ALL WALES HIGHER TRAINING PROGRAMME
SOUTH WALES TRAINING PROGRAMME
1.
SPECIALIST REGISTRAR IN PALLIATIVE MEDICINE.
2.
SpR/StR ROTATIONAL POST IN SOUTH WALES BETWEEN
Holme Tower Marie Curie Hospice, Penarth
Velindre Hospital, Cardiff (2 posts)
University Hospital of Wales, Cardiff
Llandough Hospital, Penarth
Y Bwthyn Newydd, Princess of Wales Hospital, Bridgend
Ty Olwen, Morriston Hospital, Swansea (3 posts)
Royal Gwent Hospital Newport
SE Cardiff and Vale of Glamorgan Community SPC Team based at Marie Curie Hospice, Penarth
3A.
THE WORK OF THE DEPARTMENT(S) IN SOUTH WALES
3A.1
Specialist Registrar in Palliative Medicine.
This post provides a comprehensive training for those wishing to pursue a career to Consultant level in
Palliative Medicine and covers all the experience required to reach a CCT with experience in all health care
settings. All trainees will rotate every 8 months between some of the following locations to obtain the
required range of experience.
In-patient specialist palliative care experience is gained in Holme Tower Marie Curie Hospice, Ty Olwen
Palliative care unit and Y Bythyn Newydd Bridgend. The rotation also includes experience at the Regional
Oncology Centre at Velindre Hospital and with the hospital palliative care teams at the University Hospital of
Wales. Hospital, Royal Gwent Hospital Newport and Morriston and Singleton Hospitals Swansea. Community
experience is gained at Ty Olwen or In Cardiff and Vale in a joint post between between the SE Cardiff and
Vale of Glamorgan Community SPC Team based at Marie Curie Hospice, Penarth and George Thomas Trust.
3.2
Medical Staffing is as follows:-
Holme Tower Marie Curie Hospice
Two Consultants
One
One
One
One
One
One
Dr. Anthony Byrne (Medical Director) until Feb 2010
Dr Jo Hayes
2 other locum consultants (6 sessions) from Jan 2010
ST for inpatient unit)
ST (community team )
ST (for hospital team)
ST2
ST1
FY1
Velindre Hospital
Two Consultants in Palliative Medicine
Professor Ilora Finlay
Dr Nicki Pease
Two ST posts
One Macmillan Nurse (WTE)
Nineteen Consultant Clinical Oncologists and thirteen Specialist registrars
Cardiff & Vale NHS Trust Including University Hospital of Wales & Llandough Hospitals
Two Consultants in Palliative Medicine
Three Macmillan Nurses
Dr. Melanie Jefferson (UHW)
Dr Anthony Byrne (Llandough) from Feb 2010
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Y Bwthyn Newydd, Princess of Wales Hospital
Three Consultants in Palliative Medicine
Dr Pola Grzybowska
Dr Fiona Rawlinson
3rd consultant to be appointed
One SHO shared with rheumatology
One FP2
One FY1
Ty Olwen, Morriston Hospital
Two Consultants in Palliative Medicine
One Senior Lecturer/Consultant in
Palliative Medicine
Four Staff Grades
One FP2
Dr Idris Baker (Lead clinician)
Post to be filled
Dr. Helen Taylor
Royal Gwent Hospital
Senior Lecturer/Consultant in Palliative Medicine
One ST
3A.3
Dr Simon Noble
Duties of the post.
The programme is designed to rotate between at least six of the posts and also to provide experience in a
wide range of specialties that inter-relate and impinge on palliative medicine. The list of rotational
opportunities listed later is not exclusive and other opportunities can be arranged as required. The full range
of medical specialties is well represented through the hospitals in Newport, Swansea and Cardiff and full
research and teaching facilities through the Cardiff University.
It is envisaged that the successful applicant will take the opportunity to experience other specialties and the
timetable is flexible to allow for this. The current timetable for each unit is as below.
Holme Tower Marie Curie Hospice
Monday
Team Meeting
Consultant Ward
Round
Tuesday
Study period
Wednesday
Ward work and
Day Centre
MDT Meeting
Ward review
Best Practice
Seminars
(monthly)
Teaching/Audit
Ward work
Domicilary visits
Thursday
Consultant ward
round
Undergraduate
teaching
MDT meeting
Undergraduate
teaching
Friday
Community MDT
meeting
SpR teaching
Ward
Work
Domicilary visits
It is expected that the Specialist Registrar will see day patients as appropriate.
Cardiff and Vale Community post based with George Thomas Hospice Care and Marie Curie
Hospice, Penarth
Monday
George Thomas
Hospice Care
(GTHC)
Multidisciplinary
Team Meeting
GTHC
Domiciliary
Visits GTHC
Tuesday
GTHC
Wednesday
Marie Curie
Community Team
Domiciliary Visits
Marie Curie
Community Team
Multidisciplinary
Clinical Meeting
Marie Curie
Community Team
Domiciliary Visits
2
Thursday
Marie Curie
Community Team
Medical Student
Teaching or
Community Team
Teaching
Marie Curie
Community Team
Medical Student
Teaching or
Community Team
Teaching
Friday
SpR Teaching or
Personal Study
Time
GTHC
Velindre Hospital
SpR Post 1
Monday
MDM – Active
Support
Unit(ASU) &
Consultant
Review
Tuesday
Ward review
Velindre
Or
Oncology Clinic
Velindre
Wednesday
Consultant Ward
Round ASU
Thursday
Evidence Based
Meeting monthly
with UHW Team
Clinic patient
review
Friday
MDM ASU
Ward work
Monthly SpR
Meeting
Ward work
Ward review
1pm Team
Meeting
Pall Med/ Chronic
Pain Clinic or
Alternate weeks
Clinical Audit
Study Afternoon
Ward work –
Velindre
Wednesday
MDM- First Floor
Thursday
Evidence Based
Meeting monthly
with UHW team
Clinic and ward
patient review BJ
Friday
Ward work
Monthly SpR
Meeting
(MDM = Multi-disciplinary team Meeting)
SpR Post 2
Monday
First Floor
Ward Round
Alternate Weeks
Community
Liaison Meeting
George Thomas
Trust (GTT)
Tuesday
Domiciliary Visits
with George
Thomas Trust
(GTT)
Or Ward Review
Study Afternoon
Oncology Clinic
Royal Gwent with
Dr Chris Gaffney
1pm Team
Meeting
Pall Med/ Chronic
Pain Clinic or
Alternate weeks
Clinical Audit
Every 6thweek
Undergraduate
Teaching
Holme Tower all
day
Oncology Clinic
Royal Gwent
Dr Alison
Brewster
Ward Review
University Hospital of Wales
Monday
Ward review
Tuesday
Ward work/ Head
and Neck Cancer
MDT
Palliative Medicine
MDT
Ward review
Monthly MND
Clinic
Consultant ward
round
Wednesday
8.00 a.m.
Colorectal cancer
MDT
Hospital Grand
Round
Study afternoon
Thursday
Ward review
Friday
SpR Teaching
monthly
Ward Review
Ward review
Opportunity will also be given for placement in Llandough Hospital during this part of the
rotation according to training needs
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Y Bwthyn Newydd, Princess of Wales Hospital, Bridgend
Monday
Ward work (PM)
Discharge
meeting (Audit)
Staff Support
meeting
Tuesday
MDT Planning
meeting
Uro/Oncology
Meeting
Postgrad meeting
Research
Wednesday
Ward consultations
or Day Care
Thursday
Ward work (PM)
Friday
PM – OPD
Colorectal/Oncology
meeting
Teaching
(monthly)
Multidisciplinary
Educational
meeting
Clinical meeting
(G(I)M)
Ward consultants
Ward work
Domiciliaries
Domiciliaries
Tŷ Olwen, Swansea NHS Trust
Post 1: Inpatient unit based at Morriston Hospital
Monday
am
pm
Tuesday
Wednesday
Thursday
PM
PM
PM
PM
0900-0930 Ward
meeting
Ward work
0900-0930 Ward
meeting
0900-1300
11-1200 alt wks
Neuro-oncology MDT
12-1300 monthly
Service audit
progress meeting
PM
1030-1200
Ward work
Consultant ward
round
4th Fri – Swales
SpR education
meeting
PM
MDT meeting
Ward work
PM
PM
PM
1300
1230-1400 Medical
team education/audit
1300-1400 Grand
Round
Registrar Teaching
(consultant) monthly
Audit/teaching prep
etc
Ward work and
Consultant ward
round
Ward work
Friday
PM
Ward work
Monthly Service
Audit afternoon
Post 2: Hospital Palliative Care Team[HPCT]( Singleton plus Morriston Hospital but based at
Singleton Hospital
Monday
Tuesday
Wednesday
Thursday
am
pm
Friday
PM
PM
PM
PM
PM
Ward work
2nd Monday: HPCT
medical staff
teaching (CON)
08-0900 GIT MDT
0830-0930 Colorectal
MDT
0900-1200
Ward work
0945-1200
Consultant HPCT
round (Singleton)
Ward work
PM
PM
PM
PM
PM
Ward work
13-1400 Oncology
Seminar
1230-1400 Medical
team education/audit
1330-1430 Head
and Neck MDT
Ward work
Teaching and audit
preparation
Ward work
Monthly Service
Audit afternoon
09-0945 Oncology
Ward round
Consultant HPCT
Ward round
Ward work
4
4th Fri – Swales
SpR education
meeting
Post 3 : Community Palliative care Team [CPCT] based at Ty Olwen, Morriston Hospital
Monday
am
Wednesday
Thursday
Friday
PM
PM
PM
PM
0900 Team Meeting
0900 Team Meeting
0900 Team Meeting
0900 Team Meeting
0900 Team
Meeting
Community
team/visits
pm
Tuesday
PM
CPCT education
meeting
Community
team/visits
PM
PM
13-1400 Lung Cancer
MDT
Audit/ teaching prep
etc
4th Fri – Swales
SpR education
meeting
PM
PM
1230-1400 Medical
team education/audit
13-1400 Grand
Round
Monthly Service
Audit afternoon
Community
team/visits
PM
Community
team/visits
Community
team/visits
Royal Gwent Hospital
Monday
Team Meeting
Ward work
Tuesday
Hot review
Ward work
Wednesday
Team education
(Monthly)
Case reviews
Thursday
Lung cancer
clinic
Ward review
Teaching/Audit
Study period
GI cancer clinic
Ward work
Lung MDT
Friday
Ward work
SpR teaching
Ward
Work
HOLME TOWER MARIE CURIE Hospice is a 30-bedded Hospice and Palliative Care Unit with over 500
admissions a year of whom over 50% are discharged to home. The average length of stay is 13 days and
full diagnostic services are available at nearby Llandough Hospital. There is an active Day Care Unit where
alternative therapies such as hypnotherapy and reflexology are available. Minor treatments including blood
transfusions and paracentesis are undertaken on a day care basis.
There are four Marie Curie community nurses working from Holme Tower and there is close liaison with both
a home care team run by the George Thomas Trust and with Tenovus Cancer Information Centre to prevent
duplication of service.
There are two outpatient clinics one at Llandough Hospital (2 miles away) and the other at Velindre Hospital,
the cancer centre. There is a bereavement service for relatives of patients known to Holme Tower.
VELINDRE HOSPITAL is the regional cancer centre for South East Wales. At Velindre Hospital palliative
medicine advice is provided by Professor and a Consultant, two Specialist Registrars in Palliative Medicine
and a Macmillan nurse .The team sees in the region of 800 referrals a year. Velindre Hospital undertakes all
clinical oncology for South East Wales. There are nineteen Consultant Clinical Oncologists and thirteen
specialist registrars in oncology; all have a commitment to liaise and work with palliative medicine.
There are full diagnostic radiology services for oncology patients at Velindre, including MRI. PET scanning is
being commissioned. Velindre Hospital has a total of 87 beds and currently about 70% of the workload
involves non-curative anti-cancer treatments, which are aimed at prolonging life.
The Certificate/Diploma/ MSc in Palliative Medicine is organised from Velindre and the administration base is
there. Cancer Relief Macmillan Fund funded the initial development of the Diploma in 1989; the Diploma
has been extended into a Masters Degree now in its sixth year.
UNIVERSITY HOSPITAL OF WALES is the main teaching hospital for the Cardiff University School of
Medicine. This post will form the medical component with a consultant of the Palliative Care Team at the
University Hospital of Wales along with three hospital Macmillan Nurses. The team receives 1000 referrals at
a year and 15% of these patients have non-malignant disease. All areas of the hospital make referrals to
the team including tertiary services of Cardiology, Haematology, Nephrology and Neurology. There is a wellestablished close working relationship with neurology, haematology and pain management services and
opportunity to attend chronic pain and motor neurone disease clinics. Opportunity may also be given for
trainees to gain experience of other specialist tertiary services. In addition the trainee will spend some of
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the placement in Llandough Hospital with Dr Byrne where experience in management of both malignant and
non-malignant lung disease and gynaecological cancers can be gained.
Y BWTHYN NEWYDD UNIT, PRINCESS OF WALES HOSPITAL, BRIDGEND is the District General
Hospital for Bridgend and surrounding area. The palliative care department is run by Drs Pola Grzybowska
and Fiona Rawlinson, with a retirement vacancy to be filled shortly. The department is responsible for 8 inpatient beds, a Day Hospital with up to 20 patients a session, 4 days a week at Y Bwthyn Newydd a
specialist purpose built unit developed with Macmillan , a Day Hospital with up to 20 patients a session, 4
days a week. Y Bwthyn is also the clinical base for the integrated hospital, community, day care Macmillan
nursing team. The post allows the Specialist Registrar opportunity to see the interface of palliative medicine
in a with all departments and professional groups in the busy District General Hospital as well as opportunity
for experience with community services. The department has embraced new technology; Canisc (our local
Cancer information electronic clinical record) is available throughout the trust, this supports us being
virtually paper free and provides excellent access to our clinical record across our trust. This post at times
may occasionally provide some support to the DHG in Neath Port Talbot.
TY OLWEN, MORRISTON HOSPITAL, SWANSEA
Ty Olwen Palliative Care Service, Swansea NHS Trust provides specialist inpatient care, in a newly
refurbished 20-bed inpatient unit, situated on the campus of a busy hospital which has a range of secondary
and tertiary services including regional cardiac centre, renal unit, neurosurgical services and the national
centre for Burns and Plastic surgery. The service and its administration are based in Morriston Hospital .As
designated Cancer Centre, the Lung, Urological and Neuroncology Cancer teams are based on the Morriston
Hospital Campus together with Facio-Maxillary surgery. The inpatient unit receives huge benefit from access
to diagnostic services in radiology and pathology as well as support from colleagues in respiratory medicine
gastroenterology etc. There is a strong multidisciplinary team in the inpatient unit, which includes
physiotherapy, occupational therapy, chaplains, social worker and pharmacist.
The service provides a Trust-wide Hospital Palliative Care team, which supports patients and families in the
Department of Radiotherapy and Oncology. There is a whole floor dedicated to oncology and haematology
inpatient care and considerable team activity is focused here but there are many other patients in surgical ,
gynaecological and medical beds throughout the hospital .The team is well supported by diagnostic services.
The Hospital Palliative Care team regularly supports 9 Cancer MDTs.
The Community Palliative Care Team provides a unique opportunity with a full multidisciplinary approach to
patient care and has on average about 130 patients in Swansea and Neath Port Talbot.
There is a Day Care Service at Ty Olwen offering places for patients on three days per week and the medical
team in the Community respond to requests for medical advice in this patient group.
There is a strong culture of audit. Many of the CNS and medical team undertake postgraduate degree
courses.
Education and teaching are important components of our service and is now even more important with the
growing School of Medicine and the important relationship with Swansea University.
Planning to expand the service to meet the need of patients with other diseases than cancer is advancing.
ROYAL GWENT HOSPITAL
The Royal Gwent Hospital is a busy 700 bedded DGH serving the surrounding population of Gwent. The
hospital based team is lead by Dr Simon Noble and consists of an Associate Specialist and a team of Clinical
Nurse Specialists. The surrounding population has a greater proportion of non malignant terminal disease
patients than those with cancer and this is reflected in the clinical caseload.
The trainee will have opportunity to attend heart failure, chronic lung disease and neurodegenerative
disease clinics as well as participate in joint oncology clinics.
The team works closely with the neighbouring St Anne’s Hospice and the Community services provided by
the St David’s Foundation and Hospice of the Valleys. Trainees will be encouraged to spend time with each
local provider.
Rotational Opportunities:
The following departments have indicated that they would welcome rotation from the Specialist Registrar in
Palliative Medicine to spend however much time would be desirable to ensure a full education has been
obtained from this post:-
Paediatric Oncology & Palliative Care
Dr Richard Hain is a Senior Lecturer in Paediatric Palliative Medicine and all trainees will rotate through an
attachment to the department as part of their training.
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Medical Genetics
Professor Julian Samson’s department of Medical Genetics is one of the leading departments in the United
Kingdom. Experience with any of genetically related disease groups including the cancer genetics
department could be easily arranged.
4.
CLINICAL DUTIES OF POST
Clinical
1. To participate in providing advice on symptom control to doctors in the area requesting advice.
2. Maintenance of accurate medical records and accurate prescription records.
3. Attendance at the Outpatient Clinic attached to that post, to see new and follow up patients as required.
4. To work as part of a multi-disciplinary team and liaise with other professionals within the team as
appropriate.
5. To communicate clinical decisions and advice to the Consultants responsible for the patients care.
6. To supervise junior staff where appropriate.
7. To communicate rapidly and accurately with the patient’s General Practitioner about the patient’s
condition and to ensure that the General Practitioner has been notified immediately on the death of the
patient.
Teaching
Teaching is a major commitment of Palliative Medicine in Wales. The Specialist Registrar would be expected
to attend teaching sessions as appropriate and to undertake a variety of different teaching activities to
provide training in teaching and education principles, particularly small group discussion and group
facilitation, lecture preparation and delivery, in medical students for final MBBCH and OSCE format. The
department of Palliative Medicine is involved in teaching medical students throughout MB ChB as well as
doctors from overseas and other disciplines.
Research
Research is an important aspect of palliative medicine in Wales. The post holder will be actively encouraged
to undertake research interest and develop a research project within a short time of coming into post.
Those wishing to pursue an MD will be actively encouraged to do so.
Administrative duties
The successful applicant will be expected to be involved in the organisation of the on-call rota, liaison with
GPs and Journal Club.
Participation in audit
To participate in palliative medicine audit programmes at all units and to participate in the All Wales Audit as
that becomes established over the next few years.
Location of duties
In South Wales
Holme Tower Marie CurieHospice, Bridgeman Road, Penarth, South Glamorgan
Velindre Hospital, Whitchurch, Cardiff
University Hospital of Wales, Heath Park, Cardiff
Llandough Hospital, Penarth
Y Bwthyn Newydd Unit, Princess of Wales Hospital, Bridgend
Ty Olwen Palliative Care Service, Morriston Hospital, Swansea
Royal Gwent Hospital Newport
George Thomas trust Hospice Cardiff
Occasional duties in case of emergency
The junior doctor accepts that he/she will also perform duties and occasional emergencies in unforeseen
circumstances at the request of the Consultant in Palliative Medicine, in consultation where practical with his
or her colleagues both senior and junior. It has been agreed between the professions and the department
that while juniors accept that they will perform such duties, the Secretary of State stresses that additional
7
commitments arising under this sub-section are exceptional and in particular that juniors should not be
required to undertake work of this kind for prolonged periods on a regular basis.
5
5.1
STUDY AND TRAINING.
Postgraduate training
This post is recognised for postgraduate training and covers all aspects as specified in the APM curriculum
document. Supervision of postgraduate training is undertaken by the Specialist Training Committee who will
carry out the annual appraisal interviews of all Specialist Registrars in Palliative Medicine. The members of
this committee are Professor Ilora Finlay, Dr. Ian Back, Dr. Melanie Jefferson, Dr Helen Taylor, Dr Idris
Baker, Dr Anthony Byrne, Dr Nicki Pease, Dr Matt Makin, Dr Andy Fowell, Dr Simon Noble, Dr Fiona
Rawlinson and Dr Pola Grzybowska. All Specialist Registrars will have opportunity to attend the generic
curriculum organised by the Postgraduate Dean’s office, the topics of which include managerial skills, ethics
and medical law, communication skills, teaching techniques and Health Informatics.
5.2
Facilities for study leave
Study time has been incorporated in the timetable of both posts to ensure that the post holder undertakes
sufficient reading and studying. The Diploma and MSc in Palliative Medicine are available for Specialist
Registrars to participate in over the course of their training.
5.3
Library Facilities
Library facilities are available through the Cardiff University School of Medicine at UHW and Swansea Clinical
School, Velindre Hospital, Royal Gwent Hospital, Princess of Wales Hospital, Bridgend and Morriston
Hospital, Swansea. The CDROM search facilities are easily accessible in all these venues (booking is
required at UHW). The library at Llandough Hospital is a general medical library. The library at Velindre
Hospital is a specialist oncology library. Holme Tower has a small collection of specialist reference
textbooks.
5.4
Other postgraduate medical education courses
There is a wide range of courses/study days organised by the local Postgraduate Medical Education
Department. All junior staff are encouraged to attend APM study days and other relevant courses where
possible.
6.
CONDITIONS OF SERVICE.
6.1
Specialist Registrar posts are covered by the terms and conditions of service for hospital, medical
and dental staff, which should be read in conjunction with the general Whitley Council conditions of service.
6.2
The posts are full time and the hours of duty are a standard working week of forty hours. In
addition to this the post holder must be available for non-resident on call. If on call the candidate must be
resident within 25 miles of Holme Tower when on call for SE Wales and within one hours drive when working
in Swansea. The rotas are New Deal compliant.
Remuneration for out-of-hours work is paid appropriate to the “banding” of these posts, in accordance with
the junior doctor pay deal and contract.
6.3
The salary scale is as pro rata.
7.
OTHER FACILITIES.
The University Hospital of Wales has a large sports and social club to which the applicant would be eligible to
join.
There is ample free parking at Holme Tower and Velindre and pay and display car parks at University
Hospital of Wales, Llandough Hospital, Princess of Wales Hospital Singleton Hospital and Morriston Hospital.
South Wales has a regular inter-city train service to London Paddington and a good regional network of rail
and bus services as well as road links.
8.
CONDITIONS OF APPOINTMENT.
8.1
The essential qualifications are as outlined in the person specification for the posts.
8.2
The completion of a satisfactory health questionnaire is a condition of the appointment.
8.3
Owing to the vulnerability of those receiving health care, this post is exempt from provisions of
Section 4(2) of the Rehabilitation of Offenders Act 1974. Details of any criminal convictions you may have
8
had must be disclosed; failing to do so could result in dismissal. Any information given will be completely
confidential and will be considered only in relation to an application for positions to which the order applies.
8.4
Medical staff are required to be registered with the General Medical Council.
8.5
The post holder must comply with the UK Capital Health Departments guidance on “Protecting
Health Care Workers and Patients from Hepatitis B” (PSM (93) 12).
8.6
Removal Expenses
The terms and conditions of service state: “removal expenses shall be reimbursed and grants paid only
when the employing authority is satisfied that the removal of the practitioners home is required and that the
arrangements proposed are reasonable”. As the Specialist Registrar posts are partly funded from charitable
sources, the control over removal expenses will need to be stringent. Therefore, successful candidates are
advised not to enter into contractual arrangements for the removal of the home until such time as formal
approval is confirmed in writing.
9.
DATE POST BECOMES VACANT
Start date to be agreed.
VISITING
Candidates for the South Wales Rotation wishing to make an informal visit may do so by making direct
arrangements with Dr. Melanie Jefferson at University Hospital of Wales (02920 743377) or Consultants at
other centres in the rotation.
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