NHS Lothian Acute Division Directorate of Surgery Department of Renal Medicine, Royal Infirmary of

Clinical Fellow in Transplantation

1. Outline of the post

Further particulars are presented for a Clinical Fellow post in the Department of Renal Medicine at the Royal Infirmary of Edinburgh a particular focus on the Renal Transplant service. This is a full-time post which has been funded by NHS Lothian for one year from August 2015 to provide further sub-speciality training in medical aspects of Transplantation. The post is intended for post CCT training or out of programme training for senior Renal trainees who intend to pursue a career focused on transplant medicine. The Royal Infirmary of Edinburgh provides kidney transplantation to the North, East and South-East of , and kidney-pancreas transplantation for the whole of Scotland. Recent changes in organ procurement and allocation has resulted in a significant increase in renal and SKP transplant activity, both inpatient and outpatient, at the Royal Infirmary of Edinburgh. The team within the RIE plays an active role in developing techniques for organ preservation and procurement, and is leading the way in the UK with normothermic regional perfusion. Consultant surgeons and nephrologists also have an active research profile in both clinical and laboratory based renal transplant research. There is an active Live donor programme including ABO/HLA incompatible transplantation and a successful pancreatic islet transplant programme. The Royal Infirmary of Edinburgh also provides liver transplantation for the whole of Scotland and there would be the opportunity for the appointee to spend time in the liver transplant service if interested. The post holder will be based mainly in the Department of Renal Medicine at the Royal Infirmary of Edinburgh and would participate in the StR on call rota.

2. NHS Lothian

NHS Lothian is an integrated NHS Board in Scotland providing primary, community, mental health and services. Mr Tim Davison is Chief Executive and Dr David Farquharson is Medical Director.

The NHS Board determines strategy, allocates resources and provides governance across the health system. Services are delivered by Lothian University hospitals division, the and Associated mental health services, 4 community health (and social care) partnerships (CH(C)Ps) in City of Edinburgh, , and , and a Public Health directorate.

NHS Lothian serves a population of 850,000.

The Transplant unit provides a supra-regional service to Fife, Tayside, Borders, Grampian and Highland regions and serves a population of 3.5 million for renal Transplantation and 5.5 million for pancreas transplantation.

DATE Page 1 of 12 2.1 University Hospitals Division

The University Hospitals Division provides a full range of secondary and tertiary clinical services to the populations of Edinburgh, Midlothian, East Lothian and West Lothian. The Division is one of the major research and teaching centres in the United Kingdom.

Hospitals included in the Division are:

The Royal Infirmary of Edinburgh The The Royal Hospital for Sick Children, Edinburgh St Johns Hospital Royal Victoria Hospital The Princess Alexandra Eye Pavilion.

The Royal Infirmary (RIE) is a major teaching hospital on a green field site in the South East of the city of Edinburgh built in 2003. It comprises 25 wards, 869 beds, and 24 operating theatres, and is equipped with modern theatre and critical care equipment and monitoring. Within the main building is a dedicated, multidisciplinary, 5 theatre day surgery complex. The hospital provides for most specialities and is the centre for:  General surgery with a focus on the upper GI tract  Vascular surgery  Hepato-biliary and Transplant medicine and surgery  Cardiac and Thoracic surgery  Elective and trauma Orthopaedics surgery  Neonatology  Obstetrics & Gynaecology  Cardiology  Renal Medicine  Sleep Medicine  Regional major Accident and Emergency centre.

There is a Combined Assessment Unit which takes unselected GP or direct emergency referrals, and from A&E. CAU includes the Dept of Liaison Psychiatry and the Scottish Poisons Bureau and Treatment Centre. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM and PET scanning will be available in 2008). There is a full range of lecture theatres, a library and AV facilities.

The Western General Hospital (WGH) has 600 beds and 5 operating theatres and is equipped with modern theatre and critical care equipment and monitoring. The Anne Ferguson building was completed in 2001. The hospital provides for most specialties and is the centre for:  Neurology, Neurosurgery and neuropathology  UK CJD unit  Colorectal Surgery  Urology and Scottish Lithotriptor Centre  Breast Surgery and Breast screening • Gastro-Intestinal disease  Rheumatology  Infectious Diseases  Haematology Oncology  Medical Oncology  Radiation Oncology (including 6 LINACs)  Dermatology (Inpatient)  Medicine of the Elderly/Stroke Medicine

DATE Page 2 of 12 There is an Acute Receiving Unit, which accepts GP referrals and 999 ambulance medical cases on a zoned basis within the city, and a nurse led Minor Injuries Unit. There is no trauma unit at this hospital. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, MR, Ultrasound and NM).There is a full range of lecture theatres, a library and AV facilities.

St John’s Hospital opened in 1989 and is located in the centre of Livingston, a new town about 30 minutes drive west from Edinburgh. The hospital provides for most common specialties but does not have emergency general surgery or orthopaedic trauma operating. The hospital has a paediatric ward and is the centre for:  General Medicine with specialists in Cardiology, Diabetes & Endocrinology, Gastroenterology, Respiratory Medicine and Care of the Elderly  Obstetrics & Gynaecology  Child Health including Paediatrics and community child health  The supraregional Burns and Plastic Surgery unit.  Oral and Maxillofacial Surgery  ENT  Critical Care (ITU, HDU and CCU)  Accident and Emergency  General Surgery  Orthopaedics  Anaesthetics  Mental Health including ICCU and ICPU

Since 2005 general surgery and orthopaedics have been reconfigured in NHS Lothian with SJH being developed as a major elective centre for the region. Lothian’s ENT service was relocated to SJH to create an integrated head and neck unit with OMFS and Plastic Surgery.

Recent developments at SJH include a new endoscopy suite, an Intensive Psychiatric Care Unit, a digital mammography unit, an oncology (cancer care) day centre, a satellite renal dialysis unit and a £2.75m reprovision of A&E. There are full supporting Laboratory and Diagnostic Radiology Services (including CT, Ultrasound and NM).

The hospital has been accredited full teaching hospital status by the University of Edinburgh. There is a full range of lecture theatres, a library and AV facilities.

The Royal Hospital for Sick Children (RHSC) is a 141 bedded hospital providing general and specialist services for children. The hospital is situated in a residential area close to the centre of Edinburgh and is approximately 3 miles from the site of the New Royal Infirmary and the co- located University of Edinburgh Medical School and 3 miles from the Western General Hospital. The RHSC is a 151-bedded Hospital, and is the main paediatric teaching hospital for the South- East of Scotland providing general and specialised services on a local, regional and national basis. It acts as the local paediatric referral centre for the children of Edinburgh and surrounding areas, and as a tertiary referral centre for intensive care patients; gastroenterology, hepatology & nutrition; respiratory medicine; cardiology; nephrology; neurology; oncology; haematology; neonatal surgery; plastic surgery; orthopaedic surgery; urological surgery and aspects of general surgery.

Hospital accommodation encompasses five theatres, a critical care unit comprising a 6/8 bedded Paediatric Intensive Care Unit, 4/6 bedded High Dependency Unit and a 3 bedded Neonatal Intensive Care Unit. There is an excellent library facility and a modern lecture theatre with a full range of audio-visual equipment.

All services are supported by comprehensive radiology, neurophysiology, laboratory and therapy services. The local radiology department provides on site Magnetic Resonance Imaging, CT Scanning, nuclear scanning and ultrasound. On site laboratories provide biochemistry, haematology, pathology and neuropathology services

DATE Page 3 of 12 2.2 Community Healthcare Partnerships

The four established Lothian Community Health (and Social Care) Partnerships serve the population of Edinburgh, Midlothian, East Lothian and West Lothian.

Hospitals in the CH(C)Ps include:

The in Edinburgh in Midlothian Roodlands Hospital in East Lothian.

The four CHPs are coterminous with Edinburgh, Midlothian, East Lothian and West Lothian Councils bringing together those responsible for planning, managing and providing community- based health services for the population of Edinburgh and the Lothians.

There are 7,500 members of staff. In addition, there are approximately 1,000 independent contractors in General Medical and Dental Practice, as well as pharmacists and opticians. A population of 850,000 people is served across health board area. The range of services care of the elderly, medical rehabilitation, community mental health, substance misuse and learning disability, district nursing and health visiting, family planning, well woman, , comprehensive dental care and those provided by Professions Allied to Medicine, such as physiotherapy, pharmacies and optometrists. Specialist services provided include brain injury rehabilitation, bio-engineering and prosthetics, drugs and alcohol misuse and harm reduction, AIDS/HIV and Children and Family Psychiatric Services.

2.3 Royal Edinburgh hospital and Associated Services

The Royal Edinburgh and Associated Services provides a range of Mental Health services to the population of Lothian and other Boards within Scotland.

The Royal Edinburgh Hospital is located on the south side of the City of Edinburgh. It comprises some 20 wards, 420 beds, day hospitals and outpatient facilities. The hospital provides the following range of specialities:- . Acute Mental Health . Rehabilitation . Psychiatric Emergency Team 24/7 . Outpatients . Assessment Phychiatry of Old Age . Forensic Medium Security Unit . Inpatient facilities for under 18s . Psychotherapy Service . Psychology Services . Services for Eating Disorders . Day Hospitals – Psychiatry of Old Age

There are an additional 46 bed and 1 day hospitals for Psychiatry of Old Age in the north of the city at the Royal Victoria Hospital.

The hospital is currently housed in a mix of accommodation ranging from 19th century to present. There is a major project now in place to take forward a reprovisioning programme in line with the strategic vision with the “Delivery for Mental Health” Scottish Executive 2006.

DATE Page 4 of 12 2.4 Department of Public Health Medicine

The aim is to improve the health of the people of Lothian in collaboration with many other partners. Using our range of knowledge, experience and networking capability, our distinctive contributions are:

 the promotion of specific measures to monitor and improve health;

 the collation and interpretation of health related information.

The following objectives have been agreed as the basis for the Department’s work plans:

1. To monitor the health status and health needs of people in Lothian;

2 To promote improvements in the health of Lothian people directly, and by providing information and advice to the public on health matters;

3. To assist Lothian NHS Board to fulfil its statutory obligations;

4. To contribute to strategic changes within the NHS in Lothian by providing information on clinical effectiveness;

5. To facilitate improvements in health and health care services directly, and through ‘managed clinical networks’ and wider alliances;

6. To contribute on a 24 hour basis to the control and prevention of communicable diseases and environmental hazards;

7. To maintain commitments to teaching, training, professional development, audit and research.

To enable efficient management of the Department: there are at present four groups in the Directorate. These are; Healthy Communities, Healthcare; Health Protection and Health Information.

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3. University of Edinburgh

The University of Edinburgh was established in 1582 and is one of the largest in the United Kingdom located on a number of prominent sites in Scotland’s capital city. It is Scotland’s premier research University and within the top 5 Universities in Europe for its Biomedical Sciences.

The University of Edinburgh’s College of Medicine and Veterinary Medicine (CMVM; Head Professor Sir John Savill) is an internationally leading force in basic-to-clinical translational research. The College has a consistent 30-year strategy of interdisciplinarity and integration of basic and clinical sciences. In the most recent Research Assessment Exercise (2008), the University of Edinburgh was top in the United Kingdom within the UoA4 category of Hospital-based Clinical Subjects. In 2008/9, CMVM attracted over £120 million in external peer-reviewed grant funding.

It has established several major interdisciplinary research Centres:

i. MRC Centre for Inflammation Research (Director, Professor John Iredale) ii. Centre for Cardiovascular Science (Director, Professor Brian Walker) incorporating the BHF Centre of Research Excellence (Director, Professor John Mullins) iii. Centre for Reproductive Biology (Director, Professor Phillipa Saunders) and MRC Human Reproductive Sciences Unit (Director, Professor Robert Millar) including the Tommy’s Centre (Director, Professor Jane Norman). iv. MRC Centre for Regenerative Medicine (Director, Professor Sir Ian Wilmut) v. Centre for Molecular Medicine (Director, Professor David Porteous) vi. Centre for Cancer Research (Director, Professor David Harrison) vii. Centre for Population Health Sciences (Director, Professor Harry Campbell) viii. MRC Human Genetics Unit (Director, Professor Nick Hastie)

These Centres are predominantly based at two sites: the Queen’s Medical Research Institute at the Royal Infirmary, and the Institute of Genetics and Molecular Medicine at the Western General Hospital. The co-location of basic science and clinical groups within state-of-the-art infrastructure and technology provides an excellent and exciting opportunity to conduct translational research at the highest level.

This academic power base is supported by clinical research infrastructure that includes:

i Wellcome Trust Clinical Research Facility ii Clinical Research Imaging Centre iii Edinburgh Clinical Trials Unit (UKCRN Registered) and Health Services Research Unit iv Scottish Brain Imaging Research Centre v Experimental Cancer Medicine Centre vi Academic and Clinical Central Office for Research and Development

4. NHS Library and Postgraduate Facilities There are excellent facilities on all sites.

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5. Departmental Information

The Department of Renal Medicine The Department provides an area renal service for Edinburgh, Lothian and Borders (population 800,000). There are 8 NHS consultants (Dr C Whitworth (ADMD), Dr P Gibson, Dr J Goddard (Clinical Lead), Dr W Metcalfe, Dr J Neary, Dr S Watson, Dr L Henderson and Dr P Phelan) and six Honorary Consultants (Professor AN Turner, Dr R Phelps, Dr D Kluth, Dr J Hughes, Dr B Conway and Dr N Dhaun) who all contribute to the clinical services both in Renal and Transplant. There are two Speciality Doctors, Dr S Miya and Dr S Mikros, who have a primary responsibility to the out- patient dialysis service. There are 3-4 Specialty trainees in Renal Medicine, and 7 CMTs/FY2s. The Renal Unit at present has a six bed renal high dependency ward with dialysis stations for unstable patients. There is considerable overlap between renal and transplant areas with a new build merger to a 14 bed combined renal and transplant HDU with work commencing in 2015. There is a 22 bed general nephrology ward and an outpatient ambulatory care area for renal and transplant patients to be assessed and treated as day cases where appropriate is due to open January 2015. The hospital also has a Medical Day-case unit and a Day-bed Surgical unit for patients admitted for procedures such as renal biopsy, angiography and vascular access. There is a 38 station haemodialysis unit at the Royal Infirmary of Edinburgh; within this area there is an 8 station area for patients colonised with multi-resistant microbes, and 2 cubicles for patients with blood-borne virus infections. There is a 9 station satellite haemodialysis unit at the Western General Hospital, a 12 station satellite haemodialysis unit at the Borders General, and a 10 station Satellite unit at St Johns Hospital, Livingston all operating 3 shifts per day. There are currently approximately 275 haemodialysis patients under the care of the unit, five home haemodialysis patients and approximately 35 peritoneal dialysis patients (CAPD and APD). There are 80 new patients to renal replacement treatment. The Royal Infirmary has a busy Intensive Care Unit and a general High Dependency unit, the regional Cardiothoracic Unit and the Scottish Liver Transplant Service and Fulminant Hepatic Failure Service: a renal advisory service and renal replacement support are provided to these areas. The Renal Unit also provides an area advisory service for other hospitals in Lothian and Borders. There are weekly general renal clinics and a joint renal-diabetes clinic at the Royal Infirmary of Edinburgh as well as weekly outreach general renal clinics at the Western General Hospital and at St John’s Hospital, Livingston. In the Royal Infirmary of Edinburgh there are also a weekly end-stage clinics for peritoneal dialysis, home haemodialysis patients and hospital haemodialysis. There is a weekly programme of Renal research/audit/clinical meetings during term time and joint meetings with the Transplant Unit. There is a weekly renal biopsy review meeting. There is also a monthly multi-disciplinary meeting where renal replacement therapy is planned for patients approaching dialysis, a monthly Community Dialysis meeting (home haemodialysis and peritoneal dialysis), and a weekly transplant meeting to review new patients and patients on the transplant list. There is also a two monthly multidisciplinary Directorate meeting. The Unit has a well-established computer database (Proton) for the dialysis and transplant patients, with terminals throughout the Unit. Computer links to laboratories enable automatic updating of laboratory results.

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The Renal Transplant Service is based on a combined renal, pancreas and liver transplant ward with 4 high dependency beds and 21 ward beds for transplant patients although there is considerable flexibility with bed usage with the Renal Unit as above. A renal transplant service (living donor and Cadaveric) is provided for Lothian, Borders, Fife, Tayside, Grampian and Highland giving a catchment population of 2.6 million. The Transplant Unit also provides pancreas transplantation for the whole of Scotland (5.1 million). The Transplant Surgical team are Professor S Wigmore (Clinical Director); Professor JLR Forsythe, Mr M Akyol Mr J Casey, Ms L Marson (Clinical Lead), Mr J Powell, Mr I Currie, Ms Adair, Mr E Harrison and Mr G Oniscu. Approx 100 renal transplants and 15-20 combined kidney and pancreas transplants are carried out per year at present. The Transplant Unit is also centre to The Scottish National Pancreatic Islet Transplant Programme and has carried out 31 islet transplants since it was established in 2009. At present there is a local renal transplant follow up population of approximately 400 but with additional follow–up of patients who are ultimately repatriated to referring areas when stable, approximately 3000 follow-up appointments per year are currently required. Currently there are three renal transplant follow up clinics per week and it is envisaged that this post-holder would support at least one of these clinics as well as a new ambulatory care area which is being established to support early follow up of recent transplant recipients. In addition, there is a Renal Transplant Assessment clinic which is primarily provided by Transplant Surgeons, Transplant Nephrologist, Transplant Coordinators and anaesthetists. It is envisaged that this appointment will help provide support to this assessment clinic.

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6. Details of the Post

The successful candidate will be expected to join the Renal Transplant Service. He/She will provide clinic-based follow-up of transplant (Renal/SKP) patients in conjunction with a Consultant Transplant surgeon and Nephrologist. The successful candidate will also have the opportunity to contribute to the weekly multi-disciplinary Transplant Assessment clinic. This is likely to include involvement with the living donor programme, and engagement with the weekly living donor multidisciplinary team meeting. There will be an opportunity to undertake clinical research within living donor or deceased donor transplantation. As part of national commissioning of renal transplant services, there has been agreement that early follow up post transplant will be supported by members of the RIE team. The post holder will work with referring clinicians to ensure that this is set up, using a variety of methods, such as teleconferencing, skype and virtual clinics. The on-call commitment would be on the Renal StR rota and is currently non-resident on-call nights and weekend daytime coverIn addition to in-patient transplantation (Wards 117 and 206T), on call cover will include the care of patients with acute renal failure (mainly on Renal HDU Ward 115 and Ward 206) and general nephrology inpatients (Ward 206R). The successful candidate will be expected to reside within 10 miles of the Royal Infirmary of Edinburgh, and to provide reciprocal cover for colleagues during periods of annual/professional and sick leave. The successful candidate would have the opportunity to develop complementary interests. The appointee would be expected to be in an approved StR post or equivalent or have recently gained a CCT in Renal Medicine but not yet appointed to a substantive Consultant post.

This an Exposure Prone post.

7. Research and Development

There are ample Research opportunities with well-established research groups based in the Centre for Inflammation Research led by Prof AN Turner, Dr RG Phelps, Dr D Kluth, Dr J Hughes, Dr B Conway, Dr N Dhaun and Dr D Ferenbach. Dr J Goddard and Prof D Webb also lead a group looking at endothelial dysfunction and renal disease. There are also Transplant Research groups led by Professor S Wigmore and Miss L Marson.

In addition, the Transplant Unit has close collaborative links with the departments of Histocompatability and Immunohistochemistry, Microbiology and Pathology. The successful candidate will have dedicated time within their programme to undertake transplant-related research.

Dr Metcalfe is currently chair of the Scottish Renal Registry and there may be opportunities to undertake registry work related to transplant outcomes depending on the interest of the candidate.

NHS Lothian is also committed to improving the quality and safety of its services for patients. NHS Lothian is participating in the Scottish Patient Safety Programme and it is evident that this initiative is strongly supported by clinical staff with many elements of the programme impacting on Renal Medicine.

8. Teaching

The postholder will have the opportunity to participate in undergraduate and postgraduate teaching.

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9. Job Plan

Example timetable:

Monday Tuesday Wednesday Thursday Friday AM 0830-1130 0830-1130 0830-0930 0830-Transplant 0830-1130 Transplant Transplant Transplant M&M Transplant ward ward round ward round ward round round 09.00 - 1130 1230- 1300 09.30 – 12.30 Transplant ward weekly Live Transplant round 12.00 Weekly Renal donor MDT clinic Transplant MDT 13.00 Weekly SPK MDT

PM Ward work Research & Research & Transplant Ward work Development Development assessment Clinic 1330-1600

1530 Department 1530-1630 Educational Handover round meetings 1630-1700 Pathology Meeting

1630-1700 1630-1700 1630-1700 1630-1700 Transplant Transplant Transplant 1630-1700 Transplant results results results results Transplant results

DATE Page 10 of 12 10. Contact Details

For further information and arrangements to visit please contact:

Dr J Goddard Consultant Renal Physician and Clinical Lead Department of Renal Medicine Royal Infirmary of Edinburgh 51 Little France Crescent Old Dalkeith Road EDINBURGH EH16 4SA Tel: 0131 242 1206 Fax: 0131 242 1233 Email: [email protected]

Ms Lorna Marson Transplant Surgeon Royal Infirmary of Edinburgh 51 Little France Crescent Old Dalkeith Road EDINBURGH EH16 4SA Tel: 0131 242 1715 Email: [email protected]

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3 Person Specification

REQUIREMENT ESSENTIAL DESIRABLE GMC Registered Medical Practitioner QUALIFICATIONS/ Completed higher medical Have a CCT and be on the training in renal medicine TRAINING GMC Specialist Register or be Not in a substantive Consultant eligible for inclusion on the post GMC Specialist Register or be within 12 months of a CCT in Renal Medicine and able to take time out of programme.

EXPERIENCE/ Wide experience in Renal Experience in high risk Medicine and Transplantation Transplant programmes – eg KNOWLEDGE Experience in Teaching (formal ABO incompatible and HLA and informal) to junior doctors incompatible and undergraduates Ability to establish links with Experience in Audit related specialties Experience in Research An interest in Renal vasculitis Evidence of commitment to An interest in development of learning and continuous Patient Safety professional development

ACADEMIC Publications in peer reviewed Higher academic degree ACHIEVEMENTS journals Keen to develop clinically focused/patient orientated

research in transplantation

PERSONAL Good communication skills Able to motivate departmental ATTRIBUTES Ability to function in a colleagues multidisciplinary team Able to organise time efficiently and effectively A Valid Driving Licence Able to contribute to on-call cover required of the post

HEPATITIS Evidence of Hepatitis B immune status

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