Royal Bournemouth and Christchurch Hospitals NHS Trust.doc

Programme Description ST3 Haematology

SPECIALTY TRAINING PROGRAMME IN HAEMATOLOGY FOR WESSEX DEANERY

This is a 5 year training programme in Haematology at registrar grade aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to support training for a CCT in Haematology.

The programme is based in hospitals in the Wessex Deanery including:

HOSPITAL LOCATIONNorth Hampshire Hospital BasingstokeThe Royal Bournemouth Hospital BournemouthDorset County Hospital DorchesterPoole General Hospital PooleQueen Alexandra Hospital PortsmouthSalisbury District Hospital Salisbury Southampton General Hospital Southampton

Wessex Deanery is a relatively small deanery with a defined geographical area which does lead to there being a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some specialties will require successful candidates to preference both commencing location and specialty. Future placements will be based, as normal, on individual training and educational needs. Please note that applications are to the Wessex Deanery as a whole. This may mean that you may be allocated to any geographic location within the Wessex Deanery depending on training needs.

The Wessex Deanery covers a geographical area from Basingstoke in North Hampshire to Dorchester in West Dorset and the Isle of Wight to the South; in addition some programmes rotate to Jersey and Chichester in West Sussex. This is a spread of approximately 65 miles North to South and 76 miles East to West. The Wessex Deanery serves a population of around 2.8 million people.

The Wessex Deanery is part of NHS Education South Central within South Central Strategic Health Authority which covers Berkshire, Buckinghamshire, Oxfordshire in the north (under Oxford Deanery) and Hampshire and Isle of Wight. In addition, Wessex Deanery provides training programmes within Dorset and South Wiltshire under a formal agreement with the South West Strategic Health Authority. The Wessex Deanery is responsible for the training of some 2,500 trainees.

Programme Description/kbrown/Sept08


Rotation Information

It is usual that trainees will spend two of their five years training at Southampton General Hospital where specialist training in paediatrics and allogeneic transplantation is available. The remaining three years will be spent at the other district general hospitals on the rotation.

Trainees are asked for preferences of placements on an annual basis, which along with training needs are taken into account when placements are made. Each post is for one years duration.

Dr Rachel Hall, Programme Director for Haematology should be contacted with further queries regarding the roation on 01202 704790.

Study and Training

The primary aim of all posts is to complete the training programme developed and there is a region wide syllabus and minimum standards of education agreed by all Trusts within the rotation.

The Deanery is committed to developing postgraduate training programmes as laid down by PMETB, Colleges and Faculties and by COPMED - the Postgraduate Deans Network. At local level college/specialty tutors work with the Programme Director and Directors of Medical Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend meetings with their nominated educational supervisor.

All posts within the training programme are recognised for postgraduate training by the Postgraduate Medical Education Training Board (PMETB) in accordance with their standards for training.

Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service.

All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals but the list is aimed at covering the majority of duties:

1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached F1.

2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior medical staff.

3. Attend and participate in ward rounds as timetabled

4. Attend outpatient clinics.



5. Take part in rostered emergency work.

6. Dictate discharge summaries.

7. Study for higher examination and maintain continued professional development.

8. Attend weekly educational and multidisciplinary sessions.

9. Undertake audit at various times throughout the rotations.

10.Teach medical students as directed.

11.Co-operate with members of the personnel department when monitoring hours of work and other personnel issues.

12.Attend induction in each hospital or new department

13.Comply with all local policies including dress code, annual and study leave

Information about hospital Trusts in the rotation

Royal Bournemouth and Christchurch Hospitals NHS Trust

Medical Staff5 Consultants3 Specialist Registrars (one year rotation)2 Senior House Officers on 6 monthly medical rotations

Nursing Staff1 H Grade Senior Nurse Manager1 G Grade Sister Ward 101 G Grade Sister Ward 112 G Grade Home Care Sister24 Grade A – F Nurses Ward 1110 Grade D – E Nurses Ward 101 Blood transfusion practitioner2 Haematology specialist nurses2 Haematology research nurses

Scientific Staff

1 Clinical scientist B Immunology2 Clinical scientists B Flow Cytometry3 Clinical scientist B Cytogenetics1 Research scientist Molecular biology1 Research scientist Cell Culture

Laboratory Staff1 MLSO3 Haematology1 MLSO 3 Blood Transfusion22 MLSOs Whole time & MLAs



Clinical Haematology

The clinical facilities at the Royal Bournemouth Hospital are exemplary. Ward 11, the inpatient area, has a two-bed bone marrow transplant suite with en-suite bathrooms and WCs and HEPA ventilation. In addition there is a Laminar-air flow 5-bedded unit containing 3 single rooms and one twin room. There are another 5 single rooms; a six-bedded bay and another single bed space. We have performed autologous stem cell transplants here since 1986. Support facilities within the hospital necessary for the comprehensive care of seriously ill haematology patients include

♦ Intensive care, dialysis and haemofiltration,♦ Full interventional and radiology services♦ Echocardiography♦ Bronchoscopy♦ Gastroenterological endoscopy

Consultant Physicians in neurology, rheumatology, dermatology, endocrinology, nephrology, diabetology, cardiology and thoracic medicine are readily available. Two palliative care consultants are attached to the unit.

Inpatients & Daycare

Ward 11 caters for both haematology and oncology patients and has 84% bed occupancy. Oncology patients, account for around 20% of the in-patient occupancy. Nursing staff have post-registration qualifications in Haematology, Oncology, bone marrow transplantation and care of the dying. Ward 10 is adjacent to Ward 11 and consists of 12 day-case beds. The ward is used for the administration of chemotherapy, bone marrow aspirates and trephines, blood and platelet transfusions, lumbar punctures, cell separator procedures and clinical assessments. The ward is shared between Haematology and Medical Oncology. In 2000-1 ward 10 handled 5301 Haematology and 7294 Oncology day-patients. There were 5940 occupied bed-days on ward 11. Nurses specifically trained for this purpose administer all chemotherapy. A comprehensive rota of specialist nurse’s is able to operate the cell separators, both for plasma exchange and leucapheresis. A major charity initiative is underway to expand the space available on Ward 10. Homecare Nurses employed by the Hospital are available to review patients at home, administering simple treatments, including platelets as well as phlebotomy.

Outpatients

Eleven outpatient clinics are held weekly. In the last year 16,626 outpatients were seen. Over 10,000 of these were in the anticoagulant clinics. These are run by specially trained nurses and Biomedical Scientists, supervised by medical staff. An average of 2-3 ward referrals are seen daily. Around 200 new patients with haematological malignancies are seen annually, the commonest diagnoses



being NHL (c 80 cases), Myelodysplasia (c 40), Chronic Lymphocytic Leukaemia (c 40), Myeloma and macroglobulinaemia (c 30) and myeloproliferative disorders (c 20). Around 10 stem cell autografts are performed and at any one time 2 to 5 patients with acute leukaemia are undergoing treatment. Two multi-disciplinary meetings are held weekly. On Tuesday a clinical Grand Round is held with, a microbiologist, nurse counsellor, pharmacist and dietician present. On Friday, a teleconferenced MDT meeting is held with the radiologists and histopathologists. Wednesday outpatient clinics are held next to those held by a radiotherapist and a surgeon specialising in lymph node biopsy and splenectomy. The Haemophilia centre with 25 severe haemophiliacs is based at the Royal Bournemouth Hospital and a visiting haemaophilia consultant from Southampton does a weekly outpatient clinic.

Laboratory Haematology

The laboratory is spacious and well equipped. It has full CPA accreditation and participates in all appropriate NEQAS schemes. There are sub-departments of routine and special haematology, coagulation, blood transfusion, immunology, cytogenetics and molecular biology. Routine laboratories are provided with the Telepath 2000 computer system. Around 700 blood counts are performed per day on two Bayer Advia 120 analysers. Haematinics assays are performed with the Beckman Coulter Access immunoassay system. The coagulation laboratory is equipped with ACL Futura Plus, ACL 3000 and Bio Merisux miniVIDAS machines. The Blood Transfusion Laboratory uses the Diamed system and has recently introduced new automatic Blood Grouping machinery, as well as evaluating the electronic cross match. Molecular assays are performed for Factor V Leiden, Arg 506Gin and the Prothrombin G20210A gene mutations. The immunology laboratory performs routine autoantibody screens and measurement of complement components. Routine cytogenetics is performed on lymphoid malignancies for diagnostic purposes. Cytogenetic analysis for myeloid malignancies is performed at the Regional cytogenetics Centre in Salisbury, as are assays of minimal residual disease. CD34 measurements for stem cell transplants are carried out within the department. We also routinely measure cell markers on both lymphoid and myeloid malignancies by flow cytometry. The cell culture department measures CFU – GM colonies, and process and cryopreserve stem cell harvests. It also measures blood and marrow BFUes for the diagnosis of polycythaemia.

Research

The department has an international reputation for research into Myelodysplasia and Chronic Lymphocytic Leukaemia. The department has 2 specialist research nurses and a large portfolio of national and international trials open for recruitment.



The Role of the Specialist Registrar

This post gives excellent training in laboratory and clinical haematology. Its strengths are the wide experience gained in the management of haematological malignancies, including lymphomas and the close contact with high quality research. At any one time, three Specialist Registrars will be in post, one based in the laboratory and two mostly clinical. All are expected to attend the multidisciplinary meetings on Tuesdays and Fridays. You will have weekly outpatient clinics. The two clinical Specialist Registrars will be responsible for the day-to-day management of in-patients and day case patients. In addition they will be involved in the training and instruction of the SHO who works with them. At least one consultant will work closely with the Specialist Registrars and will always be available for consultation. The laboratory Specialist Registrar will be responsible for the laboratory and for providing a service to other departments in the hospital. All five consultants will work closely with the laboratory Specialist Registrar.

Clinical Training

The following clinical skills will be obtained during the period of clinical training.

The treatment of haematological malignancies

Familiarisation with protocols for the management of acute leukaemia, Hodgkin’s disease, non-Hodgkin’s lymphoma, myelodysplastic syndrome, myeloproliferative syndromes, myeloma and macroglobulinaemia. The management of severe neutropaenia, the management of fungal infection; the management of thrombocytopenia and anaemia; the use of blood products; the management of tunnelled central lines.

Stem cell transplantation

The collection of stem cells by leucapheresis and bone marrow harvest; administration of cryopreserved stem cells.

Haematological emergencies

The management of tumour lysis syndrome; the management of superior vena-caval syndrome; the management of hypercalcaemia; the management of hyperviscosity syndrome.



Diagnostic procedures

Bone marrow aspirate from iliac crest and sternum; bone marrow trephine; lumbar puncture; pleural tap; pleural biopsy.

Therapeutic procedures

The use of cell separators; therapeutic venesection; drainage of ascites; drainage of pleural effusion; pleuradhesis; intrathecal chemotherapy; the use of radiotherapy.

An understanding of palliative care.

Non-malignant haematology

The investigation and management of anaemia, thrombocytopenia, neutropaenia; the management of autoimmune haematological conditions; the management of cold-reactive syndromes.

The management of bleeding disorders

The management of patients with inhibitors to clotting factors; primarily patients with haemophilia (including those with inhibitors to factor concentrates) and von Willebrand's disease but also smaller numbers with other rarer bleeding disorders.

Laboratory Training

The following skills will be obtained during the period of Laboratory training:

♦ An understanding of the full blood count.

♦ Examination of the blood film and bone marrow aspirate.

♦ Examination of bone marrow trephine histology.

♦ A basic understanding of the histology of the lymph node and spleen.

♦ The use of Immunohistochemistry in bone marrow and lymph node histology.

♦ diffuse large cell lymphoma, mantle cell lymphoma, splenic marginal zone lymphoma, marginal zone lymphoma, small lymphocytic lymphoma, Hodgkin’s disease.

♦ An understanding of flow cytometry: application of flow cytometry to the diagnosis of leukaemia and lymphomaRecognition of common types of lymphoma, - follicular lymphoma.



♦ A basic understanding of cytogenetics: application of cytogenetics to the diagnosis of leukaemia and lymphoma.

♦ A basic understanding of molecular biology – DNA and RNA extraction; Northern and Southern blotting; RFLP analysis; PCR. Application of molecular biology to diagnosis of leukaemia and lymphoma.

♦ An understanding of bone marrow culture. Application of bone marrow culture to diagnosis and treatment of haematological malignancies.

♦ An understanding of the cryopreservation of stem cells.

♦ Simple blood transfusion techniques. The organisation of a hospital blood transfusion laboratory. The management of transfusion reactions. The SHOT report. Simple tests for coagulation. Factor assays. Detection of inhibitors. Investigation of suspected thrombophilia. The application of molecular tests to the investigation of thrombophilia.

Specialist Registrars will acquire an understanding of the following management topics: The structure of the NHS; Management structure of an NHS Trust; CPA accreditation; The SOP; COSH regulations; Quality assurance, including NEQUAS schemes; Risk management; Clinical governance; Cancer basic data sets; Equipment acquisition; Personnel management; Designing a job description; NHS research (Culyer) funding; Ethics committees.

Each Specialist Registrar will undertake at least one audit annually.

Portsmouth Hospitals NHS Trust

Queen Alexandra Hospital, St Mary’s Hospital and The Royal Hospital Haslar

Portsmouth Hospitals NHS Trust is one of the largest acute hospital trusts in the country and the second largest employer in the area. The first phase of the new state of the art hospital on the Queen Alexandra Hospital site is now open, and the main new hospital build is due to open in the summer of 2009.

The Trust is proud of its military associations and hosts the largest Ministry of Defence Hospital Unit (MDHU) in the country. The MDHU Portsmouth also means that the Trust has wider responsibilities than standard NHS organisations. Military staff account for 3% of the Trust’s total workforce. We have a responsibility to ensure these staff have appropriate clinical experience that helps them when they are deployed throughout the world, often on Active Service.

The Trust serves a population in excess of half a million, benefiting from the acute and specialist health services provided. The annual budget for the Trust is in excess of £370 million and we employ 7000 staff on three main hospital sites.



Queen Alexandra Hospital (QAH) in Cosham – 755 beds. Services include Emergency Department, all Surgical and Medical Emergencies, Trauma, Cardiology, Medicine for Older People, Respiratory, Haematology, Renal, Head & Neck and Ophthalmology.

St Mary’s Hospital (SMH) in Milton – 453 beds. Services include Maternity, Paediatrics, Oncology, Urology and Day Case Surgery.

The Royal Hospital Haslar (RHH) in Gosport – 100 beds. Services include Orthopaedic Surgery and planned General Surgery, Outpatients, Rehabilitation, a Minor Injuries Unit and a fully integrated Breast Care Unit.

The Trust works closely with the Universities of Portsmouth, Southampton and Bournemouth where a number of staff hold academic appointments. It is proud of its excellent, nationally recognised contribution to research and development.

Our healthcare staff are committed to providing the best possible quality of care for our patients. The Trust is very keen to support them by providing excellent training, whatever their job. All staff have access to library and on-line learning facilities.

Portsmouth Hospitals NHS Trust is a provider of acute health services under contract to a range of purchasers in the area of the Hampshire basin and West and South Downs. The main purchaser of Services are the Hampshire and Isle of Wight Health Authority and the local Primary Care Trusts, that are responsible for the health care of a population of around 600,000.

The area of the Health Authority borders on the Solent and English Channel and includes the City of Portsmouth and the Boroughs of Gosport, Fareham and Havant, extending from Warsash in the West to Emsworth on the Sussex border. The Northern boundaries extend beyond the South Downs to encompass Petersfield and Liss.

Portsmouth Harbour

Portsmouth Harbour



The Hospitals

Redevelopment

Construction and redevelopment of Queen Alexandra Hospital site began in 2006. The completion of this project in the 2009 will see all acute services in Portsmouth and South East Hampshire centralised on one site. The rapidly rising buildings have changed the landscape and made a significant visual impact in the surrounding area. When the new hospital is completed it will contain state of the art facilities for inpatients and outpatients as well as excellent education facilities.

The new south block will house paediatrics, maternity and most of the new wards. The new West Wing will house the Cancer centre, linear accelerators, main outpatients and the academic centre. To the North of the site the Rehabilitation Unit was the first permanent structure to be completed in September 2006. The New Pathology Building was opened in August 2007 and is linked to the main hospital campus by an access bridge. This has allowed the centralisation of pathology services from both QAH and St Mary’s Hospital (SMH). On top of the Pathology building is a helipad for an air ambulance. The basement houses the new mortuary facilities.

There is also a lot of work to be carried out in the existing buildings, which will be retained within the redevelopment. Work has included the redecoration of the wards and the installation of new windows and will be completed by 2009. Close liaison between Trust staff and Carillion Construction Limited has meant the work has progressed with minimal disruption to clinical services.

The Facilities Management arm of our partner now provides the non-clinical services such as cleaning, catering and building maintenance. The security teams have been enhanced and considerable investment has been made in the training of staff.

The redeveloped hospital will provide:

• Over 1200 inpatient beds, • Over 100 day case beds, • 27 operating theatres, 7 for day case work, • A new Cancer Centre, • Automated Blood Sciences laboratory,• State of the art diagnostic imaging facilities, including: Magnetic Resonance

Imaging and Computerised Tomography scanners.



The completion timetable for the Redevelopment is:

Phase 1: Rehabilitation Services building was completed in Summer 2006 and the Pathology and Mortuary building completed Summer 2007

Phase 2: New South and West blocks complete Summer 2009Phase 3: Refurbishment of the existing hospital complete Summer 2010

Queen Alexandra Hospital

Royal Hospital Haslar

The Royal Hospital Haslar is situated beside the sea on the eastern tip of the Gosport peninsula, and was previously the Core Hospital of the Defence Secondary Care Agency and the District General Hospital for the Gosport and Fareham peninsula.



In April 2001 most of the departments amalgamated with Portsmouth Hospitals NHS Trust resulting in the integration of military and civilian consultants into single specialist teams involved in the care of both civilian and military patients.

Trust Organisation

The Trust is divided into 4 clinical divisions: Medical services including oncology, Women and Children Services, Clinical Support Services and Surgical Services. Clinical Haematology is represented in the Medical Division and Laboratory Haematology in the Clinical Support Services Division.

Management Structure

The Trust is divided into 4 clinical divisions: Medical services, Women and Children Services, Clinical Support Services and Surgical Services. Clinical Haematology is represented in the Medical Division and Laboratory Haematology in Bloods Sciences the Clinical Support Services Division.

Management Arrangements For Portsmouth Haematology

The Pathology Service of which the Department of Haematology forms part is in the Clinical Support Services Division

Blood Sciences

The Department of Blood Sciences is the largest section of the Pathology Service. It was formed in July 2007 by the amalgamation of the departments of Clinical Biochemistry, Haematology and the specimen-handling portion of Pathology Support Services.

The PHT Pathology Service is one of the largest in the country and serves a population of approximately 600,000 people, with a much larger catchment area for some regional tests. It directly serves Queen Alexandra Hospital and St Mary’s Hospital in Portsmouth.Two large general Primary Care Trusts fall within our area of operation: Portsmouth City PCT, Hampshire PCT.

The Department of Blood Sciences performs over seven million tests annually in a new state of the art laboratory. Analysers, centrifuges and refrigerated storage are linked by a computerised track system with advanced robotics to handle and move samples through the laboratory. The department operates a 24 hour shift system, 365 days a year, on the main Queen Alexandra site, running an emergency analysis service between 9.45pm and 8.30am. A small satellite laboratory on the St Mary’s site offers a limited inpatient service between 9am and 10pm on weekdays, and an emergency transfusion service between 10pm and 8am and at weekends / bank holidays. Clinical advice is available by telephone at any time.



In addition to routine haematology, transfusion, biochemistry and endocrinology the department incorporates the haemostasis / thrombosis investigation and monitoring, immune monitoring and leukaemia cellular typing service, auto-immune immunology, neonatal and antenatal screening and fertility / andrology services. It offers over 200 tests in-house and has access to a number of other laboratories for other specialist investigations. It also acts as a centre for some specialist investigations. The regional neonatal screening service is one of the largest in the country screening 30,000 neonates a year.

Automated Haematology Track

Blood Sciences Staffing

1 Consultant Chemical Pathologist6 Consultant Haematologists (for details see below)1 Associate Specialist Chemical Pathologist6 Clinical Scientists (Biochemistry)2 Trainee Clinical Scientists (Biochemistry)

2 Head Biomedical Scientists (BMS)2 Operational managers1 Quality manager19 Section leaders38 Biomedical Scientists4 Trainee Biomedical Scientists4 Night Biomedical assistants4.5 secretaries3 Screening coordinators (clerical)1 MLA supervisor (sample handling)3 senior Medical Laboratory Assistants (MLAs)30 MLAs3 Nurse / Nurse practitioners



Clinical HaematologyMedical StaffDr Helen Dignum Consultant Clinical Director (Clinical Haematology)Dr Christopher James Consultant Clinical Director (Pathology). ACD for MedicineDr Tanya Cranfield ConsultantDr Mary Ganczakowski Consultant PFI Village Lead for Haematology & OncologyDr Hussain Hirri Consultant Lead for Haemostasis and Thrombosis Dr Robert Corser Consultant ASEC Chair for Wessex region2 Speciality Registrars2 SHOs - CT1, 2 or FY2 trainees on medical rotation

Clinical ServicesQueen Alexandra Hospital is the centre for inpatient treatment of haematological disorders. There is a dedicated Haematology ward with 12 single rooms, 4 of which have en-suite facilities. Most inpatients have haematological malignancies including acute leukaemia, myeloma and lymphoma. A small proportion of the in-patients have non-malignant conditions including haemostatic disorders. Patients requiring emergency admission are admitted direct to the ward when indicated to avoid potential delays in A&E or the MAU.

The day unit is situated adjacent to the in-patient unit and sees 15-20 patients a day for administration of chemotherapy, blood products and other parenteral treatment and procedures, such as bone marrows and lumbar punctures.

Children with Haematological disorders are initially assessed in the Paediatric department at St Mary’s Hospital by the Paediatric consultants. Children with haematological malignancies are referred to Southampton for initial treatment, but continue their treatment on a shared care arrangement with the Consultant Paediatricians.

The nursing establishment for the haematology ward and day unit is:

I Grade 0.5H Grade 1G grade 1F grade 3E grade 9.12D grade 5.19Ancillary Support 6.53

The haematology service has a dedicated pharmacist, Catrin Watkinson, who is a member of the multidisciplinary team and liaises closely with the department.



She also helps in the preparation of protocols and business cases for new drugs. Chemotherapy is all drawn up and prepared ready for administration in an aseptic unit in pharmacy and is administered by haematology nurses who have received appropriate training in the handling of cytotoxic drugs.

Dr Hussain Hirri has a specialist interest in Haemostasis and Thrombosis. He oversees the comprehensive service for investigation and management of disorders of haemostasis and thrombosis, the computerised Warfarin Clinic and the District Haemophilia Unit. He is supported by one G grade haemostasis and thrombosis nurse (currently vacant) and 2 part time F grade nurses who assist in running the Warfarin clinic.

Relationship with Oncology

The Haematology department is responsible for the care of all patients with Leukaemia and Myeloma. If these patients require local radiotherapy they are referred to a Clinical Oncologist. The care of patients with Lymphoma is shared between Haematology and Oncology. There is a joint lymphoma clinic run by Dr Ann O’Callaghan (Medical Oncologist), Dr Haba (Clinical Oncologist), Dr Christopher James and Dr Robert Corser. In addition Lymphoma patients with blood or bone marrow involvement are seen primarily in the Haematology Clinic. Patients with solid non-haematological malignancies are not treated in the Haematology department.

Ultimately Haematology will move into the planned PFI building. Oncology services currently located at St Mary’s Hospital will then become more closely integrated with haematology clinical services with anticipated rotations and sharing of junior medical staff and nursing staff.

Outpatient ServiceMost outpatient clinics are held within the Haematology Department at Queen Alexandra Hospitals. The lymphoma clinic is held in the Radiotherapy and Oncology Department at St Mary’s. Out lying clinics are also held at St Mary’s Hospital and Petersfield Community Hospitals and Haslar Hospital.



Mon Tues Wed Thurs Fri

9am Warfarin clinic QA Gen Clinic QA Gen Clinic QA Gen Clinic QA Warfarin clinic QA9am Haslar OP clinic 9 am Gen Clinic SMH Thrombophilia Bleeding disorders11am Acute FU clinic Acute FU clinic2pm Lymphoma Clinic Petersfield Clinic

Haslar Warfarin Clinic Once/month

The computerised anticoagulant clinic provides automated dosing for 200-300 patients daily so that most patients do not need to attend a Warfarin clinic. Patients are informed of their anticoagulant dose by post or telephone. There are facilities for patients to be seen in the department for starting Warfarin as an outpatient or to be added to the computer system. These clinics are nurse led. Patients with clinical problems relating to their Warfarin therapy are also seen in the clinic if required.

Clinical Haematology Workload (2006-2007)

Inpatients episodes 454Outpatients 13904 (1st visit 1814)Day Unit 2950Warfarin dosing (computerized) 50,000

The Post

The post will rotate between the Trust’s over the five years of the Speciality Registrar training period. In Portsmouth the majority of time will be spent at Queen Alexandra Hospital. The post holder will be accountable to the Consultant Haematologist’s.

Duties of the post.

The Speciality Registrar will be involved in all aspects of clinical and laboratory haematology. Routine laboratory work will include the reporting of blood films, bone marrow aspirate and trephine biopsies together with advising on blood transfusion and haemostatic problems.

Routine clinical work will include:

1. The day-to-day management of Haematology inpatients.2. Co-ordinating the treatment of outpatients and day patients.3. Management of patients with bleeding disorders.



On Call Requirement:The Speciality Registrar will be expected to provide laboratory and ward cover on one Weekend in 4, on Saturday and Sunday.

Example Time Table For Speciality Registrar

Speciality Registrar 1AM PM

Monday Academic Meeting(Business meeting)Day unit review

Multi-disciplinary team meetingConsultant ward round (teaching)

Tuesday Out patient clinic (QAH) Lymphoma Clinic St Mary’s – (optional - the StR will be supernumerary)

Wednesday

Out patients Clinic Ward work / Audit

Thursday Out patient clinic (QAH) Consultant ward round

Friday MDT meetings Day unit reviewTeaching

Speciality Registrar 2AM PM

Monday Academic Meeting(Business meeting)Laboratory work


Tuesday Out patient clinic (QAH) Laboratory workAudit

Wednesday

Haemostasis and Thrombosis clinic (SMH)Day Unit Review

Laboratory work

Thursday Audit / Bone marrow reporting

Friday MDT Meetings Laboratory workTeaching

Example CT 1 & 2 or FY2 Timetable

The Senior House Officer level trainees on the Core Medical training rotations come to Haematology for a 4-month period. The timetable for the Haematology Junior Dr on the medical rotation is as follows:



Am PM

Monday Academic meetingWard work


Tuesday Out patient clinic /ward work

Ward work3-5pm Core training programme

Wednesday

Out patient clinic /ward work

Consultant ward round

Thursday Out patient clinic /ward work

Half day

Friday Ward workConsultant ward round

Ward workTeaching

Education and Training

In Portsmouth the Speciality Registrar will receive an induction pack and attend Trust induction. The educational supervisor in Portsmouth will be Dr. Robert Corser. The Speciality Registrar will meet regularly with the educational supervisor and the Regional Speciality Education Committee will further assess their progress.

The Speciality Registrar will attend the local Wessex training programme and will be encouraged to attend all local and a reasonable number of national meetings. Protected study leave will be given for individual study, research or audit. Teaching will be given for a programme of laboratory procedures.

Clinical experience will be gained on a daily basis with consultant supervision. Regular discussions of laboratory findings will take place with the consultant staff. Additional training in blood transfusion will be arranged with the Wessex Blood Transfusion Centre.

Research

The Speciality Registrar will be encouraged to participate in research. In-patients are entered into the MRC leukaemia trials. Recent studies undertaken by the Speciality Registrar and presented at ASH and BSH include: Occurrence of auto antibodies following allogeneic transplantation, Hydroxyurea induced leg ulceration and A Review of Home Chemotherapy for Haematological malignancies. Opportunities also exist for the Speciality Registrar to undertake a project in coagulation, and in the past two past Trainees obtained MDs in coagulation while working in Portsmouth.

The Speciality Registrar will also be expected to undertake some specific audit activity either laboratory or clinical. Current and planned audit projects can be discussed with the consultants concerned.



Accommodation

The post is non-resident in Portsmouth.

Southampton University Hospitals NHS Trust

The HospitalsFacilities for clinical Haematology patients since November 2001 have been on the Southampton General Hospital (SGH) site. The provision of an intensive chemotherapy and chemotherapy and cell separator services are now at Southampton General Hospital. The development is part of the project for relocation of the Cancer Care Directorate services to SGH. There will be 6 dedicated HEPA filtered transplant suites and access to other intensive beds on the ward, for haemato-oncology patients. General Haematology patient’s are managed on the General wards in conjunction with other Medical and Surgical specialties

Staffing

Medical

4 Consultants2 Senior Lecturer/Consultant1 Consultant Paediatric Haematologist1 Honorary Consultant (4 sessions2 Staff Grades5 Specialist Registrars3 Senior House Officers- from the medical rotation

Nursing Staff

1 F grade Nurse Cell Separator and Day Care Unit SGH0.6 E grade Nurse Cell Separator and Day Care Unit SGH1 H Grade Sister Haemophilia Centre1 G Grade Nurse (31 hours/week) Counselling Myeloma/Research Nurse1 F Grade Blood Transfusion Nurse (24 hours/week)1 F Grade Nurse (26 hours/week) Patient support Nurse1 H Grade Nurse Bone Marrow Transplantation1 G Grade Nurse Bone Marrow Transplantation

Laboratory Staff

2 Grade B Clinical Scientists1.2 MLSO 44 MLSO 36.5 MLSO 213.1 MLSO 16 Trainees and MLAs8 Clerical and supportive



Clinical Haematology: Southampton General Hospital

Malignant Haematology

Patients with malignant haematological conditions, which require intensive chemotherapy, with or without stem cell transplantation are currently treated at Southampton General Hospital in the newly refurbished C6 Leukaemia and Bone Marrow Transplantation ward of the Cancer Care directorate. Details of the Transplant Centre are shown in appendix 1. There are full facilities for the care of these patients including filtered isolation rooms, oncology trained nursing staff, specialist cytotoxic pharmacy services with a centralised intravenous additive service and nurse counselling support. There are also day care facilities. These are utilised for supportive transfusions, bone marrow procedures, chemotherapy and immunoglobulin administration as well as admissions for investigation and assessment. This is located in C3 Hamwic Day Unit, shared with the Cancer Care Directorate. The clinical inpatient work of the department is predominantly adult leukaemia, multiple myeloma, myelodysplastic, myeloproliferative and lymphoproliferative conditions. There are approximately 30 new adult acute leukaemia and 30 new myeloma referrals per annum. Sibling Allogeneic Bone marrow transplantation has recently been introduced to the Unit. Adult transplantation for CML, AML and Aplastic anaemia as well as Lymphoma and Myeloma has occurred in the first year. Bone marrow and Peripheral Blood Stem cells have been used as the source of the transplant.

General Haematology

Clinical Haematology has access to 7-day inpatient beds utilised for patients requiring low dependency care, and a busy day care facility operating 5 days a week offering the full range of supportive procedures. The cell separator unit is also centred at SGH and is directed by the Haematology department. This busy unit performs over 250 procedures per year providing peripheral blood stem cell harvesting, plasma exchange, therapeutic leucapheresis, therapeutic platelet apheresis and red cell exchange procedures. The unit is staffed by a full-time sister, with the support of an additional trained nurse operator. Stem cell harvesting facilities are also available at RSH, but these will shortly be transferring to the SGH site.

Southampton is a designated Comprehensive Care Centre for Haemophilia. There are about 300 patients with congenital haemostatic disorders registered at the Southampton Haemophilia Centre; approximately 30 have severe haemophilia A, B or von Willebrand disease. A weekly, computerised anticoagulant clinic is held at SGH, focusing on the needs of patients with special requirements for anticoagulation. The majority of anticoagulant control in the locality is carried out in primary care.Southampton has a growing Asian and Afro-Caribbean population. A community nursing sister, has been appointed by the Primary Care Trust for liaison and education purposes for patients with haemoglobin disorders. The children with



haemoglobinopathies are seen in a special outpatient clinic which includes tertiary referrals from the region. A fully comprehensive range of services are available for these patients.There is a regional paediatric oncology and haematology centre at SGH caring for children with solid tumours, leukaemia, bone marrow failure syndromes, congenital bleeding disorders, haemoglobinopathies and other non-malignant haematological conditions. Paediatric stem cell harvesting is carried out for autologous transplantation in paediatric malignant disease. The consultant paediatric haematologist works closely with the department of Haematology. The rotation includes a period attached to the Paediatric Unit.

Royal South Hants Hospital

Outpatient facilities for Haematology as with other specialties within Southampton are based at the RSH in the Outpatient Centre. There are 6 general Haematology clinics per week run by the Consultant Haematologists. In addition, there are specialist clinics in leukaemia and transplantation, multiple myeloma thrombophilia, paediatric Haematology and haemoglobin disorders. There is also a weekly general Haematology clinic at Lymington Hospital a nearby Community Hospital and currently run by the Southampton City Primary Care Trust.

Lymington Hospital

This is part of the Southampton City Primary Care Trust; outpatient clinics and day facilities are available. These are supported by a sessional commitment from a Staff Grade/Associate Specialist and an E grade nurse and there is also shared medical SHO and PRHO cover. Lymington Hospital deals with the haematological day care and follow-up of patients in the New Forest area, which includes a large number of elderly people.

Laboratory Haematology

Haematology laboratory facilities are provided at two sites, Southampton General Hospital and the Royal South Hants Hospitals within the University Hospitals Trust. The laboratories have full CPA accreditation and CPSM approval for the training of MLSO staff. Both sites are comprehensively equipped with the latest instrumentation and have completed installation of the Masterlab laboratory computer system. Significant new initiatives include the integration of the Immunology laboratories into the SGH Haematology Laboratory and the establishment of a Pathology Partnership with Winchester.



Southampton General Hospital (SGH)

The laboratory houses a comprehensive, modern diagnostic facility. Specialised haemostasis investigation and haemolytic anaemia investigation are also carried out at Southampton General Hospital. Blood transfusion is centralised in the Haematology laboratory on this site. Diagnostic bone marrow services are mainly carried out at the General. The department of Histology processes trephines biopsies, which are then reported in tandem.

Royal South Hants Hospital (RSHH)The laboratory provides a rapid response laboratory facility in haematology and chemical pathology for inpatients and day work on this site. Bone marrow processing, culture and preservation facilities are located at the Royal South Hants hospital in the Specialist Steve Mills Transplant Laboratory, which is an integral part of the Haematology Department.

Research

The department is very active with research projects including;

• Recruitment and participation in MRC AML, ALL, Myeloma and CML trials. More than 100 patients are currently on follow-up on MRC trials.

• Development of quality of life as a clinical endpoint in myeloma and chronic lymphocytic leukaemia.

• Evaluation of peripheral blood stem cell harvest criteria to determine cell doses predictive of engraftment of platelets and red cells

• Role of EBV, CMV and herpes viruses 6, 7 and 8 in pathogenesis of CLL.

• Analysis of tumour related immunoglobulin genes in paraproteinaemias.

• Examination of MUC-1 expression on myeloma cells as a potential target for immunotherapy

• Antibody responses to recall antigen challenge in-patients with lymphoproliferative and paraproteinaemic disorders at diagnosis and after treatment to assess likely immunogenicity of a DNA vaccine treatment programme.

• Identification of APCR genes and Factor V Leiden mutations in patients with thrombophilia.

• Thromboelastograph (TEGs) in: Thrombophilia, Haemophilia, cardiac surgery



Role of the Specialist Registrar

Clinical DutiesThe Specialist Registrar will be trained and involved in all aspects of clinical and laboratory haematology and blood transfusion. The timetables are enclosed.

Clinical work includes

♦ The day to day management of Haematology inpatients♦ Co-ordination of the treatment of outpatients and inpatients♦ Management of patients with bleeding disorders♦ Investigation of patients with thrombophilias and management, including♦ The treatment of recurrent miscarriage in the high risk pregnancy clinic.

♦ Supervision of patients receiving plasma exchange (for TTP and inhibitors usually)

♦ Attend supervised* outpatient clinics (*until final year)♦ Paediatric haematology

Laboratory DutiesLaboratory work reporting of blood films, bone marrows, other haematological tests. Training in immunohaematology is an integral part of this. The postholder will be required to participate in medical audit. Undergraduate medical students from Southampton University Medical School are taught throughout the Trust and the postholder is required to participate in formal and informal undergraduate clinical teaching but will not be responsible for curriculum organisation development.

Southampton Transplant Centre

The Southampton Transplant Centre comprises the departments of Clinical Haematology, Medical Oncology and Paediatric Oncology and is a single centre member of EBMT. Expansion of the service to provide the Wessex Regional Allogeneic Transplant Service is supported by a major business case accepted by the Regional Purchasers. Key appointments include a further transplant consultant and staff grade post, a nurse consultant, transplant co-ordinator and 9 other nursing posts, 2 grade B clinical scientists and MLSO posts, a data handler together with pharmacy, radiology and radiotherapy support. These will all be in addition to the schedule here, which represents current staffing, activity and support.

Level of Activity

The Southampton Transplant Centre serves a population of over 1.5 million and carries out both adult and paediatric transplantation. It is the largest transplant centre south of the London to Bristol line and it is in the top 20 centres in the country on activity. Since its inception in 1989, the centre has performed 354 autologous transplants and 29 sibling matched allogeneic transplants (20 paediatric and 9 adult). In 1999, the centre performed 54 autologous transplants



and 3 paediatric matched sibling allogeneic transplants. In accordance with EBMT standards, the centre does not yet perform unrelated transplants. The indications for transplantation within the centre conform to the EBMT guidelines. Population estimates of transplantation rates based on EBMT data suggest that the number of patients requiring allogeneic transplants throughout Wessex should be between 20-30 per year.

Clinical Facilities

Adult TransplantationThe service relocated to SGH in November 2001 based within the Cancer Care Directorate as part of the relocation of oncology services. Southampton is a Calman Hine Cancer Centre and operates integrated cancer care services under the Calman Hine model. There is a cancer steering group, cancer forum and cancer site specialist focus groups with lead clinicians. The stem cell transplant group is one such focus group.

Inpatient BedsThe centre has 6 modern, purpose built, spacious isolation rooms 3 with positive pressure HEPA filtration, thew other 3 with filtered air. The rooms are equipped to a high specification and are integrated into a larger ward of intensively treated immunosuppressed patients. In addition, there are 6 other isolation beds in the Unit belonging to the Directorate suitable for reverse barrier nursing. The Cancer Directorate has its own bed manager to maximise bed utilisation and accessibility.

Outpatient Facilities

There is a day care facility for day case follow-up and assessment of transplant patients. This includes the cell separator facilities as well as facilities for chemotherapy, blood product transfusions, bone marrow examinations and other day case procedures. There is also a dedicated weekly outpatient chemotherapy clinic with specialist nursing staff.

Transplant Laboratory

The centre now has 10 years experience in collecting and manipulating haemopoietic stem cells. There is a designated weekly morning theatre session for bone marrow harvesting. The Steve Mills transplant laboratory is on site and has carried out over 500 laboratory procedures since its opening in 1989. It has extensive facilities for cell culture and haemopoietic colony assays. Threshold criteria of stem cell quality to ensure engraftment have been derived and validated by in house data. The laboratory is led by a post-doctorate grade B clinical scientist together with an experienced MLSO 2 and MLSO trainees rotate through the laboratory for training.



Medical Staff

Southampton already has 6 senior members of staff experienced in autologous blood and marrow transplantation. In addition, experience in adult and paediatric allogeneic BMT. All transplant clinicians are active in clinical trial and research within Southampton University Medical School. Patients are entered into multi-centre national and international clinical trials under the aegis of EBMT, CCSG and the MRC. Transplant team members are involved in working parties for haematological malignancy. The centre is a training and education centre for Specialist Registrars and SHOs. A dedicated SHO is also attached to the unit. The transplant centre has 2 tiers of 24 hour on-call cover with a combined on site SHO or Registrar rota and Consultant available at all times by radiopagers.

Nursing Staff

The transplant unit nursing staff is part of a team caring for neutropenic and immunosuppressed patients as recommended by the EBMT guidelines. Total staff numbers are 30.22 wte of which 15 have full ENB 237 oncology training and 6 have specific experience in blood and marrow transplantation. 3 nurses specifically trained in cell separator techniques run the peripheral blood stem cell harvesting programme and 4.13 wte form an itinerant IV specialist chemotherapy team servicing the day case and outpatient transplant practice. Hospital and community palliative care teams are accessible. There are two senior specialist nurses, one who acts as transplant co-ordinator in addition to other development roles including chairing an EBMT national nurses working party on tunnelled, indwelling venous catheters and the other is actively involved in the UK Bone Marrow Transplant Nurses forum.

Psychological Care

There is a dedicated, part-time haematology nurse counsellor for transplant patients. A massage and aromatherapist is available on the ward to transplant patients. There is a designated specialist cancer dietician visits the unit, seeing all patients undergoing transplantation. Published dietary guidelines and recommendations are available.

Paediatric Transplantation

The regional paediatric oncology unit is sited in Southampton. This is a purpose built, 10-bedded inpatient facility with 2 dedicated transplant rooms with positive pressure HEPA filtration. The unit has integrated day care and outpatient facilities together with parent accommodation. The unit has specialist dedicated paediatric trained oncology nurses together with a paediatric BMT co-ordinator and meets all the UK CCSG paediatric oncology care criteria. Paediatric blood and bone marrow transplantation shares access to the Southampton transplant laboratory. It is the only paediatric transplant centre in Wessex.



Support Facilities

HLA and Immunophenotyping

This is carried out in the Tenovus immunology laboratory in Southampton under the aegis of a national expert in tissue typing for bone marrow transplantation. HLA typing is now done almost entirely by molecular techniques and the laboratory is able to arrange searches of donor registries worldwide as well as performing confirmatory testing of donors. The service is supported by the Wessex Regional Immunology service based in Southampton.

Radiotherapy

The SGH in Southampton houses the Wessex Regional Radiotherapy Centre, which services a population of around 2 million. There are 3 specialist clinical oncologists with particular experience of the use of irradiation in haemato-oncology and transplantation – one of which has particular expertise in the use of irradiation in paediatric patients. In May 2003 the service moved to the Cancer Care Unit which has been newly constructed at the SGH site.

Microbiology

The transplant unit liaises closely with a Consultant Microbiologist with experience in the care of long-term neutropenic patients who also has expertise in the management of resistant organisms such as the increasingly common MRSA and VRE. Molecular diagnosis for CMV and fungi is integral to the allogeneic transplant development.

Radiology and Imaging

Diagnostic x-ray facilities are available on site on a 24 hour basis. A specialist service is provided by Consultants who both have particular expertise in the radiology of malignant disease. There is immediate access to ultrasound and CT scanning on site for transplant unit patients. MRI scanning is also available at SGH.

Cytogenetics

The transplant unit liaises with the Wessex Regional Cytogenetics Service in Salisbury with a Consultant who attends the unit weekly for case conferences. Specialist techniques available include FISH and the use of mini satellite probes to assess engraftment.



Blood Product Support

The Southampton Centre of the National Blood Service is situated on the main campus of SGH supplying a comprehensive range of specialist blood products.

Pharmacy ServicesSpecialist pharmacy services are available on site with a nominated pharmacist responsible for all cytotoxic drug administration. The pharmacy provides a central intravenous additive service (CIVAS).

Data CollectionThere is an in house data collection service and outpatient follow up records are maintained indefinitely. Data is reported to the EBMT and BSBMT.transplant unit at SGH was the result of the conversion and upgrading of existing ward accommodation. All clinical Haematology services including day cases, outpatient

West Dorset General Hospitals NHS Trust, Dorchester The new Dorset County Hospital was completed in 1997 and achieved the centralisation of all services for acutely ill patients into a modern Hospital on one site, approximately 1 mile from the town centre.

The Trust provides excellent facilities to a largely rural population of 220,000 (with concentrations in Weymouth and Dorchester) and many innovative services such as an award-winning art collection to enhance the environment for patients. Housing 500 beds Dorset County Hospital has been recognised as an Exemplar Site by the Department of Health. There are only eight such sites in the country, which have been chosen because of the high quality of the patient environment. In 2001 the Trust won the national 'Clean Hospital Award'. The Trust currently employs around 2,500 personnel, treating more than 100,000 patients each year and provides the a wide range of services.

The Hospital is recognised as a Cancer Unit within the Dorset Cancer Network for the provision of services for patients with Breast, Colorectal, Urological, Upper Gastrointestinal, Lung and Haematological Malignancies. While most Chemotherapy is given locally, the Radiotherapy Centre is in the Cancer Centre at Poole

Palliative Care Services are provided by the local hospice (Joseph Weld) where there are 18 beds. The Medical Director of the Hospice is Dr Richard Sloan, an Honorary Consultant to the Trust, as is Dr Karen Steadman. These two Consultants regularly visit patients with malignant and non-malignant diseases within the Hospital.



Dorset County Hospital is the hub of the district's inpatient facilities but community Hospitals are situated in the surrounding major towns and provide the spokes to the central unit. These include, Weymouth Community Hospital, Bridport Hospital, Blandford Hospital and Yeatman Hospital, Sherborne.

PATHOLOGY STAFFGeneral Manager Mrs A WilsonHead Biomedical Scientist Mr M Hamblin

HaematologyConsultant Haematologist Dr M Al-Hilali - Whole TimeConsultant Haematologist Dr A Moosa - Whole TimeConsultant Haematologist Vacant - Whole TimeSpecialist Registrar Current Post -Whole TimeStaff Grade (Haematology) Dr Sameer Ghandi - Whole TimeS.H.O. Medical Rotation - 0.5 WTE

Chemical PathologyConsultant Chemical Pathologist Dr K Wakelin - Whole TimeConsultant Grade Biochemist Dr M Billingham - Whole Time

MicrobiologyConsultant Microbiologist Dr S Crook - Part TimeConsultant Microbiologist Dr S Groom - Part TimeConsultant Microbiologist Dr Sanja Clements -Whole Time

Histopathology/CytologyConsultant Histo/Cytopathologist Dr Corrado D’Arrigo -Whole Time Consultant Histo/Cytopathologist Dr J Mikel - Whole TimeConsultant Histo/Cytopathologist Dr A Thomas - Whole TimeConsultant Histo/Cytopathologist Locum - Whole Time

HAEMATOLOGY DEPARTMENT

Nursing Staff - Day Chemotherapy Unit 1 G Grade Sister 1 F Grade SRN3 Grade E-F Chemotherapy NursesInpatient Nursing with a Ward Sister (Grade G) and 9 Grade D-F Nurses are shared with other medical teams using Ilchester B ward

Laboratory Staff1 x BMS45 x BMS2 (+ funding for Hospital Transfusion Practitioner)15 x BMS1



4 x Trainee BMS (rotating)

Clinical HaematologyThe clinical facilities at the Dorset County Hospital are excellent. Ilchester B Ward, the inpatient area, has a two-bed suite with en-suite bathrooms and WCs and HEPA ventilation. In addition there is 14-bedded unit containing 2 single isolation rooms. We have used intensive chemotherapy for the treatment of Acute Leukaemia and relapsed Lymphoma since 1985. Support facilities within the hospital necessary for the comprehensive care of seriously ill haematology patients include an intensive care unit, the Dorset Renal Unit, full radiology services, echocardiography, bronchoscopy and gastroenterological endoscopy.Consultant Physicians in neurology, rheumatology, dermatology, endocrinology, nephrology, diabetology, cardiology and thoracic medicine are readily available. A palliative care consultant is attached to the unit.

Fortuneswell Day-chemotherapy Unit The Fortuneswell Chemotherapy Unit caters for both haematology and oncology patients. More than 1400 clinical episodes were seen each year. Oncology patients, account for around 20% of the in-patient occupancy. Nursing staff have post-registration qualifications in Haematology, Oncology, chemotherapy and care of the dying. The Unit housed the haematology and oncology outpatient services and is used for the administration of chemotherapy, bone marrow aspirates and trephines, cell separator procedures and clinical assessments. Blood and platelet transfusions, lumbar punctures and IV infusions of Iron and Immunoglobulin are performed in the Day-medicine Unit of the hospital.

Haematology OutpatientsEight outpatient clinics are held weekly. More 500 new haematology patients are seen each year in addition to more that 5000 follow up general haematology and 1300 chemotherapy episodes. The anticoagulant department managed more than 18,000 dosing episodes last year. Specially trained Biomedical Scientists, supervised by medical staff, run the anticoagulant service. An average of 5-7 ward referrals are seen weekly. Around 180 new patients with haematological malignancies are seen annually, the commonest diagnoses being NHL (c 84 cases), Myelodysplasia (c 36), Chronic Lymphocytic Leukaemia (c 30), Myeloma and macroglobulinaemia (c 20) and myeloproliferative disorders (c 10). Around 2 to 4 patients with acute leukaemia are undergoing treatment. One multi-disciplinary meeting and a Friday grand round are held weekly. The Haemophilia centre with around 10 severe haemophiliacs is based at the Dorset County Hospital.

Laboratory HaematologyThe laboratory is spacious and well equipped. It has full CPA accreditation and participates in all appropriate NEQAS schemes. There are sub-departments of routine and special haematology, coagulation and blood transfusion. Routine



laboratories are provided with the Sunquest computer system. Around 500 blood counts are performed per day on two Coulter STKS analysers. Haematinics assays are performed with the Beckman Coulter Access immunoassay system. The coagulation laboratory is equipped with Sysmex 1500 with ACL 1000 machines. The Blood Transfusion Laboratory uses the Diamed system and has recently introduced new automatic Blood Grouping machinery, as well as evaluating the electronic cross match. Immunological, Cytogenetic analysis and molecular investigation are performed at the regional centres in Southampton and Salisbury

ResearchThe department has an active participation in clinical trials for Leukaemia, Myeloma and Lymphoma. Two research/clinical trial nurses facilitate local entry and documentation of clinical trials.

THE ROLE OF THE SPECIALIST REGISTRARThis post gives good training in laboratory and clinical haematology. Its strengths are the wide experience gained in the management of haematological malignancies, including lymphomas, myeloma and acute leukaemia. The specialist registrar is expected to attend the MDT and departmental grad round. You will have weekly outpatient clinics and will have responsibility for the day-to-day management of in-patients and for the training and instruction of the SHO who works with them. At least one of the consultants will work closely with the Specialist Registrar and will always be available for consultation. The Specialist Registrar will have laboratory sessions for training and for providing a service to other departments in the hospital. The three consultants, the associate specialist and the staff grade are all responsible for the laboratory for one day in the week, and each will work closely with the Specialist Registrar.

Example Timetable – Specialist Registrar

AM Lunch PM

Monday Ward Work MDT / Ward Work

Tuesday OPD Bone Marrow Clinic

Laboratory Session

Wednesday Chemotherapy Clinic / Ward Work

Teaching

Thursday OPD SHO teaching / Ward Work

Friday Regional MDT

Consultant Ward Round

Ground Round /Teaching

Laboratory Session



Audit and Continuing Professional DevelopmentTime will be allocated in the job plan for audit and CPD activities. There are regular haematology journal clubs, multidisciplinary meetings, a weekly medical journal club, grand round case presentations and an active post graduate society hosting weekly lectures for all hospital staff and local general practitioners. There is also a “Wessex” haematology group that meets regularly for educational purposes. Apart from regular local teaching there will also be release for the fortnightly regional teaching sessions that rotate between the hospitals that currently make up the Wessex rotation.

On-CallOne Saturday every 4 weeks

For further information or to discuss the post please contact Dr Mahir Al-Hilali, Consultant Haematologist on 01305-254327.

Basingstoke and North Hampshire NHS Foundation Trust

Medical Staff4 Consultants, including Haemophilia Director (1 post vacant)1 Associate Specialist1 Specialist Registrar (one year rotation)1 ST2 on 4 monthly medical rotation1 FY1 on 2 monthly medical rotation

Nursing Staff1 Band 8 Haematology Nurse Practitioner1 Band 8 Haemophilia Specialist Nurse1 Band 7 Haematology CNS3 Band 7 Anticoagulation Specialist Nurses1 Band 7 Sister Wessex ward1 Band 6 Haematology Nurse18 Band 5 Nurses – Wessex ward / Basing Unit

Laboratory Staff

Transfusion Medicine:1 Transfusion Practitioner/ Blood Bank Manager1 Senior BMS in Transfusion 1 BMS in Transfusion1 Trainee rotating through Transfusion and Laboratory Haematology



Haematology:1 Coagulation Practitioner1 Lead BMS in Haematology2 Senior BMS in Haematology7 BMS1 in Haematology2 MLA in Haematology

Clinical Haematology Service

This is run from the Elizabeth Hall centre consisting of a newly built inpatient and outpatient unit, which provides facilities for haematology and oncology. The Wessex Ward has facilities for 10 patients, including three rooms with positive pressure and HEPA filtration. The outpatient unit, Basing Unit is used for day care, administration of chemotherapy, blood products and other parenteral treatments and procedures such as bone marrows, therapeutic venesections, lumbar punctures and intrathecal chemotherapy. Level 2 services are provided with compliance with the Haematology IOG. The centre is staffed by a complement of nursing staff, chemotherapy staff and specialist nurses. Review of patients is formed as part of the outpatient visit. The consultants are supported by an experienced Associate Specialist, Specialist Registrar, Haematology ST2 and FY1. Conditions treated include leukaemia, lymphoma, myeloproliferative disorders, myelodysplasia and non malignant haematological disorders. There is a weekly MDT ward round with participation from the nursing staff, nurse practitioner in haematology, pharmacy oncologist, consultant microbiologist, oncology dietician, palliative care nurses and the haematology doctors. The unit is within the Central South Coast network. Network MDT management meetings are being held twice weekly via video conferencing. There are also histopathology, bone marrow and radiology review meetings with specific clinicians locally.

There is a commitment to clinical trials with participation in many NCRI trials supported by a clinical trials practitioner.The Elizabeth Hall Unit also provides a base for a medical oncologist and visiting clinical oncologists. St Michaels Hospice is situated in a separate building within the BNHFT site with two palliative care consultants.

Haemophilia Service

There is a newly refurbished purposely-designed Haemophilia centre within the BNHFT site. The centre is separate from the hospital and has good flexible clinical facilities and patient parking. The Haemophilia Centre until recently shared Comprehensive Care Status with Southampton providing care for haemophiliacs and a number of patients with a variety of bleeding disorders. However, following a recent Strategic Health Authority review, NHH has been



designated the managing organisation for Hampshire & IOW Haemophilia Services. Haemophilia and thrombotic services are provided by a multi-disciplinary team comprising of a Duty Director, haemophilia and anticoagulation specialist nurses, principal BMS and centre co-ordinator. Innovative models of service delivery have been introduced utilising the skills of senior nursing and scientific staff. Patients in the easy bruising clinic are seen by the Principal BMS. Anticoagulation management services are provided by an experienced team of specialist nurses and Senior Biomedical Scientist. Predominantly a postal system is employed with patients bled in the community, samples sent into the laboratory and dosage instructions returned to the patient.

Laboratory HaematologyThe laboratory has full CPA accreditation and participates in all appropriate NEQAS schemes. The Haematology area of the Blood Sciences department at BNHFT is equipped with Advia-2120, MDA-180, Bio-Rad Variant II, FACSsort flow cytometer, PFA100, and Diamed ID Gelstation. The trusts LIMS is Clinisys WinPath. The department provides the full range of routine and specialist services, including haemoglobinopathy screening, immune monitoring, immunophenotyping. Also anticoagulant services, specialist haemostasis, thrombophilia and haemophilia assays are carried out as the laboratory serves the on-site regional Comprehensive Care Haemophilia Centre. The Blood Transfusion Laboratory uses the Diamed system. We are awaiting the implementation of electronic blood tracking system.

Specialist Registrar Clinical Training The following clinical skills will be obtained during the period of clinical training at Basingstoke;The treatment of haematological malignancies, management of haematological emergencies, full range of diagnostic and therapeutic procedures, an understanding of palliative care, the management of non-malignant haematological conditions, the management of bleeding disorders and a full range of laboratory and management training.

Educational timetable for SpR in Haematology at BNHFT:(General Haematology, Laboratory Haematology, Transfusion Medicine, Clinical Haematology)

Monday:a.m. Consultant Ward Rounda.m. Ward Referralsp.m. Myeloma clinic (followed by discussion on diagnosis and management of myeloma patients)

Tuesday:



a.m. General Haematology and New Patient Clinic (followed by discussion on presentation and management of haematological disorders)a.m. Lymphoma MDT (videoconference with Southampton)p.m. Bone Marrow List

Wednesday:a.m. Lymphoma Clinic (followed by discussion on presentation and management of lymphoma)p.m. Consultants Bone Marrow review meetingp.m. Morphology Teaching (reporting blood films and bone marrows under Consultant supervision)

Thursday:a.m. Journal Cluba.m. MDT Ward Round followed by Consultant Ward Round Friday:a.m. Radiology MDT Meeting alternate weeksa.m. Haematological malignancies MDT (videoconference with Southampton)a.m. Teaching session with Educational Supervisor

Daily: Basing Unit (Chemotherapy Day Unit) and Inpatients on Wessex Ward

On call: 1:4 weekends (with Consultant cover)

Educational timetable for SpR in Haematology at BNHFT(Regional Haemophilia Comprehensive Care Centre for Hampshire and Isle of Wight) Monday:a.m. Anticoagulation Clinic (New Patients)

Tuesday:a.m. Thrombophilia clinicp.m. Mild Bleeding Disorders Clinic p.m. Hepatitis Joint Clinic with Hepatology Consultant (every 2 months)

Wednesday:a.m. HIV Joint Clinic with GUM Consultant (every 2 months)

Thursday:a.m. Journal Cluba.m. Anticoagulation Clinic (New Patients)p.m. Severe Haemophilia Clinicp.m. Paediatrics Joint Clinic with Paediatric Consultant (every 3 months)



Friday:a.m. High Risk Pregnancy Clinic (thrombophilia and bleeding disorders)a.m. Teaching session with Educational Supervisor

Daily: Walk-in Haemophilia Day Unit

On call: 1:4 weekends (with Consultant cover)

Poole Hospital Acute NHS Trust

Department of Haematology

Medical Staff3 Consultant HaematologistsDedicated SHO1 SpR Haematology

Laboratory Staff1 Haematology Laboratory Manager2 BMS Grade 34 BMS Grade 213 BMS Grade 12 Trainee BMS’s8 MLA28 Phlebotomists (Most part time)2 Secretaries

Nurse Specialists2 Anticoagulation1 Clinical Haematology Nurse Specialist

Department Statistics

Clinical Haematology (2007-8)Inpatients 560Outpatients 4800 (1st visit =

580)Day Unit 2600

Laboratory Workload (2007-8)Haematology and blood bank tests:FBC 220,000Clotting tests 130,000Haematinics 27,000Cross-matches 5,500Antenatal 5,000Bone marrows 287 aspirates and



131 trephines

Laboratory ServicesThe haematology laboratory provides all the usual routine and specialist diagnostic tests including flow cytometry, specialist haemostasis and thrombosis investigations, haemoglobin electrophoresis, haematinics, and PCR for thrombophilia-associated mutations. About 35% of the workload is from GP users. Poole is the Wessex centre for antenatal haemoglobinopathy screening. Laboratory instrumentation includes 2 Abbott Cell-dyne Sapphires , 2 MDAs, 2 automated ESR analysers, 1 Autovue Blood Grouping analyser, 1 flow cytometer, 1 PFA100, 2 Menarini HPLC analysers, Beckman Coulter Access immunoassay system and one thermo-cycler PCR analyser.

The blood bank comprises a separate area within haematology providing standard blood products as well as factor concentrates. There is an active Blood Transfusion Committee which meets regularly, and an intra-operative red cell salvage machine. Out of hours laboratory service is provided for haematology and blood transfusion by state registered Biomedical Scientist staff. Poole is currently implementing a barcoded-patient wristband system for blood product issue.

Basic diagnostic support is offered to paediatric cases. Haemophiliac paediatric cases are managed at Poole but paediatric oncology by local Paediatricians in conjunction with Southampton.

The haematology department has full CPA accreditation, last inspected 2008. There is full participation in NEQAS with excellent performance.

Inpatient ServicesClinical Haematology is part of the Oncology Directorate, laboratory part of the Pathology Directorate. Poole Hospital forms the hub of the Dorset Cancer Centre, comprising Poole, Dorset County Hospital and the Royal Bournemouth and Christchurch Foundation Trust. Haematology shares two dedicated wards with Clinical and Medical Oncology. There are two HEPA filtered isolation rooms. The unit deals with patients with all sorts of haematological disorders including those requiring chemotherapy for acute and chronic leukaemias, low and high grade lymphomas and myeloma. Poole is consistently one of the busiest District General Hospitals for autologous stem cell and marrow transplants in the UK. Allogeneic transplants are referred externally. There is also a very busy day case facility for the outpatient treatment of patients with haematological and oncological disorders. Specialist nurses are fully trained in venepuncture, chemotherapy administration, venesections and PICC-line insertion. There are facilities for stem cell harvesting and plasma exchange. Hickman lines are inserted within the department and training available for SpRs. The Haematology department is supported by a dedicated SHO on the general medical rotation and a Haematology Nurse Specialist. There is a weekly multidisciplinary meeting



video-linked to RBH and DCH.

OutpatientsThere are 6 regular outpatient clinics per week at Poole and alternate week clinics at Swanage Hospital and at the Victoria Hospital, Wimborne. Occasional haemophilia clinics are held jointly with Paediatrics. There will be ample opportunity for the SpR to attend any of these clinics. Anticoagulant dosing is performed by 3 dedicated staff using Dawn 4S software.

Role of the SpRThe role of the SpR will include:

• Day-to-day management of Haematology inpatients, day patients and outpatients.

• Haematological advice to GPs and hospital staff including seeing ward referrals.

• Practical procedures including: bone marrow aspiration and biopsy, pleural and ascitic aspiration, lumbar puncture, Hickman line insertion, peripheral blood stem cell and bone marrow harvesting and plasma exchange.

• Laboratory duties including the reporting of blood films and other laboratory results, and advice on specialist further investigations and transfusion issues.

• Ward supervision of the Haematology SHO

• Teaching of SHOs, medical students and other clinical staff.

• Presentation of at least one audit.

• A research interest leading to a publication would be strongly encouraged.

ManagementThe post holder will be managerially responsible to the Specialty Clinician for Pathology.

Timetable The proposed timetable for the SpR is:


AM PM

Monday General Haematology Clinic Laboratory / ward work

Tuesday Laboratory / ward work Consultant Ward Round

Wednesday Haemato-oncology clinic Hickman list / Admin / CPD

Thursday Haemostasis clinic. Grand round.

Laboratory / ward work

Friday Multidisciplinary meeting alt wksConsultant Ward Round

Admin / Teaching


Audit and Continuing Professional Development

Time will be allocated in the job plan for audit and CPD activities and the registrar will be expected to present at least one audit. There are weekly multidisciplinary meetings, a weekly medical journal club, weekly Grand Round case presentations in term and excellent facilities for reading and on-line research based in the Postgraduate Medical Centre Library. Apart from regular local teaching, attendance at the regional training days is expected.

For further information or to discuss the post please contact Dr Fergus Jack, telephone 01202 442583, or Dr Andrew Bell, 01202 442498.

Salisbury NHS Foundation Trust

Medical Staff3 Consultants1 Specialist Registrars (one year rotation)1 FY2 doctor (4-monthly medical rotations)

Nursing Staff1 Haematology CNS1 TP2 Anti-Caogulation Nurses1 Chemotherapy Nurse Practitioner (currently Oncology only)

Scientific Staff1 BMS3 HAEMATOLOGY1 BMS 3 BLOOD TRANSFUSION3 BMS 2 HAEMATOLOGY1 BMS 2 BLOOD TRANSFUSION9.5 WTE BMS1 + TRAINEE6 MLA (HAEMATOLOGY&BIOCHEMISTRY)

Clinical Haematology

The Haematology/Oncology Department combines Clinical Haematology and Medical Oncology services and operates from the Pembroke Unit: this comprises Pembroke Ward, a 21 bed inpatient ward (6 siderooms) housing Haematology and Medical Oncology inpatients as well as other inpatients with cancer-related problems and general medical patients, and the Pembroke Suite, where day case investigations and treatments, including outpatient chemotherapy and blood component transfusions are administered. Facilities include a COBE Spectra cell separator for plasma exchange and blood stem cell collection. A weekly



venesection clinic is run by a Clinical Assistant. There is a team of Oncology trained nurses fully experienced in cannulation and administration of cytotoxic drugs.

The Clinical Haematology service provides care at BCSH Level 3 for adult patients from beyond the whole catchment area of Salisbury Healthcare NHS Trust with a wide variety of malignant and non-malignant haematological conditions, and includes a satellite service (in conjunction with Royal Bournemouth Hospital) for autologous peripheral blood stem cell transplantation. Peripheral blood stem cell mobilisation and collection is performed in Salisbury, but cell processing and storage is arranged through the Steve Mills Laboratory at Southampton General Hospital. Preparations are underway for JACIE accreditation of this service. A Quality Manager has recently been recruited to facilitate this.

A number of patients with inherited bleeding disorders are managed in Salisbury, under the care of Dr Tamara Everington and in conjunction with the Comprehensive Care Centre is Southampton/Basingstoke.

Patients requiring allogeneic transplantation or radiotherapy are referred to Southampton General Hospital. There is active recruitment to national clinical trials for patients with haematological malignancies.

Salisbury District Hospital is a Cancer Unit and a member of the Central South Coast Cancer Network. It participates in the Western Multidisciplinary Teams to comply with the NICE Improving Outcomes Guidance in Haematological Malignancies. MDT meetings are held on a weekly basis in Southampton with video-conferencing links to Salisbury/Basingstoke/Winchester. Separate meetings are held for Lymphomas and Leukaemias/Myeloma. The Trust’s chemotherapy services underwent Peer Review in December 2005 and Haematological Malignancies were peer reviewed in 2007.

The Department of Clinical Radiology provides a full range of diagnostic and therapeutic modalities, including CT and MRI, as well as insertion of indwelling venous catheters. Patients requiring PET scans are currently sent to the InHealth NHS PET/CT Diagnsotic Centre in Southampton. Medical Microbiology service is on site.

Up to thirteen outpatient clnics are held weekly, including specialist paediatric / haematology, thrombophilia and myeloproferative disorders clinics. Daily anticoagulant clinics are run by specially trained nurses.

Clinical Haematology workload figures for 2005 are shown below:

New outpatients 448



Follow-up outpatients 3011

Inpatient episodes 249*

Ward referrals >100

Day case attendances 1686

*Average inpatient numbers at any one time 5-10.

In general, paediatric haemato-oncology cases are referred to Southampton University Hospitals NHS Trust for investigation and management. The Medical Oncology service is led by 2 Medical Oncologists and 1 Clinical Oncologist who divide their time between Southampton and Salisbury. The majority of the work is out-patient based with chemotherapy being administered on Pembroke Suite. Junior medical staffing for the Clinical Haematology/Oncology service is currently provided by the Haematology F2 and the Respiratory team (2 SpRs, 1 F2 and 2 F1s) who share a system of ward-based working on Pembroke Ward. Oncology patients requiring admission for neutropenic sepsis are admitted under the Haematology team, others under the Respiratory team.

The department is committed to providing flexible and high quality care for patients that meets locally and nationally identified standards. There is close liaison with the Salisbury Palliative Care service.

Staffing – Clinical Haematology/Oncology

Consultant Haematologists: Dr Jonathan Cullis (Lead Clinician)Dr Effie GrandDr Tamara Everington

Consultant Medical Oncologists: Dr Melanie Harvey (Locum)Dr Tim Iveson

Consultant Clinical Oncologist: Dr Adi Bhatnagar Joint Lead Cancer Nurses: Belinda Mills, Helena Bridgman Haematology Nurse Specialist: David HutchinsSister, Pembroke Ward Carolyn SawyerSister, Pembroke Suite Sarah SalisburyChemotherapy Nurse Practitioner Claire MarshF2, Haematology/Oncology on rotation



Laboratory Medicine

The Department of Laboratory Medicine was created in 1995 by a merger of Haematology and Blood Transfusion with Chemical Pathology, and provides an analytical service to Salisbury, South Wiltshire and parts of Hampshire and Dorset. The department is housed in modern laboratories and has full CPA accreditation (inspected in September 2008).

The routine haematology laboratory is well equipped with 2 Abbott Cell-dyn Sapphire FBC analysers and processes approximately 600 samples per day. Blood film and bone marrow staining are carried out using an automated slide maker stainer. Blood coagulation uses Sysmex CA1500 analysers for both coagulation screens and for the monitoring of anticoagulant therapy. The department currently operates a postal service for monitoring of anticoagulant therapy. Investigation of haemostasis and thrombophilia are carried out in the laboratory. The laboratory processes approximately 2000 requests per annum for Antenatal screening for Sickle cell & thalassaemia. Haematinic assays are carried out within Laboratory Medicine using the Roche modular system and the Beckman Access. Samples for Factor V Leiden, Prothrombin G20120A or cytogenetic malignancy markers are referred to the Regional Genetics department here at Salisbury.

The department is enrolled in all relevant NEQAS EQA schemes.

The Immunology section carries out autoimmune profiles as well as thyroid antibodies and rheumatoid factor detection. Cell markers for both lymphoid and myeloid malignancies are sent to the Wessex Immunology department at Southampton General Hospital.

Blood Transfusion uses the Ortho Innova blood grouping analyser and is working towards the imminent introduction of electronic blood issue.

The Genetics service is adjacent to Laboratory Medicine and is headed by Professor Nick Cross: there is an extremely strong research element and the two departments have close liaison and offer excellent opportunities for collaborative research.

The Anticoagulant Service is run using the Dawn computer package by 1.5wte Anticoagulation Nurse Specialists. The department received 867 new referrals for anticoagulation last year, and currently monitors 2250 patients. There are plans to organise a nurse-led thrombophilia clinic alongside the consultant thrombophilia clinic.

A 0.6 WTE Transfusion Practitioner is in post with plans to increase this to a full-time role.



The Role of the Specialist Registrar

This post gives excellent training in laboratory and clinical haematology. Its strengths are the wide experience gained in the management of haematological malignancies, including lymphomas and the close contact with high quality research. Only one Specialist Registrar is in post and therefore gains experience in all aspects of clinical and laboratory activity. The SpR is expected to attend the multidisciplinary meetings on Tuesdays and Fridays, weekly outpatient clinics and is responsible for the day-to-day management of in-patients and for the supervision of the F2 who works with them. The consultants rotate on a monthly basis through inpatient, outpateint (Pembroke Suite) and laboratory roles. At least one of the consultants is always be available for consultation. The Specialist Registrar is expected to report all his / her marrows and to present these at a weekly morphology session and also receives blood films on a daily basis for reporting. The Specialist Registrar is expected to present cases at the fortnightly joint Haematology / Radiology meeting and the monthly Histopathology meeting. The SpR is also expected to present at the Grand Round.

Haematology Curriculum

In the UK clinical haematology is an intensive, exciting and rewarding but demanding speciality that encompasses both clinical and laboratory practice. As a result of this dual role, haematologists take an active part in every stage of patient management from initial clinic visit, to laboratory assessment/diagnosis and finally to treatment. Clinical care is delivered in both in-patient and out-patient environments and the haematologist frequently contributes to diagnosis and management in other specialties and in the intensive care setting. This holistic approach to clinical care is a highlight of the specialty.

Haematology is developing rapidly with respect to therapeutic advances and lends itself to research. Within haematology there is the opportunity to further develop special interests in a wide variety of clinical and laboratory areas (e.g. haemogloginopathies, haemostasis and thrombosis, transfusion medicine, malignant haematology, transplantation). The specialty may suit a wide variety of individuals including those who may wish to combine a clinical and academic career. The haematology consultant workforce is currently expanding. Entry into haematology specialist training occurs after completion of core training (CMT, ACCS) competencies and requires success in the MRCP Part 1 examination.The duration of specialist training is around 5 years. Satisfactory completion of training requires that the trainee acquires both the competencies set out in the generic curriculum applicable to all physicianly specialities and those of the haematology curriculum. The completion of training also requires that the



trainee obtains, by examination, both full MRCP and MRCPath. As specialists in haematology are involved in direct patient care and in management of haematology pathology laboratories, specialist training covers both these components, including training in transfusion medicine. Specialist training starts with an introduction to laboratory practice and subsequently continues through a variety of posts which will:

i) include core and special interest haematology, incorporating haematological oncology, transplantation, paediatric haematology, haemostasis and thrombosis and blood transfusion practiceii) allow the trainee exposure to the broad range of diseases of the blood and bone marrow, both primary and secondary to other systemic diseaseiii) permit haematology training in a range of different settings including an academic environment, a District General Hospital, and Paediatric Haematology and Blood Transfusion Units

Specialist training may be extended to accommodate less than full time training. One year of specialist training may be approved for research, which is relevant to the specialty and in an area approved by the Chair or Secretary of the Specialty Advisory Committee. Approval will take account will be taken of the generic training value of the research and any clinical experience gained during the period of research. On award of CCT a haematologist will be able to work as a consultant specialist within the National Health Service and will have the competencies required to do so, as well as to develop further special interest expertise if desired.

For the full haematology training curriculum please refer to the JRCPTB website specialist haematology page.

Teaching

The Wessex haematology training programme runs a very successful teaching programme. This involves compulsory ‘training days’ which are held at one of the rotation placement hospitals on a 6 weekly basis. Trainees must attend >75% of these training days to successfully progress though training.

In addition ‘ on the job’ teaching is provided at all the placement hospitals on a regular basis during a placement.

Main Conditions of Service

The posts are whole-time and the appointments are subject to:



1. The Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales)

2. Satisfactory registration with the General Medical Council 3. Medical Fitness – You may be required to undergo a medical examination

and chest x-ray. Potential applicants should be aware of the Department of Health and GMC/GDC requirements with regards to HIV/AIDS and Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be required to provide, in advance of appointment, evidence of immunity or have a local blood test (as deemed necessary by the Occupational Health Department)

4. Right to work in the UK5. Criminal Records Check/POCA check carried out by the Trust Medical HR

department. 6. Pre-employment checks carried out by the Trust Medical HR department.

Hours

Your duty hours will be between 40 and 56 hours per week (part-time staff pro rata) depending upon the pattern of work offered by the employer, which should be in accordance with paragraph 20 of the TCS. This may include work in the evenings, at night and weekends. The TCS may be viewed at [insert Deanery link and/or] http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm All posts on the rotation are working towards compliance with the European Working Time Directive regulations.

Pay

You should be paid monthly at the rates set out in the national terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service (England and Wales), “the TCS”, as amended from time to time. The payscales are reviewed annually. Current rates of pay may be viewed at [insert Deanery link and/or] http://www.nhsemployers.org/pay-conditions/pay-conditions-2339.cfm. Part-time posts will be paid pro-rata.

Pay supplement

Depending upon the working pattern and hours of duty you are contracted to undertake by the employer you should be paid a monthly additional pay supplement at the rates set out in paragraph 22 of the TCS. The current payscales may be viewed at http://www.nhsemployers.org/pay-conditions/pay-conditions-2339.cfm The pay supplement is not reckonable for NHS pension purposes. The pay supplement will be determined by the employer and should be made clear in their offer of employment and subject to monitoring.


http://www.nhsemployers.org/pay-conditions/pay-conditions-2339.cfm





Pension

You will be entitled to join or continue as a member of the NHS Pension Scheme, subject to its terms and rules, which may be amended from time to time. Further information can be viewed at http://www.nhspa.gov.uk/nhspa_site/index.htm

Annual leave

Your entitlement to annual leave will be five or six weeks per annum depending upon your previous service/incremental point, as set out in paragraphs 205 – 206 of the TCS.

The TCS may be viewed at http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm

Sick pay

Entitlements are outlined in paragraphs 255-240 of the TCS.

Notice

You will be required to give your employer and entitled to receive from them notice in accordance with paragraphs 195 – 196 of the TCS.

Study leave

The employer is expected to offer study leave in accordance with paragraphs 250 – 254 of the TCS. Local policy and procedure will be explained at your induction.

Travel expenses

The employer is expected to offer travel expenses in accordance with paragraphs 277 – 308 of the TCS for journeys incurred in performing your duties. Local policy and procedure will be explained at induction.

Subsistence expenses

The employer is expected to offer subsistence expenses in accordance with paragraph 311 of the TCS. Local policy and procedure will be explained at induction.

Relocation expenses

The employer will have a local policy for relocation expenses based on paragraphs 314 – 315 of the TCS and national guidance at http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm. You are





http://www.nhspa.gov.uk/nhspa_site/index.htm


advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure. In addition to local policy there is Deanery guidance which can be viewed on www.nesc.nhs.uk

Pre-employment checks

All NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements expected to be in line with national guidance at http://www.nhsemployers.org/primary/primary-3524.cfm

Professional registration

It will be a requirement of employment that you have professional registration with the GMC for the duration of your employment.

Health and safety

All employers have a duty to protect their workers from harm. You will be advised by the employer of local policies and procedures intended to protect your health and safety and to comply with these.

Disciplinary and grievance procedures

The employer will have local policies and procedures for dealing with any disciplinary concerns or grievances you may have. They will advise you how to access these, not later than eight weeks after commencement of employment.

Educational supervisor

The employer will confirm your supervisor on commencement.

General information The Deanery’s management of Specialty Training programmes, including issues such as taking time out of programme and dealing with concerns or complaints, is available at www.nesc.nhs.uk and in the national ‘Gold guide’ to Specialty Training at http://www.mmc.nhs.uk/


http://www.mmc.nhs.uk/

http://www.nesc.nhs.uk/

http://www.nhsemployers.org/primary/primary-3524.cfm

http://www.nesc.nhs.uk/

Documents

Royal Bournemouth and Christchurch Hospitals NHS Trust.doc