OXFORD DEANERY SPECIALTY TRAINING PROGRAMME
IN HEPATOLOGY/TRANSPLANT
9 months Oxford/ 3 months Cambridge
General Information
The HEPATOLOGY Training Programme
The Hepatology Training programme is a shared post approved for subspecialty
accreditation in Hepatology by the JRCPTB and is appropriate for ST3+ post holders wishing
to specialise in Hepatology long term. The post will rotate with Oxford University Hospital
(John Radcliffe) to complete 1 year in Hepatology, starting with 3 months in Addenbrooke’s
followed by 9 months in Oxford. A broad variety of experience is available for applicants in
Liver Transplantation, Hepatology and Endoscopy as well as audit/research. This post will in
particular provide experience of inpatient and outpatient liver transplantation as well as the
assessment process. It is recognised that many people applying for this post will come from
different backgrounds and the approach at Addenbrooke’s and John Radcliffe Hospital is to
be as flexible as possible.
The post holder must already be in a gastroenterology specialist training programme and
this is a 1 year out of programme attachment consisting of:


3 months of liver transplant experience at Addenbrookes Hospital Cambridge
from September 2nd 2013 to December 1st 2013
9 month specialist hepatology experience at John Radcliffe Hospital,
Cambridge from December 2nd 2013 to August 31st 2014
This post is designed for bespoke training in advanced hepatology and will fulfil all
requirements for the “year 4 specialist hepatology” as outlined in the current
gastroenterology/hepatology curriculum needed for the award of CCT in hepatology.
However all trainees will need to spend at least another 12 months in recognised hepatology
placements in their rotation and complete all required competencies for the award of CCT.
Assessments
The trainee will undertake work-based assessments (including but not limited to case-based
discussion, DOPS, miniCEX to demonstrate the acquisition of competencies. Over the year
the trainee will complete a full multi-source feedback and all other work-based
assessments,to at least the minimal numbers as outlined in the appropriate curriculum
document.
Cambridge Transplant 3 months
ADDENBROOKE'S HOSPITAL, PART OF CAMBRIDGE UNIVERSITY
HOSPITALS NHS FOUNDATION TRUST
Appointment of:
Start date:
Transplant Clinical Fellow
(Oxford/Cambridge)
2nd September – 1st December 2013
General Information
Addenbrooke’s Hospital, part of Cambridge University Hospitals NHS Foundation
Trust
Addenbrooke’s Hospital
Addenbrooke’s is a thriving, modern NHS hospital based in Cambridge England, with more
than 7,000 members of staff, 1,110 beds and a budget of £353 million.
The hospital fulfils a number of important functions. It is the local hospital for people living in
the Cambridge area, it is a specialist centre for a regional, national and international
population, it is the teaching hospital for the University of Cambridge, and it is a world-class
centre for medical research.
Addenbrooke's is now a flagship NHS hospital having achieved NHS Foundation Trust
status in July 2004. It is also working in partnership with the University and other major
scientific and charitable organisations, and bidding to become The Cambridge Biomedical
Campus, an enhanced biomedical centre for research and scientific development.
The hospital already shares its site with a range of other organisations including the
University Clinical School, the National Blood Authority, and laboratories funded by the
Medical Research Council (MRC), the Wellcome Trust and Glaxo SmithKline. Building is
currently underway on the University of Cambridge Hutchison/Cancer Research UK (CRUK)
Cancer Centre, which will house 30 research groups using the latest techniques to target
cancer.
Addenbrooke's provides emergency, surgical and medical services, and is a centre of The
hospital has 24 operating theatres, five intensive care units, 14 clinics and 42 wards. Last
year 55,168 men, women and children were treated as inpatients, 59,208 people attended
accident and emergency, and there were 369,491 visits to outpatient clinics.
There is continuing significant growth in research of international excellence in cancer,
diabetes, heart disease, neurosciences and mental health. Two new cancer research
buildings are planned, which together will house more than 450 scientists in cell and
molecular biology, and a new centre will study the interaction between genes and
environment in the cause of cancer and how this might be applied to screening and
prevention. Addenbrooke's Clinical Research Centre was opened in 1999 and provides
dedicated facilities for clinical investigation
Description of the Department of Hepatology - Cambridge
Outpatients
There are weekly liver transplant follow up clinics and a waiting list clinic. Subspecialist
hepatology clinics include viral hepatitis, metabolic liver disease, tumours, autoimmune liver
diseaes, alcohol, fatty liver and cirrhosis. A number of outreach transplant follow up clinics
for regional hospitals are established.
Inpatient Care
The transplant ward averages 16 liver inpatients at present and is covered by a specialist
registrar in Hepatology, a group of CT level juniors who are training in medicine or surgery
and specialist registrars in surgery who rotate through the unit. The Liver Transplant Ward
also includes a High Dependency Unit with 4 beds dedicated to the care of patients with liver
disease, renal disease and those who have had kidney, liver or pancreas transplants. There
are close links with the Intensive Care Units where there are dedicated facilities for patients
with liver disease and liver transplantation. Inpatient care on the Liver Transplant Ward and
in Intensive Care is shared with the consultants in those specialties. Inpatient Hepatology
covers a broad range of patients with acute and chronic liver disease. The average inpatient
number at present is 22 and is covered on the ward by a specialist registrar and 3 CT level
juniors.
MDTs
Weekly MDTs include primary liver cancer (sMDT), pancreatobiliary malignancy (sMDT),
liver histology, liver radiology, transplant assessment, liver audit and clinical governance.
Endoscopy
There is a brand new Endoscopy Unit covering all aspects of gastrointestinal and hepatic
Endoscopy, ERCP and Endoscopic Ultrasound.
There is a very active educational programme aimed at specialist registrars. Any successful
applicants would be welcome to join such education, but it would be recognised that this
would not be regarded as essential.
There is also an active research and audit programme to which the successful candidate
would be expected to contribute.
Timetable
An example timetable is included below although this will be discussed with the applicant
and amended according to experience desired. Candidates must accept that there is a
certain service commitment involving primarily inpatient care (pre and post transplant) and
endoscopy. In addition the successful candidate would contribute to the specialist registrar
on-call rota on a 1 in 5 basis – this rota is for hepatology and liver transplant patients as well
as emergency endoscopy.
Example timetable for transplant clinical fellow
Monday
Tuesday
Wednesday
Thursday
Friday
Transplant OP
(not every
week)
CMT teaching
Endoscopy or
Cons W/R
(hep)
am
Transplant
OP
pm Business +
audit meeting
Audit/researc
h
Surgical W/R
SpR W/R
(undergrad
teaching)
Cons W/R
(hep)
Cons W/R
(transplant)
SpR W/R
Audit/research
Medical staff
round
Audit/research
Surgical W/R
Liver cancer
MDT
Transplant
assessments /
New Hep
Clinic
Surgical W/R
X-ray
meeting
Path meeting
Transplant
MDT
Cons W/R
(transplant)
Notes:
This is an advanced hepatology fellowship, and the development of endoscopic skills not the
predominant feature of the post. Separate advanced endoscopy fellowships are available for
this. Some exposure to advanced endoscopic techniques may be available following
discussion with the unit’s director of endoscopy training.
The post does not provide training in G(I)M or luminal gastroenterology.
There are also subspecialty hepatology clinics on Wed am, Thurs am and the new patient
liver clinic on Thurs pm if this exposure is required.
Oxford Hepatology 9 months
JOHN RADCLIFFE HOSPITAL, OXFORD UNIVERSITY HOPSITAL
NHS TRUST
Appointment of:
Start date:
Hepatology NTN
2nd December 2013- 31st August 2014
General Information
The Oxford University Hospitals (John Radcliffe and Churchill sites in Oxford and
Banbury site) is one of the largest teaching trusts in the country and has an
international reputation for the excellence of its services and its role in teaching and
research
It provides a district general hospital service for around 700,000 people in
Oxfordshire. The trusts specialist services serve a population of around 2,5 million in
Oxfordshire, Buckinghamshire, Berkshire, Wiltshire, Gloucestershire and
Northampton shire. Tertiary referral services include cardiology, neurosciences and
renal medicine
There is a renal, small bowel and pancreatic transplant service at the Churchill
Hospital
The OUH sees over half a million patients/year as an outpatients and around
100,000 elective and day case /year.
The trust has close links with the University of Oxford and Oxford Medical School.
Description of the Department of Hepatology - Oxford
Medical Staff of the gastroenterology/hepatology unit - consultants
Dr Collier
Dr Chapman
Dr Ellis
Dr Barnes
Dr Travis
Dr Keshav
Dr Braden
Dr East
Dr Bailey
Hepatology
Hepatology
Hepatology and Gastroenterology (Banbury)
Honorary Hepatology Consultant/ Welcome funded
Luminal gastroenterology/IBD
Luminal Gastroenterology /IBD
Endoscopy/Gastroenterology (ERCP/EUS)
Endoscopy/Bowel cancer screening
Upper GI Endoscopy (including ERCP)
Medical staff –others
Specialist registrars
ST1/ST2
FY1
4
4
1
Clinical Hepatology Nurses
2.5
Inpatients and Outpatients
The Hepatology is one of 4 specialist registrar posts at the John Radcliffe Hospital. The
inpatient service is divided into luminal and hepatobiliary. One of the gastroenterology
spSRs will work alongside this post holder in being responsible for the clinical care of
inpatients 18 bedded ward 5F with hepatobiliary disease and assessment hepatobiliary
referrals across the trust under the care of Dr Chapman and Collier.
About 600 new patients and 2500 follow ups are seen in the main liver clinic/year
Experience is available in a wide range of fhepatobiliary diseases in a busy unit. Dr
Chapmans specific interest is in primary sclerosing cholangitis and biliary disease. Dr
Collier’s interests are viral hepatitis, alcoholic liver disease and hepatocellular carcinoma
Although liver transplantation is not performed in the unit there are 6 joint liver transplant
clinics in Oxford/year with the Birmingham/ Cambridge transplant team. There are also joint
specialist liver clinic in cystic fibrosis, haemophilia and HIV/HCV.
Complex liver disease is seen through referrals from the other tertiary specialist units
including renal, cardiac and neurosciences
There is close collaboration between radiologists and liver pathologist and liver surgeons
with several multidisciplinary meetings weekly to discuss patient management.
The interventional radiologists perform transjugular liver biopsies, TIPSS and percutaenous
biliary interventions.
Attendance is required at a weekly journal club, lunchtime unit meeting, radiology and
pathology meetings
There is an opportunity to take part in clinical research during the attachment which is
encouraged.
Endoscopy
There is an opportunity to train in both EUS and ERCP. With 3 ERCPS and 2 EUS lists a
week including dedicated training lists There are 2 clinics a week (viral hepatitis and general
Hepatology). There is opportunity to take part in 3rd general Hepatology clinic and specialist
liver clinics in cystic fibrosis and HIV/HCV co-infection.
There is the opportunity to do regular therapeutic gastroscopy and the post holder takes part
in a 1 in 8 on call fro the unit including emergency gastroscopy. This gives opportunity to
learn oesophageal banding and management of gastric varices.
The post holder will also take part in a 1 in 28 SpR hospital at night team
Teaching
There is a weekly Thursday afternoon regional gastroenterology/Hepatology
teaching programme which includes formal teaching and clinical cases meeting.
There are also teaching lists in EUS (Dr Braden) and ERCP (Dr Bailey)
Timetable
Day
Morning
Afternoon
Monday
hepatitis Clinic
Cancer MDT
Admin
Tuesday
Ward work
Consultant ward round
Radiology meeting
Wednesday
Ward work
ERCP(training)
Thursday
EUS (training)
CME/teaching
Liver histology
Friday
Liver clinic
Ward work/ERCP
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.
January 2013
PERSON SPECIFICATION
Post: Hepatology/Transplant NTN
Department: Hepatology
ESSENTIAL CRITERIA
DESIRABLE CRITERIA
Education/Qualifications
MRCP or equivalent
Postgraduate degree
Completion of at least 3 years
clinical training as a
Gastroenterology SpR
Experience in Hepatology
Experience
Smooth Progression through
training grades
Skills/Ability/Knowledge
Broad General Medical
Knowledge.
At least 12 months clinical
training time remaining until
CCT date on date of taking
up the advanced hepatology
post
Experience of Supervising
other staff
Able to undertake practical
procedures.
Excellent time management.
Understanding of Clinical
Governance.
Qualities/Attributes
Works well in a team
Good communication
Good organisational skills
Enthusiastic and motivated
Ability to Perform under
stress
GMC Full Registration
Other Requirements
Confirmation from respective
Training Programme Director
that trainee may take up the
post and that the trainee’s
progression and experience
are appropriate to achieve
core curriculum and/or PYA
requirement competencies by
planned CCT date
Personal involvement in
audit.
Publication of a short report
or completion of a research
project.