UNIVERSITY OF OXFORD / OXFORD DEANERY
Department of Public Health
Further particulars for the post of
NIHR Academic Clinical Fellow in Public Health
Job title - Academic Clinical Fellow ST1
Duration of post - Three years
This job description covers both the ACF in Public Health and
ACF Public Health (Blood and Transplant Medicine) posts
Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to
University/NHS Trust/Deanery partnerships nationally through competition. Oxford has
been very successful attracting 79 ACF and 30 Clinical Lecturer posts to date. 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.
The Department of Public Health is part of a wider group of academic units focused on
population and public health sciences and based together in Old Road Campus. The
University Department of Public Health provides an excellent environment of multidisciplinary research and teaching. It includes a number of distinguished groups and
units. Members of the department play a diverse range of roles regionally, nationally
and internationally in public health. The department is successful in nurturing and
developing several trainees in PH and junior research fellows to achieve academic
careers. In recent years, trainees and junior research fellows from the department of
Public Health have gone on to take up MRC HSR fellowships, Wellcome Fellowships,
DH scientist awards, established academic posts in Oxford and senior lectureships in
public health medicine in other universities.
The Academic Clinical Fellowship programme is expected to expand and strengthen
academic training in Public Health. The fellowship enables the Public Health training
scheme to provide academic training and support to appropriate candidates to enable
them prepare for a career in academic Public Health.
The ACF will be supported in preparing applications to continue their research either for
Research Training Fellowships or Post-doctoral funding if they already hold a PhD.
Support and mentorship will be provided to pursue an academic career for successful
candidates, in order to secure University Lectureships, Intermediate post-doctoral
fellowships and clinician scientist awards. In the event that academic career progression
is unsuccessful and clinical competences are met, the ACF will continue in the
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advertised specialty clinical training programme in accordance with the NIHR Academic
Clinical Fellowships: Entry, Eligibility and Exit points for Appointments made in 2012.
Two posts are available:
1. One post is part of a fully-funded NIHR Research Professorship programme
awarded to Prof Marian Knight at the NPEU. The research will take place at the
National Perinatal Epidemiology Unit at the Department of Public Health,
University of Oxford.
The NPEU is an internationally recognised, multi-disciplinary research unit based
at the University of Oxford, Old Road Campus in Headington, Oxford. The Unit
undertakes research about pregnancy, childbirth and newborn babies. For more
information please visit: http://www.npeu.ox.ac.uk/
2. A second post (in conjunction with one of the NHS Blood & Transplant research
groups which are part of the Nuffield Department of Laboratory and Clinical
Sciences (http://www.ndcls.ox.ac.uk/research.php Department of Transfusion
Medicine at Oxford) and the National Perinatal Epidemiology Unit.
This post provides a unique opportunity to enable the candidate develop a
special interest in translational research relevant to both population health and to
Transfusion or Transplant Medicine.
Selection Criteria
The Academic Clinical Fellowship Programmes will offer training to new entrants to
specialist public health training who can demonstrate that they have outstanding
potential for development as a clinical academic in research and/or education. Training
will be flexible and trainee-centred, as far as possible, with mentoring to ensure the
attainment of both academic and clinical goals. The specialty trainee selected for the
Fellowship Programme will be awarded an NTN(a) at the start of the Programme.
Training objectives
The main objectives of the programme will be to provide:

an entry point for doctors aspiring to a research based career in Public
Health as well as provide training in Public Health competencies leading to a
CCT

Academic training and support to enable entry into appropriate public health
research posts.
Structure of the training programme
The first stage of generic specialty training in public health (two years) requires
acquisition of core service skills. In the first two years of training the trainee would
complete their requirements of one year in ‘service’ Public Health and three months in
Health Protection. Service training would be provided at appropriate placements in the
Thames Valley. The next stage would focus on intensive academic training including the
selection of appropriate research projects and developing teaching.
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Rotation Information
Training in Public Health is available in service placements, Health Protection Unit and
public health academic departments at Oxford University. Those appointed will be
expected to move training locations within the Thames Valley (Oxfordshire,
Buckinghamshire and Berkshire) during their training,
Placement Information
The ACF will be based with public health teams in the counties of Buckinghamshire,
Berkshire, and Oxfordshire.
Overview of the Public Health Training component
Public Health training is competency-based, with trainees required to demonstrate the
acquisition of a range of public health skills and knowledge. Most training is achieved
through practical experience undertaken at a variety of attachments. All training
placements are arranged via the Training Programme Director to ensure that they are
appropriate to the learning needs of the trainee.
On offer of appointment a trainee will be allocated to a service placement within the
Oxford Deanery, under the supervision of an approved trainer. Usually the training
location will have other trainees on attachment, which serves to provide a good support
structure for programme entrants. Trainees will spend a minimum period of one year
(whole time equivalent) in this placement. Initially the trainee will be expected to
undertake the MSc in Global Health Sciences at Oxford University.
Training in Health Protection
Experience in communicable disease and non-communicable disease hazards is an
essential (and integral) part of public health training. The Thames Valley Health
Protection Unit, in conjunction with the Training Programme Director has developed a
policy for Health Protection training in line with Faculty guidelines. Placement in the
Health Protection Unit will be for a mandatory period of three months. The Health
Protection Unit currently hosts monthly meetings for public health trainees, which
includes a journal club and discussion of current health protection issues.
Health protection on-call
All trainees are expected to participate in the Thames Valley health protection on-call
rota, when appropriate. There is currently national agreement that trainees will only be
allowed to go on the on-call rota after they have completed the Part A exam and have
been signed off as competent to be on-call by the supervising Consultant in Health
Protection.
At the current time, the on-call rota operates on an approximately 1 in 9 basis.
The ACF will be expected to complete the MFPH exams at the end of 24 months and
the ‘service’ and health protection competencies at the end of 36 months. If appropriate
the ACF will be able to undertake the MSC in Global Health Sciences at the University
of Oxford. It is envisaged that by the end of the post the registrar will be successful in
obtaining a research fellowship and pursue a DPhil. Regular appraisals will be
undertaken to monitor progress towards this goal and appropriate interventions will be
initiated to ensure relevant career progression towards a CCT in Public Health.
Overview of the research component
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The trainee will be placed in a research unit to gain sufficient experience for appropriate
development of a research interest and planning of grant applications for a higher
degree. Protected research time will usually be allocated part-time (weekly) at the start
during the mandatory ‘clinical’ time and then in blocks in order to ensure that the ACF
has continuous time in the academic department. This would allow time for informed
selection of a research area and project towards a higher degree and be optimal for
preparing to make external Fellowship applications.
Opportunities for research available to the ACF for the post based at the NPEU
National Perinatal Epidemiology Unit (NPEU)
The NPEU is an internationally recognised, multi-disciplinary research unit based at the
University of Oxford, Old Road Campus in Headington, Oxford. The Unit undertakes
research about pregnancy, childbirth and newborn babies. This is reflected in the
backgrounds of the people working in the Unit (obstetrics, midwifery, paediatrics,
epidemiology, social science, economics, statistics, programming, plus administrative
and clerical staff). Funding is provided by grants from a variety of sources including the
Department of Health Policy Research Programme, the National Institute for Health
Research (NIHR), other funding agencies and medical research charities.
For more information please visit: http://www.npeu.ox.ac.uk/
The post is associated with a fully-funded NIHR Research Professorship programme
awarded to Prof Marian Knight at the NPEU. The research undertaken will be
supervised by Professor Knight and it is a requirement of one of the posts that the
research undertaken by the ACF is linked to her fields of interest. The range of projects
led by Professor Knight, within which the fellowship could be based, are identified
below, and focuses principally on severe complications of pregnancy and early life. In
the first year of the three year Academic Fellowship the ACF is expected to be involved
in teaching and explore the range of research opportunities and projects offered. This
would allow time for informed selection of a research area and projects which would
contribute towards an application for a higher degree.
UKOSS
Rare disorders are paradoxically an important cause of morbidity and mortality in
pregnancy. Although they are individually uncommon, together they affect thousands of
women, and many result in severe sequelae for the mother and/or the infant. To
accumulate sufficient numbers of cases to investigate risk factors for a particular
condition or to determine the outcome of pregnancy for women with the disorder would
require an extensive collaboration to achieve a relatively small study. As a consequence
these conditions are under-researched, our understanding of them is poor and any
interventions used in current clinical practice are rarely based on robust evidence.
The UK Obstetric Surveillance System (UKOSS) is a national collaboration of over 700
midwives, obstetricians and anaesthetists in all maternity units in the UK, set up to
identify cases of uncommon obstetric disorders, and thus enable a rolling programme of
parallel epidemiological surveillance.
Active data collection is undertaken by a monthly mailing of a report card to the Clinical
Director, Head of Midwifery and Clinical Risk Manager for Obstetrics (individualised for
each centre) in each hospital with a consultant-led maternity unit. The system can be
used to conduct descriptive, case-control and cohort studies and the information
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generated is used to develop policy and guidelines for prevention and treatment of
these uncommon conditions.
Further detail of the UKOSS system is available on the UKOSS website
www.npeu.ox.ac.uk/ukoss.
BAPS-CASS
The British Association of Paediatric Surgeons Congenital Anomalies Surveillance
System (BAPS-CASS) is a joint research initiative between BAPS and the NPEU.
BAPS-CASS uses similar methods to those developed for UKOSS and is designed to
conduct anonymised descriptive studies of the surgical management of a range of rare
congenital anomalies.
Similar to UKOSS, BAPS-CASS uses a monthly mailing card which contains a list of
conditions currently under surveillance to be sent one single nominated coordinating
clinician (Paediatric Surgeon) in each paediatric surgical unit in the UK.
Further detail of the BAPS-CASS system is available on the BAPS-CASS website
www.npeu.ox.ac.uk/baps-cass
UKNeS: The NIHR UK Maternal Near-miss Surveillance Programme
A comprehensive programme of study of maternal deaths has been undertaken in the
UK for more than 50 years. It is now recognised that in countries such as the UK,
where maternal deaths are rare, study of near-miss severe maternal morbidity (defined
as a “severe life-threatening obstetric complication necessitating urgent medical
intervention in order to prevent likely death of the mother”) provides additional important
information to aid disease prevention, treatment and service provision. The NIHR has
awarded funding to a collaborative group of co-investigators from UK universities,
professional and lay organisations, led by Prof Marian Knight, to carry out the NIHR
Maternal Near-miss Surveillance Programme, an integrated programme of research
studies on near-miss maternal morbidity.
UKNeS comprises six inter-related workstreams:
Workstream 1 will employ primary data collection to conduct descriptive and casecontrol studies to establish the incidence, risk factors, management and outcomes of
uterine rupture, placenta accreta, HELLP syndrome, septicaemic shock and amniotic
fluid embolism.
Workstream 2 will use logistic regression analysis of previously collected maternal
deaths data and near-miss morbidity data to investigate factors associated with case
fatality in women with AFLP, AFE, antenatal pulmonary embolism, antenatal stroke and
eclampsia.
Workstream 3 will investigate inequalities in rates of near-miss maternal morbidity in
three groups: women from routine and manual socio-economic groups, ethnic minority
women and older women through both primary cohort studies and secondary data
analysis.
Workstream 4 will explore methods to improve local learning from adverse events
through comparing an expert panel/confidential enquiry approach with root cause
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analysis to examine individual cases of near-miss maternal morbidity at the hospital
level and to identify instances of substandard care.
Workstream 5 will develop economic evaluation methods using information from the
other workstreams, published observational and other data to investigate the costeffectiveness of different managements for near-miss maternal morbidities, focussing
initially on peripartum haemorrhage.
Workstream 6 will explore women’s experiences of near-miss maternal morbidity and
long term outcomes through a qualitative interview study of women experiencing nearmiss maternal morbidity and a cross sectional survey of women who have had a
peripartum hysterectomy for severe haemorrhage.
Further detail on the NIHR Severe Maternal Morbidity (Maternal Near-miss Surveillance
Programme is available on the UKNeS website https://www.npeu.ox.ac.uk/uknes.
MBRRACE-UK
Despite a well-developed health care system in the UK, almost one in every 100 births
in the UK results in a stillbirth or death in the early weeks after birth, and up to 100
women die each year during or shortly after pregnancy. The world-renowned UK
Confidential Enquiry programme has led to huge improvements in the health and care
of women and their babies over its almost 60 year history, but there remain instances of
poor care to be addressed. This new programme continues and expands work
investigating deaths to include women and their babies who are severely ill but survive,
thus helping to identify ways in which we can prevent both illness and deaths in the
future.
This new work includes:



Expanding the Confidential Enquiries into Maternal Deaths to include ‘near-miss’
maternal morbidity
Undertaking Confidential Enquiries into specific causes of stillbirth, neonatal and
infant death and morbidity
Developing a National Childbirth Audit to monitor trends in maternal, stillbirth,
neonatal and infant mortality and morbidity
MBRRACE-UK is led by a team of clinicians, epidemiologists, statisticians, social
scientists and members of the public from the National Perinatal Epidemiology Unit,
University of Oxford, the University of Leicester, Sands the stillbirth and neonatal death
charity, The University of Liverpool, the University of Birmingham, University College
London, Imperial College London, and general practice. The administrative team is
based in the National Perinatal Epidemiology Unit, University of Oxford. Prof Knight
leads the MBRRACE-UK maternal programme.
Opportunities for research available to the ACF for the post in conjunction with
Transfusion medicine
The ACF will be placed in a research unit undertaking research related to population
health and transfusion/transplant medicine to gain sufficient experience for appropriate
development of a research interest and planning of grant applications for a higher
degree. There are excellent research facilities in Transfusion Medicine in Oxford. There
are 2 clinical research groups (see below) based in NHS Blood & Transplant and which
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are part of the Nuffield Department of Laboratory and Clinical Sciences
(http://www.ndcls.ox.ac.uk/research.php). It is anticipated that the ACF will work with
one of these research groups and Professor Knight (see below).
Projects available include:
1. Professor Marian Knight (National Perinatal Epidemiology Unit, Department of
Public Health) and Professor Mike Murphy:
Professor Knight’s work focuses on complications of pregnancy and early life, and in
collaboration with Prof Murphy, there are a number of potential research projects
available linked to Transfusion Medicine which would allow the development of research
skills in academic public health within this ACF post. The skills developed would
include: analysis of routine data, data linkage, development, conduct and analysis of
cohort, case-control and interventional studies, economic evaluation and assessment of
screening programmes. Examples of projects include:
a. Antenatal screening for fetal neonatal alloimmune thrombocytopenia (FNAIT).
The National Screening Committee has recently reviewed this topic and has
identified a number of research questions which need addressing before a
decision to implement screening can be made. Areas for research include
development and implementation of a randomised controlled trial of screening,
economic evaluation of such a trial and longer term follow-up of affected infants.
b. Work to link data on women with renal and other transplants who have
undergone pregnancy (data collected through the UK Obstetric Surveillance
System (UKOSS), see www.npeu.ox.ac.uk/ukoss) with existing transplant
registries to allow assessment of the long-term impact on graft function.
c. Further work relating to the surveillance and management of severe postpartum
haemorrhage. A number of studies (peripartum hysterectomy, second line
therapies for peripartum haemorrhage, massive transfusion in obstetric
haemorrhage) have been undertaken or are ongoing through the UKOSS, and
there is the possibility of further observational and/or interventional studies if this
is an area of interest of the successful candidate. In addition, work to develop a
suitable means of surveillance of postpartum haemorrhage (PPH) using routine
data would be valuable, as current studies suggest that the rate of PPH is
increasing, although the causes remain unclear.
2. Professor Murphy & Dr Stanworth: clinical research (systematic reviews,
clinical trials) to develop safe and effective transfusion practice.
The primary objective of the group is to strengthen the evidence base for the
effective and safe practice of transfusion medicine. The need to achieve this
objective was highlighted in successive ‘Better Blood Transfusion’ Health Service
Circulars and from 2000 a supporting infrastructure for clinical research has been
established to meet this objective, including a Systematic Reviews Initiative (SRI)
supported by the UK Cochrane Centre, a Clinical Studies Unit (supported by the
MRC Clinical Trials Unit), and linkage to the National Comparative Audit of Blood
Transfusion programme (supported by the Royal College of Physicians Clinical
Evaluation and Effectiveness Unit). The group has support from the Oxford
Haemophilia Centre for novel laboratory studies of haemostasis. How blood
transfusions are used are often linked to issues of public health importance, for
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example, inappropriate use of red cell transfusions to manage anaemia in
pregnancy.
Specific activities include:1) Further developments of the electronic blood transfusion management system which
was designed in 2001 and fully implemented throughout the OUH in 2006. It facilitates
safer practice, saves time and reduces costs. It was one of the first 6 recommended
interventions for NHS Trusts as part of the NHS Quality, Innovation Productivity and
Prevention (QIPP) programme, and has won many national awards, including the
Health Service Journal Award for Improving Care with Technology and UK IT Industry
Awards for Public Sector Project of the Year in 2009. We have recently demonstrated
the benefit of the system for active monitoring of transfusion practice and driving better
practice.
Developments being explored include:
 A ‘decision support’ module to provide guidance to clinicians ordering blood to
promote adherence to guidelines for the appropriate use of blood and further
reduce costs
 A ‘data mining’ tool to provide clinical teams with regular comparative data on
their blood usage,
 The inclusion of information of intra-operative cell salvage and near-patient
haemostasis testing to increase the effectiveness of blood conservation
activities, and
 Linkage with other clinical IT developments in Oxford such as active patient
monitoring and medicines management.
2) Clinical studies and systematic reviews. Investigation of the use of blood transfusions
in critically ill patients for example in trauma, critical care, and cardiac by-pass surgery.
A number of clinical studies and trials in patients who are bleeding or at risk of major
bleeding will be completed or started in the next 3 years: A multicentre randomised controlled trial of restrictive v. liberal red cell
transfusions in acute upper gastro-intestinal bleeding will start in 2012.
 A UK wide study of outcomes in trauma patients receiving multiple transfusions is
ongoing.
 A multicentre international randomised controlled trial to study whether patients
receiving "fresh" blood up under 7 days storage age do better compared to those
given standard aged blood is just beginning.
 Two new study proposals will investigate products designed to improve blood
clotting and which might reduce FFP usage. These are an evaluation of
fibrinogen concentrate in bleeding trauma patients, and a study to investigate
whether a commercially available clotting factor concentrate can safely reduce
bleeding in patients undergoing cardiac by-pass surgery.
 Further trials of anti-fibrinolytics in patients with acute haemorrhage are being
planned.
In many of the group’s clinical studies, an economic cost evaluation is included,
because it is important to know whether the study or the methods used to improve the
quality of care, actually represent good value for money. We have an established link
with the University of Oxford Health Economics department.
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3) Implementation research, to address the gap between research and practice An
NIHR Programme Grant for Applied Research has recently been awarded to undertake
a 5 year programme of clinical research into developing and testing enhanced methods
to deliver ‘Audit and Feedback’ across the NHS, with a focus on blood transfusion. This
will include a national cluster randomised trial.
3. Professor Roberts:
A cutting-edge donor health research study is underway to determine whether donors
can safely donate blood more frequently than the current guidelines. 50,000 donors
(approximately half men and half women) will be recruited to a two-year study. Men will
be allocated, at random, to donate at , 10 or 12 weeks and women to 12, 14 or 16
weeks. We will be inviting whole blood donors from the 25 NHSBT donor centres to join
the study, who will then donate at these intervals for a period of two years. One aim is to
see whether we can tailor donation intervals to individual donors, depending on diet and
genetic tendency to anaemia.
Academic supervisors and projects
The ACF is assigned a mentor (one of Division’s senior academic clinicians) and an
academic supervisor and ‘service’ trainer.
Overall coordination and management of the programme is provided by a senior
management group for public health comprising the following:
 Professor Ray Fitzpatrick (RF), Professor of Public Health and Primary Care and
Director NHS R&D Academic Unit, Oxford
 Professor Marian Knight
 Dr Premila Webster (PW), Training Programme Director and Head of PH School.
 Dr Adrian Smith, Director of Undergraduate Medical Education
Mentorship, Milestones, and Competence
Post holders will undergo an ARCP assessment on an annual basis to assess the
quality of their training. Quality assurance arrangements as outlined in the training
policy for PH registrars will be implemented. The post will attract an NTN (a).
For further details of the training programme in PH please visit the Oxford Deanery
School of Public Health website http://phoxd.org.uk/
For further information contact Dr Premila Webster 01865-289249 or Prof Marian Knight
01865-289727
(marian.knight@npeu.ox.ac.uk
or
Professor
Mike
Murphy
(mike.murphy@nhsbt.nhs.uk).
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