JOB DESCRIPTION
INTEGRATED ACADEMIC TRAINING PROGRAMME ACADEMIC CLINICAL FELLOWSHIP IN HAEMATOLOGY ST3 LEVEL
October 2017 LOCAL TRAINING PROGRAMME
The major objective of the current ACF rotation based at Addenbrooke’s Hospital is to foster future academic and NHS leaders in haematology and transfusion medicine. This academic post was secured as part of the NIHR Integrated Academic Training: Academic Clinical Fellowship Programme and is a protected academic training post in a first class training rotation situated in a world class research environment. This ACF post has been awarded under the research theme ‘Platform Sciences’. The appointee will be expected to develop a research programme in that theme area.
The Trainee will be exposed to a top ranking academic and clinical department in Addenbrookes Hopsital, while usually rotating for around 8 months to a DGH in Norwich, or Ipswich or West Suffolk or King’s Lynn or Peterborough to ensure a broad exposure to general haematology (see below).
This academic trainee will rotate through training slots in Addenbrookes which are currently: general laboratory, lymphoma, coagulation, transfusion, paediatrics and the 2 ward slots (general and stem cell transplantation). There will also be an attachment at a district general hospital. This will provide laboratory and clinical haematology training leading to Part 1 FRCPath. The 25% academic time required in an NTN(A) in the first 3 years will consist of two 4-month academic slots, complemented by a transfusion course and 6 weeks annual study leave, as well as weekly educational meetings, coagulation, morphology and case based teaching, and regular research group presentations. The two 4-month academic slots will offer general orientation in the research interests of the department and the wider opportunities available in Cambridge and attachments to 1 or more research groups, depending on the trainees’ interests.
Mentoring for the academic trainees will be provided throughout by the academic lead and deputy for haematology trainees, Professor Brian Huntly and Dr Dan Hodson. At appointment, trainees will be made aware of the research themes of the department. During regular reviews with the academic mentors, a favoured area of research will be identified, along with a preferred Principal Investigator either in Cambridge or in another centre. The PI will then lead on developing a project and a fellowship application for funding to pursue a PhD. As the academic training plan follows the current format of the haematology training rotation, any academic SpR wishing to switch to a non-academic slot would be considered for the next available vacancy.
The chairperson of the local training committee will be responsible for ensuring that the Local Training Programme reflects the National Curriculum for Haematology and that each trainee has an Individual Training Programme. In addition to an academic mentor, Professor Huntly or Dr Hodson, an Educational Supervisor, who will be a consultant haematologist, will be appointed within each trust to ensure that facilities and opportunities are made available to the trainee and to conduct formative assessment.
The assessment of all haematology trainees comprises supervisors' reports at the end of each attachment and continuous assessment of nationally determined competencies, including workplace based assessments, monitored through the training record on e-portfolio (through the JRCPTB in the Royal College of Physicians). This is reviewed at the yearly formative assessments (ARCP) conducted under the auspices of the postgraduate dean. Summative assessment will be made by examination for FRCPath. Assessment of progress towards an academic training fellowship will be undertaken by the mentor in discussion with heads of the relevant research laboratories after each attachment
Regional Training Committee
The haematology training programme within the Eastern Deanery is coordinated by a training committee which meets at least twice a year. The current composition of the regional training committee is as follows: Dr Jenny Craig (Chair of regional training committee) Dr Martin Besser (training programme director, TPD) Prof Tony Green (Regional Speciality Advisor and University Representative) Dr Michael Dronfield (Associate Dean) Professor Brian Huntly (academic representative) Dr Katie Rice (Norwich) Dr Dora Foukaneli (Transfusion representative) Dr D Ademokum (Ipswich) Dr Mamatha Karanth (West Suffolk) Dr K Rege (Peterborough) Dr Emily Mitchell (SpR/ LAT representative)
ADDENBROOKE’S HOSPITAL, Cambridge University Hospitals NHS Foundation Trust
A Brief Description of Addenbrookes Hospital
Addenbrooke's was granted Trust status from 1 April 1993. It offers a full range of acute, maternity and mental health services, which are provided from two main hospital sites - Addenbrooke's Hospital and Fulbourn Hospital. Community psychiatry and midwifery services form part of the service ensuring continuity for those patients who are more appropriately cared for in their own communities.
Addenbrooke's Hospital (approx. 1100 beds) lies on the southern boundary of Cambridge city occupying a 66 acre site which is shared by the University Of Cambridge School Of Clinical Medicine, the Medical Research Council, the Regional Blood Transfusion Centre and the Parke Davis Research Institute. Close links with the University have given the hospital an international reputation for converting research and development into practical health care. The hospital has a long history of training first class doctors and offers excellent opportunities for training in biomedical computing, molecular biology, medical statistics, health service management as well as higher specialist training.
The Rosie Maternity Hospital (94 beds and 19 special care cots) is also located on the Addenbrooke's site and includes the Regional Neonatal Intensive Care Unit.
Fulbourn Hospital (366 beds) is situated on the outskirts of Cambridge, approximately 3 miles from the Addenbrooke's site. It provides the main in-patient base for general and specialised psychiatric services supplemented by out-patient and community services.
Addenbrooke's Hospital employs over 7,000 staff and offers both a district general hospital service to a more local constituency and is a specialist referral centre for a wider catchment population. Some special services, such as bowel/liver transplantation, draw patients supra-regionally or internationally.
Dr Mike More was appointed as the Trust's fourth chairman in 2017 and will chair the board consisting of eight executive and four non-executive directors. They are responsible for the strategic management of the Trust. The eight executive directors also sit on the Addenbrooke's executive board which coordinates operational policies and practice where general practitioners' views are represented).
University of Cambridge Clinical School
The University of Cambridge has granted medical degrees since 1540. The Clinical School of the University, which was formally established in 1975, admitted its first clinical students the following year and at present admits about 130 students each year. The Clinical School has its base at Addenbrooke's Hospital where purpose built accommodation for the school, comprising lecture theatres, seminar rooms, medical library (which includes 900 serials) and postgraduate medical centre, was opened in 1980. In addition to receiving clinical instruction at Addenbrooke's Hospital and other hospitals in and around Cambridge, clinical students undertake part of their training in hospitals further afield in the East Anglian and neighbouring regions; they also spend short periods attached to general practices throughout East Anglia. The teaching programme is co-ordinated by the clinical dean. Cambridge is arguably the premier biomedical research centre in Europe. Over recent years four new research institutes have been built on the Addenbrookes site, which also houses the new MRC laboratory of Molecular Biology. The major Clinical School departments were all top-rated in the recent research selectivity exercise.
The Department of Haematology, Addenbrookes Hospital
The haematology department at Addenbrookes offers the full range of clinical and laboratory haematology. It acts as a tertiary referral centre for complex cases and serves as routine service for local patients.
The Clinical Service In-patients are housed in 1) a 16 bed dedicated haematology ward (C10) with hepa filtration consisting of 11 single, one triple, and one double room and 2) ward D6 (shared with neurosciences) with 11 haematology beds and 3) Ward C9 a teenage and young adult facility with 11 beds. Nearby there is a haematology day unit (ward E10) which houses the regional apheresis service and a 20 bed/space haematology day unit has just been refurbished and will open in October 2017. The wards are well equipped and have a full complement of qualified nursing staff, ward clerk and a phlebotomy service. The nursing staff are full time haematology nurses qualified to administer chemotherapeutic agents and antibiotics as well as perform stem cell harvesting and apheresis. The in patient and day unit medical care is primarily provided by 2 pre-registration house officers(FY1), 2 senior house officer (ST1/2), clinical fellows and 2 specialist registrars. The ward is occupied predominantly by patients suffering from leukaemia, lymphoma, myeloma and similar disorders, although patients with non-malignant disorders such as TTP, sickle cell disease, haemophilia, etc, are also treated as inpatients on the haematology wards.
The clinical department includes the regional bone marrow and stem cell transplantation programme. The estimated referral population base is around 3-4 million. Norfolk and Norwich and Ipswich hospital perform autografting according to common protocols and policies. Stem cell processing and storage is performed on the Addenbrooke's site in the stem cell laboratory. There are shared care meetings 2 times a year with all participants and an annual regional transplant meeting which reviews the transplant programme and has an educational component.
The department is the designated regional Comprehensive Care Centre for haemophilia and has a large referral practice for thrombophilia and immunohaematological disorders. Anticoagulant care is delivered through a centrally coordinated combined hospital and community based service and primarily delivered by dedicated clinical nurse specialists. Addenbrooke’s is the regional referral centre for paediatric haematology (Dr M Gattens, Dr Ann Kelly) and paediatric oncology (Dr D Williams, Dr J Nicolson, Dr A Burke).
Outpatient clinics include general haematology disorders (Dr Symington, Dr Thomas, Dr Besser), haemophilia (Dr Symington/Thomas) Women’s haematology clinic (Dr Symington), specialist clinics for MPD/CML (Prof Huntly, Dr Godfrey), MDS and marrow failure syndromes (Prof Warren, Dr Foukaneli, Dr Wong) lymphoma (Dr Follows, Dr Uttenthal, Dr Hodson), CLL (Dr Follows, Dr Ringshausen), transplantation (Dr Craig, Dr Crawley Dr Krishnamurthy, Dr Uttenthal), myeloma and acute leukaemia (Dr Craig, Dr Crawley, Dr Krishnamurthy, Dr Vassiliou, Dr Chapman).
The diagnostic haematology laboratory is situated in the main clinical laboratory and is fully accredited (CPA). It is responsible for providing a routine and emergency service to this trust and general practitioners, serving a population of 250,000 plus referral work. Specialist areas include 1) the Haemato- Oncology Diagnostic service consisting of molecular diagnosis, immunophenotyping, cytogenetics and cell biology sections, facilities including 4-channel FACS, Taqman PCR, digital image analysis, automated metaphase image capture and multicolour FISH. 2) the stem cell laboratory 3) specialist coagulation and thrombophilia services. The transfusion laboratory is fully integrated within haematology.
The diagnostic haematology laboratory processed over 900,000 tests annually (diagnostic lab 640,000; blood transfusion 100,000; blood product issuing 45,000; haemostasis 150,000) of which 30% were GP requests. Major equipment: Beckman Coulter LH1500 system, 4 Trinity Biotech MDA 180s, 2 Ortho Autovue Innovas and 1 Beckman Coulter Exel flowcytometer. The department participates in all appropriate quality assurance schemes including UKNEQAS Blood Group Serology, Coagulation, Microbiology (parasites) and Leucocyte Immunophenotyping. The haematology laboratory has a budget of £1-8m / year.
Departmental policy is decided at a monthly consultant’s meeting chaired by Professor Green. Haematology falls within 2 divisions in the trust, the specialty leads for these being Dr C Crawley (haematology in cancer), Dr M. Besser (Medical Haematology) and Dr M Scott (haematology laboratory in the Investigative Sciences division). Workload activity contracts with PCTs and other hospitals are under regular review and managed by the Health Agreements department of the Trust. Clinical governance is supervised by a dedicated committee. Guidelines for full implementation of clinical governance at a local level have been drawn up in accordance with the department of health guidelines. Management arrangements are consistent with the recommendations of the Strategic Review of Pathology Services paragraphs 4.22 and 4.26.
The Academic Department of Haematology
Academic Haematology
There are exceptionally strong links between the Addenbrooke’s Department of Haematology and the University of Cambridge Department of Haematology, with Professor Tony Green acting as chairman of the former and head of the latter.
The University department contains 7 Professors (AR Green, AJ Warren, R Read, W Ouwehand, B Göttgens, J Huntingdon and B Huntly), 1 Readers (S Mendez-Ferrer), one Senior Lecturer (C Ghaevert), two senior clinical fellow (Dr Ringshausen and Dr Vassiliou), two intermediate Clinical Fellows (Dr M Chapman and Dr Hodson) and 3 intermediate non-clinical fellows (E Laurenti, , D Kent and C Pina) has an annual research spend of £4-5M, and in the last 5 years has had numerous publications in high-ranking journals (including Nature, Nature Genetics, Science, Cell Stem Cell, Nature Cell Biology, Lancet, NEJM and Blood).The major research interests of the department are:
Stem cell and leukaemia biology
This focuses on the transcriptional regulation of haematopoietic stem cells and pathogenesis of myeloid leukaemias that arise from such stem cells. Research groups are situated in the Cambridge Institute for Medical Research (CIMR) and MRC laboratory of Molecular Biology. Major thrusts include the pathogenesis of bone marrow failure syndromes (Professor Warren), the transcriptional regulation of haematopoietic stem cells (Prof Göttgens,), the biology of normal and leukaemia stem cells (Prof Huntly, Dr E Laurenti, Wellcome Henry Dale Fellow and Dr D Kent, LRF Bennett fellow), the molecular pathogenesis of myeloproliferative disorders (Professor Green) the biology of Myeloma (Dr Chapman) and CLL and lymphoma (Dr Ringshausen and Dr Hodson) and the role of the bone marrow niche in normal and malignant haematopoiesis (Dr Mendez-Ferrer).
Thrombosis/haemostasis and structural medicine
This focuses on structural approaches to a number of clinically important molecules with research groups based in the CIMR. Prof Huntingdon is studying the mechanisms that control the behaviour of coagulation proteins and other serpins. The group of Professor Read (Wellcome Trust Principal Fellow) works on extending the power and scope of methods used in protein crystallography and has particular interest in the mechanism of action of bacterial toxins.
Transfusion medicine
Research groups are based in the NHS Blood and Transplant building. This houses a GMP facility, stem cell processing and stem cell research laboratories together with groups working on platelet immuno- biology and functional genomics (Prof Ouwehand), the use of antibody engineering to generate novel and clinically useful monoclonal antibodies (Prof Ouwehand) and the study of megakaryocyte biology (Prof Ouwehand and C Ghaevert). There is also a Clinical Studies Unit in conjunction with the MRC Clinical Trials Unit.
The main sources of departmental research funding are Wellcome Trust, MRC and Leukaemia Research Fund. In addition the Department holds a $6M Centre Grant from the US Leukemia and Lymphoma Society, the only Centre Grant to be awarded outside the US.
The Haematology StR rotation in Addenbrookes.
Addenbrookes has a total of 11 haematology SpRs (including 5 academic clinical fellows and 3 clinical lecturers,) who rotate through the following slots: general ward, haemostasis, transfusion, general laboratory haematology, lymphoma, stem cell transplantation, paediatric haematology and academic/clinical trials (see below). There are regular clinical and laboratory teaching sessions and a departmental seminar programme in addition to the weekly morphology, audit, education and review sessions and network wide MDTs. The successful candidate will form an integral part of the clinical and laboratory haematology service. As well as the varied clinical and laboratory duties outlined above, the registrar is expected to share in the undergraduate and postgraduate teaching undertaken by the unit. The unit has a modern and well equipped teaching room including multiple-headed microscopes and television projection systems. The registrar is also expected to involve him/herself in the many research projects and clinical trials being undertaken in the unit.
Timetable An example of a timetable for an academic trainee is shown below but the order of attachments is variable :
Academic NTN Months 1-4 Month 5-8 Months 9 -12
Year one Laboratory general Ward general academic Year two DGH DGH Laboratory coagulation/ transfusion Year three Laboratory Ward BMT academic Years 4-6 ( subject to PhD external funding) 7 + 8 Clinical lecturer To complete training /return to programme
The present medical staff establishment comprises:
NHS Consultants University (Honorary Consultants) Dr Trevor Baglin Professor A R Green Dr M Besser Dr JIO Craig Professor A J Warren Dr C Crawley Dr L M Williamson Dr A Godfrey Prof W Ouwehand Dr G Follows Dr B Huntly Dr D Perry Dr G Vassilliou Dr T Foukaneli Dr C Ghaevert Dr P Krishnamurthy Dr M Chapman Dr B Uttenthal Dr I Ringshausen Dr E Nicholson (locum) Dr D Hodson
Other Medical Staff Clinical Fellows 3
Trainee Medical Staff Specialist Registrars 9 Clinical Lecturers (Hon Specialist Registrars) 2 Senior House Officers 2 Pre-registration House Officers (FY1) 2
Other Staff Clinical Scientists 1 (Grade C) 8 (Grade B) 6 (Trainee Grade A) Biomedical Scientists 49 (23 BMS1, 12 BMS2, 5 BMS3, 1 BMS4, trainees 8) Medical Laboratory Assistants 9 Medical Technical Officers 3 Admin and Clerical staff 10
Timetable Timetables for each of the 8 training positions are included below.
Weekly educational activities
Monday 12.00 educational meetings: case presentations, audit, journal club, 14.00 Consultant ward round
Tuesday 13.00 Transfusion medicine seminar 14.00 Haemostasis case reviews
Wednesday 08.15 X-ray meeting, 09.00 Paediatric & adult morphology, 13.00 Hospital Grand Round,
Thursday 08.00 Coagulation Teaching, 14:00 Consultant ward round Friday 08.30 Morphology teaching 14.00 Consultant Case reviews
Timetables for StR posts
1) Stem cell transplant Registrar
Monday Tuesday Wednesday Thursday Friday
8.15: Registrar 8.15: X-ray Meeting 8.15: Registrar training training (Morphology) 8.45: Team (Coagulation) Ward Duties 8.45: Morphology meeting Meeting 8.45: Transplant AM Handover 9.00: Pre BMT MDT Clinic Stem cell laboratory Ward Duties Ward Duties 9.30: Post Transplant Stem cell lab & clinic collection meeting (monthly) 12.30: Lunch Haematology Grand Round meeting 2.00: Registrar Bone marrow training harvest 1.30pm nd th (Consults/admin) 2 & 4 Ward Duties Ward Duties 2.00: Consultant PM Mondays Ward Round Ward Duties 2.00: Consultant
Ward Round 4.00: Handover
2) Ward Registrar (General)
Monday Tuesday Wednesday Thursday Friday
9.00: Myeloma and acute leukaemia 8.15: Registrar working MDT 8.15: X-ray Meeting 8.15: Registrar training (Morphology) training 8.45: Handover 9.30 8.45: Morphology (Coagulation) AM Intrathecal chemo – Paraproteinaemia Meeting Ward haem day unit and acute leukaemia Ward duties
clinic Ward Duties Ward duties
12.30: Lunch Haematology Grand Round meeting 2.00: Registrar training (Consults/admin) 2.00: Consultant 2.00: Consultant Ward duties Ward Duties PM Ward Round Ward Round Ward Duties
4.00: Handover
3) Haemostasis and thrombosis
Monday Tuesday Wednesday Thursday Friday 8.15: Teaching (Coagulation)
8.45: Handover 8.45: Morphology 9.00: 8.15: Teaching Meeting Thrombophilia and (Morphology) AM 9.30: Laboratory Anticoagulant clinic Haemophilia Laboratory (alternate weeks) Laboratory Clinic
11.00: HODs meeting 12.30: HODS Lunch Haematology Grand Round Management meeting Group (monthly) 2.00 Teaching (Consults/admin) Laboratory Laboratory PM Laboratory Laboratory
Laboratory
Monthly MDT Meetings: Haemophilia. 3-monthly MDT Thrombosis Treatment/Anticoagulation
4) Lymphoma
Monday Tuesday Wednesday Thursday Friday 8.15: X-ray Meeting 8.15: Teaching 8.45: Morphology 8.15: Teaching (Morphology) 8.45: Handover Meeting (Coagulation)
Consults IT list 9.30-11.00 (onc AM 9.30: Bone 9.15: Lymphoma 9.00: Chemo clinic day unit) marrow list MDT Consults
12.30: Lunch Haematology Grand Round meeting 2.00: Teaching
Consults 1.30: Lymphoma Consults 2.00 CLL clinic Consults (malignant clinic IT list 3.00-4.00 PM 4pm Handover haematology) (onc day unit)
5) General Laboratory Registrar
Monday Tuesday Wednesday Thursday Friday
8.30: MPD MDT 8.15: Teaching 8.45: Morphology (Coagulation) 8.15: Teaching Meeting 8.45: Handover 09.30 MPD Clinic (Morphology)
AM (for Aug 09 CL1) 11.00: HODs 9.00: Women’s Laboratory meeting Laboratory Haematology Clinic Lab duties
Laboratory
12.30: Lunch Haematology Grand Round meeting 2.00: Teaching Laboratory Laboratory Laboratory Laboratory (Consults/admin) PM
Laboratory
6) Paediatric Registrar
Monday Tuesday Wednesday Thursday Friday
8.15: X-ray Meeting
8.45: Morphology 8.15: Teaching Meeting 8.15: Teaching (Coagulation) 8.45: handover 9.00: (Morphology)
AM Oncology Clinic 9.15: General 9.00: Haemato- Ward Round & Procedures Haematology Procedure list PDU Oncology Clinic Ward Round Clinic
Psychosocial meeting 12.30: Grand Round Haematology Lunch Haematology Oncology MDT Lunchtime Seminar meeting
Ward/ Lab Journal Club
& audit 2.00: Teaching PM Ward/ Lab 2.00: ALL Follow- (Consults/admin)
up Ward/ Lab clinic (monthly)
7) Academic Haematology
Monday Tuesday Wednesday Thursday Friday
8.15: X-ray Meeting
8.15: Teaching 8.15: Teaching 8.45: Handover 8.45: Morphology (Morphology) Academic/ trials (Coagulation) AM Meeting
Academic/ trials Academic/ trials Academic/ trials Academic/ trials
12.30: Haematology Transfusion Lunch Grand Round meeting Medicine Seminar
2.00: Teaching PM Academic/ trials 2.00: CLL clinic Academic/ trials Academic/ trials Academic/ trials
8) Transfusion
Monday Tuesday Wednesday Thursday Friday 8.15: 8.45: Handover 9.00: Transfusion lab 8.15: Teaching Teaching meeting (Coagulation) (Morphology) 9.25: Transfusion Consults AM MDS/Leukaemia/ 9.30: 9.00: General Consults/ Consults/ Myeloma MDT Haem clinic Transfusion Transfusion 12.30: Lunch Haematology Grand Round meeting 2.00: Teaching Hospital transfusion
PM 2.00: MDS clinic Transfusion Consults Transfusion Consults committee (quarterly) 4pm Transfusion Consults Handover
During this rotation the StR will gain knowledge and experience of the clinical and laboratory aspects of blood transfusion. There are opportunities to attend the Hospital Transfusion Team meeting, the Hospital Transfusion Committee meeting, and regional transfusion meetings.
Study and Training
The posts are recognised by the Royal College of Physicians and the Postgraduate Dean. The regional training programme reflects the curriculum produced by the Royal College of Physicians and provides comprehensive training in all aspects of clinical and laboratory haematology including transfusion, paediatric haematology as well as exposure to a broad range of basic research related haematology.
The Postgraduate Medical Centre situated at Addenbrooke's Hospital, provides a comprehensive training menu for Higher Specialist Trainees. A traditional “Grand Round” for attendance by all medical staff is held every Wednesday lunchtime. Educational Standards for the Trust are agreed each year with the Postgraduate Dean. There is an excellent library and biomedical computing unit for computer assisted learning.
Study leave is granted in accordance with 'Guide to Specialist Registrar Training' March 1998. It should be noted that there are currently no funds available to cover the costs of attending any specialty-specific courses which colleges regard as mandatory and which exceed maximum payment of expenses in any financial year.
General Information
Within the university city of Cambridge is to be found an unrivalled range of educational facilities and diverse cultural, sporting and other leisure activities. The Arts Theatre is being rebuilt and there are many musical activities to enjoy. The Fitzwilliam Museum is world renowned.
For children there is a full range of public and private educational institutions covering all age groups.
Communications with the rest of England have much improved in recent years, particularly by road so that Cambridge is now served by the national motor way network. Regular train services to King's Cross have a journey time of less than one hour. There is also a direct line to Liverpool Street station and Stansted International Airport.
In 1989 a shopping concourse was opened at the hospital with excellent shopping facilities - an advice centre, bank, café, clothes boutique, dry cleaners, financial advisory services, florist, hairdressing salon, handicraft shop, mini market, newsagents/confectioners, shoe repair/gift shop, solicitor and travel agents together with a recently opened food court which offers fast food (hamburgers, pizzas and sandwiches) as well as conventional options from early morning until late in the evening.
In addition the Frank Lee Leisure Centre provides comprehensive facilities for swimming, squash, a multi- sports hall, a floodlit outdoor multi-sports facility and a profiles fitness suite.
The Cambridge University Postgraduate Medical Centre has catering and bar facilities as well as the library, lecture theatres and seminar rooms. Designated junior medical staff car parking is adjacent to the main hospital with other parking facilities.
Visiting
Arrangements can be made to visit the Department by contacting:
Dr JIO Craig Department of Haematology, Box 234 Addenbrooke’s NHS Trust, Hills Road Cambridge CB2 2QQ Tel: 01223 596289 Email [email protected]
Professor BJP Huntly University of Cambridge Cambridge Institute for Medical Research Box 139 Hills Rd, Cambridge, CB2 5NH Tel: 01223 336828 E-mai [email protected]
JOB DESCRIPTION FOR A SPECIALTY REGISTRAR IN HAEMATOLOGY AT THE IPSWICH HOSPITAL (ROTATING WITH ADDENBROOKE’S HOSPITAL, CAMBRIDGE)
Location of post: This is a rotational post in the Department of Haematology at the Ipswich Hospital, Suffolk, and in the Department of Haematology at Addenbrooke’s Hospital, Cambridge.
Consultant supervision: There are four Consultant Haematologists in Ipswich:- Dr Andrew Hodson, MRCP, FRCPath, MD Dr I.M.H.Chalmers FRCP FRCPath MD Dr J.A.Ademokun FRCP MRCPath MD Dr I.N.Whalley MRCP MRCPath MD
Other Medical Staff Dr M.Salam Staff Grade in Haematology 6 sessions Three full time medical SHOs for Clinical Haematology and Clinical Oncology
Laboratory Staff (whole time equivalents) 1x BMS 4, 2x BMS 3, 2x BMS 2, 7.2x BMS 1, 5.3x MLA, 7.4 Phlebotomists (MLAs) One data collection and audit assistant - 18 hours 1 Clerical 3 Medical Secretaries (HCO)
Description of the post The post at Ipswich will provide broad training in both clinical and laboratory Haematology, as practised in a large district general hospital, and will provide suitable preparation for MRCPath Part One.
Laboratory training The Registrar will participate in the provision of a diagnostic Haematology service, and will be expected to develop a close working relationship with the Technical staff. He/she will assist the Consultants, and will maintain regular liaison with other hospital medical staff and General Practitioners. Attachment to sections of the laboratory will be arranged for agreed periods, under the supervision of a Consultant and with the technical assistance of a Senior MLSO. Specific experience will be gained in General Haematology, Bone Marrow examination, Cytochemistry, Blood Transfusion, Coagulation, Haemoglobinopathy investigation, and Haemolytic investigations. Experience in serum protein electrophoresis and paraprotein analysis is available by arrangement with the Department of Clinical Biochemistry. Radio-isotope work is carried out by staff in the Department of Nuclear Medicine and Medical Physics, who will provide appropriate training.
Clinical Haematology The Department provides a comprehensive and largely independent clinical service. Autologous bone marrow and stem cell transplantation are performed on a collaborative basis with Addenbrooke’s, with mobilisation, high dose therapy, stem cell infusion, and pre-engraftment care being undertaken in Ipswich. Allogeneic bone marrow transplantation is not performed in Ipswich.
Clinical work is mostly located in purpose built wing, separate from the main hospital, housing the Department of Clinical Oncology and Radiotherapy, and Clinical Haematology. Facilities are shared with six consultant Clinical Oncologists. There are Oncology/Radiotherapy Specialist Registrars, whilst the three SHOs work for both Oncology and Clinical Haematology.
The Haematology/Oncology ward provides a total of 25 beds with 7 in single rooms. Day case chemotherapy, investigation, and elective transfusion facilities are available in the departmental Day Unit, and are managed by nurse practitioners under the supervision of a Clinical Nurse Specialist in Haematology. Most chemotherapy is given by the nurses, and is prepared in an on-site pharmacy facility. Beds are also available in the 5-day Clinical Investigation Unit.
The Registrar will have direct responsibility for in-patient care with authority over the SHOs, and under supervision of the Consultants.
He/she will attend the regular Haematology outpatient clinics in order to gain experience in outpatient management of haematological diseases, and will attend the outpatient review meetings. Four new patient clinics, three review clinics, and two Lymphoma clinics (joint with Oncology), occur each week.
A combined Paediatric Oncology and Haematology clinic is held monthly which the Registrar may attend. He/she will be actively involved in the management of paediatric cases with haematological problems. There are quarterly Paediatric clinics in general haematology, and bleeding disorders, which the Registrar may attend.
The anti-coagulant clinics are run by the BMSs and Nurse Specialists with access to medical staff when needed. The Registrar participates in this supervision and is expected to gain experience in the administration of this large clinical service.
The department is a Haemophilia Treatment Unit with 20 registered patients and five regular attenders. A full analytic and treatment service is provided for these patients. Haemophiliacs on holiday in the area attend regularly. The Registrar will participate in the provision of this service.
On-Call Duties One in four Saturday/Sunday weekends second on-call, non-resident, to provide clinical cover for all patients on the Oncology ward, and to provide clinical support to the Haematology Laboratory. Occasional weekday nights on-call by mutual agreement with the Consultant Haematologists. The Registrar may be asked for haematological advice by other clinical teams and GPs. Consultants in both Haematology and Oncology would always be available on-call to support the Registrar. Details of on-call payments can be obtained from Medical Staffing. Information regarding On-call arrangements to be confirmed.
Training Structure Training in Ipswich is largely gained through on-the-job experience, with close supervision by the Consultants. Microscope morphology review, post clinic review meetings, and a learning emphasis during ward rounds and clinics, are at the core of the programme. A half day per week of free time to study is permitted whenever possible.
Teaching and Postgraduate Education There is an active postgraduate education programme run by the clinical tutor, with regular lunchtime meetings each week and a general medical journal club. The Registrar will be expected to attend these meetings, and to present material when requested.
Clinico-pathological conferences are held regularly.
13 The Registrar will be expected to teach students and junior doctors, as well as other professions if requested.
Audit The registrar will be expected to attend the monthly general medicine audit meetings, which involve a wide range of specialties, and deal with specific clinical topics or take the form of case note review. Haematology cases are audited on a regular basis at these meetings. The registrar will be encouraged to conduct audit projects and will receive help from the departmental data collection and audit assistant.
Study Facilities There is a well equipped Medical Library adjacent to the Laboratory. All the major journals are taken including the important Haematological publications i.e. Brit J Haem., Blood, Haematological Oncology, Clinics in Haematology, Seminars, Blood Reviews, J Lab Clin Haem, J Clin Path etc. Study leave will be fully supported, and the Registrar will be encouraged to attend educational and academic meetings.
Research The Registrar will be encouraged to pursue a research interest and appropriate laboratory facilities made available. Joint projects may be possible with other departments.
Management The Registrar will attend meetings of the Directorate of Pathology and of the Haematology Department. He/she will be encouraged to attend Laboratory and Medical management courses.
Laboratory Accommodation The Registrar will share a large air-conditioned office with the Staff grade doctor, and the departmental data assistant. Appropriate furniture, microscope, and personal computer will be provided.
Residence Hospital single or married accommodation may be available.
Timetable Monday Tuesday Wednesday Thursday Friday 2 new patient clinics General Day unit and in- Seminar Anticoagulant Day unit and in- Haematology clinic am patient ward 1 new patient clinic clinic patient ward Anticoagulant round Anticoagulant clinic Lab training or rounds clinic study/research session Lymphoma General MDT pm Ward work Lymphoma clinic haematology Ward work Ward work clinic
The registrar routinely attends 2 general clinics, the lymphoma clinic, occasional new patient clinics and 2 ward rounds. Other clinics are optional
14
THE IPSWICH HOSPITAL This is a large modern district general hospital with 850 beds, of which 36 are day case beds. The hospital is linked to Cambridge University, providing both undergraduate and postgraduate medical education. A full range of medical and surgical specialties is provided. Radiology services are comprehensive, including computerised tomography, and magnetic resonance imaging. The Hospital is a Resource Management site with a Clinical Directorate structure.
DIRECTORATE OF PATHOLOGY This is housed in one building. Specialties provided are: Clinical Biochemistry, Histopathology with Cytology, Microbiology (Public Health Laboratory Service), and Laboratory Haematology with Blood Transfusion. The close physical relationship of the departments facilitates very good communication and co-operation. The Director of Pathology is a Clinical Director, with the post presently held by a Consultant Microbiologist. There are five Consultant Histopathologists, one Consultant Clinical Biochemist, one Principal Biochemist, and two Consultant Microbiologists, in addition to the four Consultant Haematologists.
DIRECTORATE OF ONCOLOGY AND CLINICAL HAEMATOLOGY Clinical haematology services are managed within this separate directorate.
15 JOB DESCRIPTION FOR A SPECIALTY REGISTRAR IN HAEMATOLOGY AT NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST (ROTATING WITH ADDENBROOKE’S HOSPITAL, CAMBRIDGE)
Brief Description of Norfolk and Norwich University Hospital NHS Trust
The Norfolk and Norwich Health Care NHS Trust is within the Eastern Region of the NHS which covers the counties of Cambridgeshire, Norfolk, Suffolk, Buckinghamshire, Berkshire, Northamptonshire, Oxfordshire and Bedfordshire.
The Trust was established on 1 April 1994. At present it comprises the Norfolk and Norwich University Hospital and Cromer Hospital. It provides acute services to an area of approximately 1200 square miles from Wells next the Sea on the north coast of the county to Thetford in the south and from Fakenham in the West to Acle in the east. The current resident population in the catchment area is over 500,000 people. The Norfolk and Norwich University Hospital is a new PFI-built hospital which opened in 2002. It has 1000 beds and provides most medical and surgical services with the exception of neurosurgery and cardiac transplantation. Cromer hospital is situated on the coast and there are major plans for its redevelopment as a day procedure unit.
The management structure consists of 4 divisions. Clinical haematology is part of division one (medical) and laboratory haematology is part of division 4 (support services).
The NNUH is a designated Cancer Centre within the Norfolk and Waveney Cancer Network and works closely with the James Paget Hospital, 20 miles away on the coast.
HAEMATOLOGY DEPARTMENT
The clinical service is based at the Norfolk and Norwich University Hospital. The Norfolk and Norwich is one of the busiest general hospitals in the country and therefore offers a superb opportunity to experience first hand a wide range of benign and malignant haematological conditions. Support departments include renal dialysis unit, a fully equipped radiotherapy department, and a large ITU.
The Department is the largest haemophilia centres in Anglian part of the region with over 100 registered patients of whom 10 are severely affected.
Medical Staff: The haematology consultants (Dr J Z Wimperis, Dr G E Turner, Dr M J Auger, Dr K Bowles, Dr H Lyall, Dr M Lawes), one staff grade (Dr I Gow), 3 specialist registrars and two dedicated SHOs (who are on the medical rotation, rotating every 4 months). Resident on-call cover is provided in core hours by the 2 haematology SHOs and the 3 radiotherapy SHOs, and by a larger pool of medical SHOs outwith core times.
Services provided: the haematology department provides services for patients with malignant disorders to BSH level 3, having started its stem cell autologous transplants in 1997. Where possible, patients are managed as outpatients. The department participates in national and international trials for malignant haematological diseases and in thrombosis and haemostasis. The Cancer Trials Unit is situated within the haematology department and provides specific support.
16 There are 6 anticoagulant nurse specialists who provide computer dosing support for 2500 patients on warfarin, run a fast track VTE (DVT and PE) service and dose the majority of medical inpatients on warfarin. A transfusion nurse specialist has been in post since 1999; the Trust has a rolling programme of transfusion education which extends to the associated Community Trusts.
Links with other departments: within the NNUH there are very close links with histopathology and radiology, with weekly MDT meetings being held. Radiology operates a filmless department, with all investigations online via PACS. Addenbrooke’s Hospital is the Comprehensive Care Centre for patients with bleeding disorders; it is also the parent bone marrow transplant unit and fortnightly telephone conference discussions are held about patients.
Beds: Haematology share the 36 bedded Mulbarton ward with Oncology, and have access to a further 10 beds on the adjacent Langley ward. The wards consist of single bedded rooms with ensuite facilities and 6 bedded single sex bays. The ward is occupied predominately by patients suffering from leukaemia, lymphoma and myeloma and other allied disorders. Since 1997 the unit has also carried out stem cell transplants.
Day Unit: The nurse-led Weybourne day unit is situated in the Colney Centre and has 12 stations for chemotherapy and blood product administration. The ward and day units are well equipped and have a full complement of nursing staff, ward clerks, phlebotomy service, a near patient haematology analyser and two haematology liaison nurses.
Outpatient clinics: Outpatient clinics include general haematology (DR Turner) and haemato-oncology. The latter is divided into specialist clinics for MPD/MDS/acute leukaemia/transplantation (Dr Parker), high grade lymphoma and Hodgkin’s Lymphoma (Dr Wimperis), plasma cell disorders (Dr Auger) CML (Dr Turner). Chemotherapy clinics (2 per week) and venesection clinics (1 per week) are staffed by nursing and medical staff. There is a weekly combined Paediatric Oncology and Haematology clinic (attended every two months by a consultant – Dr Gattens or Dr Nicholson - from Addenbrookes) which the Registrar may attend. S/he will be actively involved in the management of paediatric cases with haematological problems. There are quarterly Paediatric clinics in general haematology, and bleeding disorders, which the Registrar may attend.
Other clinical activities during the week include two consultant ward rounds, a weekly Radiology and Histology multidisciplinary meeting, a procedure list, weekly, audit review and a departmental seminar programme.
Teaching facilities: there is a seminar room available with microscope, a television monitoring system for meetings, teaching and ward rounds. In the laboratory there is a multiheaded microscope for teaching purposes. There is an extensive suite of teaching rooms including a 120 seat lecture theatre sited within the hospital and a well-equipped clinical skills area. The hospital runs an active programme of medical grand rounds in which Haematology present regularly. There are also numerous postgraduate meetings each week within the hospital.
17 Laboratory: A major expansion and reconfiguration of the laboratory was undertaken late 2005 early 2006, with the subsequent introduction of three Abbott Sapphire Haematology analysers with tracking. Replacement of the Diamed Diana Compaqs, two MDA coagulometers and Coulter Epics Profile II flow cytometer is scheduled for 2006. There are active on site Cytogenetics and Molecular Genetics Departments. The laboratory is partly integrated with clinical chemistry and is also part of the Norfolk Pathology Network which includes the James Paget Hospital, Gorleston and the Queen Elizabeth Hospital at King’s Lynn. There is a monthly laboratory QC meeting.
Hospice: Norwich has a purpose built 25 bed hospice. There is a close working relationship with this unit and the director Dr K Soden. There are two palliative acre consultants based at the NNUH.
University of East Anglia Medical School: this opened in 2002 and has over 120 students in each year, the majority of them being mature students. The curriculum takes a novel problem based approach to medicine and the majority of haematology teaching takes place in year 2. The department will continue to play a major role in curriculum development and delivers several lectures and seminars annually to the year 2 students. Clinical student attachments to the haematology unit take place each term for 4 weeks.
The successful candidate will form an integral part of the Haematology team both clinical and in sharing the teaching undertaken on a regular basis by the department. In addition they will be encouraged to take part in any audit, clinical trials or research projects undertaken by the Department.
Monday Tuesday Wednesday Thursday Friday
New patient OP clinic x 2 Histology/Radiolo clinic OP clinic x 2 SpR teaching AM gy MDT meeting outpatient /study
clinic x 1
Departmental Hospital Grand Lunch Medical grand round meeting Round Ward round Grand Ward Round Procedure list Paediatrics Lab duties and Lab duties and – All Lab duties and PM clinic ward referrals ward referrals ward referrals
POST GRADUATE MEDICAL CENTRE The Norfolk and Norwich Hospital is recognised as a designated postgraduate education centre. The PGME Centre, NANIME (Norfolk and Norwich Institute for Medical Education) has an excellent reference library with modern audio-visual teaching aids. The Centre has a full and active programme, providing junior staff with a wide variety of meetings of medical and surgical interest.
Study Leave will be granted in accordance ‘Guide to Specialist Registrar Training’ March 1996. It should be noted that there are currently no funds available to cover the costs of attending any specialty-specific courses which Colleges regard as mandatory, but funding will be considered for each application.
18 GENERAL INFORMATION Norwich is a City of approximately 130,000 people situated 110 miles from London, 65 miles from Cambridge and approximately 20 miles from the east coast. Historically it is the best documented city in England and has an exceptional balance between development and preservation. Its civic amenities provide for a large area of East Anglia of which it is the Regional capital. Norwich is well endowed with facilities for entertainment and the arts. It has one of Europe's most thriving provincial theatres recently re-opened after major refurbishment. Music festivals at Aldeburgh and King's Lynn are within easy reach, in addition to the triennial Norfolk and Norwich festival. There is a full range of sporting and recreational facilities and the Norfolk Broads are nearby. The North Norfolk coast comprises a combination of small seaside resorts, National Trust coastline and wildlife sanctuaries.
Norwich has a large number of schools including private fee paying and comprehensive schools which cater for all bands of ability. There is a modern College of Further and Higher Education which has a wide and varied curriculum. The University of East Anglia is situated on the western edge of the City.
Visiting
Candidates wishing to visit should contact Dr K Bowles or Dr Martin Auger at the Norfolk and Norwich University Hospital. telephone 01603 286286 ext 5979 for haematology secretaries or air call bleep via switchboard or email [email protected] or [email protected].
19 WEST SUFFOLK HOSPITAL
JOB DESCRIPTION FOR A SPECIALTY REGISTRAR IN HAEMATOLOGY AT THE WEST SUFFOLK HOSPITAL (ROTATING WITH ADDENBROOKE’S HOSPITAL, CAMBRIDGE)
West Suffolk Hospital (University of Cambridge Teaching Hospital Trust)
This post is based at the West Suffolk Hospital, in Bury St Edmunds, the major population centre of West Suffolk. It is a well run and friendly district general hospital, providing high quality care with a capacity of approximately 680 beds. The hospital was built in 1974 and is set in attractive wooded grounds. It serves a local population of approximately 280,000.
There is a full range of acute services including a Special Care Baby Unit, an Intensive Therapy Unit, a 24- hour Recovery Unit, a Coronary Care Unit and a High Dependency Unit and a new Dialysis Unit. There is a wide range of radiological diagnostic facilities including CT scanning (spiral), ultrasound, isotope imaging and MRI. Haematology is well supported by the histopathology department and two histopathologists have a special interest in haematological malignancies presenting the WSH cases at the Regional lymphoma MDT and providing a bone marrow trephine review meeting.
On site is St Nicholas Hospice, which is an independent, charity funded unit as well as a metal health unit.
Bury St Edmunds is an attractive and historic market and cathedral town which is expanding and developing in line with the rapid growth of successful business in East Anglia. There are good shopping facilities and amenities for sport and recreation, culture and social activity and a good range of restaurants and take-aways. There are good road links to Cambridge (35 mins) and the Midlands to the west and Ipswich and the coast to the east. There is a fast road (M11) and rail (via Cambridge, Ipswich, Stowmarket) connection to London.
Laboratory Service – Dept of Haematology
The Haematology laboratory is staffed as follows:
The Haematology laboratory is staffed as follows:
15.0 WTE BMSs (one trainee) 2.0 WTE MLAs 8.0 WTE MLA/Phlebotomists 1.5 WTE Admin/Clerical
Mrs Yvonne Field, BMS4 is the Laboratory Manager for the combined Haematology service.
The Haematology Laboratory is fully computerised (ISOFT-APEX) and provides a comprehensive service covering all aspects of general haematology (238,000 requests annually) and transfusion medicine. Over 50% of the work comes from GPs. Routine blood cell counting is provided by 2 Coulter LH750 machines (700-800 counts/day). The laboratory has two IL Futura for coagulation studies (soon to be replaced) and a full range of thrombophilia investigations is established.
Blood transfusion is under day-to-day management by a BMS with responsibility for this area, supervised by the BMS4. The department is fully automated with 2 Ortho Innovas in place for blood groups and antibody screens. Cross matching of blood for transfusion is via an immediate spin technique, with plans to switch to electronic issue in the near future. The Blood Transfusion committee meets quarterly and is chaired by Dr A Sauvage (Accident & Emergency Consultant). The transfusion nurse specialist plays an active role in training staff across the Trust, implementing National guidelines and improving the appropriate use of blood as well as cell salvage. Dr Beatty currently provides a lead for Transfusion. 20
The anticoagulant service monitors approximately 2,500 patients on Warfarin. The laboratory uses the DAWN AC computer system, which is run by the Lead BMS2 and overseen by the anticoagulant specialist nurse. Dr Chitnavis currently provides a lead for the haemostasis and thrombosis service. Assays for clotting factors are established to support the Haemophilia service. A selective thrombophilia screening service is also provided.
There is an integrated haemaglobinopathy service. Samples are run on the biochemistry TOSIGY HPLC analyser. Further investigation is performed by electrophoresis in haematology and abnormal results are reviewed by a consultant.
The immunophenotyping and cytogenetics for leukaemia diagnosis are performed by Addenbrooke’s Hospital and reviewed at the weekly teleconferenced ‘non-lymphoma’ MDT.
The laboratory participates in the following EQA schemes:
NEQAS FBC and differential white cell counts, haematinics, blood films, malaria parasites, coagulation factor assays, thrombophilia screens, clotting screens, blood transfusion and haemoglobin electrophoresis.
Haematology has recently undergone its CPA re-inspection and has received full CPA accreditation. Microbiology, Biochemistry and Histopathology are also all fully accredited. The next inspection is due April – Sept 2007.
The Pathology Services at WSH are part of the West Anglia Pathology Network comprising Addenbrookes, Hinchingbrooke, WSH and Papworth.
Teaching facilities: there is laboratory area equipped with a teaching microscope and LCD screen and image capture facilities. A further teaching head is on order.
Clinical Service
Clinical Haematology and Oncology Services share a new dedicated 11-bedded ward, and purpose-build outpatient and day unit facilities. The day unit provides day care facilities for platelet transfusion, chemotherapy administration and minor procedures (eg. Intrathecal chemotherapy, central-line insertion and bone marrow aspirate and trephine biopsies). The ward has the capacity to increase to 16 beds with 2 HEPA filtered rooms. These facilities were recently upgraded and extended with the assistance of Macmillan. The department also has access to a medical day care unit where patients can go for transfusion, infusion of bisphosphonates etc.
The unit provides a Level 2 Haematology clinical service at the West Suffolk Hospital thus providing care for all haematological malignancies including acute leukaemia.
The Haematology department’s close links with Addenbrooke’s Hospital allow most patients requiring bone marrow transplantation to be referred to Cambridge.
The current annual in-patient workload is around 3,000 cases (i.e. 3% of the total Trust in-patient case load).
The lymphomas are managed in a combined lymphoma clinic run by a Haematologist in collaboration with Dr Margaret Moody, Consultant Clinical Oncologist. On average, there is one new referral each week. All new cases are discussed at the Regional Lymphoma MDT chaired by Dr George Follows at Addenbrooke’s Hospital. There are teleconferencing facilities allowing regional hospitals forming the West Anglia Cancer Network to participate. These currently comprise Addenbrookes, West Suffolk Hospital, Peterborough, King’s Lynn, Bedford and Hinchingbrooke.
Paediatric Haematology is dealt with on a regional basis centred at Addenbrooke’s Hospital. Follow up care of paediatric leukaemia and lymphoma patients is currently provided by the paediatricians.
21
Haemophilia patients are managed at the Regional Centre at Addenbrooke’s Hospital with a limited Haemophilia Service being provided locally at WSH.
Approximately 60 outpatients are seen each week, around five being new referrals. In addition to the Lymphoma Clinic there are four general outpatient clinics including new patient and telephone appointments. In compliance with the two week cancer referral target, there are slots for the urgent referral of new patients and their immediate investigation.
Supporting Clinical Staff
A multi-disciplinary team exists working in collaboration with the Consultant Haematologist, the key members of which are:
Clinical Nurse Specialists (1.5 WTE); Transfusion Nurse (1 WTE); Coagulation Nurse, Clinical Haematology and Oncology Unit Sister; a designated pharmacist and senior laboratory staff.
The post holder can expect support from the team with regard to service development, quality assurance, standards, treatment protocols, audit, clinical governance and research.
Staffing Haematology: a) Dr S Young - Min Consultant Haematologist b) Dr C Beatty Consultant Haematologist (PT) c) Dr D Chitnavis Consultant Haematologist (PT) d) Dr M Karanthe Consultant Haematologist
TEACHING
Teaching and Postgraduate Medical Education
There is a newly built, well equipped and active Education Centre, which provides a varied programme of lectures, and regular weekly meetings organised in a wide variety of specialities. There is an excellent multi-disciplinary library, which is well stocked with textbooks, standard journals, CD ROM journals, and there is a computer room with access to Medline, the Internet and Email on a 24-hour basis. There is a Clinical Skills Unit within the Education Centre with several Clinical Skills Co-ordinators who train junior and senior medical students, as well as junior doctors, in various practical techniques such as venepuncture, inserting drips and arterial blood gases. Resuscitation training is available here, as well as training on insertion of central lines.
The appointee will be expected to take an active part in teaching the doctors in training in the Haematology department as well as medical students. Regular audit sessions are held. The hospital is a popular training placement for both medical students and doctors in training; most of the specialist registrars are on regional rotations and there are trainees within the speciality.
Cambridge Graduate Course
The Cambridge Graduate Medical Course is based at the West Suffolk Hospital, which provides a fast track 4 year course for 20 students a year who would hold an existing degree.
The West Suffolk Hospital will continue to receive both first and final year clinical students from the current standard University of Cambridge course.
22
StR Timetable West Suffolk Hospital
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 9.00am Multidisciplinary Addenbrookes review of patients on 8.30am Xray Mtg IV chemotherapy 9.00am SpR Talk 9.30am Slide Review 9.30 9.00-12.00 9.00am Non lymphoma MDT 10.30am AM Dr Chitnavis Clinic – 11.00am Lymphoma Day unit/ward Ward Round General/coagulation Multidisciplinary Bone marrow/IT list 10.00am diagnostic review linked Chemotherapy Clinic to Addenbrookes (parallel clinic with 12.00 Local MDT – Margaret Moody, review of new/problem Consultant patients Radiotherapy) 12.30pm 12.30pm West Suffolk Hospital LUNCH West Suffolk Meeting or Postgraduate Meeting Departmental educational meeting
2.00pm 2.00pm 2.00pm Laboratory Multidisciplinary Ward Study Half Day 3.00pm
PM Round Audit (Tuesday or Wed Dr Beatty Bone marrow 4.00pm pm) General Clinic trephine meeting Lab
(Morphology/Coag)
On rota for Ward/GP Referrals/Advice
Visiting
Candidates wishing to visit should contact Dr C Beatty, Dr D Chitnavis, Dr M Karanthe or Dr S Young Min at the West Suffolk Hospital. Telephone 01284 713073/2 for haematology secretaries or bleep via switchboard (01284 71300) or email [email protected].
23 JOB DESCRIPTION FOR A SPECIALTY REGISTRAR IN HAEMATOLOGY AT KING’S LYNN HOSPITAL (ROTATING WITH ADDENBROOKES HOSPITAL, CAMBRIDGE)
Location of post
This is a rotational post currently with a maximum of 2 years in the department of haematology at King’s Lynn Hospital, Norfolk, and 3 years in the department of haematology at Addenbrookes Hospital, Cambridge.
Consultant supervision There are 3 consultants at King’s Lynn:
Dr Peter Coates - part time Dr Martin - full time Dr Jane Keidan - part time (7 sessions) Dr L Cooke - full time
Other medical staff
A pre-registration house office dedicated to Shouldham Ward (Macmillan Centre) who is shared with oncology and palliative care.
Specialist nursing staff
There are 5 G grade specialist haematology sisters:
Sister Jayne Miller - 1 whole time general haematology Sister Lesley Grimmer - 0.6 whole time equivalent general haematology Sister Claire Atterbury - 1 whole time transfusion and general haematology Sister Kate Willis - 0.8 whole time equivalent coagulation Sister Annette Miles - 0.53 whole equivalent haematology trials nurse
Laboratory staff in the combined haemochemistry department (whole time equivalents)
1 consultant chemical pathologist 1 haemochemistry manager BMS 4 2 chief biomedical scientists 3 senior biomedical scientists 10.25 biomedical scientists 7.39 medical laboratory assistants 4 trainee biomedical scientists 3.08 clerical staff
Description of the post
King’s Lynn Hospital haematology department is a busy and progressive district general hospital department managing all the haematology needs of the local population of 220,000 inhabitants. A broad training in clinical and laboratory haematology is therefore provided together with teaching and facilities suitable for preparation of the MRC Path examination.
Clinical haematology
In 2005 the clinical haematology department managed 1,320 elective inpatient and day case episodes, 86 emergency admissions, 445 new outpatient visits, 4,425 follow up outpatient visits, 135 coagulation new patient visits, and 5,128 coagulation follow up cases. All cases of malignant haematology were reported to the East Anglian Cancer Registry and figures subsequently produced for 1 year and 5 year survival of these patients were comparable with figures produced by the rest of East Anglia.
24 Clinical haematology services are mainly provided in a new Macmillan Unit which contains a 12 bedded ward shared with oncology and palliative care, a 4 room outpatient suite, a chemotherapy room and a palliative day care lounge. The clinical management of patients is governed by an extensive set of protocols and chemotherapy is delivered by specially trained nurses and a specialist team of pharmacists. Palliative care services are provided by specialist nurses in the palliative day care area of the Macmillan centre and by a team of Macmillan nurses with a part time consultant in palliative care.
All cases of haematological malignancy are diagnosed and managed in conjunction with the haematology department at Addenbrookes Hospital and discussions take place each week by video conferencing with the lymphoma, leukaemia and myeloma teams at Addenbrookes. In addition, there is a weekly King’s Lynn multi-disciplinary team meeting/ward round where all current inpatient cases are discussed. The haematology team are also engaged in monthly quality meetings and additionally monthly team meetings to ensure that standards are maintained and problems quickly addressed.
The specialist registrar in haematology will have every opportunity to receive training in the diagnosis and management of in and out patients suffering from haematological disorders. This training will include haematological problems arising within other parts of the hospital and requests for help from GPs and other community staff. In addition there is a weekly coagulation clinic at King’s Lynn where cases of bleeding and clotting are diagnosed and managed. Daily anticoagulant clinics are run by specialist nurses and BMS staff in the laboratory but the majority of anticoagulation monitoring is undertaken in the community. There are 24 patients suffering from haemophilia in the King’s Lynn area and these patients are managed in conjunction with Addenbrookes.
Haemoglobinopathy services – the Trust is a pilot site for antenatal haemoglobinopathy screening and counselling services are provided for affected couples.
Transfusion department is fully automated with electronic issue. There is a clinically orientated transfusion team which meets monthly to actively manage transfusion practice within the Trust. Antenatal serology services are provided locally.
Specialist Registrar timetable Monday 8.30 am to 9.15 am ward round 9.15 am to 10.00 am MDT discussion with Addenbrookes 10.00 to 1.00 pm outpatient clinic or ward round 1.30 pm to 3.00 pm bone marrow clinic or overflow clinic
Tuesday 9 am to 1.00 pm outpatient clinic or ward round 1.00 pm to 2.00 pm haematology tutorial 2.00 pm to 4.00 pm overflow clinic
Wednesday 9.00 am to 10.30 am main ward round 10.30 am to 11.00 am lymphoma MDT 2.00 pm to 5.00 pm follow up clinic
Thursday 9.00 am to 1.00 pm Wisbech clinic 1 in 3 10.45 am to 12.30 pm coagulation clinic 1 in 4 ward round and bone marrow clinic 1 in 2 12.30 pm to 2.00 pm medical meeting 2.00 pm to 3.30 pm quality or team meeting, management/admin or private study Friday 9.00 am to 9.30 am ward round 10.00 am to 12.30 pm urgent cancer referral clinic or anticoagulation clinic cover 12.30 pm to 2.00 pm Friday lunchtime hospital meeting and lecture Friday pm audit/private study On-call duties: the specialist registrar will always be on-call with a consultant haematologist. During the working week the specialist registrar will be on-call 1 working day every fortnight (9am to 5 pm). The specialist registrar will also be on-call for 48 hours over a weekend 1 in 10. During the on-call period the specialist registrar will take all calls and problems from the laboratory, Macmillan Unit, hospital and general community. Problems will subsequently be discussed in a debriefing session with the on-call
25 consultant haematologist. The appropriate on-call payment will be available. On call duties to be confirmed
Teaching and postgraduate education
The specialist registrar will learn by practical experience of clinical and laboratory problems and in addition will attend the weekly haematology tutorials on a Tuesday, the weekly morphology sessions and discussions at the Monday Addenbrookes MDT, weekly slide teaching at 1 pm on Mondays locally, weekly Wednesday Lymphoma MDT video conferences with Addenbrookes, Thursday lunchtime weekly general medicine case presentation meeting, weekly Friday lunchtime hospital lecture, monthly haematology quality meeting, monthly haematology team meeting and a monthly laboratory management meeting.
Audit
Eleven haematology department audits were undertaken in 2005 and the SpR will be encouraged to complete an audit project during their time at King’s Lynn.
Study facilities
The Queen Elizabeth Hospital, King’s Lynn has a well equipped medical library with free access to computerised literature searches. The SpR will have a dedicated room in the laboratory. This room is equipped with a laptop computer which is connected to the internet for information searching facilities. The laboratory has a seminar room and library with current and back copies of haematology journals including Clinics in Haematology, Blood Reviews, The British Journal of Haematology and the Journal of Laboratory and Clinical Haematology.
Research
The specialist registrar will be encouraged to pursue a research interest during their stay at King’s Lynn. Resident hospital single or married accommodation may be available.
The Queen Elizabeth Hospital, King’s Lynn
The Queen Elizabeth Hospital, King’s Lynn is a 505 bedded district general hospital set in open countryside on the edge of King’s Lynn and providing a comprehensive range of specialist acute and community based health care services for a population of 220,000.
26 JOB DESCRIPTION FOR A SPECIALTY REGISTRAR IN HAEMATOLOGY AT PETERBOROUGH AND STAMFORD NHS FOUNDATION TRUST
PETERBOROUGH AND STAMFORD NHS TRUST
Introduction
The Trust was established on 1 April 1993 and comprises three hospitals: Peterborough District Hospital - 424 beds Edith Cavell Hospital - 257 beds Stamford and Rutland Hospital - 90 beds Foundation status was awarded in April 2004
Peterborough District Hospital
The Peterborough District Hospital has 424 beds and provides acute medical services for the people of Peterborough and the surrounding district. The Trust’s Accident and Emergency department is situated on site, together with Homerton College of Health Studies, Outpatient, Radiology and Pathology departments.
The Hospital is designated as a Postgraduate Medical Education Centre and provides an active programme of postgraduate education in a modern centre on site.
The District Hospital has: Five main operating theatres A six-bed intensive care unit A day surgery unit An accident and emergency department An endoscopy unit A dental and ophthalmology wing, incorporating its own operating theatre A three roomed ultrasound department A thirty-bedded Stroke Unit An emergency medical admissions ward with examination bay A 38-bed children’s ward with integral assessment bay, high dependency area and outpatient department A gynaecology department with an early pregnancy assessment facility and well developed outpatient treatment practices
The Maternity Unit, a satellite building at the District Hospital, comprises 45 beds, two theatre facilities and a Special Care Baby Unit with intensive care facilities comprising a total of 16 cots.
The Surgical Recovery Unit opened in March 2000. This unit offers higher levels of nursing care and expertise for patients who are recovering from major surgery.
The Trust opened a new, state of the art, Vascular Laboratory in January 2000. This laboratory undertakes sophisticated diagnostic procedure which guides the surgeons and physicians in the treatment of patients with vascular disease.
The Accident & Emergency Department was upgraded in 2001 and now includes an observation unit which provides the hospital with a further six beds.
Clinical support services on site include:
Full Radiology Department with high tech CT Scanner, Dual Head Gamma Camera, Angiography suite, Ultrasound department and a MRI Unit. Full Pathology laboratory including a Ward Order Communications Module for electronic requesting and reporting, plus online GP reporting.
27 Active Rehabilitation Department, whose facilities include a hydrotherapy pool and two gymnasiums. Full range of pharmaceutical services including TPN and Cytotoxics. Outpatient clinics. Health Records – includes reception/appointments, admissions, document image processing and health records access and library. Access to library services available on a 24-hour basis to support emergency admissions. The majority of services are also available at Edith Cavell Hospital. A full range of therapy services supporting the work of multi-disciplinary teams and receiving direct GP referrals.
Recent developments include a state of the art switchboard which includes direct dial in, call logger and voicemail, mobile phones on a local network and site paging facilities.
Regional specialities such as neurosurgery and cardiothoracic surgery are undertaken at Addenbrooke’s and Papworth Hospitals in Cambridge.
Edith Cavell Hospital
The Edith Cavell Hospital was opened in 1988 on a green-field site approximately two miles from Peterborough District Hospital. The hospital has 257 beds, comprising:
A four-bedded high dependency unit Isolation Medicine for the elderly General surgical Urological Adult and paediatric ENT Orthopaedic Outpatients Day surgery beds A hyperbaric oxygen unit
In addition there are four inpatient beds for the management of chronic intractable pain.
Facilities at the hospital include five operating theatres, radiology, MRI service, breast imaging unit, bone mineral densitometry unit, pharmacy, a four-bedded high dependency unit and a day ward facility.
The Robert Horrell Macmillan Day Centre is situated on site and offers services to patients living with a diagnosis of cancer.
Stamford and Rutland Hospital
The Stamford and Rutland Hospital, in Stamford (13 miles north of Peterborough) joined Peterborough and Stamford Hospitals NHS Foundation Trust on 1 April 2002.
The hospital comprises 90 beds, one operating theatre and a procedure suite. There are various surgical and medical services. There is a casualty department (not 24 hours) together with x-ray facilities, physiotherapy and pathology services. There are no resident anaesthetists and senior anaesthetists service the operating lists. There is a resident medical officer.
Ministry Of Defence Hospital Unit
Peterborough and Stamford Hospitals NHS Foundation Trust is one of five trusts selected by the Ministry of Defence to host a Ministry of Defence Hospital Unit (MDHU).
The MDHU was formally opened on 29 February 1996 and comprises approximately 150 military uniformed personnel, integrated within the Trust.
Consultants, junior doctors, nurses and professions allied to medicine are employed in numerous areas. The MoD is responsible to the Trust for the management of an elective orthopaedic ward at the Edith 28 Cavell Hospital and a three-bed Surgical Recovery Unit at Peterborough District Hospital. Military nursing staff also work on the acute medical admissions ward, A&E, ITU and in theatres. Military student nurses of all three services have clinical secondments on NHS wards across the Trust.
THE HAEMATOLOGY DEPARTMENT
Laboratory aspects
The Haematology laboratories are situated in the original building of the District Hospital site. They are situated on the first floor above the Day Unit and other out-patient clinics. There was a major refurbishment of the analytical areas in 2004, including environmental temperature control & replacement main Haematology analysers. Immunology is housed 1 floor above in a similar modern environment. The Trust has commenced a PFI project which will conclude with relocation of all the District site services to the Edith Cavell site. The planned completion date is 2010.
The laboratory equipment includes: Beckman Coulter LH750 Haematology analysers x 2 Beckman Coulter Epics XL Flow Cytometer Sedimatic ESR IL Futura & Advance Coagulation Analysers BEST 2000 Elisa system Pharmacia Unicap system Biorad Variant Haemoglobin analyser Autovue Blood Transfusion analysers x 2 Olympus Microscopes with facilities for digital imaging and storage
Apart from the Unicap analyser, all analysers are linked to the laboratory computer (Telepath-ISOFT). This computer network is linked via an interface to the hospital PAS. Much use is made of the ward Order Communications Module (OCM) for the requesting of Pathology tests which aids the speed and accuracy of data entry within Pathology and enables the requesters to view authorised results on ward terminals. In- patient requests are 100% electronic; Out-patients are increasing slowly. GPs at present make use of hand-written request forms but most surgeries receive electronic reports via the telephone lines (soon to be NHS net with encryption). The Blood Transfusion section has made use of Electronic Issue since 1999.
The Haematology laboratory test repertoire is wide with provision of immunophenotyping, haemoglobinopathy screening, thrombophilia screening (excluding genetic tests), and measurement of clotting factors, von Willebrand factor and activity. All sections of Haematology Laboratory (General, Coagulation, Immunophenotyping, Blood Transfusion, Immunology & Semenology) take part in regular internal and external quality control programmes. The EQA performance of all sections has been consistently excellent. The Haematology laboratory has provisional CPA accreditation following an assessment in October 2005.
Staffing of Haematology/Immunology Department
Consultant Haematologists 4 (3WTE) Specialist Registrar 1 Haematology Services Manager 1 Secretary 1.5 Clinical Scientist (Immunology) 1 BMS3 2 BMS2 5 BMS1 6.5 BMS trainee 3 ATO (shared with Pathology reception, Phlebotomy & Chemistry) 23 WTE
29 Workload of Haematology/Immunology/Blood Transfusion Department (2004-2005)
Full Blood Counts 162550 ESRs 36470 Coagulation screens 20224 INRs 11058 APTTs 773 Ddimers 3282 Blood films 10884 HbA2 1137
ANA 3882 TTG 1731 Blood groups 18239 Cross-matches 5281 Blood units issued 15850 Antenatal groups 7158
GP requests account for about 55% of the workload.
Clinical aspects
The Clinical Haematology department comprises four Consultant Haematologists (approx 3WTE), one Specialist Registrar (this post), three senior house officers (part of General Medical rotation), and one Clinical Nurse Specialist. The Department undertakes the care of patients with malignant disorders (acute and chronic leukaemias, lymphomas, myeloma and myeloproliferative disorders), non-malignant blood disorders (haemoglobinopathies and other anaemias) and disorders of haemostasis and thrombosis. The Department is part of the West Anglia Cancer Network and has obtained Calman Hine accreditation for delivery of cancer care.
Following a recent review of haematological cancer services in the West Anglia Cancer Network, all level 2 services for the population of west and north Cambridgeshire (Peterborough, Stamford and Huntington) are now undertaken at the Peterborough District Hospital Haematology/Oncology Unit. Hence, this unit now serves a population of 450,000 for level 2 haematological cancer services. In order to achieve this development, the Clinical Haematology departments of both the Peterborough & Stamford Hospitals NHS Foundation Trust and the Hinchingbrooke Hospital NHS Trust have made formal links. As a result, these two Clinical Haematology departments now share clinical responsibilities including in-patient/out-patient care and on-call commitments.
The Haematology/Oncology Unit has facilities for both inpatient and outpatient/day care. The inpatient care facilities consist of a shared Haematology/Oncology ward with 16 beds including 6 side rooms. The ward received 356 haematology admissions in 2004-2005. The outpatient care facilities include a designated Day unit which is adequately staffed by suitably trained nurses. A variety of clinical procedures such as administration of chemotherapy, blood/platelet transfusions, bone marrow aspirations and care of central venous catheters etc are routinely carried out in this Day Unit. The Day Unit attended to 1500 day cases and administered 4000 chemotherapies in 2004. Facilities exist for emergency or palliative radiotherapy but for more definitive treatment, patients are usually referred to Addenbrooke’s Hospital.
Peterborough is a Haemophilia centre, the local comprehensive care centre is Addenbrooke's Hospital, Cambridge. The department has facilities and expertise for coagulation investigations including factor assays. However, more complex bleeding disorders are referred to the Haemophilia centre at Cambridge.
The vast proportion of anticoagulant management is done via a postal service using a computer dosing system but there are still two anticoagulant clinics per week for unstable patients.
There is presently a paediatric haematology clinic run by a local paediatrician, together with support from Addenbrooke's Hospital, Cambridge. All paediatric malignancies are channelled through Cambridge and only very limited activity exists in Peterborough.
Clinical support for in-patient and out-patient care will be provided by the Specialist Registrar in Haematology and the three shared Senior House officers with Oncology. Evening and weekend cover is 30 supplied by junior medical staff in the Department of Medicine. A full time Clinical Nurse Specialist in Haematology is involved in nurse training, preparation of protocols and patient liaison and counselling. The cytotoxic drugs are prepared by the Aseptic Unit of the Pharmacy department. Both in-patient and out-patient Haematology/Oncology nursing staff are appropriately trained in the administration of cytotoxic drugs.
Currently patients from this Trust are not entered into national or regional Haematology trials but plans are being made to seek infrastructure support to allow this.
Although the Clinical Haematology and Oncology Units share a ward, junior medical and nursing staff. Consultant staff in these departments do not provide mutual cover. Oncology emergencies are cared for by the Medical Admitting Team.
Staffing of the Clinical Haematology Department
Medical Staff
Consultant Haematologists:
Dr M Sivakumaran Full time Dr KP Rege Full time Dr CE Hoggarth 0.4 WTE (shared with Hinchingbrooke Healthcare Trust) Dr SK Nagumantry 0.7 WTE (shared with Hinchingbrooke Healthcare Trust)
Specialist Registrar in Haematology (this post)
Junior Medical Staff: 3 Senior House Officers (part of the General Medicine Rotation. A House Officer, Senior House Officer and Specialist Registrar in General Medicine provide out of hours cover)
Nursing Staff
1 Clinical Nurse Specialist in Haematology Full time
1 Transfusion Nurse Specialist Full time
1 Matron for Haematology and Oncology – both ward and clinic Full time
5 Band 6 Clinical Nurse Leaders in Haematology and Oncology Full time both ward and clinic.
Educational opportunities There are 2 weekly consultant ward rounds for business and teaching. All members of the clinical team attend including the departmental pharmacist. There is a weekly teleconferenced MDT meeting with Addenbrooke’s Hospital for leukaemia and myeloma. There is a weekly MDT meeting which is teleconferenced with Addenbrooke’s Hospital (for lymphoma patients) for part of the meeting and Hinchingbrooke Hospital for the whole meeting. All relevant radiology and all histology from the preceding week is reviewed at this meeting. At this trust, trephines are reported by the Histopathologists but we are keen to set up a joint reporting session. There are 4 weekly clinics for general haematology, 2 clinics for unstable patients taking anticoagulants and a monthly thrombophilia / haemoglobinopathy clinic. Bone marrows will be reported jointly with the appropriate Consultant Haematologist. A laboratory meeting to report the immunophenotyping results along with cellular morphology will be arranged. There are weekly medical Grand Round presentations and a weekly educational meeting for all hospital staff.
31 Educational supervision The educational supervisor will be Dr Kanchan Rege
Academic Programme Director: Professor Brian Huntly
Clinical Programme Director: Dr Martin Besser
Programme contact for further information: Professor Brian Huntly, Addenbrooke’s Hospital, 01223 245151
For further information please contact: Health Education East of England, 2-4 Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB [email protected]
Alternatively, please visit the NIHR website: https://www.nihr.ac.uk/funding-and-support/
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