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Developing people for health and healthcare
www.hee.nhs.uk [email protected] @NHS_HealthEdEng
We are the Local Education and Training Board for Wessex
SPECIALTY TRAINING PROGRAMME IN HAEMATOLOGY FOR HEALTH
EDUCATION WESSEX
This is a 5 year training programme in Haematology at ST3 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. Details of essential competences and qualifications are detailed in the MMC person specification for Haematology at ST3 which is available from www.mmc.nhs.uk
This 5 year Specialty Training programme will allow the successful applicant to
achieve the award of a Certificate of Completion of Training (CCT) in Haematology,
subject to satisfactory progression.
The programme is based in hospitals in the Wessex Deanery including:
HOSPITAL LOCATION
North Hampshire Hospital Basingstoke
The Royal Bournemouth Hospital Bournemouth
Dorset County Hospital Dorchester
Poole General Hospital Poole
Queen Alexandra Hospital Portsmouth
Salisbury District Hospital Salisbury
Southampton General Hospital Southampton
Health Education Wessex is responsible for the planning, development, education
and training of the healthcare and public health workforce across Hampshire, Dorset,
Isle of Wight and Salisbury. We also provide medical training for the States of Jersey
and GP appraisal services for Jersey and Guernsey. We believe that the key to
improving the health and healthcare of the 2.8 million people living in Wessex is
Developing people for health and healthcare
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We are the Local Education and Training Board for Wessex
investment in the skills and values of the 52,000 people working in the NHS and in
primary care.
Within the field of postgraduate medical education and training, we manage across
primary and secondary care for these health communities – totalling around 2,400
doctors in training at any one time across 12 Trusts and 160 GP practices. In
addition, we support the workforce development for GP Practice Nurses and Public
Health practitioners as well managing a bespoke GP appraisal service for
established GP Practitioners to meet the requirements for revalidation in accordance
with the statutory requirements set by the General Medical Council.
We manage training programmes for postgraduate medical training according to the
statutory standards set by the General Medical Council (GMC) and have
responsibility for establishing and maintaining quality management systems for all
posts and programmes as required by the GMC.
The work of the Deanery is guided by the principles embedded within the NHS
constitution.
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.
Rotational placements will be made each year with the training need of the registrar
being the most important factor. After this the preference of the trainee for a
particular post is taken in to consideration. It may not be possible for a trainee to go
to a placement of their choice. Usually each post is for one year’s duration. In
exceptional circumstances you may need to rotate for a Shorter period
Developing people for health and healthcare
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We are the Local Education and Training Board for Wessex
Study and Training
The primary aim of all posts is 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 GMC, 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 General Medical Council (GMC) 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.
Developing people for health and healthcare
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12. Attend induction in each hospital or new department
13. Comply with all local policies including dress code, annual and study leave
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.
Information about Hospital Trusts in the rotation
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
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Clinical Haematology
The clinical haematology unit has adjacent inpatient and day wards.
Ward 11 is the Haematology inpatient ward and has 15 beds, which include 2 single
rooms with laminar airflow and en-suite facilities, 3 single rooms and a 2 bedded
room with filtered air, 5 single rooms and a 3-bedded bay. The inpatient unit has
facilities for BCSH level 3 and is JACIE-accredited for autologous stem cell
procurement and transplantation. The Unit transplants 20-25 patients annually.
Ward 10 is the day ward, has two 6 bedded bays and is used for clinical
assessments, chemotherapy clinics, administration of chemotherapy, blood products
and coagulation factors, diagnostic and therapeutic procedures including
venesections, aphaeresis, tunnelled central venous catheter (CVC) removals, bone
marrow biopsies and intrathecal chemotherapy. Tunnelled CVC and PICC are
inserted in Radiology. The day care facilities on ward 10 are shared with medical
oncology. In 2011-12, the day unit managed 7786 Haematology and 8698 Oncology
day-case patients.
Outpatient clinics include 8 Consultant-led weekly general haematology and disease-
specific LPD, myeloma, transplant, haemostasis and thrombosis clinics. There are,
in addition, weekly nurse-led chemotherapy, MPN and venesection clinics.
The Department has 6 Consultants, a Consultant Nurse and 5 Specialist Nurses.
Most nurses working on wards 10 and 11 have post-registration qualifications in
haematology, oncology, blood & marrow transplantation and/or care of the dying.
The Department has a Clinical Trials Unit staffed by Trials Coordinator, Data
Manager and 3 Research Nurses, and participates in many national and
international clinical trials in acute leukaemia, lymphoma, CLL, myeloma, MDS and
MPN.
The Department houses the Dorset hub of the Wessex Haemophilia Comprehensive
Care Network (WHCCN). The Network Comprehensive Care Centre (CCC) is based
at Basingstoke and North Hampshire Hospitals NHS Foundation Trust.
Comprehensive care for patients with inherited and acquired bleeding disorders in
East Dorset is led by a full-time Consultant in Haemostasis and Thrombosis based in
Bournemouth. Adult patients are managed in Bournemouth and children are
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managed in Poole. Elective orthopaedic surgery and GUM services for East Dorset
are based in Bournemouth. Paediatrics, ENT and Oral Surgery are based in Poole.
The anticoagulation service is led by Consultant Nurse with 4 trained anticoagulation
practitioners. There are 4000 patients registered with the anticoagulation clinic. The
clinics are managed according to pre-defined algorithms authorised by the hospital’s
Thrombosis Committee and Drugs & Therapeutics Committee. Majority of patients
on oral anticoagulation therapy are managed by postal dosing using DAWN-AC v7.9
software. The team also runs peri-operative bridging clinics for patients on warfarin.
The anticoagulant service is linked to the hospital’s fast-track DVT service which is
run from the Emergency Department.
Laboratory Haematology The haematology laboratory is CPA and MHRA-accredited and performs
approximately 240,000 blood counts annually using two ADVIA 2120 analysers.
About 500 diagnostic marrow aspirates are processed annually. Serum ferritin, B12
and folate levels are analysed on Beckman-Coulter ACCESS 2 analyser.
Haemoglobinopathy screening is performed at Poole hospital.
The coagulation laboratory uses two ACL TOP analysers. Approximately 100,000
INR samples are analysed annually. Comprehensive thrombophilia screening
including molecular tests are performed electively. Thromboelastogram (TEG) is
available for 24/7 use. PFA-100 screening test is available at Poole Hospital. Light-
transmission aggregometry is performed to assess platelet function on an elective
basis. The laboratory has trained personnel to perform a full panel of special
coagulation tests e.g. clotting factor assays.
The transfusion laboratory performs 25,000 group and screen and 7000 cross
matches per year. There is an automated grouping machine and the department
uses DIAMED column technology. All of the laboratories use the Telepath 1 system
from i-Soft.
A Haematological Malignancy Diagnostic Service (HMDS) for Dorset Cancer
Network is being developed and is expected to be fully operational by 2014.
Flowcytometry is performed in-house using a FACSCalibur analyser. Bournemouth
provides the immunophenotyping service to Dorset Cancer Network. Molecular and
cytogenetic laboratories are on site but are used mainly for research. All routine
diagnostic cytogenetic and molecular genetic studies are performed at Wessex
Genetics Laboratory in Salisbury District Hospital.
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Research There is an active laboratory research unit within the department. The main research
interests are in diagnosis, genetic abnormalities, prognostic features and
management of chronic haematological malignancies, especially chronic lymphocytic
leukaemia, low-grade lymphoma and myelodysplastic syndromes. The department
attracts funding from the Leukaemia Research Fund as well as other grants and
local charities.
Duties of specialist trainee in haematology The Department trains 3 specialist haematology (ST3-7) and 2 core medical trainees
(ST1-2). The ST3-7 trainees rotate between inpatient ward, day ward and laboratory
every 2 months. The ST1-2 trainees rotate between inpatient ward and day ward
every month. The trainees are expected to provide inpatient, day ward, outpatient
and laboratory haematology services under Consultant supervision to East Dorset
population of 500,000. The Haematology on-call service is non-resident, 1-in-5, first-
on-call for periods 3-7.30pm and 8-9am on weekdays, 8am-7.30pm on weekends,
and second-on-call for periods 7.30pm-8am. The Hospital-at-night (HAN) will take
over the first-on-call clinical duties 7.30pm to 8am. All laboratory and coagulation
related out-of-hours calls will bypass the HAN team and will go directly to the
Haematology doctor on call. The on-call trainee for Haematology on the previous
night will have time off in lieu the next day from 3pm.
Day Ward 11 Ward 10 Laboratory
Monday AM Registrar ward
round
Clinic – day ward Haemostasis clinic
PM Ward work Procedures
Prescriptions
BM reporting
Film Q
Tuesday AM
1245
Consultant ward
round
Morphology meeting
Day ward clinic
Morphology
meeting
BM list
Morphology
meeting
1315
1400
Teach-in session
Teach-in session
Teach-in session
HMDS sign-out
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PM Ward work
Film Q
Procedures
Prescriptions
Consultations
Bridging clinic
Wednesday AM Registrar ward
round
Day ward clinic Outpatient clinic
PM Ward work
BM list
Prescriptions
BM reporting
Thursday AM Registrar ward
rounds
Day ward clinic Outpatient clinic
PM Ward work Procedures
Prescriptions
BM reporting
Consultations
Friday 0830
AM
MDT meeting
Consultant ward
round
MDT meeting
Day ward clinic
MDT meeting
Consultations
1245
PM
Grand round
Ward work
Grand round
Prescriptions
Film Q
Grand round
BM reporting
Training Opportunities The post will provide excellent training opportunities for work-based experiential
learning in diagnostics and clinical management of haematological disorders through
clinics, Consultant-led and personal ward rounds, consultative haematology on other
wards, placements in haematology laboratory, multi-disciplinary team meetings,
participation in clinical trials as sub-investigators, supervised on-call experience,
audits and teaching of junior trainees. Trainees will be well-supported by Consultants
who will provide clinical supervision at workplace with regular assessments through
standard curriculum-approved assessment tools. Trainees are expected to complete
at least one major audit in a year.
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Although the clinical and laboratory experience offered is primarily aimed towards
practice of Haematology in district general hospital, the Unit has acquired a
reputation for academic excellence with a sound clinical and laboratory research
base, particularly in chronic lymphocytic leukaemia and myelodysplastic syndromes.
Trainees will gain excellent experience in clinical management of all haematological
cancers in adults including acute leukaemia, lymphoma, myeloma and autologous
stem cell transplantation. Diagnostic haematology training will be provided
throughout and laboratory placements will allow trainees to acquire expertise in
routine diagnostics e.g. morphology, specialist diagnostic techniques e.g.
flowcytometry, and laboratory management e.g. NEQAS. In addition, the Consultants
will provide regular teaching sessions in morphology, flowcytometry, obstetric
haematology, haemostasis and thrombosis.
Further Information Detailed information on all aspects of the Department’s activities can be obtained
from the Unit’s web page at http://www.rbch.nhs.uk/haematology
Portsmouth Hospitals NHS Trust - Queen Alexandra Hospital
Introduction 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 Western
South Downs. The current main purchasers are Hampshire PCT and Portsmouth
City PCT. It is expected that these will be replaced by 3 CCGs.
The catchment population for the Trust extends from Warsash in the West to the
Sussex border and its northern boundaries encompass Petersfield and Liss. With the
exception of the rural north, it is an essentially urban area, having grown around the
Royal Naval establishments of Gosport and Portsmouth. As well as Naval bases it
now provides a wide range of modern high-tech industry and the facilities associated
with a commercial port and cross-channel ferry terminal. Southsea and Hayling
Island are popular holiday resorts and the city of Portsmouth continues to undergo
major development along its waterfront including Gunwharf Quays, the Spinnaker
Tower and plans for a new stadium for its football club. There is easy access to the
many sailing and water sport facilities on the coast, the countryside of the new South
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Downs National Park and good transport links to the M27, Southampton airport and,
via the ferry terminal, to the Continent.
Portsmouth Hospitals NHS Trust provides a range of acute services concentrated at Queen Alexandra Hospital in Cosham. The Queen Alexandra Hospital site has undergone a major redevelopment to create a modern and 'fit for purpose' hospital, which opened in June 2009. This work was done in partnership with 'The Hospital Company', a consortium of Carillion plc and the Royal Bank of Scotland. This development includes new spacious ward facilities, a purpose built Main OP department and state of the art pathology laboratories.
The Trust is also home to the Wessex Renal and Transplant Unit and it holds prestigious Cancer Beacon Status for the Head and Neck Cancer Services. Hosting the largest Ministry of Defence Hospital Unit (MDHU) in the country, the Trust enjoys strong military connections and is proud of this association. This means that as a Trust, we have wider responsibilities than those of standard NHS organisations. Military staff now account for 3% of the total workforce and the Trust has responsibility to ensure the staff have exposure to the appropriate clinical experience required during their times of deployment throughout the world.
Portsmouth Harbour QA main entrance
General Information
Portsmouth Hospitals NHS Trust is one of the largest in England with an annual income of £400 million. It provides acute healthcare services for almost 1,000,000 people, has a regional speciality in its renal and Transplant Unit and is a designated Cancer Centre. It encompasses postgraduate teaching facilities and is involved in
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training of nurses and undergraduate doctors from the University of Southampton. The Trust is the lead body for the local Research and Development Support Unit and has close links with the University of Portsmouth and its new School of Postgraduate Medicine for both education and research.
The Trust provides most of its services at Queen Alexandra Hospital in Cosham with 1396 beds.
Haematology Services
The Haematology service is based at Queen Alexandra Hospital with peripheral clinics in Gosport War Memorial Hospital, St Mary’s Hospital Fratton, Petersfield Hospital, Fareham Community Hospital.
The Haematology Department consists of 6 Consultants, with a 0.7 wte Speciality Doctor and two Speciality Registrars from the Wessex Rotation. The post is based at Queen Alexandra Hospital.
The department works as a team, with cross-cover of ward patients, and rotation through laboratory duties, liaison patients, but individual clinic lists. At present all the consultants see the full range of haematological oncology, with the exception of lymphoma which is run as a separate clinic service jointly with oncology.
Haematology Staff
Consultants
Dr Helen Dignum Clinical Director, General and Malignant Haematology
Dr Tanya Cranfield (retiring) General and Malignant Haematology
Dr Robert Corser General and Malignant Haematology, Lymphoma
Dr Mary Ganczakowski General and Malignant Haematology, Haemoglobinopathy
Dr Hussain Hirri General Haematology, Haemophilia, Thrombosis
Dr Chris James General and Malignant Haematology, Laboratory Lead, Associate Medical Director
Other Staff
Dr Gwynn Matthias Speciality Doctor (0.7 wte)
2 Speciality Registrars from Wessex Rotation, rotating annually
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Haematology Clinical Nurse Specialist Substantive Post Vacant, 0.4 wte interim post
Lymphoma Clinical Nurse Specialist 1 wte.
0.4 wte Haemophilia Nurse Specialists, secondment from North Hampshire Hospitals
1.89 wte Anticoagulation Nurse Specialists
The size and population base of the hospital mean a busy wide-ranging clinical service. The service is Level 2B, providing the full range of adult haematology care including acute leukaemia induction and complex chemotherapy, as well as the full range of other benign and malignant haematological conditions. Bone marrow transplant referrals are sent to Southampton; the department has an excellent working relationship with the Wessex Bone Marrow Transplant Centre at Southampton which performs autologous, sibling and matched unrelated bone marrow transplants. In future, Portsmouth hopes to become a satellite centre for autologous transplants.
The regional Renal Service is based in Portsmouth giving additional exposure to myeloma patients in renal failure and plasma exchange treatment facilities for TTP. Paediatric haematological malignancy is managed at Southampton with shared care at Portsmouth by the Paediatricians. The lymphoma CNS also provides Teenage and Young Adult Cancer CNS expertise.
Inpatient Facilities
Inpatients are housed on the 45 bedded F5, F6, F7 haematology/oncology ward complex in the new PFI build. F6 has 10 hepa-filtered rooms; further cubicles are on F5 and F7. There are 12-18 haematology inpatients at any time, principally acute leukaemia treatment, myeloma, elderly haematology and non-malignant haematology. The ward consultant manages all the haematology inpatients, assisted by the ward registrar; ward consultant cover rotates every 1-4 weeks. There is a weekly ward multidisciplinary meeting, supported by microbiology and palliative care. There are seven haematology-oncology SHO doctors covering the 45 beds and day unit..
Outpatient Facilities
Clinics are held in the Haematology Oncology Centre on Level B. All consultants have two main clinics for general and malignant haematology on weekday mornings which include both new and follow-up patients. There are additional emergency/rapid review clinics on Monday and Friday lunchtimes. Specialist thrombophilia and haemophilia clinics are held weekly. There are two nurse-led anticoagulation education clinics week. Additional general haematology peripheral
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clinics are held at least once a month at other sites: St Mary’s Hospital (Portsmouth), Gosport War Memorial Hospital, Coldeast Hospital (Fareham), Petersfield Hospital.
Lymphoma clinics are run led by Dr Ann O’Callaghan, Consultant Medical Oncologist, and Dr Corser, Haematology, with Dr James, on Tuesday and Wednesday afternoons.
Day Unit The Haematology Oncology Day Unit is adjacent to Outpatients on Level B and administers intravenous chemotherapy, blood and platelet transfusions, immunoglobulin infusions iron infusions, venesections etc. Bone Marrow Biopsies are performed in the Laboratory with MLA support
Haematology Activity 2011-2012
Outpatient New 757
Outpatient Follow-up 7283
Anticoagulation New 700
Anticoagulation Follow-up 435 clinic, 100,000 Anticoag tests
Thrombophilia New 266
Thrombophilia Follow-up 141
Day Unit Activity 1313
Inpatient numbers: elective 144
Inpatients: non-elective 235
Haematology MDTs Haematology has two weekly video conferenced Cancer MDTs with its MDT partner Western Sussex Hospitals Trust, Chichester, supported by an MDT coordinator in a purpose-built MDT room. There is Leukaemia/Myeloma MDT and a Lymphoma MDT which is also attended by a specialist lymphoma histopathologist from Southampton by videoconferencing. Bone marrow transplants are arranged by referral to Wessex Bone Marrow Transplant Centre, with whom there are close working relationships.
MDT new diagnosis 2010 (Jan-Dec) April 2011- March 2012 AML 30 32
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ALL 4 4 Myeloma 52 37 CML 2 10 CLL 29 25 Lymphoma 98 132 Hodgkins 13 14 MPD 38 32 MDS 12 10
Haemophilia and Thrombophilia
The department is a District Haemophilia Centre. Dr Hirri leads the service and works with the Regional Haemophilia Network. Haemophilia Clinical Nurse Specialist and A&C are seconded from North Hampshire NHS Trust at Basingstoke. There are 51 Haemophilia A patients on the database, including 9 severe haemophiliacs. Dr Hirri runs a monthly joint paediatric haematology clinics. Dr Hirri and Dr James run a weekly thrombophilia clinic. Research The department actively participates in a number of NCRI haematology and lymphoma trials and is supported by two clinical trials practitioners and a clinical trials assistant. There is excellent administrative support from the Central South Coast Cancer Research Network.
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Blood sciences - Automated Haematology Track
Laboratory Haematology
The Blood Sciences Department is an integrated haematology and biochemistry
department in a purpose-built PFI laboratory which opened in 2008. There is a high
level of automation, with an integrated robotic track system. One of the haematology
consultants is the lead clinician for transfusion and attends the Hospital Transfusion
Committee, supported by two transfusion nurse practitioners.
Currently we have an onsite flow cytometry laboratory. Haemoglobinopathy testing provides a regional service for universal neonatal screening.
Future pathology services may be subject to change, for example a network pathology consortium is under consideration, with some redistribution of services, which could involve increased Blood Sciences at Portsmouth. Training will be given in flow cytometry interpretation, morphology.
Anticoagulation
The department operates a postal anticoagulation service for 8000 patients (2012). Community phlebotomy INRs are analysed in the laboratory and dosed on RAID software by anticoagulation specialist nurses with assistance from the medical staff.
Management Structure Haematology works across administrative boundaries:
Clinical Haematology is part of the Cancer and Surgery Clinical Service Centre. The Chief of Service is Mr Constantinos Yiangou..
Laboratory Haematology is part of Blood Sciences, Clinical Lead Dr David Sinclair, part of the Pathology Directorate, Clinical Director Dr David Cowlishaw, within the Support Services Clinical Service Centre, Chief of Service Dr Simon Ward.
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Clinic Timetable
Mon Tues Wed Thurs Fri
9am
Warfarin clinic
QA Gen Clinic QA
Gen Clinic QA
Gen Clinic QA
Warfarin clinic
QA
9am Petersfield Clinic GWMH OP clinic
9 am Once/month Gen Clinic SMH Thrombophilia
11am Acute FU clinic Haemostasis
Acute FU
clinic
2pm Lymphoma Clinic
Lymphoma
clinic
Special Clinic
alternate weeks,
Duties of the post The Specialty 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:
The day-to-day management of Haematology inpatients.
Co-ordinating the treatment of outpatients and day patients.
Management of patients with bleeding disorders.
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On Call Requirement: The Specialty Registrar will be expected to provide laboratory and ward cover on
one Weekend in 4, on Saturday and Sunday.
Current Time Table for Speciality Registrar
Speciality Registrar Ward
AM PM
Monday
Academic Meeting or
Business meeting)
Day unit review
Multi-disciplinary team meeting
Consultant ward round (teaching)
Tuesday Ward Work Lymphoma Clinic (optional – by
discussion)
Wednesday Out patients Clinic Lymphoma Clinic
Ward work / Audit
Thursday Ward Work Consultant ward round
Friday MDT meetings Day unit review
Teaching
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Speciality Registrar Laboratory
AM PM
Monday
Academic or Business Meeting
Laboratory work
Multi-disciplinary team meeting
Consultant ward round
(teaching)
Tuesday Out patient clinic (QAH) Laboratory work
Audit
Wednesday Out patient clinic (QAH)
Thrombosis clinic
Day Unit Review
Laboratory work
Thursday Out patient clinic (QAH)
Haemostasis Clinic
Audit / Bone marrow reporting
Friday MDT Meetings Laboratory work
Teaching
Education and Training
In Portsmouth the Specialty Registrar will receive an induction pack and attend Trust
induction. The Specialty Registrar will meet regularly with the educational supervisor
and the Regional Specialty Education Committee will further assess their progress.
The Specialty 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.
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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 Specialty Registrar will be encouraged to participate in research. In-patients are
entered into the NCRI leukaemia trials. Specialty Registrars are encouraged to
develop areas of personal interest where appropriate in active research projects.
Recent studies undertaken by the Specialty 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.
The Specialty Registrar must 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.
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University Hospital Southampton NHS Foundation Trust
The University City of Southampton has a long maritime history and is now a busy
container port and cruise liner terminal. It is close to the New Forest and the
Cathedral City of Winchester and the area provides excellent housing, schooling and
recreational links, particularly for sailing enthusiasts. There are excellent road links
via the M3 and M27 and a fast direct rail service to London (Waterloo). Domestic
and European air services are provided from Southampton Airport.
University Hospital Southampton NHS Foundation Trust (UHS) provides acute
healthcare services for the Southampton area (population 550,000). This covers an
area bordering on the Solent and extending to the boundary of Winchester in the
north, the Wiltshire border in the west and the River Hamble in the east. In addition,
many specialist services are provided to a much wider area extending to Chichester,
Portsmouth, Winchester, Basingstoke, Salisbury, Bournemouth and Poole,
Dorchester, the Isle of Wight and the Channel Islands. These include the defining
services of the Trust in cancer, neurosciences, respiratory, gastrointestinal, women
and children and cardiothoracic. Southampton forms one of the two teaching
hospitals in the South Central Strategic Health Authority and, as a Regional Cancer
Centre, provides comprehensive cancer services for a large population in excess of
3 million. UHS encompasses two sites, Southampton General Hospital (SGH), with
1,200 beds and Princess Anne Hospital (PAH) with 124 beds.
UHS is one of the largest NHS Trusts in the country. The University of Southampton
is one of the country’s leading research intensive higher education institutions and its
strategy is to become world class in all activities. The Faculty of Medicine has a clear
strategy to provide a research environment that will allow it to secure a long term
future as a leading biomedical research institution. Central to this are the Biomedical
Research Units (BRUs), a partnership between the National Institute of Health
Research (NIHR), University Hospital Southampton Foundation NHS Trust (UHS)
and the University of Southampton School of Medicin. Southampton is home to two
units: the Respiratory BRU and the Nutrition, Diet and Lifestyle BRU. Work is
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underway on a new 2800m² building on the Southampton General Hospital site
which, along with the Wellcome Trust Clinical Research Facility, will form a focal
point for research at the heart of the hospital, with a total area of 4000 m². This will
help to bring more research activity to Southampton and foster a centre of
excellence, bringing the best of new research ideas into clinical care. There is an
active research program in Haemato-Oncology attracting funds from the LLR and
CRUK. The department of Haematology is committed to providing a high quality
clinical service and to develop the R&D potential through collaboration with existing
successful R&D activity areas.
UHS Department of Haematology Medical Staff
5 Consultants
2 Senior Lecturers/Consultants
2 Consultant Paediatric Haematologists
Associate specialist
6 Specialty Registrars on Wessex rotation
4 SHOs – on medical rotation working partial shift system with oncology SHOs
The consultants work as a team and have individual areas of responsibility for both
clinical and managerial parts of the service in which they provide leadership. Existing
Leads are shown below.
UHS Clinical Haematology Clinical Haematology, incorporating Haemato-oncology, Transplantation, General
Haematology, Haemoglobinopathy and Haemostasis and Thrombosis services is
part of the Cancer Care Group. The Cancer Care Group is part of the Surgical and
Cancer Services Division (Division A) and is formed of the departments of Clinical
Haematology, Medical Oncology, Clinical Oncology and Palliative Care.
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All Clinical Haematology services including inpatients, all day cases, chemotherapy
and cell separator services and Haemostasis & Thrombosis Centre are located on
the UHS site. There is a well-developed clinical service for patients with myeloma,
acute and chronic leukaemias with the emphasis on a multi-disciplinary approach to
care. There are also comprehensive clinical and laboratory services in
haemoglobinopathy, coagulation and general haematology.
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.
Haemato-Oncology All in-patient and day case haemato-oncology services transferred to the SGH site in
December 2001. An intensive chemotherapy and transplant unit was created at SGH
by conversion and upgrading of existing ward accommodation (C6L). Following the
opening of the purpose built extension to C6L in 2010, there is currently a 20 bedded
acute leukaemia and transplant ward, providing level 4 care for patients with
Haematological Malignancies (BCSH Guidelines 1995). The unit provides level 2
care for acute leukaemia for neighbouring NHS Trusts. There are ongoing plans to
create an adjacent dedicated haematology day unit. Patients with haematological
malignancies not requiring intensive chemotherapy are generally admitted to other
beds within Cancer Care on wards C4 or D3.
The clinical inpatient work of the department predominantly relates to the full range
of adult leukaemia, multiple myeloma, myelodysplastic, myeloproliferative and
lymphoproliferative disorders. There are approximately 30-40 new adult acute
leukaemia and 30 new myeloma referrals per annum per annum – the reference
base is growing rapidly. The clinical workload is supported by Clinical Nurse
Specialists in Myeloma and Leukaemia.
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All outpatient haemato-oncology services transferred to the SGH site in March 2010.
There is a core of oncology trained nursing staff, specialist cytotoxic pharmacy
services with a centralised intravenous additive service and nurse/counselling
support.
The Wessex Blood and Marrow Transplant Service The Wessex Blood and Marrow Transplant Unit based on C6L has been providing
an allogeneic transplant programme to a large geographical area encompassing the
Central South Coast Cancer Network and Dorset since 2001 to supplement the
existing autologous transplant service established in 1989. The Transplant
Programme received JACIE accreditation in December 2008. The program performs
approximately 50 autologous transplants per annum, mainly for patients with
myeloma or lymphoma (in conjunction with Medical Oncology) for patients from
Southampton and surrounding hospitals. The unit provides an allogeneic
transplantation service for the Central South Coast Region with approximately 40-45
allogeneic transplants per year, including unrelated donor transplants. There is
active collaboration with other haematologists within the region and a thriving clinical
network specifically relating to transplantation. The unit delivers outcomes that are
some of the best in the UK. The stem cell collection facilities are accredited with the
Human Tissue Authority (HTA).
The Transplant Program is supported by a Clinical Nurse Specialist, two WTE
Transplant Co-ordinators and a Quality Manager. A Transplant Data Manager is due
to be appointed shortly.
There is an integral Apheresis service with a lead Apheresis nurse with the support
of additional trained nurse operators. This busy unit performs over 250 procedures
per year providing peripheral blood stem cell harvesting, plasma exchange,
therapeutic leucopheresis and red cell exchange procedures. The Apheresis service
received a license from the Human Tissue Authority in September 2008. The
Wessex Blood and Marrow Transplantation Service works closely with the NHSBT
Steve Mills Laboratory which provides stem cell processing and storage services on
site. The NHSBT laboratory has MHRA and HTA licenses and JACIE accreditation.
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Haemostasis & Thrombosis Centre University Hospitals Southampton NHS Foundation Trust is a Haemophilia
Comprehensive Care Centre. It mainly serves patients from Hampshire and the
Channel Islands although patients from further afield are also registered. At present
there are more than 420 congenital bleeding disorder patients including 50 patients
with a severe bleeding disorder. A fully comprehensive service from initial diagnosis
to the subsequent care in the hospital and community is provided. The Haemostasis
& Thrombosis team includes two adult and two paediatric haematologist. The
Centre provides diagnostic services for thrombophilia, and follow-up anticoagulation
service for outpatients who are not managed in the community. There is also a joint
haematology/obstetric clinic for the management of high-risk bleeding or thrombotic
pregnancies, every two weeks. The Centre is actively involved in national and
international trials and has research collaboration with the University.
Haemoglobinopathy Southampton has a growing Asian and Afro-Caribbean population with
approximately 70 to 80 patients with haemoglobinopathy using the service. There is
a regular haemoglobinopathy clinic, a dedicated haemoglobinopathy laboratory
service including antenatal screening and plans to further develop the adult
haemoglobinopathy service including transitional care from paediatrics. At present,
patients with haemoglobin disorders requiring inpatient admission are managed on
the medical wards by the medical teams with regular input from the haematology
team.
Paediatric Haematology There is a regional paediatric oncology/haematology service at University Hospital
Southampton which covers the Wessex region. The service is responsible for the
diagnosis and treatment of children with acute leukaemia, bone marrow failure
syndromes, haemoglobinopathies, bleeding disorders and non-malignant
haematological disorders. The paediatric haematologists provide a consultative
service for the regional PICU, NICU, paediatric cardiology and child health
departments as well as the 10 district hospitals. The department performs high dose
chemotherapy with stem cell rescue; allogeneic transplants are referred to Bristol
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Children’s Hospital but the immediate aftercare is undertaken at Southampton.
Haemoglobinopathy cases have increased significantly, with a specialised clinic
being held for paediatric patients. The paediatric haematologist participates in a 1 in
4 rota with the paediatric oncologists, so the Consultant Haematologist on call may
need to advise on non-oncological paediatric patients, with the support of the on call
Haematology SpR. The haematology SpR is attached to the department for 3
months.
Outpatient and Day Care Facilities Outpatient facilities for Haematology are based at SGH, predominantly in the
purpose built Oncology Outpatients Department that opened in March 2010. There
are 2 large combined haematology clinics per week run jointly by the Consultant
Haematologists, one for general haematological disorders and one for haemato-
oncology. In addition, there are specialist clinics in transplantation, myeloma,
haemostasis, thrombophila and haemoglobin disorders. A clinic for women with high-
risk pregnancies is held jointly with the Department of Obstetrics and Gynaecology at
PAH. There is also a weekly general haematology clinic at Lymington New Forest
Hospital. Overall, there are approximately 660 new referrals and 5300 follow-up
patients seen in the haematology out-patient clinics per annum.
A new day unit was opened in 2003 providing chemotherapy, apheresis, minor
procedures such as bone marrow biopsies and intrathecal chemotherapy and patient
follow-up. Clinical Haematology currently has access to beds utilised for patients
requiring low dependency care in addition to a number of chairs. Each working day,
approximately 15 to 25 haematology patients attend the day care facility. The cell
separator unit is also centred at SGH, directed by the Haematology department and
is currently an integral part of the day care facility. It is planned to transfer all
haematology day cases, including apheresis services, to a dedicated unit adjacent to
the current in-patient leukaemia and transplant ward at SGH.
UHS Laboratory Services Laboratory Haematology is part of the Radiology and Pathology Care Group within
Division B, alongside the Emergency Medicine, Specialist Medicine and
Ophthalmology Care Groups.
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Haematology laboratory facilities are provided at SGH. The laboratory has full CPA
accreditation and HPC approval for the training of BMS staff. The laboratory has
been equipped with the latest instrumentation and has the CliniSys Labcentre
laboratory computer system. There is a high degree of automation and recent
benchmarking shows its workload and efficiency to be in the upper quartile in the
teaching hospital peer group. The services provided are excellent.
Laboratory Haematology The laboratory houses a comprehensive, modern diagnostic facility. Specialised
haemostasis investigation and haemolytic anaemia investigation are available.
Immunophenotyping and molecular studies are performed at SGH. SGH possesses
2 Futura analysers, 2 TEGS, platelet aggregometer and PFA100. In 2009, the
laboratory processed 590,000 automated haematology tests, 390,000 haemostasis
and special haematology tests and 66,000 blood transfusion requests. 32% of
haematology laboratory tests originate from general practice.
Laboratory Haematology is organised in to two sections, Blood Transfusion and
Haematology & Coagulation.
Staff Whole Time Equivalents
Senior Manager / BMS 4 band 8c 1.5
BMS 3 band 8 2
BMS 2 band 7 16.66
BMS 1 band 6 6.53
Trainee BMS band 5 1
MLA band 2 5
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Diagnostic bone marrow services are carried out at UHS. The department of cellular
pathology processes trephine biopsies which are then returned to Haematology for
reporting or reported in conjunction with the cellular pathologists. Regular regional
multidisciplinary diagnostic team meetings are held; Thursday mornings for
Paediatric reviews and Friday mornings for Adult Haematology. UHS also hosts the
Central South Coast Cancer Network (Western) MDT meeting for Leukaemia and
Myeloma.
Molecular Pathology and Immunophenotyping In addition to the routine haematology laboratory services there is a specialised
molecular pathology laboratory under the supervision of a Consultant Clinical
Scientist. The laboratory provides essential diagnostic and molecular monitoring
assays including chimerism, BCR-ABL quantification by PCR, minimum residual
disease analysis, B and T cell clonality. The immunophenotyping labaoratory,
managed by the Immunology Department, provides a full repertoire of diagnostic and
MRD immunophenotyping for haematological malignancies. Cases are jointly
reviewed at the diagnostic MDTs.
The Wessex Regional Genetics Laboratory (WRGL) is located at Salisbury District
Hospital. There is a close working relationship between WRGL and the Haematology
Consultants at UHS with regular clinical meetings. There are plans to fully integrate
reporting of haematological oncology specimens with the aim of developing IOG
compliant integrated haemato-pathology reporting.
Steve Mills Stem Cell Laboratory
Bone marrow processing, culture and preservation facilities are located at the
Southampton National Blood Service Facility on the SGH site in the Steve Mills
Transplant Laboratory.
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Current Departmental Research Activity
Recruitment and participation in NCRN AML, ALL, Myeloma and CML trials.
Participation in high quality drug evaluation studies to GCP standards
Targeted radiotherapy as part of conditioning for stem cell transplantation
Clofarabine pre-conditioning in allogeneic transplantation for high risk AML
Development of quality of life as a clinical endpoint in myeloma and chronic lymphocytic leukaemia.
Molecular methods for the evaluation of minimal residual disease in stem cell harvest material and in patients following stem cell transplantation.
Evaluation of molecular methods for monitoring patients following stem cell transplantation
Immune reconstitution post allogeneic SCT
Analysis of tumour related immunoglobulin genes in paraproteinaemias.
Clinical pilot studies in administration of patient specific DNA vaccines in patients with myeloma.
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Role of the Speciality Registrar
Clinical Duties
The Speciality 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 Duties Laboratory work reporting of blood films, bone marrows, other haematological tests.
Training in immunohaematology is an integral part of this. The post holder will be
required to participate in medical audit. Undergraduate medical students from
Southampton University Medical School are taught throughout the Trust and the post
holder is required to participate in formal and informal undergraduate clinical
teaching but will not be responsible for curriculum organisation development.
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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 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. 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.
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PATHOLOGY STAFF:
General Manager
Head Biomedical Scientist
Haematology:
3 X Consultant Haematologist
Speciality Registrar
Staff Grade (Haematology)
S.H.O.
Chemical Pathology:
Consultant Chemical Pathologist
Consultant Grade Biochemist
Microbiology:
3 X Consultant Microbiologist
Histopathology/Cytology:
4 x Consultant Histo/Cytopathologist
HAEMATOLOGY DEPARTMENT Nursing Staff - Day Chemotherapy Unit:
1 G Grade Sister
1 F Grade SRN
3 Grade E-F Chemotherapy Nurses
Inpatient Nursing with a Ward Sister (Grade G) and 9 Grade D-F Nurses are shared with other medical teams using Ilchester B ward
Laboratory Staff:
1 x BMS4
5 x BMS2 (+ funding for Hospital Transfusion Practitioner)
15 x BMS1
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4 x Trainee BMS (rotating)
Clinical Haematology
The 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.
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Haematology Outpatients Eight 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 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 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
Research The 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.
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The Role Of The Speciality Registrar This 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 Speciality 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 Speciality Registrar and will always
be available for consultation. The Speciality Registrar will have laboratory sessions
for training and for providing a service to other departments in the hospital. The three
consultants, the associate Speciality and the staff grade are all responsible for the
laboratory for one day in the week, and each will work closely with the Speciality
Registrar.
Example Timetable – Speciality 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 Development Time 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,
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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-Call One Saturday every 4 weeks
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Hampshire Hospitals NHS Foundation Trust
Hampshire Hospitals NHS Foundation Trust came into being in January 2012 as a
result of the integration of Basingstoke and North Hampshire NHS Foundation Trust,
which achieved Foundation Trust status in 2006, and Winchester and Eastleigh
Healthcare Trust. Hampshire Hospitals NHS Foundation Trust serves a population of
approximately 600,000 across North and mid-Hampshire and parts of west
Berkshire. The population is predominantly centred around Basingstoke, Winchester,
Eastleigh and Andover as well as the surrounding towns and villages across
Hampshire and parts of west Berkshire including Tadley to the north; Alton and
Bordon to the east; Romsey and Chandlers Ford to the south, Stockbridge, Bishops
Waltham and Alresford. It is a fundamental principle of the new combined Trust that
it will provide fully integrated clinical services across the two acute hospitals in
Basingstoke and Winchester, with the provision of outpatient services within
community hospitals at Andover and Alton and the future development of services
within primary care.
Clinical Haematology is managed within Cancer Services, which includes clinical and
medical oncology, clinical haematology and palliative care. These services are
currently provided at both BNHH and RHCH sites. At the BNHH site it is within the
Basing Unit (Outpatients and Day Unit) and Wessex Ward (inpatients) and at the
RHCH site it is provided on the Nick Jonas Ward (Outpatients and Day Unit).
Palliative care is also provided at St Michael’s Hospice, which is on the BNHH site.
Currently radiotherapy provision is from Southampton University Hospital. Plans for
an Associate Cancer Centre with radiotherapy provision are at an advanced stage.
Clinical Haematology Medical Staff
6 Consultants
1 Associate Specialist
1 Speciality Registrar (one year rotation)
1 CT1/2 / GP trainee on 4 monthly medical rotation
1 FY1 on 2 monthly medical rotation
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Nursing Staff
1 Clinical Service Manager Cancer Services
1 Haematology Nurse Practitioner
2 Haematology CNS
1 part time Haematology Research nurse
1 part time Clinical Trials Administrator
2 Ward Sisters
2 Transfusion Practitioners
Team of chemotherapy trained nurses
The Elizabeth Hall Centre in BNHH consists of a purpose built in-patient unit
(Wessex Ward) and day care unit (Basing Unit). The Wessex ward is an 11bed ward
providing isolation rooms with positive pressure ventilation and HEPA filtration and
en-suite facilities for patients receiving intensive chemotherapy. The Basing Unit is
used for outpatient clinics, chemotherapy, venesections, bone marrow biopsies,
intrathecal chemotherapy, line insertions and all supportive care.
The Nick Jonas ward at RHCH provides outpatient clinics, day case chemotherapy
and supportive care as well as bone marrow biopsies and venesections. It is
envisaged that all these services will be provided within an Associate Cancer Centre
once it is built.
Services for malignant haematology are provided to BCSH level 2b. Referrals for
autologous and allogeneic stem cell transplant are predominantly to the regional
stem cell transplant centre in University Hospital Southampton and occasionally to
other transplant centres.
Clinical Activity
No. of New Cases 2010/2011*
CML 8
CLL 56
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NHL (low grade) 66
NHL (high grade) 74
Hodgkin Lymphoma 6
Myeloma 40
MDS/MPD 108
AML/ALL 20
TOTAL 378
*based on MDT registration for BNHH and RHCH
sites
All cases of haematological malignancy are reviewed and discussed locally with
regular bone marrow, radiology and histology meetings. Regionally the unit lies
within the Central South Coast Cancer Network (CSCCN). Network MDT
management meetings are run twice weekly by video-conference with network leads
in Southampton. There is a weekly MDT ward round with participation from the
nursing staff, haematology CNS, oncology pharmacist, consultant microbiologist,
oncology dietician, and palliative care and haematology doctors. BNHH is also a
designated site for treatment of Teenage and Young Adult patients (TYA). The
conditions treated include acute and chronic leukaemia, lymphoma (including
primary CNS lymphoma, Burkitt’s Lymphoma and relapsed lymphoma), myeloma,
myelodysplasia, myeloproliferative disorders and non-malignant haematological
disorders. There is a strong commitment to clinical trials with participation in many
NCRI trials. The current clinical trials portfolio (active recruitment and follow up)
within the trust include: AML17, AML16, LI-1, AML HR, AML 15, UKALL14, Myeloma
X, SPIRIT 2, SPIRIT 1, PT1, InCiTe, , RIAltO, REMODL-B, PACIFICO, RATHL,
RENEW, Symphony, Familial CLL Study, NSHLG, EBV-NK/T, WM1.
Haemophilia, Haemostasis and Thrombosis Centre There is a specialist Haemophilia, Haemostasis and Thrombosis Centre within the
BNHH site that is purpose-designed and separate from the hospital with good
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flexible clinical facilities and dedicated parking. The multidisciplinary team provides
comprehensive care for patients with congenital and acquired bleeding disorders. It
is also the site for the thrombophilia and anticoagulant clinics.
Laboratory Haematology Currently there are fully CPA accredited laboratories offering a full range of services
on both the BNHH and RHCH sites. These services include routine haematology
(FBC and ESR automation, blood film, blood parasitology, haemoglobinopathy, bone
marrow aspirate processing and reporting), blood transfusion and routine
coagulation. There are also specialist services available on the BNHH site including
specialist haemostasis and thrombosis and immunophenotyping.
The blood transfusion service provides full genotyping where required and complies
with MHRA. It is well represented in the Trust’s transfusion committee and laboratory
management meetings. Clinical haematology input is provided for the issue of blood
products to enable appropriate use of these products. The laboratory out of hours
service provides 24hr cover for both the laboratories enabling provision of all tests
required for the immediate clinical management of patients. Specialist or batched
tests are completed in normal working hours. There are well developed referral
pathways for complex investigations not provided locally.
Equipment The BNHH site currently has two ADVIA 2120i analysers with slide makers, two
Destiny Max, two Biorad variant II, Flex 900 post analytical sorter, Vitech ESR, two
Diamed gel station, PFA100, PAP8, blood coagulometer, Sebux Hydrasis. The
RHCH site has one Sysmex track, two Sysmex FBC analysers and one slide maker,
two Diamed gel stations, two Menarine 8160, two ESR analysers, plasma
viscometer.
Work load and staffing
Annual Workload (2010/2011) BNHH and RHCH sites
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FBC 382,166
Films 35,120
ESR 93,359
Bone Marrows 618
Coagulation Screens 62,071
Factor Assays 1,069
-Lupus 797
-Antithrombin 466
-Protein C 468
-Protein S 470
-P mutation 369
-FVL 369
Blood Transfusion requests 37,939
Units of blood crossmatched 12,254
Staffing (WTE) BNHH and RHCH sites
BMS Band 8 4.5 BMS Band 4 3
BMS Band 7 7 BMS Band 3 1.5
BMS Band 6 20.2 MLA 5
BMS Band 5 3
The laboratory has full CPA accreditation and MHRA approval for blood transfusion
and participates in all relevant NEQAS EQA schemes. The laboratory is recognised
by the College and Council for Professions Supplementary to Medicine (CPSM) for
training.
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Role of the Speciality Registrar This post provides an excellent training in clinical and laboratory haematology. The
post holder will be based in Basingstoke and North Hampshire Hospital. The
Speciality Registrar will gain the wide experience in the treatment of haematological
malignancies, the 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.
At least one of the consultants will always be available for advice. The Speciality
Registrar will be responsible for day-to-day management of haematology inpatients
and day patients, reviewing ward referrals and responding to clinical and laboratory
enquiries. The Speciality Registrar will attend the multidisciplinary meetings and
outpatient clinics. The Speciality Registrar will participate in teaching of medical,
nursing and laboratory staff. There are regular haematology and medical journal
clubs and grand round case presentations.
On call: 1:4 weekends with Consultant cover
Management Speciality Registrar will further develop an understanding of the key management
areas, including the management structure of an NHS Foundation Trust, clinical
governance, risk management, CPA and MHRA accreditation, internal and external
quality assurance including NEQAS schemes.
Audit Speciality Registrar will undertake at least one audit annually.
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Salisbury NHS Foundation Trust
Medical Staff
3 Consultants
1 Speciality Registrars (one year rotation)
1 FY2 doctor (4-monthly medical rotations)
Nursing Staff
1 Haematology CNS
1 TP
2 Anti-Coagulation Nurses
1 Chemotherapy Nurse Practitioner (currently Oncology only)
Scientific Staff
BMS3 HAEMATOLOGY
1 BMS 3 BLOOD TRANSFUSION
BMS 2 HAEMATOLOGY
1 BMS 2 BLOOD TRANSFUSION
9.5 WTE BMS1 + TRAINEE
6 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
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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 a consultant 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 Diagnostic Centre in Southampton. Medical Microbiology service is on
site.
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Up to thirteen outpatient clinics 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 Speciality Registrars,
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.
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Staffing – Clinical Haematology/Oncology
3 x Consultant Haematologists
2 x Consultant Medical Oncologists
1 x Consultant Clinical Oncologist
2 x Joint Lead Cancer Nurses
Haematology Nurse Specialist
Sister, Pembroke Ward
Sister, Pembroke Suite
Chemotherapy Nurse Practitioner
F2, 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.
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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 Speciality 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
Speciality Registrar is in post and therefore gains experience in all aspects of clinical
and laboratory activity. The Speciality Registrar 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, outpatient (Pembroke Suite) and laboratory roles. At least one of the
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consultants is always be available for consultation. The Speciality 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 Speciality
Registrar is expected to present cases at the fortnightly joint Haematology /
Radiology meeting and the monthly Histopathology meeting. The Speciality Registrar
is also expected to present at the Grand Round.
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Poole Hospital Acute NHS Trust
Department of Haematology
Medical Staff: 3 Consultant Haematologists – Dr Fergus Jack, Dr Rebecca Madden, Dr Darshyani Furby Dedicated SHO 1 Specialist Registrar Haematology Laboratory Staff: 1 Haematology Laboratory Manager 2 BMS Grade 3 4 BMS Grade 2 13 BMS Grade 1 2 Trainee BMS 8 MLA 28 Phlebotomists (Most part time) 2 Secretaries Nurse Specialists: 2 Anticoagulation 1 Clinical Haematology Nurse Specialist 0.5 Research nurse Department Statistics: Clinical Haematology (2007-8) Inpatients 560 Outpatients 4800 (1st visit = 580) Day Unit 2600
Laboratory Services
The haematology laboratory provides all the usual routine and specialist diagnostic tests including flow cytometry, specialist haemostasis and thrombosis
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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 Services
Clinical 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 provides a comprehensive service for haematological disorders including acute and chronic leukaemia, lymphoma and myeloma. Poole is consistently one of the busiest District
Wessex Deanery
Wessex Deanery is part of the South Central Strategic Health Authority and provides postgraduate medical and dental education for Hampshire, Isle of Wight, and the States of Jersey, and for Dorset and South Wiltshire on behalf of the South West Strategic Health Authority
General Hospitals for autologous stem cell and marrow transplants in the UK. Allogeneic transplants are referred externally. There is also a busy day case facility for the outpatient treatment of patients with haematological and oncological
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disorders. Specialist nurses are fully trained in venepuncture, chemotherapy administration, venesection 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 Specialist Registrars. 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.
Outpatients
There 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 Specialist Registrar to attend any of these clinics. Anticoagulant dosing is performed by 3 dedicated staff using Dawn 4S software.
Role of the Specialist Registrar
The role of the Specialist Registrar 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 ascetic 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.
Management
The post holder will be managerially responsible to the Specialty Clinician for Pathology.
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Timetable
The proposed timetable for the Specialist Registrar is:
AM PM
Monday Laboratory / ward work Histology MDM
Lab / ward work/FJ/RM ward round
Tuesday General Haematology Clinic
AJB Ward Round
Wednesday Haemato-oncology clinic
Admin / CPD
Thursday General haematology clinic. Grand round.
Laboratory / ward work
Friday Haemato-oncology multidisciplinary meeting Consultant Ward Round Oncology educational session
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.
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
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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 UK
5. 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
The working hours for junior doctors in training are now 48-hours averaged over 26
weeks (six months). Doctors in training also have an individual right to opt-out if they
choose to do so, but they cannot opt-out of rest break or leave requirements.
However, the contracts for doctors in training make clear that overall hours must not
exceed 56 hours in a week (New Deal Contract requirements) across all their
employments and any locum work they do.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/EWT
D/Pages/EWTD.aspx
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
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viewed at
http://www.nhsemployers.org/PayAndContracts/Pay%20circulars/Pages/PayCircular
sMedicalandDental.aspx
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/ . The pay supplement is not reckonable for
NHS pension purposes. The pay supplement will be determined by the employer and
should be made clear in their offer of employment and subject to monitoring.
Pension
You will be entitled to join or continue as a member of the NHS Pension Scheme,
subject to its terms and rules, which may be amended from time to time.
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/PayAndContracts/MedicalandDentalContracts/JuniorD
octorsDentistsGPReg/Pages/DoctorsInTraining-
JuniorDoctorsTermsAndConditions150908.aspx
Sick pay
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Entitlements are outlined in paragraphs 225-240 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/PayAndContracts/MedicalandDentalContracts/JuniorD
octorsDentistsGPReg/Pages/DoctorsInTraining-
JuniorDoctorsTermsAndConditions150908.aspx
You are advised to check eligibility and confirm any entitlement with the employer
before incurring any expenditure. In addition to local policy there is Deanery
guidance which can be viewed on www.wessexdeanery.nhs.uk
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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/RecruitmentAndRetention/Employment-
checks/Pages/Employment-checks.aspx
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.
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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.wessexdeanery.nhs.uk and in the national ‘Gold guide’ to
Specialty Training at
http://www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspx