Oxford Deanery Specialty Training Programme in Rheumatology

HEALTH EDUCATION THAMES VALLEY - SPECIALTY TRAINING PROGRAMME IN RHEUMATOLOGY

About Health Education Thames Valley

We are the Local Education and Training Board (LETB) for Thames Valley covering Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of effective workforce planning and excellent education and training to develop a highly capable, flexible and motivated workforce that delivers improvements in health for the population of Thames Valley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.

Health Education Thames Valley is a relatively small organisation with a defined geographical area which serves as a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some programmes will require successful candidates to indicate a location and specialty. Future placements will usually be based on individual training and educational needs. Please note that applications are to the Health Education Thames Valley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs.

The Rheumatology /GIM Training Programme

The training programme is a 5 year dual rheumatology/GIM programme, starting at ST3 level. In exceptional circumstances a single accredited rheumatology training programme may be possible. During this time, the trainee's work will be monitored for satisfactory progress by their Educational Supervisor and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews and upon satisfactory acquisition of competences and Clinical Supervisor reports.

The posts on this rotation have been approved for Specialist Training by the Royal College of Physicians. The posts attract National Training Numbers and training towards a Certificate of Completion of Training (CCT).

The Postgraduate Dean has confirmed that these post have the necessary educational and staffing approvals. The programme is based in several different Trusts throughout Health Education Thames Valley so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:

Trust Hospitals and Locations Oxford University Hospitals Nuffield Orthopaedic Centre, Oxford NHS Trust http://www.ouh.nhs.uk/ Heatherwood and Wexham Wexham Park Hospital, Slough Park Hospitals NHS http://www.heatherwoodandwexham.nhs.uk/location/wexham- Foundation Trust park-hospital-slough Royal Berkshire NHS Royal Berkshire Hospital, Reading Foundation Trust http://www.royalberkshire.nhs.uk/ Buckinghamshire Stoke Mandeville, Aylesbury Healthcare NHS Trust http://www.buckshealthcare.nhs.uk/ Great Western Hospitals Great Western Hospital, Swindon NHS Foundation Trust http://www.swindon-marlborough.nhs.uk/ Gloucester Hospitals Cheltenham General Hospital, Cheltenham NHS Trust http://www.glos hospital s.org.uk

The Area

The Oxford Deanery Rheumatology programme covers the counties of Oxfordshire, Berkshire, Buckinghamshire, Northamptonshire and Wiltshire. This part of the country is particularly pleasant to live in and has excellent cultural facilities and recreational sports, as well as good schools both in the private and state sectors. There are good road and rail links with all parts of the country and there is easy access to London and Heathrow Airport.

A wide variety of housing is available to rent and buy within the Region both in towns and in surrounding villages.

The hospitals involved in the training programme are the Nuffield Orthopaedic Centre in Oxford, Royal Berkshire Hospitals in Reading, Wexham Park Hospital in Slough, Stoke Mandeville Hospital in Aylesbury and Great Western Hospital, Swindon. A new post in Cheltenham is to commence August 2015 (details to follow)

The Principles of the Training Scheme

The principles of the rotations agreed by the Oxford Regional Rheumatology Speciality Training Committee are as follows: 1. A 5 year dual Rheumatology/GIM accreditation programme. 2. The exact order of rotation is at the Deanery’s discretion. The relevant rotation will often need adjustment at the time of new appointments. 3. The principles of training are set out on the JRCPTB website (http://www.jrcptb.org.uk/) Continuing Formal Appraisal of the specialist Grade Registrar

Formal appraisal of the trainees is conducted annually by the Specialty Training Committee at the ARCP and a representative from the Specialist Advisory Committee in Rheumatology to ensure that:

1. The trainees’ development and knowledge gained is satisfactory. If the development of a trainee is not satisfactory, the problem should be identified early and action taken to correct this.

2. An attachment which is not providing appropriate training and educational opportunities is identified, adjusted and improved.

A formal meeting will occur at the beginning and also at the end of each attachment with the trainee, at least one of the trainers and an “outside” assessor one not currently working with the trainee. The purpose of this meeting is to ensure that the post is providing all of the requirements for the trainee to cover the curriculum, set goals for the trainee and to assess progress. Should problems arise either with the training programme or the trainee then action to solve the problem, in terms of discussion, counselling or modification of goals, will be taken with the involvement of the outside assessor.

Duties of the post

The precise details of each post will vary with each hospital (see later). However, the following duties are relevant to all Hospitals in the rotations.

The specialist registrar will attend

a. At least two supervised outpatient clinics in general Rheumatology case mix per week with other clinics, as required.

b. At least one ward round per week.

c. He or she will have the experience of continuing care of Rheumatology patients on an In and Outpatient basis.

d. The trainee will record knowledge, experience and skills acquired during the post in the training record.

e. The trainee will be involved in the training and supervision of Senior House Officers and of Paramedical Staff and participate in audit and contribute to hospital teaching meetings.

f. He or she will become involved in the management and administration of the department. Educational Contract

Wherever possible trainees will be assisted to undertake research and publication. Progress in these areas will be assessed and discussed at the annual appraisals. The training programme benefits from a part time Masters Course in Musculoskeletal Science, based at the University of Oxford, which all trainees are encouraged to take up.

Trust Information

THE OXFORD UNIVERSITY HOSPITALS NHS TRUST

THE NUFFIELD ORTHOPAEDIC CENTRE, OXFORD

The successful candidate will work directly with the Consultant Rheumatologists (Professor N Arden, Dr K Bailey, Professor P Bowness, Dr J David, Dr K Javaid, Professor R Luqmani, Dr C Swales, Professor P Taylor, Professor BP Wordsworth, Dr Julia Newton) and as part of the training for clinical and administrative responsibilities.

The rheumatology unit at the NOC has a world-class reputation for research and teaching and trainees will have an opportunity to develop expertise and research experience in a variety of subspecialities including vasculitis, inherited disorders spondyloarthritis, immunology, osteoporosis and rare metabolic boone diseases, and sports and exercise medicine. The rheumatology unit is part of a BIU with the NDORMS.

The trainee will be involved in the teaching of undergraduates when they attend the hospital for orthopaedic/rheumatological clerking, will be involved in the teaching of other staff, not only those attached to the hospital but attending courses held for professions supplementary to medicine, and be involved in postgraduate teaching and in clinical conferences.

Rheumatology Unit

This comprises a section of Ward D for inpatients (usually around 8) and the Day Care Unit. The major features of the unit’s work are the application of detailed team assessment of patient’s difficulties and the very close integration of medical and surgical care of patients with rheumatic diseases. The pre and post-operative assessment and care is undertaken in the medical unit with regular ward rounds, clinical conferences and combined out-patient clinics being held with the orthopaedic surgeons.

Unit activities include regular case conferences, X-ray, Imaging, Pathological and audit sessions as well as frequent combined meetings with Regional Colleagues.

Out-patient clinics including general rheumatology, vasculitis, sports and exercise medicine and paediatric rheumatology are held at the Nuffield Orthopaedic Centre, Oxford. Outreach clinics are held in Banbury, Bicester, Witney and Chipping Norton.

Teaching Facilities

Within the Nuffield Department of Medicine and Orthopaedic Surgery at the JRH II Hospital and the Nuffield Orthopaedic Centre, the following teaching facilities are available and would provide the candidates with unrivalled contact with the problems which are closely related to his/her own specialty and for learning the inter- relationships of the specialties:

Medical Staff Conferences Lectures in Basic Science of the Musculo-Skeletal System X-ray demonstrations including CT, MRI and Ultrasonography Clinical Pathological Conferences Combined Clinics with Immunologists and others interested in Connective Tissue Diseases

Research

Any research will be carried out within the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS). Several of the consultants regularly act as academic supervisors for trainees. Professor Wordsworth has a focus on genetics of rheumatic diseases and on patients with heritable complex connective tissue diseases and leads the musculoskeletal theme on rare diseases for the National Institute for Health Research with Dr Javaid. Professor Luqmani is the theme leader for vasculitis research at the NDORMS, focusing on the epidemiology, mechanisms, treatment and long term outcome of systemic vasculitis. Professor Taylor is the Norman Collisson Chair of musculoskeletal sciences at Oxford and directs the new clinical trials unit within NDORMS. He has experience of over 15 years in biologic therapy testing with particular expertise in early proof of concept trials and experimental medicine studies using targeted therapy as a probe of pathogenesis to investigate in vivo biology of the therapeutic target. Professor Bowness has a strong laboratory research programme investigating the immunology of inflammatory arthritis, particularly the spondyloarthropathies. Professors Taylor, Luqmani and Bowness have recently been funded by Arthritis Research UK to set up an experimental arthritis treatment centre, with a focus on using imaging techniques to demonstrate effectiveness of novel agents in early phase clinical trials in inflammatory arthritis.

Professor Arden directs the Musculoskeletal Epidemiology Unit with Dr Javaid, Professor Cooper, Dr Judge and Prieto-Alhambra focusing on the epidemiology of osteoarthritis, osteoporosis and sports injury. The unit has a strong track record of training and successful supervision of clinical fellows with national and international collaborations, publications in high impact general and specialist journals as well as successful grant applications. We have recently been awarded the ARUK Sports Injury and Osteoarthritis Centre of Excellence and an NIHR HS&DR grant to determine effective models of secondary fracture prevention in addition to being part of the ARUK Epidemiology UK-Rime network.

Should the interests of the trainee lie outside this range of experience suitable advice and supervision will be arranged in the university departments.

Candidates are advised to visit the hospital and should contact:

Dr J David, Professor P Wordsworth, Professor P Bowness , Professor R Luqmani Nuffield Orthopaedic Centre Headington Oxford OX3 7LD Telephone : (01865) 227527

General Condition of Service

There is an on call rota for rheumatology.

On call cover for Rheumatological referrals for all oxford specialist centres and regional GPs. General medicine cover of Nuffield Orthopaedic Centre. Rheumatology opinions for Oxford University Hospitals. .

THE ROYAL BERKSHIRE NHS FOUNDATION TRUST

The Royal Berkshire Hospital, one of the largest District General Hospitals in the UK, has a high reputation as a medical training centre and has been popular with rheumatology trainees in the Oxford Deanery for the wide variety and intensity of experience that it offers in both Rheumatology and in General Internal Medicine. The Rheumatology Department at the Royal Berkshire NHSFT provides rheumatology services to patients from the districts of Reading, Wokingham, Newbury, Henley-on-Thames, Wallingford and Wantage - a population over 550,000.

 Consultants Dr Antony Bradlow – Rheumatology Dr Jeremy McNally – Rheumatology & General Internal Medicine Dr Antoni Chan - Rheumatology & General Internal Medicine Dr Gordon MacDonald– Rheumatology & General Internal Medicine Dr Joanne Kitchen - Rheumatology & General Internal Medicine Medicine

Three Specialist Registrars: Oxford Rotation (Rheumatology & GIM)

 Two Senior House Officers (1 CMT + 1 GPVTS  Two House Physicians  One Hospital Practitioner  Seven Nurse Specialists (DAWN, Biologics, Osteoporosis)

Rheumatologists and General Physicians.

Rheumatology in Reading spans the entire spectrum of musculoskeletal disease from soft tissue problems to complicated connective tissue disease. A full orthopaedic service is available.

There are combined Orthopaedic Hand, Dermatology, and Vasculitis clinics (the latter with a renal physician with an interest in vasculitis) and a weekly Combined Radiology meeting with s specialist muscolskeletal radiologists.

Early arthritis and Biologics services are provided by the Rheumatology Department. The Department has its own physiotherapists and occupational therapists as well as regular sessions in clinical psychology. The Department runs metabolic bone clinics and has access to DEXA scanning.

The Specialist Trainees’ particular duties are on the enclosed weekly programme. The STs will work with all five consultants. Their inpatient duties include cover of a combined GIM/ rheumatology ward and of those outlying patients for which the Rheumatology Department has responsibility. Under the supervision of the consultants the trainees provide a daily consultation service to the Clinical Decision Unit (CDU) and see all rheumatology in-patient referrals in the Trust.

The G(I)M / Rheumatology ward (currently Lodden ward) has several hundred admissions annually and has access to an on-site hydrotherapy pool. A dedicated IMID Unit attached to this ward deals with the many day cases admitted for treatments such as pulse intravenous Cyclophosphamide therapy and intravenous biologic treatment.

In addition to the combination of rheumatology and general medicine in the same department, the Department’s strengths are its comprehensive teaching programme and the high level of supervision of Medical Staff in Training by the Consultants..

Research and Development

The department is actively involved in clinical research. We have a number of ongoing Comprehensive Local Research Network (CLRN) research studies (as part of the Thames Valley network) and commercially sponsored biologic clinical trials. Trainees are encouraged to participate actively in the R&D activities of the Department. The University of Reading has several Health Research Fellowships which are designated for funding of collaborative clinical research sessions. Specialist Trainees are encouraged to consider undertaking a collaborative research project under this scheme. Those interested are advised to obtain a copy of the University of Reading Health Research Group prospectus from the Rheumatology consultants before interview. The Royal Berkshire NHSFT is also starting a Research Funding scheme to pump prime research projects from 2010. STs will be encouraged to apply for this through open competition. For further information please contact:

Dr Jeremy McNally 0118 322 6559 [email protected]

BUCKINGHAMSHIRE HEALTHCARE NHS TRUST

The Hospitals

Rheumatology at Buckinghamshire Healthcare is based at Stoke Mandeville (SMH) and Amersham Hospitals (AGH), with clinics also being held at Wycombe Hospital. This post is based at Stoke Mandeville Hospital with 2 Specialist trainees. The post provides a broad experience in rheumatology and the opportunity to train in general medicine. Trainees are also encouraged to attend specialist clinics and participate in research activities and clinical audit.

Structure of Department of Rheumatology

The department currently has 4 consultants: Dr Sally Edmonds, Dr Richard Stevens Dr Malgosia Magliano and Dr Chetan Narshi. Dr Edmonds has a particular interest in paediatric rheumatology and runs one paediatric clinic per month. Dr Magliano leads an osteoporosis service and development of early arthritis pathway. The department is developing a MSK ultrasound service to support Early Arthritis Clinics. The department has 3 specialist nurses (2.4 WTE) who run nurse led clinics, a rheumatology helpline and a busy day unit (Stoke Mandeville) where infusions of biologic, cytotoxic and other intra-venous agents are given. The department has two specialist registrars, one FY1 trainee and a GP VTS trainee. There is also a specialist ankylosing spondylitis clinic run by a senior physiotherapist and a combined hand clinic with plastic surgeons. The department provides a consulting service for the hospital in patients with a weekly consultant lead ward round. The department has one full time research nurse and an active research portfolio. There is also an excellent support from rheumatology OT and podiatry available across three hospital sites, with access to physiotherapy and hydrotherapy as well as clinical psychology. The radiology department provides a specialist MSK service with weekly X-ray meetings. DXA scan service is available in Amersham Hospital. The Unit has excellent secretarial support.

The Specialist Registrars posts

There are two posts based at SMH: Rheumatology (SpR1) and Rheumatology/GIM (SpR2). Specialist trainees run general rheumatology clinics as well as early arthritis, flare and biologics lists under consultant supervision. They support Rheumatology Day Unit activities and assess inpatient referrals. Specialist trainees supervise the work of FY1 and GPVTS trainees and work closely with our specialist nurses.

Timetable

AM Lunch PM Monday SpR Admin/WR SpR Admin/WR

Tuesday New Patient clinics including Follow-up Clinics Early Arthritis clinic Paediatric Clinic (1stTuesday) Wednesday 8.15-9.00 MDT Xray meeting SpR Admin/WR 9-10am Hospital Grand Round 10am Flare clinic Thursday Regional Meetings (NOC, CPC Consultant Ward Round Oxford 1stThursday) meeting (times may vary) Combined Hand Clinic Rheumatology Educational (2ndThursday) Meeting 4-5pm Osteoporosis Clinic Monthly Management/ (3rdThursday) Governance meetings 2- 5pm Friday SpR2 - Biologics clinics SMH SpR Admin/WR SpR1 Clinic at AGH with Dr Nashi

Education and Training

Educational activities include:  MDT X-ray meeting with MSK radiologists and orthopaedic – weekly  Hospital Medical Grand Round – weekly  Rheumatology Departmental meetings – weekly  Hospital Academic Half Day and Audit meetings - monthly  Oxford Rheumatology Regional meetings every 1st Thursday of the month  ILD meeting with the respiratory team – monthly  Combined rheumatology/orthopaedic educational meetings every 6 months  Combined educational meetings with Wexham Park Hospital every 4 months

Rheumatology department has up to date library of excellent rheumatology textbooks and a subscription to the online anatomy software. There is an excellent support from the PGC library and audit department. Trainees are encouraged to get involved in clinical research and undertake regular audit.

For further information please contact: Dr Malgosia Magliano Tel 01296316664 [email protected] HEATHERWOOD AND WEXHAM PARK HOSITALS NHS TRUST

Wexham Park Hospital is situated on the outskirts of Slough and is part of the Heatherwood and Wexham Park Hospitals Trust which serves the population of East Berkshire. The Hospital has more than 600 beds and houses all general medical specialities. Staff

 Consultants Dr Alan Steuer – Rheumatology & General Internal Medicine Dr Francesca Demetriadi – Rheumatology Dr Matt Adler - Rheumatology and General Internal Medicine Dr Jenny Watkins – Rheumatology Dr Simona Gindea - Rheumatology & General Internal Medicine Dr Ishita Patel - Rheumatology & General Internal Medicine

Three Specialist Registrars: One linked to London Two to Oxford Rotation

 Two FY1s  CT1-2  One Hospital Practitioner  Three Nurse Specialists

The Department is supported by a full multi-disciplinary team, including a dedicated Occupational Therapist, Physiotherapist, Podiatrist and Social Worker.

The adult General Medical wards at Wexham Park are organised on a consultant ward based system. Rheumatology patients are generally admitted or transferred to ward 6. Responsibilities of the post:

 2-4 general Rheumatology Clinics per week  Weekly injection clinic  Day to day care of Adult inpatients.  Contribution to the running of day care procedures for biological and cytotoxic therapies.  General Medicine inpatients on ward 6  Teaching of junior staff shared with consultants.  Optional monthly paediatric rheumatology clinic

Education and Training  There are weekly Rheumatology teaching and X-Ray meetings. There is also a weekly medical unit session.

 An academic half day involving all the physicians is held monthly.

 Monthly postgraduate Clinical Meetings are held at Oxford and every 3 months the Department meets with the Department of Rheumatology at Frimley Park.

 There is a twice yearly regional clinical and audit meeting.

 The hospital has an excellent new Postgraduate Centre with a well stocked library and good IT facilities available.

For further information please contact:

Dr Alan Steuer 01753 633166 [email protected]

Great Western Hospitals NHS Foundation Trust

The Great Western Hospital Swindon is a large, busy, modern district general hospital situated on a green field site near junction 15 of the M4 between the Marlborough Downs, the Ridgeway and the Vale of the White Horse. The population served by the Rheumatology department extends between Oxfordshire, Wiltshire, Avon and Berkshire, a population of approximately 300,000. The hospital is a teaching Academy for the University of Bristol undergraduates and has

The Specialist Trainee post, is part of the Oxford Deanery training rotation and provides a wide range of training in general Rheumatology including inflammatory arthritis, connective tissue disease management, soft tissue rheumatism plus specialist Sjogren’s, bone health and paediatric rheumatology clinics. Clinical load includes four to five rheumatology outpatient clinics per week, inpatient referrals and cover to the Day Therapy Unit. The postholder would be expected to attend the Oxford Rheumatology meetings and training sessions, and to develop a local research project whilst in Swindon. One day per week will be set aside for a clinical research project of the applicants’ choice.

Staffing

 3 Consultant Rheumatologists (Dr David Collins, Dr Elizabeth Price and Dr Lyn Williamson)  4 Nurse Practitioners.  1 Research Nurse.  1 Specialist Registrar (this appointment).  1 Specialist Registrar (Severn Deanery).  Administrative and Secretarial staff.

Inpatient and Day case Beds

The number of inpatient admissions is small, usually no more than one or two at any one time. In comparison, many more patients are treated as day cases (currently 4- 500 day case patients per annum). We have access to beds on the Day Therapy Unit. This is a Monday to Friday 9am – 5 pm facility catering for Rheumatology, Haematology, Oncology and Pain patients. It is the ideal environment for patients requiring steroid infusions, injectable immunosupressive agents including Cyclophosphamide and Biologics, and minor salivary gland lip biopsies.

Facilities at the Hospital

The Rheumatology department is based in the ‘Osprey’ Department on the third floor of the hospital with Diabetes, Haematology, Oncology and the Pain clinic. Within this area is a suite of Outpatient consulting rooms, a day area for medical procedures, consultant, metrology and secretarial offices.

The department sees the full range of musculoskeletal conditions and offers specialist clinics in paediatrics, Sjogrens syndrome and bone health.

The department has full responsibility for the prescribing and monitoring of DMARDS, using a nurse led DAWN database system. The postholder will be expected to assist when needed in the monitoring of these patients.

The department is supported by a full orthopaedic service, including spinal surgery; and full radiology facilities including CT, MRI, nuclear medicine and DEXA.

Proposed Timetable

AM Lunchtime PM Monday General rheumatology Grand Round Ward work/admin clinic (DAC) Tuesday Monthly teaching clinic Research/Education/Audit (DAC) Research/Education/Audi t Wednesday Radiology & MDT General rheumatology meetings clinic (LW)

Thursday Oxford mtg. (1st Ward Thursday) or work/admin/research/audit General rheumatology clinic (EJP) Friday Ward work/admin General rheumatology clinic (EJP - Devizes)

Note: There is no on call commitment for this post.

The job plan including its integral work programme will be reviewed after a first meeting with the educational supervisor. Amendments will be made after agreement. Opportunities to attend the specialist clinics are available.

Teaching & Training

Weekly Medical and Surgical Grand round Monthly study half days including interdepartmental meeting with orthopaedics, dermatology or pathology departments Weekly radiology meetings Monthly regional rheumatology meetings at Oxford with SpR teaching session

Research

The trainee is expected to complete a clinical research project of his/her choice during their time at Swindon. The choice of project will be made between the candidate and supervising consultants. A choice of topics is on offer including clinical rheumatology, acupuncture, psoriatic arthritis, Sjogrens syndrome and osteoporosis. In addition we have a number of ongoing Comprehensive Local Research Network (CLRN) research studies and commercially sponsored clinical trials. Trainees are encouraged to participate actively in all the R&D activities of the Department.

Audit There is an ongoing programme of audit in which the SpR is expected to participate.

Teaching Opportunities The GWH has close undergraduate teaching links with Oxford University Medical Schools and is a teaching academy for the Bristol University medical school. There are opportunities to organise teaching for undergraduates, foundation, and core medical training doctors. In addition the trainee will be expected to present at Grand Rounds and to help with other training provided by the departmental consultants for example to local general practitioners.

Administration

The trainee will be expected to do all necessary administration pertaining to patients they have seen clinically. Where appropriate the post holder will be encouraged and supported in a management project which is relevant to the current departmental needs.

Further Information Dr David Collins 1793 604317 Dr Elizabeth Price 01793 604319 Dr Lyn Williamson 01793 604318

Cheltenham General Hospital

This is a new post for August 2015 – detail not available at time of publication.

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/your-workforce/need-to-know/european-working-time- directive

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/your-workforce/pay-and-reward/pay/pay-and- conditions-circulars/medical-and-dental-pay-and-conditions-circulars 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/your-workforce/pay-and-reward/pay/pay-and- conditions-circulars/medical-and-dental-pay-and-conditions-circulars 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/your-workforce/pay-and-reward/nhs-terms-and- conditions/junior-doctors-dentists-gp-registrars/junior-doctors-terms-and-conditions- of-service-and-associated-documents

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/MedicalandDentalContracts/JuniorD octorsDentistsGPReg/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/your-workforce/recruit/employment-checks/nhs- employment-check-standards

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.

For further information; Please contact Dr Alan Steuer – Training Programme Director for Rheumatology HETV [email protected]