr James Morris
Mrs Elaine Strachan-Hall
Directors attending the Board
Director of Planning and Information
Director of Estates & Facilities
Director of Human Resources
Mr Andrew Stevens
Mr Ian Humphries
Vacant
Divisional Chairmen & Divisional Directors also attend the Board meetings
Divisional Chairman - Division A
Divisional Chairman - Division B
Divisional Chairman - Division C
Director - Division A
Director - Division B
Director - Division C
Dr John Reynolds
Mr Mike Greenall
Dr David Lindsell
Ms Moira Logie
Ms Kathleen Simcock
Ms Joanna Paul
This completes the Oxford part of the job description
Stroke Trainee (Oxford/Reading)
11
JOB DESCRIPTION
With the exception of section 10, this job description explains the Reading component of the
rotation, primarily at the Royal Berkshire NHS Hospital
1.
JOB TITLE:
Specialist Registrar / Specialty Registrar in Stroke Medicine
2.
GRADE:
Specialist Registrar / Specialty Registrar
3.
SPECIALTY
Stroke Medicine
4.
REASON FOR VACANCY
New post (1 year, fixed-term)
5.
CLINICAL SUPERVISING CONSULTANTS:
Dr André Van Wyk (Stroke and Elderly Care Medicine)
Dr Dr Enrico Flossmann (Neurology)
Vacant Stroke consultant post
EDUCATIONAL SUPERVISOR:
Educational Supervisor role would rotate between the local
Clinical Supervisors.
6.
7.
PROGRAMME DIRECTOR & REGIONAL SPECIALTY ADVISOR:
Dr James Kennedy
8.
ANNUAL AND STUDY LEAVE
All leave must be planned in advance and agreed with the supervising consultants.
Neurology Specialist Registrars provide cover on the Stroke unit so that at least one
specialist registrar is available every weekday. Annual leave entitlement will be 5 or 6
weeks, depending on the appointee’s seniority.
9.
SALARY
Salary will be calculated according the Specialist Registrar / Specialty Registrar scale.
The post-holder’s point on the scale will be defined according to seniority and On-Call
commitments.
Stroke Trainee (Oxford/Reading)
12
READING PROGRAMME DESCRIPTION:
Stroke Trainee, Reading:
The Stroke Service at the Royal Berkshire Hospital is consultant-led with close collaboration
between Elderly Care Medicine, Neurology and Neurorehabilitation and support of on-site Neuroradiology services The stroke service developed its pathway, care processes and services, in line
with National Stroke Strategy 2007; RCP NCG 2012; NICE 2010 and 2013; bi-annual National
Sentinel Stroke Audit and SSNAP.
The Acute Stroke Unit was first developed in 2001 and in 2007 was increased to 28 beds by
combining Acute and Stroke Rehabilitation beds, an additional 12 stroke unit beds were added
end of 2012. Since 2005, the hospital has had a weekday Rapid Access TIA pathway and from
2009 a week day 08.00 - 18.00 thrombolysis service. In 2010 our bid to the SHA was successful
in the first tier to develop a HASU (with thrombolysis extended to 24/7) with TIA service
(extended to 7/7 based on MRI and MRA imaging). The thrombolysis service is consultant led;
having use of telemedicine out of hours with ‘round the clock’ Clinical Nurses Specialist on site.
With the establishment of the hyperacute stroke service, stroke physicians and neurologists work
closely in the management of the first 72 hours of patient care on HASU.
December 2012 further extension Stroke Unit beds on Caversham ward for patients needing
more Stroke Unit rehab and allow flexibility with stroke case load fluctuation (allowing 4 specialist
Neurology beds). Close links are in place with the Neuro Rehabilitation Unit with 8 stroke beds,
and the community-based Early Supported Discharge team. This has enabled more than halving
of average length of stay. It is expected recent further establishment of stroke ESD teams in all
our catchment areas will ensure patients are able to receive rehab and care they need in the
most appropriate setting. Also extended ESD in Berkshire West will help the transition of patients
needing longer Stroke Unit rehab back home. This will enable the flow through the service and
help keep the front door open!
RBFT stroke physicians and neurology consultants have access to neuro-surgery and
interventional Neuro-radiology at the Oxford University NHS Trust (OUH NHS Trust) through
excellent working relationships between the two trusts. RBFT neurology consultants have
honorary contracts and admitting rights to the neurology department at OUH NHS Trust.
Stroke Trainee (Oxford/Reading)
13
This post is a 6/12 stroke fellow training post in Reading generally at rotating with Oxford
University Hospital NHS Trust for six months The combined Acute Stroke Unit currently has 2
ST1/2 posts and 2 FY1 posts, CASU on Caversham has an ST1/2 or VTS post.
Hyperacute Services including Thrombolysis
There is in place a 24/7 thrombolysis rota The initial rota for thrombolysis that is 1:7 with
neurologists and stroke physicians resident on site from 08h00 to 18h00 weekdays, then on call
from home 22h00-08h00 (the evening cover 18h00- 22h00 provided by A&E consultants).
Weekend day time 10h00-19h00 covered by A&E, with neurologists and stroke physicians on call
from home outside these hours. The off site on call utilises a system of stroke specialist nurses,
medical registrars and telemedicine.
There are twice daily weekday ward rounds on the HASU enabling early diagnosis and
management, identification of stroke mimics, facilitation of patient movement through the stroke
service, potential repatriation of outlying patients to local ASU’s and input to patients with medical
needs for longer periods of monitoring. This is coordinated by two daily MDT board round
discussion on HASU by the Stroke Consultant. Daily weekend HASU consultant ward rounds.
Acute Services
There are three times weekly ward rounds on ASU and CASU and flexibility to provide input for
problems and see new patients. There are two formal sit down MDT’s; for combined SU and one
for CASU (Caversham ward) where individual patients are discussed with goal setting and setting
up discharge plans.
TIA Service
There is a daily Consultant delivered Rapid Access TIA service currently operating by a Stroke
Specialist Nurse co-ordinating referrals by mobile phone. This ensures all high risk TIAs
(stratified using the ABCD2 score) are seen within 24 hours.
Early Supported Discharge Scheme
There is in-reach by Berkshire West ESD to the combined stroke unit ,also linking to Berkshire
East ESD. Referrals are made directly to South Oxfordshire ESD. There are plans for service
redesign for BW ESD to increase its capacity and to also accept patients later down the
rehabilitation phase.
Stroke Trainee (Oxford/Reading)
14
Service Development
There is an ongoing process to optimize stroke service working for consistently achieving under
four hour target for admission direct to the stroke unit and improve on all stroke inpatients
receiving greater than 90% of their care on Stroke Unit. With the newly opened CASU beds
programme in place for developing leaders on the unit, improving pathways and team building.
Our aim is to ensure stroke unit care for patients needing inpatient rehab and the flow of patients
allowing ongoing direct access to HASU beds and with extending stroke rehabilitation back
home.
Opportunities in helping develop protocols, training juniors and multidisciplinary team staff,
contributing to the audit processes in place and the four weekly thrombolysis multi professional
meeting.
The is a combined weekly stroke /neurovascular consultant ward round and a weekly.
Neuroradiology meeting...There is an opportunity to restart a stroke journal club with the
support of the clinical librarian.
Facilities include:
 A HASU (5 beds) and a combined Stroke Unit of 23 beds and rehabilitation SRU
beds and Caversham Stroke Unit (12 beds) for stroke patients
 Specialist Neuro Rehabilitation Unit on Caversham ward (16 beds catering
predominantly for the needs of younger stroke patients)
 Hyperacute Thrombolysis Service.
 Rapid Access TIA service 7/7 during working week for same-day assessment on
ASU of high risk patients using ABCD2 score.
 Neurovascular Consultant and 2 Stroke Consultant posts
The Stroke Service has daily consultant-led ward rounds on the Acute Stroke Unit by
consultants in Neurology, Elderly Care and Neuro-rehabilitation.
Trainees will have daily responsibility for patients referred to and treated by the Stroke
Service: initial review, ongoing patient-management, ward rounds, coordinated
multidisciplinary input, timetabled to provide hyper-acute stroke response team on Mondays
and Fridays (whilst on site on other days, appointee can attend for own training purposes, if
available); input into the Rapid Access TIA service seeing lower risk patients (on designated
duty day).
Work Pattern and Team Timetables
The standard working day is 08.00 to 18.00.
Primary focus: gaining an understanding of stroke and TIA and the elements of the
seamless service essential to improve outcomes; understanding the impact on patients and
those close to them, with measures to support them. In line with anticipated National Stroke
Strategy revisions, there will be post adjustments. Post holder is not expected to do any oncall outside the Stroke service.
Base SU ward timetable for Stroke Specialist Registrar
Stroke Trainee (Oxford/Reading)
15
A
M
P
M
MONDAY
Combined
SU
AvW
ward
round
Hyper
-acute
O/C
TUESDAY
Neuro ASU
ward round
AvW:
Outpatients
clinic
ASU
MDT
Ward
work
Oxford Stroke
and
Neuroradiolog
y seminar
WEDNESDAY
Neuroreha
b
ASU
ward
round
THURSDAY
Neuro
/
Neuroreha
b meeting
then
Neuro
ASU and
AvW MDT
SRU ward
round
FRIDAY
AvW
ASU
WR
Hyper
-acute
O/C
17h30
RBH
Neuroradiolog
y meeting
This timetable reflects the working pattern of the Stroke Unit. It is anticipated that 6-7
training sessions will be involved, including the outpatients Rapid Access TIA slot. To meet
appointee training needs the other 3-4 sessions will be used for:



regional weekly Oxford training
a flexible monthly training rota (2 sessions weekly) with Neurorehabilitation providing
training in the specialist service spectrum; they include eg. inpatient, case
conferences, spasticity management, a stroke FU clinic, occasional HVs and
community rehabilitation
remainder: for research, data collection and understanding stroke pathway.
The specialist Neurorehabilitation service offers: training in the special needs of young,
working stroke patients, including the psychological and emotional impact of stroke on
employment and driving, with spasticity management, and other complex rehabilitation
issues.
Also important is audit, research, data collection and understanding the Stroke pathway.
There is experience of Palliative Care and developing Community Rehabilitation.
Blank timetable for Stroke Specialist Registar personal planning
MONDAY
TUESDA
Y
Stroke Trainee (Oxford/Reading)
WEDNESDA
Y
THURSDA
Y
FRIDA
Y
16
A
M
Hyper
-acute
O/C
PM
The Stroke Unit
Falls within the Urgent Care Group within the Royal Berkshire Foundation Trust with close
links to the Department of Elderly Care.
Elderly Care Medicine is based at the Royal Berkshire Foundation NHS Trust. The three
teams include 3 Specialist Registrars 5 ST1/ST2/F2, 4 F1 and 2 Neuro CMT’s doctors ( 1
Stroke Unit and 1 Neurorehabiliation (Caversham) ward).
Research, Audit and Service Development
There are close links for education and research with the University of Reading: the London
Road site is less than 50 yards from the hospital. Elderly Care Medicine has Professor
Margot Gosney with a research interest and publications in Stroke. Research is
encouraged and closely mentored. One session per week can be used for audit, research,
personal study, data and guideline development. Links with Neurology, Neurorehabilitation,
other specialties, Health Services and PAMS, facilitate research with clinical and laboratory
based studies. It is envisaged that all Registrars working in Reading will undertake
research of a sufficient standard to be presented nationally and published in peer reviewed
journals
Educational Facilities
The Royal Berkshire NHS Foundation Trust has a Trust Educational Centre with modern
lecture theatre, Microsoft Office computing and audiovisual facilities, seven teaching rooms
and a clinical skills facility. A dynamic library includes electronic resources (eg: Athens)
accessible from any computer in the hospital via intranet. The library has expressed a
strong interest in developing its Stroke reference section. There is a clinical librarian who
will support specialty meetings or journal clubs.
Teaching
Appointee will be encouraged to teach junior colleagues, nurses, PAMS, take an active role
in Stroke training, in local and regional seminars and grand round presentations. The
stroke curriculum is available online with expected competencies. Specialist Registrars are
encouraged to use local, national and on-line facilities to fulfill educational criteria.
Stroke Trainee (Oxford/Reading)
17
Meetings
Monday lunchtime
Wednesday lunchtime
Teaching seminars with Consultants in various
specialties
Compulsory Oxford Neuroradiology and case-based
teaching
Elderly Care department teaching
Wed PM
Thursday 12.10 pm – 1.10 pm
Grand round
Monthly
Regional STR GER teaching and G(I)M
Audit
Adult Medicine and Stroke service
Dr Chatterjee organises Elderly Care departmental
audits; Dr Emma Vaux Quality Improvement Projects.
Tuesday pm:
Administration
Appointee will be required to monitor and coordinate leave arrangements of junior doctors.
Background
The Royal Berkshire NHS Foundation Trust serves a rapidly growing population of
approximately 0.5 million. The Trust provides services across West Berkshire covering the
areas of Reading, Wokingham, Newbury and part of South Oxfordshire. Reading is a
University town and a centre for administration and light industry. Wokingham is
predominantly a commuter locality and Newbury is predominantly agricultural.
The Trust
The Royal Berkshire Hospital achieved Foundation Trust Status on 1st June 2006. It was the first
Foundation Trust in the South Central Strategic Health Authority area which covers Hampshire,
Isle of Wight, Berkshire, Oxfordshire and Buckinghamshire. The Trust has a successful track
record of delivering high quality acute medical and surgical services for 500,000 patients across
Reading, Wokingham and West Berkshire and specialist services to a wider population. The
Trust is one of the largest general hospital Trusts in the country and is Reading's biggest
employer:
We have:
over 4,800 staff
607 acute, 44 paediatric and 57 maternity post natal beds
204 day beds and spaces
an annual budget of £290 million.
All in a day's work:
Stroke Trainee (Oxford/Reading)
18
16 babies born
106 emergency admissions
208 patients seen in A&E
65 operations carried out
790 Radiology procedures
2,500 meals cooked
£7,000 spent on repairs and maintenance
Services associated with this very large District General Hospital include: Medicine:
General, Gastroenterology, Renal, Diabetes and Endocrinology, Cardiology,
Elderly Care, Stroke Unit, Neurology, Neuro Rehabilitation, Respiratory, Rheumatology,
GU, Dermatology, Haematology and Oncology.
Surgery:
Trauma & Orthopaedics, General, Urology,
Ophthalmology, Obstetrics & Gynaecology and Paediatrics.
ENT,
and
Oral,
and
Clinical Support Services: Pathology, Radiotherapy, CT Scanning, MRI, Nuclear
Medicine, Radio isotopes, Accident & Emergency, Intensive Care Unit, High Dependency
Unit, Clinical Decision Unit.
The CCG’s run hospital-based services in Community Hospitals in Newbury, Henley,
Wokingham and Prospect Park, Reading. There is Residential Care rehabilitation at
Tanfields in Reading and Walnut Close (WILC) in Newbury area. Mental Health Services
are provided by a newly formed Trust managing both acute psychiatric and community
mental health.
MEDICINE AT ROYAL BERKSHIRE FOUNDATION NHS TRUST
The Gastroenterologists: Dr Margaret Myszor, Dr Jonathan Booth and Dr Jon Simmons (also
Nutrition Team), Dr Nisch Chandra, Dr Alex Evans and Dr Caroline Green who have their own
rota for Gastroenterology emergencies and also participate in the General Medicine take.
There are two Endocrine Specialists: Dr Hugh Simpson and Dr Mogah El Sheikh, based in the
Diabetes Centre, who also have General Medicine commitments.
The Respiratory team: Dr Chris Davies, Dr Andy Zurek, Dr Ann McGowan and Dr Grace
Robinson, Dr John Park, also participate in General Medicine take
The Rheumatologists who also do General Medicine, include Dr Jeremy McNally,
Professor Anthony Bradlow, Dr Antoni Chan, Dr Gordon Mac Donald
The Elderly Care Medicine department comprises Professor Margot Gosney, Professor
David Oliver and 5 whole time NHS Consultants – Dr Apurba Chatterjee, Dr André van
Wyk, Dr Mike Pearson , Dr Hannah King and Dr Janet Lippett (CD) and 3 Community
Geriatricians Dr Sarah Logan, Dr Shashi Gadgil and Dr Yetunde Sote and there are 3
Specialist Registrars.
Stroke Trainee (Oxford/Reading)
19
The Stroke Unit is consultant-led with Dr André van Wyk and Neurologists:, Dr Andrew
Weir, Dr Marco Bogdanovic, Dr Richard Armstrong and Dr Enrico Flossmann Dr Saleem
Khan Associate Specialist with support from the Neurology SpR input .
Neurorehabilitation , Dr Hamid Sultan, Dr Faraz Jeddi and Associate Specialist Dr Peter
Tun
The Cardiology firm: Dr Nicos Spyrou, Dr Will Orr, Dr Charlie McKenna, Dr Jon Swinburn,
Dr Andrew Elkington and Dr Bhavesh Sachdev, and Dr Karen Luxton Associate Specialist.
The Cardiologists have no general medical commitments, cover all cardiac emergencies
and provide a Cardiologist-of-the-day service to acute medicine. Follow up of acute cardiac
problems is by the cardiac firm. There is also on site angiography, pacemaker insertion and
facilities for angioplasty and electro-physiological studies.
The Renal Medicine department provides a comprehensive renal service: Dr Lindsey
Barker, Dr Emma Vaux and Dr Mobin Mohteshamzadeh; Dr Nitin Bhandari and Dr Oliver
Flossmann they also have General Medicine commitments.
All acute general medical admissions are via the Clinical Decisions Unit. The acute
General Medical Physicians participate in a 1 in 16 weekday and a 1 in 16 weekend rota
acting as Physician of the Day. All conflicting commitments on this day [Clinics etc] are
cancelled and the Physician is expected to see each patient admitted together with a team
of junior doctors in order to plan treatment, discharge, or admission to a three-day short
stay ward, or to a specialist ward.
The Physician is expected to do morning, lunchtime and evening ward rounds, also training
junior medical staff. The Elderly Care Medicine Physicians provide a parallel rota to deal
with acute geriatric admissions taking in all needs related to admissions over the age of 65.
The majority of admissions are medical emergencies direct from General Practitioners;
some are admitted from A&E. All go through the Clinical Decision Unit. A four-bedded
Higher Monitoring Unit is part of the Clinical Decisions Unit.
Stroke Trainee (Oxford/Reading)
20
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 52-hours 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/Pages/EW
TD.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/PayCircularsMedicaland
Dental.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/PayCircularsMedicaland
Dental.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 205-206 of the TCS. The
TCS may be viewed at
http://www.nhsemployers.org/PayAndContracts/MedicalandDentalContracts/JuniorDoctorsDentis
tsGPReg/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 250254 of the TCS. Local policy and procedure will be explained at induction.
Stroke Trainee (Oxford/Reading)
21
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/JuniorDoctorsDentis
tsGPReg/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/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.
April 2014
Stroke Trainee (Oxford/Reading)
22