isle of wight healthcare nhs trust.doc.doc

Programme Description

SPECIALTY TRAINING PROGRAMME IN [SPECIALTY] PROGRAMME IN WESSEX DEANERY

This is a 7 month LAT in Cardiology at ST3 aimed at doctors who can demonstrate the essential competencies to enter this level of training.

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

HOSPITAL LOCATIONNorth Hampshire Hospital BasingstokeThe Royal Bournemouth Hospital BournemouthSt Richards Hospital Chichester Dorset County Hospital DorsetSt Mary’s Hospital Isle of WightJersey General Hospital St Helier, Jersey Poole Hospital PooleQueen Alexandra Hospital PortsmouthSt Mary’s Hospital PortsmouthSalisbury District Hospital Salisbury Southampton General Hospital SouthamptonRoyal Hampshire County Hospital Winchester

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

Programme Description/kbrown/Sept08


Health Authority. The Wessex Deanery is responsible for the training of some 2,500 trainees.

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. Training will be given in all aspects of non-invasive cardiac testing available on site.

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

Trust Generic/Specialty Information – please insert relevant information

Isle of Wight Healthcare NHS Trust

Organisational

The Cardiology Departments at Portsmouth and the Isle of Wight have developed formal links. This supports the development of a single department spanning different sites working to agreed protocols and standards across all areas including inpatient care. By the end of 2005 virtually all cardiac services except surgery should be provided for Island patients in either Newport or Portsmouth. Both sites will be integrated into the Central South Coast Cardiac Network, which includes Southampton. Once the current expansion in Southampton is complete, this centre will provide cardiac surgical services to patients within the Network.

A full non-invasive diagnostic service is run in Newport. Patients requiring coronary angiography have this performed in a new Catheter Laboratory at Queen Alexandra Hospital, Portsmouth. Percutaneous coronary intervention should be established in Portsmouth during 2005. Permanent pacing is currently undertaken at Southampton, although planning is underway to repatriate this service to the Isle of Wight.

The Island based service has recently been improved through the development of one-stop clinics; rapid access chest pain clinics and the establishment of trans-oesophageal echocardiography.

Patients requiring cardiac surgery are currently referred to the Royal Sussex County Hospital in Brighton. There are further close links with cardiac surgeons at Southampton and the Royal Brompton.

Medical Staffing

3 Consultant Cardiologists

1 Staff Grade for Cardiology

1 Specialist Registrar Cardiology and GIM

General Information

Cardiology is one of 8 sub-specialties within the Care Group.



A new Cardiac Centre is currently being built on site and is due to open in early 2005. The CCU in the new building will be ‘state-of-the-art’ with an adjacent pacing room and step-down ward.

The Cardiology Department has an establishment of:

1.00 MTO5 (currently as job share) Cardiac Technician

2.54 MTO 3/2 Cardiac Technicians

0.95 Grade A Health Care Assistant

The new department has been designed to allow integration of senior doctors’ office space with the secretariat, consulting rooms, and the clinical areas. The Coronary Care Unit and step-down ward is adjacent.

Out-Patients

The Specialist Registrar will attend a mix of general medicine and cardiology clinics weekly and also the chest pain clinic weekly. In the main out-patient clinics there will be an opportunity to see a mix of new and follow-up patients. In the chest pain clinic the post-holder will see and assess new patients with recent onset chest pain.

In-Patients

The Specialist Registrar will be responsible for the day to day running of general medical and cardiology in-patients under the supervision of the Consultant Cardiologists. The Specialist Registrar will take a lead role in the management of patients on the CCU. The post-holder will be expected to advise medical Senior House Officers and House Officers, and to provide an acute medical opinion for other specialties on request. During on-call periods the Specialist Registrar will be in charge of the resident on-call medical team. When “on take” adult patients of all ages will be accepted for admission.

Training

Training will be given in all aspects of non-invasive cardiac testing available on site. Training will be given in various invasive procedures such as pericardiocentesis and temporary pacing. There will be some exposure to cardiac catheterisation, and permanent pacemaker implantation.



General

The post-holder will be responsible for reporting of a proportion of non-invasive tests, and for dictation of departmental discharge summaries. The Specialist Registrar will participate in clinical audit. The post-holder will also participate in the teaching of medical and nursing staff and arrange clinical meetings and clinical ward rounds for medical staff and students. Opportunities are available for research, which is encouraged by the senior medical staff.

Timetable

AM PM

Monday CCU/step-down round Gen Med/Cardiac Clinic

Tuesday Echo/cardiac caths Research

Wednesday Academic session Admin

Thursday Ward work Chest Pain clinic

Friday CCU/step-down round TOE/Echo/admin

Study and Research

The medical unit academic activities are well supported by junior doctors as well as consultants. Wednesday morning each week is a full academic session. The successful candidate will be expected to play his/her part in the postgraduate activities, teaching and clinical audit. Undergraduate teaching is provided for fifth (final) year students from the Southampton Medical School. Regular weekly tutorials are presented by the SHOs with SpR and consultant support. The medical unit is a Membership Examination Centre and three of the consultants locally are examiners. There is a very high pass rate for MRCP by senior house officers.

Facilities

There is an office for the Specialist Registrars in medicine with computer access.

Contact

Candidates are welcome to contact Dr M Connaughton or Dr D Price on 01983 534114.



North Hampshire Hospitals NHS Trust

Medical Directorate

Consultant Staff2 Cardiology2.8 Gastroenterology2 Respiratory Diseases2 Diabetes/Endocrinology2 Rheumatology2 Care of the Elderly1 Neurology1 Stroke Physician

Other Medical Staff3 Cardiology SpRs2 Respiratory SpRs1 Endocrinology SpR1 Gastroenterology SpR1 GIM & Rheumatology SpR2 Acute Medicine SpRs9 Senior House Officers3 FY210FY1

Directorate Accommodation and Facilities

The Directorate occupies two floors of the main North Hampshire Hospital building. There are four acute medical wards, two wards for care of the elderly and a nine-bedded CCU. There are also self-contained units for stroke rehabilitation, day assessment and medical admission assessment. Heart and lung function testing is also located within these floors and there is a seminar room for staff education and training. There is a dedicated catheter laboratory where primary and elective angioplasty, day case catheterisation and pacemaker insertion takes place on a daily basis. In addition to General Medicine, there are Consultants in Dermatology, Clinical Haematology, Genito-Urinary Medicine and visiting Consultants in Oncology, Neurology and Nephrology.

Clinical Duties

This post is approved by the Wessex Cardiology ASEC and the Postgraduate Dean. It forms part of the Wessex Cardiology training rotation. The post is recognised for Specialist Registrar training in Cardiology and General Internal Medicine. The post-holder will divide their time between general medicine and specialist cardiology duties. The successful applicant will be appointed to a training programme within the regional training scheme or to a locum with accreditation for training post.



Training

Specialist Registrars will receive training in cardiac catheterisation and permanent pacing. There will also be the opportunity to insert intra-aortic balloon pumps and perform preicardiocentesis.Training will also be given in all aspects of non-invasive cardiology available on-site. This includes both transthoracic and transoesophageal echocardiography.There are close cardiac surgical links with the Royal Brompton Hospital and the SpRs will benefit from exposure to the joint clinics run on a monthly basis.

Out-Patients

The Specialist Registrar will attend two general medicine/cardiology clinics weekly and also a chest pain clinic weekly. In the main out-patient clinic there will be an opportunity to see a mix of new and follow-up patients. In the chest pain clinic the post-holder will see and assess new patients with recent onset chest pain. There will also be the opportunity to attend the specialist hypertension and heart failure clinics as well as to gain experience at the nationally renowned cardiac rehabilitation centre at Alton.

In-Patients

The Specialist Registrar will be responsible for the day to day running of general medical and cardiology in-patients under the supervision of the Consultant Cardiologists. The Specialist Registrar will take a lead role in the management of patients on the CCU and will act as the co-ordinator to referrals for invasive cardiac investigations and treatment. The post-holder will be expected to supervise the work of the Senior House Officers and House Officers, and to provide an acute medical opinion for other Directorates. During on-call periods the Specialist Registrar will be in charge of the integrated on-call medical team.

The Cardiology Team

2 Consultants3 Specialist Registrars2 Senior House Officers2 FY1

Visits

Visits to the Department are welcomed and can be arranged by contacting

The Postgraduate & Medical Personnel ManagerTel: 01256 314792

Dr A BishopTel: 01256 313633 or

Dr C BrookesTel: 01256 314713



Poole Hospital NHS Trust

The Work of the Department

There are approximately 120 beds including those for infectious diseases, coronary care and intensive care. There are eight physicians, each of whom has a different special interest. All junior staff attend the diabetic clinics and retinopathy clinic providing experience in the management of both in and outpatient diabetes. There are facilities for exercise testing, echocardiocardiography and isotope studies. The Specialist Registrar is thus trained in all aspects of the non-invasive assessment of cardiac patients. Each firm also deals with general medical patients taking acute medical emergencies.

Staff

8 Consultants

1 Specialist Registrar

4 SHOs

7 House Officers

Clinical Duties

General management of the inpatients under the guidance of the Consultant. Outpatient duties 2 sessions per week.

Weekly Programme

8.30 am daily – Coronary Care Ward Round

AM PM

Monday Ward round Myoview meetingClinic

Tuesday Clinic Ward/Admin

Wednesday CCU WIR DLBCardiac Catheter List (Bournemouth)

Echo List

Thursday Pacing (Bournemouth) MeetingWard/Admin

Friday - Ward/Admin



On top of this basic programme time has to be found for:

(a) Dictation of discharge summaries – 3 to 4 hours weekly

(b) Preparation of clinical meetings (approximately 1 week in 7)

(c) Preparation for and giving tutorials to House Physicians and nurses (variable)

(d) Research projects and writing papers

Teaching

Teaching of junior staff and occasional lectures to nurses. Regular teaching rounds in rotation.

Other Responsibilities/Opportunities

(a) Training in permanent cardiac pacing and cardiac catheterisation

(b) Supervision of exercise myoview scans

(c) Supervision of cardiac rehabilitation (maximum 1 hour per week).

In case of prolonged absence, external or internal ‘locum’ cover will be contracted where possible.

Cardiac Unit and Facilities

An 8-bedded and monitors Coronary Care Unit (CCU) consists of 4 acute beds and 4 progressive care beds (new unit opening shortly). It is closely linked (in staffing and geographically) to the 6-bedded Intensive Care Unit. Between the two units is a large pacing/procedures room, fully monitored and radiologically protected. Typical procedures performed here include temporary transvenous pacing (single and dual chamber), elective cardioversion, pericardial aspiration and right heart catheterisation, including Swan-Ganz catheter placement, where it is preferred not to undertake this at the bedside.

The CCU receives > 1300 patients per year. Audit in 1995 revealed a 33% acute myocardial infarct rate. There is no age-related admission policy. Audit of case workload in 1995 revealed diagnoses of acute myocardial infarction, unstable angina, undiagnosed chest pain, acute cardiovascular failure, tricyclic drug overdose, massive pulmonary embolism, cardiac arrhythmias including heart block, cardiac tamponade, infective endocarditis and acute aortic dissection. Junior staff are encouraged to use this unit as a “cardiac care unit” and not just a coronary care unit. The Cardiac Department itself has recently moved into the Philip Arnold Unit and comprises an exercise bicycle/treadmill suite, ECG, 24-



hour ECG analysis room, respiratory function laboratory and echocardiograph laboratory. Outpatient facilities include an ECG and spirometry investigation room.

Cardiac Investigation

The department performs 11,000 ECGs a year (plus approximately 2,000 a year performed on CCU by nursing staff), 2,500 exercise tests, 3,600 echocardiograms, 3,600 24-hour electrocardiograms. In conjunction with the Medical Physics Department 190 tetrofosmin exercise and adenosine stress SPECT scans are performed.

Echocardiography

One HP Sonas 2500 machine

One Accuson Cypress machine

4 trained echo technicians

Junior medical staff who specifically wish to train in cardiology attend the Hewlett Packard echo course. If study leave awards are not made then cardiac endowment funds are used to fund the courses necessary.

Stress Testing

Routine testing is performed on a Marquette Case 2 treadmill and computer-augmented cardiograph. A Bosch isokinetic bicycle is also available for pre and post cardiac rehabilitation assessments.

24-hour ECG Analysis

The Department has 12 Reynolds Tracker recorders and a Reynolds 700 analysis system. Three cardiomemo recorders are also used for recording inpatients with very intermittent symptoms.

Myoview Single Photon Emission Computed Tomography (SPECT)

The Department generally performs four of these per week using a Mitsubishi computer controlled gamma camera in the Medical Physics Department. Images are interpreted jointly by the Consultant Cardiologists and Radiologist, and Medical Physicist.

Other Specialist Equipment

1. Oesophageal recording, pacing and electrophysiological assessment is performed using the Arzco oesophageal pill electrode system and dedicated pacemaker. The technique has proved useful in the analysis of complex



arrhythmias and the termination of supraventricular arrhythmias without drug administration.

2. Dual chamber temporary cardiac pacing. Standard temporary ventricular and temporary arterial J pacing electrodes are connected to an APC Micropace generator. This is used for patients in AV block with poor haemodynamics.

3. Hewlett Packard Merlin Monitors. These are the standard monitors in ICU and there is a mobile Merlin for CCU. This multi-modular system allows cardiac output studies, two invasive and one non-invasive pressures, two temperatures, expired CO2 analysis, and pulse oximetry and is invaluable in patients requiring intensive haemodynamic monitoring.

4. New x-ray intensifier awaited.

A more detailed audit of coronary care activity is planned. A computer and database software package has been purchased for this. The Hospital has a dedicated resuscitation training officer. Resuscitation policy, equipment and training is the remit of the resuscitation committee, comprising: Consultant Cardiologist, Consultant Anaesthetist, RTO Ward Sister, CCU Sister/Charge Nurse, Pharmacist, Medical Electronics Department Chief and Chief Cardiac Technician. A charity has provided a Laedal arrhythmia simulator and resuscitation monitor to supplement the basic Resusci-Annie monitor.

Teaching and Postgraduate Facilities

Senior and junior staff with MRCP/FRCP undertake teaching sessions which are timetabled around the sittings of MRCP. Formal courses are run three times a year in Wessex, one of which is at Bournemouth and Poole. Southampton medical students rotate through the district and there is a foreign medical student elective programme. On four mornings per week there is a 30-minute CCU teaching session run by the Consultant.

Portsmouth Hospitals NHS Trust

Duties of the Post

This appointment provides the opportunity to work in close contact with 8 consultants, each with complementary experience and interests that cover all aspects of clinical cardiology. There is ample opportunity to perform regular transthoracic and transoesophageal echocardiography, permanent pacemaker implantation and diagnostic angiography. Further experience in electrophysiology



and interventional angiography will be available (off site at present but later this year on site).

There are 3 other Registrars in cardiology.

Teaching/Education

The applicant will be required to contribute to a structured teaching program for final year medical students and SHOs, as well as regular departmental and hospital educational meetings. Informal teaching of juniors will be provided by registrars during their normal working practice. Within the department, one afternoon a week is dedicated to continued education with a formal presentation, as well as exchange of experiences and lessons from the week. Continued education with departmental audit and research is encouraged, with funding available for further relevant examinations (such as British Society of Echocardiography examinations.)

QAH-MAU Cover

The medical registrar will only cover the MAU and A&E. There is a post take ward round.

QAH-Ward Cover

During this time the medical registrar will cover the wards and assist in MAU.

SMH Cover

Occasional weekend cover of the wards at St Mary’s Hospital

Timetable

Every 4 weeks, each registrar will spend a week at QAH.Typical timetable during stay at QAH



AM PM

Monday CCU/Ward Round Ward Referral

Tuesday Pacing/TOE for In-Patients Departmental Educational Session

Wednesday CCU/Ward Round IP Echo

Thursday CCU/Ward Round Ward Referral

Friday CCU/Ward Out Patient Clinic

The effort is made to make sure that all the registrars will get experience in different aspects of invasive and non-invasive cardiac investigations, out patient clinics and Rapid Access Chest Pain Clinic. You will also have at least 3 half-day study leave per month

Royal Bournemouth and Christchurch Hospitals NHS Trust

Cardiac Unit

The trainees will participate in the acute medical take, share in the inpatient work, have regular training sessions in cardiac procedures, and support the working of the Chest Pain Unit. The trainees will work closely with the Cardiologists, an existing Associate Specialist in Cardiology and with the Consultant Physicians attached to the cardiac wards. The Chest Pain Unit run by an Associate Specialist in Cardiologyworks very closely with the AAU, facilitating early diagnosis and triage of a significant proportion of the medical admissions in the AAU. Close working and a flexible approach to between the two Units is encouraged. Currently both Units form part of the Medical Directorate.

The acute general medical take averages 46 patients per day. The on take medical team covers all acute medical beds including GUM patients but excluding haematology. Each team has 8 junior doctors of which 6 are on take during the day. In addition there are 4 Trust Grade SHOs allocated to Cardiology, Thoracic, Rehab and AAU respectively. Night cover at SHO level includes a shift system. Consultant led post take ward rounds are mandatory. There is a 42 bedded Acute Admissions Unit and about 85% of medical emergencies come through the unit, the exceptions being those requiring direct access to urgent specialist care including CCU, ITU, HDU and the GI bleeder unit. Patients that the on call team deem likely to be discharged within 72 hours are taken over by the AAU Consultant; approximately 48% are discharged within this period. There are a large number of planned medical admissions including day cases in part generated by the open access endoscopy, ECG and Chest XRay services. There are also a large number of routine cardiac admissions per week (pacemaker,



angiography, PCI, electrophysiology and cardioversion patients). There are beds available for HIV/AIDS patients. The Medical Directorate currently operates a ward based consultant teams system. Each specialty is allocated a specific number of beds/wards and is also linked to non-medical wards in order to provide care for outlying medical patients.

Dorset Heart Centre

In recognition of the range of cardiac services offered the service has been renamed the Dorset Heart Centre and has been officially opened by HRH the Princess Royal. The Dorset and Somerset Health Authority has a major commitment to the development of cardiac services in Dorset with the more specialised cardiology and cardiovascular interventional radiology for the County of Dorset based at the Royal Bournemouth Hospital. The Sub-Regional Dorset Pacing and Diagnostic Cardiac Catheter Services were established here in 1989 and 1994 respectively and since the devolution of these services to West Dorset in 2004 continue to serve the catchment of East Dorset and surrounding areas. The pacing service is one of the largest in the UK.

The new purpose-built Cardiac Intervention Unit (CIU) opened in April 2005 and is for the provision of Percutaneous Coronary Intervention (PCI) and Electrophysiology for a large area. The Electrophysiology Service covers the whole of Dorset (biventricular pacing, ICDs and ablation therapy) and for PCI covers most of Dorset and parts of Hampshire and Wiltshire. To go with these developments three new specialist cardiologists were appointed bringing the consultants based here to six.

There are four radiologists performing interventional vascular procedures and four vascular surgeons. There is extensive experience of endovascular aortic stenting within the cardiovascular team. All four acute hospital units in Dorset (Bournemouth, Poole, Dorset County and Yeovil) provide standard non-invasive cardiac investigations including treadmill exercise testing, 24 hour ECG ambulatory monitoring and echocardiography. There are cardiac nuclear medicine facilities at Bournemouth and Poole. Yeovil has a separate pacing service. West Dorset started a pacing and diagnostic cardiac catheter service based in Dorchester in 2004.

The Centre is at the Royal Bournemouth Hospital with an ECG outstation at Christchurch Hospital. The Centre is on one level with the Cardiac Department, pacing theatre, twelve - bedded Cardiac Care Unit (CCU), two cardiac/general medical wards (50 beds), CIU and the Medical Investigations Unit (MIU) adjacent. The seven bedded ITU and eight-bedded HDU are alongside the CCU. Elective cardioversion and pacemaker patients are mainly kept on the MIU. The Chest Pain Unit is next to the Acute Admissions Unit. The Nuclear Medicine department is within Radiology.



The new Cardiac Intervention Unit has been designed to enable a flow of patients through two routes, elective and emergency. On entering the CIU there is a fast track corridor direct to the catheter lab area. The elective route is via a separate entrance to the CIU starting with reception, pre-clerking and then the admission area before moving to the labs. There are three new single flat-plane Siemens labs adjacent to each other. Two are primarily for diagnostic catheterisation and PCI. The third lab is for electrophysiology. Adjacent to these labs is a monitored 24-trolley area for patients about to undergo or following an intervention. This area is closed overnight. Patients requiring overnight stay return to CCU. Within the CIU is a large administrative area for housing the consultants, secretaries and other administrative support as well as the nurse practitioners and others nurses.

Cardiology Staffing

6 Consultants based at RBH

7 Consultants with sessions at RBH1 Associate Specialist3 Registrars (Wessex Regional Specialist Training programme) 6 Senior House Officers3 Junior House Officers7 Clinical Assistants/Hospital Practitioners(pacing, cardiac rehabilitation, echocardiography, tilt testing and heart failure)

Equipment

Most of the equipment is modern. All the routine 12 lead ECGs are performed on Hewlett Packard/Philips Pagewriters, some with screens. There are several types of patient activated ECG recorders and receiving devices including Novacor, Cardiocall and Lifecard. Twenty-four hour ambulatory ECGs are analysed with Reynolds equipment (Pathfinder 700 and Pathfinder 600) using analogue and digital recorders. For exercise testing there are two Marquette Centras, one of which has an additional facility for signal averaging and analysis of digital ECG recordings. There is a bicycle ergometer. There are three 2D Hewlett Packard echo machines with doppler (two HP Sonos 5500 and one 4500) and an Esoate Portable “My Lab 30” together with trans –oesophageal probes. The ambulatory blood pressure machines are SpaceLabs Medical.

New pacing equipment for monitoring during implantation and follow up is in place. There is a full range of programmers, ECG machines and portable ECG scopes with a print out facility. For Tilt testing there is motorised tilt table and a CNS systems Track Force Haemodynamic system. The dedicated pacing theatre is part of the CCU, and has haemodynamic and ECG monitoring, a Philips digital C–arm with image storage and full pacing implant equipment.



The department is computerised (Tomcat and Medcon). The ITU, HDU and CCU are fully equipped with Philips Merlin monitors and central stations. Digital ECG telemetry is monitored from the CCU and extends to four adjacent wards including both cardiac wards and AAU. There is continuous ST ECG segment monitoring in the CCU, AAU and cardiac wards (Philips MIDA system). There is monitoring for all the recovery bays in the CIU. In Nuclear Medicine there are two Siemens E-Cam gamma cameras, one double-headed and with the potential capability for PET.

The three new digital flat plate Siemens catheter labs are sited adjacent to each other with the build and space for future lab expansion. The labs are fully equipped for PCI including pressure flow wires, IVUS and rotablation. There are three balloon pumps and equipment for emergency transfers. The EP lab has a Bard EP Labsystem and an EnSite 3000 Mapping and Navigation system with the facility for a full range of diagnostic and therapeutic procedures including pulmonary vein isolation / left atrial ablation. There is a common archiving and data management system and the ability to view images across the hospital (Medcon and Tomcat). There is a dedicated viewing and post-processing room.

Workload

The figures for the financial year 05/06 are as follows.

ECGs (excluding ITU/CCU) 35,819Ambulatory 24 hour recorders 2,348Other ambulatory ECG recorders

953Exercise/stress tests 2,474Ambulatory blood pressure 346Transthoracic echocardiograms

8,381Transoesophageal echocardiograms

339New pacemaker implants 526Pacemaker revisions inc. box changes

306Pacemaker checks 5,107Tilt tests (excluding those in MFE)

127Diagnostic cardiac catheters 2,816Nuclear scans (patients) 181 New referrals (excl GIM) 6,000

Cardiac Activities

1. Coronary Prevention - There is a district wide strategy for cardiovascular health and this covers primary prevention. The aim is for each of the major acute units to act as a focus of such activities. There are Lipid Clinics based at the Royal Bournemouth Hospital and run by a Consultant Endocrinologist in conjunction with a Consultant Biochemist.



2. Pre-hospital Cardiac Care - All the front-line ambulances in Dorset have at least one trained paramedic. Ambulance crew members regularly train at the hospital and are skilled in recognition of arrhythmias and selected emergency conditions, cannulation, intubation, ventilation, defibrillation, cardiac massage and drug administration. The service has 12 lead ECG machines with telemetry. This has enabled early alert of the receiving hospital and pre-hospital thrombolysis to be initiated by the Dorset Ambulance Service. The Service has the third highest number of patients that have received pre-hospital thrombolysis in the UK.

3. Coronary Thrombolysis and Primary PCI - General Practitioners have been encouraged to use the 999 facility for all suspected infarcts and to cooperate with the paramedics. There is a fast track admission policy to keep the door to needle time to a minimum. 12 lead ECGs of patients with suspected STEMI are transmitted from the ambulance to the CCU. Pre-hospital thrombolysis and thrombolysis in A&E is encouraged. Between 9 to 5 weekdays a Primary PCI service has been available since the beginning of April 2006.

4. Coronary Care Unit - Suspected myocardial infarct patients are admitted to

the CCU. There are standard guidelines for major cardiac emergencies for the junior medical and nursing staff. During the week there are daily consultant led ward rounds run by the cardiac team and juniors. A&E staff and paramedics are encouraged to attend. Some junior nursing staff rotate between CCU and the Cardiac Wards.

5. Cardiac Rehabilitation - This programme was started in 1989 and is one of the largest in the country. All eligible patients who have a myocardial infarct, PCI or cardiac surgery are invited to attend. Last year over 800 new patients and 500 partners participated in Phase III. The programme includes regular exercise, advice on healthy living and stress management and leads on to a self help period under the auspices of the Bournemouth Heart Club, a registered charity run by ex-patients. There is a supervisory team of cardiac nurses, physiotherapists and a clinical assistant. Phase I of the Bournemouth Heart Club building opened on the Royal Bournemouth Hospital site in 1996 and Phase II, incorporating a second gym and other facilities, opened in 2000. A walking group is being established.

6. Echocardiography - There is a once weekly routine session of transoesphageal echocardiography .

7. Nuclear Cardiology - This is mainly perfusion imaging. There are fortnightly joint reporting sessions run by a Consultant and the staff of Nuclear Medicine.



8. Cardiac Catheterisation/PCI - Routine diagnostic cardiac catheterisation of all Dorset adult patients started at the Royal Bournemouth Hospital in 1994. The West Dorset diagnostic catheter activity devolved to the Dorset County Hospital in 2004. Patients from East Dorset and Salisbury requiring PCI are treated in house. There were 996 PCI procedures in 05/06. Patients requiring surgery are referred to Southampton and London. The visiting and resident cardiologists are responsible for the training of the cardiac registrars that attend the catheter lab sessions.

9. Electrophysiology - Biventricular pacing is performed on site and this activity is due to expand shortly. Electrophysiology (EP studies, ICDs and ablation therapy) started within the CIU at the same time as PCI. For 2005/06 the Dorset contract was for 72 ICDs and 161 EP/ablation procedures. Patients with GUCH are referred to Southampton.

10.Cardiac Pacing - Permanent pacing was devolved from Southampton starting here in 1989 with new patients and later included all previously paced Dorset patients followed up there. It is now one of the largest pacing services in the UK. 60% of the new implants are dual chamber systems. Apart from some Poole patients follow up is mainly at the Royal Bournemouth. The procedures are largely performed by trained clinical assistants and the cardiac registrars under the supervision of the consultants. The visiting and resident cardiologists are responsible for the training of the cardiac registrars that attend the pacing sessions.

11.Research - This is encouraged. There are ongoing evaluations of pacing leads and generator programs. There are two part-time research nurses looking at adjunctive treatment post infarction, heart failure and angina. Research/Clinical Fellows in PCI and EP (one each) are due to be appointed in 06/07.

12.GP Open Access Services - Patients can be sent up to one of the twice-weekly ECG clinics with the result sent by return of post. Appropriate action is taken by the on-take medical team if necessary. Some practitioners Fax ECGs for reporting. Overall 2,300 GP initiated ECGs were reported last year. The Chest Pain Service originally established in 1992 is now subsumed into the Rapid Access Chest Pain Service and currently run by an Associate Specialist. There is no open access echo service. GP open access to ambulatory ECG and BP monitoring has been established for the Bournemouth PCT. There is also an ambulatory ECG service for one of the Ringwood and Westbourne Practices. The Heart Failure Service to the Bournemouth PCT started in 2003 and is run by a Clinical Assistant and nurse practitioners under the auspices of the cardiologists. The service has recently expanded to cover the whole of the population of East Dorset.



13.Staff Developments - As part of the drive to reduce junior doctors’ onerous duties there has been considerable movement within the Trust to recruit and train Nurse Practitioners to take over some of the roles previously performed by junior doctors. For Cardiology this has taken the form of exercise test supervision, tilt testing, routine pre-clerking of catheter patients, assistance with cardioversions and caring of heart failure patients by cardiac-trained nurses. There are also three cardiac arrhythmia nurses dealing with pre-admission assessments, assisting with device implants and follow up. There is a further nurse and clerical assistant to coordinate cardiac referrals to and from tertiary centres.

14.Teaching - There is a once weekly lunchtime cardiac case presentation and radiology review meeting. Quarterly morbidity and mortality meetings are planned. The cardiac registrars participate in the Wessex Region Teaching Programme and have their own Research Forum.

15.Audit - Door to needle times and pacemaker procedures are audited on a regular basis. Other audits have been carried out, mainly to do with patients’ views on the various services provided, on the cardiac rehabilitation service, as well as the clinical performance of the pacing and heart failure services. The National Service Framework has resulted in more comprehensive audit throughout cardiology. With the advent of the PCI and EP Services Audit meetings have been extended.

The role of the appointee The candidate will train in all three specialist cardiac techniques (echocardiography, pacing and diagnostic cardiac catheterisation), will be on the acute medical take rota and deal with cardiac inpatient and outpatient work. Training and supervision as appropriate will be provided. The candidate will work closely with the Cardiologists and also the Associate Specialist in Cardiology.

Main duties and responsibilities Ward work for the cardiology teams Assist in the running of the Rapid Access Chest Pain Clinic (RACPC) -

approximately 1 session/wk Teaching of junior medical staff, nurses and allied health professionals Provision of medical support/back-up to the nurse practitioners and

specialist nurses General cardiology outpatient clinics Specialist Cardiac Technique(s) (echocardiography, pacing and diagnostic

cardiac catheterisation

The Specialist Registrar will be responsible for supervising the intake and for first-line management of medical emergencies, under supervision of the Consultant on-call. All patients are reviewed by the Consultant the following morning on the post-take ward round. The on-take medical team covers all acute medical beds including GUM patients but excluding haematology. The inpatient



load averages 25 patients for each Cardiac Firm. In addition to the general medical component of the post, there are a large number of non-urgent cardiac admissions per week (procedures and clinic admissions). There are regular twice-weekly Consultant ward rounds when teaching is provided, and in between, the Specialist Registrar is expected to maintain close contact with the Consultants.

The Specialist Registrar is expected to supervise the Senior House Officers and House Officers, and the Coronary Care Senior House Officer, and share the organisation of the junior staff rota for the three firms.

There are early morning coronary care ward rounds with the Consultant Cardiologist of the week. The junior cardiac medical staff are expected to attend. There are twice weekly outpatient sessions in general medicine and cardiology. The Specialist Registrar will see new outpatient referrals under supervision of the Consultant, and follow-up cases from hospital admissions. The Specialist Registrar will often receive referrals from junior staff for general medical or cardiac opinions on both in and outpatients, and these are subsequently reviewed with the respective Consultant.

The results of exercise tests, ambulatory monitoring, and other non-invasive investigations are all reported formally by the Specialist Registrar or Consultants. The Specialist Registrar’s reports can be discussed with the respective Consultant.

The Specialist Registrar will be expected to attend specialist practical training in cardiac catheterisation (one to two sessions), permanent pacing (one session), surface echocardiography (one session) and transoesophageal echocardiography (only once trained in transthoracic echocardiography).

The Specialist Registrar will occasionally perform some clinical teaching of medical students and nursing staff.

The Specialist Registrar will work predominantly for one Cardiac Firm, rotating at four monthly intervals. The three registrars in cardiology will share the organisation of the pacemaker bookings.

To summarise the sessions will be much the same for each registrar but the time-tabling will vary with each of the three firms. Depending on the experience of the registrar the sessions may be adjusted to assist with training:

1 Echocardiography1 Permanent Pacing1 Diagnostic Cardiac Catheterisation1 Chest Pain Clinic1 On Call2 Cardiac Outpatients



2 Ward Work1 Administration / Cardiac Reporting1 Research/Study

The Specialist Registrar will work under the joint supervision of the Service Leads, and for the individual Cardiologists through whom the registrar will rotate on a 4 monthly basis so that each registrar will work for all the cardiologists over the year in post. There are 3 firms; each cardiac firm has two or three cardiologists.

The Royal West Sussex NHS Trust

Department of Medicine

ConsultantsThere are 13 admitting Consultants with specialist interests as follows:2 Cardiology2 Diabetes and Endocrinology2 Respiratory Medicine2 Gastroenterology1 Rheumatology4 Medicine for the Elderly

In addition there are3 Consultant Haematologists2 Consultant Dermatologists1 Consultant Neurologist1 Consultant in Rehabilitation Medicine

Junior Staff6 Specialist Registrars (including this post)3 Staff Grades13 Senior House Officers3 Trust Doctors (SHO level)9 Pre-Registration House Physicians

Since 1992 there has been complete integration of medicine and elderly medicine. An Admission ward was opened in July 1994. There are fixed on take days with no conflicting commitments for senior or junior staff. There are Consultant-led post-take ward rounds on the morning following the on-call day.

Department of Cardiology

2 Consultants1 Specialist Registrar1 Staff Grade2 Senior House Officers



1 Pre-Registration House Physician2 Hospital Practitioners

Technical Staff

1 Senior Chief (MTO5)3 Chiefs (MTO4) (full-time plus 1 vacant post)3 Senior grades (MTO3)2 students1 Cardiographer (senior)2 Cardiographers

Cardiac Rehabilitation

1 British Heart Foundation Cardiac Liaison Nurse2 Physiotherapists part-time1 Staff Nurse part-time

Cardiac Facilities

With the opening of the new development in January 1997 there is now a six bedded Coronary Care Unit with an adjoining eighteen bedded cardiac ward. The Cardiac Department is currently located near the out-patient clinics on the first floor and has recently been refurbished and enlarged. There is a rapid access chest pain clinic close to the Coronary Care Unit.

In the existing cardiac department there are three Hewlett Packard ECG machines, two Hewlett Packard Sonos 5500 echocardiography machines with colour flow doppler, a Case 15 treadmill exercise system, an Oxford Medilog 24 hour halter ECG analysis system and Reynolds and Novocor Event Recorders.

Three pacing clinics are held weekly in the department and there is a full range of programmers for analysis.

Workload

Number of procedures undertaken per year

15,000 ECGs

2,800 Echocardiograms

1,800 Treadmill Exercise Tests

1,200 24 Hour EGGs

120 Event Recorders

122 Pacemaker Implants



1,200 Pacemaker Checks

220 Cardiac Catheterisation (King Edward VII Hospital, Midhurst)

Cardiac Activities

Coronary Care UnitThe new 6 bedded CCU opened in January 1997. A daily ward round is carried out by the Consultant Cardiologist with the junior staff of the admitting medical teams.

Cardiac RehabilitationA programme of cardiac rehabilitation commenced in 1990 supported by the CHSA/BHF. This programme is now funded by the Health Authority. There are in-patient sessions followed by education out-patient sessions and exercise classes for patients post myocardial infarction and following cardiac surgery. These are run by physiotherapists and a cardiac nurse in conjunction with the cardiac medical team and are held at St Richard’s Hospital, Chichester and at Bognor War Memorial Hospital, Bognor Regis.

Pacemaker ImplantationA programme for pacing at Chichester was started in 1989. 122 new implants were undertaken in 1998/1999. Pacemaker implants have been undertaken by the Consultant Cardiologist together with the Specialist Registrar and trained pacing nurses and cardiac technicians in a theatre in the Day Surgery Unit.

Cardiac CatheterisationA programme of district cardiac catheterisation was introduced at King Edward VII Hospital, Midhurst, in 1989. There has been a steady increase in the numbers of patients investigated from 45 (1989) to 220 (2000/2001). All cardiac catheterisation has been undertaken by the Consultant Cardiologist and training is provided for the Specialist Registrar.

Tranoesphageal Echocardiography (TOE)TOE has recently started in Chichester and is undertaken in a weekly session in the Day Surgical Unit.

Cardiac MeetingThere is a weekly lunchtime meeting on Fridays where cases of cardiac interest are presented by medical teams on a rota basis. These presentations are interspersed by tutorials and lectures by the Consultant Cardiologist and visiting speakers.

Experience and Training

Medicine



The routine intake of patients averages at 20-25 admissions. The average total number of patients on the cardiac firm is 30-40 patients. There are two Consultant ward rounds weekly. There are two weekly medical / cardiac out-patient sessions. The Specialist Registrar will see new and follow-up patients and will be directly supervised by the Consultant. There is a weekly medical clinical meeting attended by Consultant Physicians and their junior staff.

CardiologyThe two Consultants undertake daily teaching ward rounds on the Coronary Care Unit. The Specialist Registrar will be expected to provide a cardiology consultation service throughout the hospital under the supervision of the Consultant Cardiologist. The Specialist Registrar will be trained in techniques / 2D echocardiography with doppler, assessment of results of treadmill exercise testing, halter 24 hour ECG analysis, etc. Pacemaker implantation and cardiac catheterisation will be supervised directly by the Consultant Cardiologist at King Edward VII Hospital, Midhurst. This training meets the requirements for General Cardiology Training and Basic Sub-speciality Training in Cardiology as set out in the guidelines for specialist training in cardiology published in the British Heart Journal in April 1995.

Recognition and Training

The post is recognised for Consultant training by the Royal College of Physicians. Teaching is more than adequate, with individual consultants arranging teaching sessions whenever required. Teaching is an integral part of this post with protected teaching sessions from 1.30 pm to 5.00 pm on Wednesday afternoon. There are also regular lunchtime departmental meetings including the Department of Medicine for the Elderly and Cardiology.

Specialist Registrar Timetable at St Richard’s Hospital, Chichester

AM PM

Monday CCU Ward RoundConsultant Ward Round

Echo List (Formal session)CCU Ward Round

Tuesday CCU Ward RoundPacing List

Cardiology Out-Patient ClinicCCU Ward Round

Wednesday Angiography Midhurst(alternate weeks)

Medical Teaching RoundEcho List - informal session(alternate weeks)CCU Ward Round

Thursday CCU Ward RoundConsultant Ward Round

Lunch: Multidisciplinary Social MeetingStudy / Research / Audit



CCU Ward Round

Friday CCU Ward RoundProcedures (TOEs +/- Pacing)

Lunch: Cardiology MeetingCardiology Out-Patient ClinicCCU Ward Round

Visiting ArrangementsArrangements for visiting the hospital and meeting members of staff may be made with:

Dr Reid’s secretaryTel: 01243 831591 or

Dr Murphy’s secretaryTel: 01243 788122 ext 2734

Salisbury Health Care NHS Trust

Introduction

This post is part of a six year unified training grade (Specialist Registrar) appointment with recognised training in Cardiology and General Medicine. There are two cardiology SPR posts in Salisbury.

Responsibilities of the post

The major responsibilities of this post in outline are to:

Supervise the admission of unselected general medical emergency patients.

See ward and A & E referrals when on take

Supervise the management of cardiology and general medical inpatients.

Perform outpatient duties in Cardiology and General Medicine.

Teach SHO, PRHO, Medical Students and Nursing staff.

Undertake training and research.

Perform duties in occasional emergencies and unforeseen circumstances at the request of the appropriate Consultants where practical.

Timetable

AM PM

Monday CCU ward roundEchocardiography list

Cardiology Outpatient clinic (New patients)

Tuesday CCU ward round/cardiac General training (CPD,



catheterisationCardiology/Medicine ward round

management, finance and personnel)

Wednesday CCU ward round Pacemaker implantation/TOE list

Thursday CCU ward roundIschaemic Heart Disease clinic

CPD and clinical governance

Friday CCU ward roundCardiology/Medicine ward round

Research

The Department of General Medicine

There are 90 medical beds shared between the Consultant Physicians. There is a CCU with five beds and eight adjacent beds monitored by telemetry. There are four ITU beds and four HDU beds.

The Consultant Physicians are

3 Cardiology and General Medicine3 Elderly Care and General Medicine2 Respiratory and General Medicine3 Gastroenterology and General Medicine 2 Diabetes, Endocrinology and General Medicine

There are additional Consultant Staff in:Dermatology (2)Rheumatology and Rehabilitation (2)Clinical Haematology (3)Clinical Oncology (2)

There are visiting consultants in Neurology and Renal Medicine.

Medical Trainees

SpRs in Respiratory Medicine, Gastroenterology, Diabetes, Elderly Care4 SHOs in Adult Medicine1 SHO in Oncology and Haematology and one in ITU6 SHOs in Elderly Care and covering Palliative Care7 PRHOs

The full range of District General Hospital facilities are provided with excellent pathology and radiology services (including 24 hour CT scanning and on site MRI scanning), upper and lower gastrointestinal endoscopy and ERCP, respiratory



function testing and bronchoscopy, EEG and Neurophysiology. Many elective procedures are performed in the purpose built Day Diagnostic Unit. Outpatient facilities are new and purpose built.

Responsibilities in General Medicine

General Medical duties of the post will include responsibility for medical emergency admissions and referrals from other wards. General Practitioner emergency referrals will be seen on the Medical Admissions ward. Management of General Medical inpatients, and outpatients in a consultant supervised clinic. The post offers wide and excellent experience in General Medicine.

Education

Weekly hospital Grand Round, weekly joint medical Xray/histology meeting, weekly CPD and Clinical Governance session


There is a full range of non-invasive investigations provided on site in Salisbury. Transoesophageal echocardiography lists take place each week. The cardiac catheter laboratory opened in October 2004. Temporary pacemakers are implanted on the Coronary Care Unit. Permanent pacemakers are implanted in the cardiac catheter laboratory. Pacemaker follow up clinic takes place in the cardiac department at Salisbury. A full cardiac rehabilitation service is provided. A nurse-led heart failure service is established and a thrombolysis nurse oversees the thrombolysis service.

Responsibilities in Cardiology

The holder will gain experience in general cardiology in accordance with the guidelines for specialist training in cardiology approved by the British Cardiac Society and the Specialist Advisory Committee in Cardiovascular Medicine of the Royal College of Physicians. There is an average of 20 medical admissions on each take day. The Cardiology firm sees 1,750 new outpatients and 2,000 follow up patients are seen by the Medical/Cardiology firm. These new and follow up patients are seen in three clinics each week. Cardiac catheterisation training presently takes place in the fixed laboratory. The full range of non-invasive techniques are available in Salisbury and the Registrar will be expected to gain experience in all techniques. Pacemaker implant lists take place each week. The registrar will gain experience in temporary and permanent pacemaking. A full cardiac rehabilitation service is provided. There will be specific training in basic and advanced life support technique by the Resuscitation Training Officer. There is the opportunity to attend the hyperlipidaemia clinic and to attend clinics of other medical specialties at the request of the trainee. The trainee will be involved in the Open Access Echocardiography clinic, Rapid Access IHD clinic, Cardiac Rehabilitation and Obstetric Cardiology.



Management

The trainee will be required to undergo some training in management. A formal syllabus, to include continuing professional development, general management, finance and personnel management is under development.

Audit

The trainee will be actively involved in audit throughout the period of the post in Salisbury.

Research

There are facilities for clinical research. Trainees with an interest in molecular medicine may benefit from the Regional Genetics Unit in Salisbury .

Southampton University Hospitals NHS Trust

Wessex Cardiothoracic Unit

The Wessex Cardiothoracic Centre serves a regional population of approximately 2.5 million in Hampshire, Dorset, Wiltshire and the Isle of Wight. Government figures project a continuing increase in population of the region in the next decade. Many patients are referred from outside Wessex, particularly from Cornwall, Devon, Somerset, West Sussex, Wales and the Channel Islands. Occasionally patients with special problems are referred from even further afield.

Facilities

The Unit is situated on Levels D and E, East and North Wings at the Southampton University Hospital (General Hospital site) and comprises:

Beds

110 Adult Cardiology/Cardiac Surgical

5 Day ward (for adult cardiac catheterisation or pacemaker patients)

6 Rapid Transfer Unit for regional referrals

14 Coronary care unit beds

5 Adult Cardiology High Care

16 Paediatric Cardiology/Paediatric Cardiac Surgical

10 Dedicated adult cardiothoracic intensive care (separate general and



paediatric intensive care units)

8 Adult ‘fast track’ cardiac surgical

Catheter Laboratories

Four cardiac catheter laboratories are sited in the department, all adjacent to the operating theatres . Two rooms have biplane digital angiography equipment, and are used for paediatric cases and a range of adult procedures including coronary intervention and electrophysiology. The other two rooms have single plane cineangiography and are used for electrophysiological (diagnostic, ablation, implantable defibrillators, resynchronisation therapy), pacing, invasive and interventional procedures. Each room has on-line computer backed physiological measurement equipment.

Outpatients and Non-Invasive Cardiology

There is a dedicated cardiothoracic outpatients department, including a rapid access service for patients with chest pain (1705 seen in 2003). Facilities for echocardiography (including doppler, colour flow mapping and TOE) and exercise testing, 24-hour ambulatory ECG monitoring and tilt table testing exist on the ward level. The Department of Nuclear Medicine undertakes nuclear cardiology and lies adjacent to the intensive care unit. Two CT scanners and an MRI Scanner are in use on the site. A £45 million cardiac expansion plan is currently underway to provide a major extension to the department. Building is completed and scheduled for opening in October 2006.

Activity of the Unit

The Unit undertakes all forms of open heart surgery, both for adult acquired (1200) and for congenital (270) heart disease, and the full range of interventional procedures including coronary intervention of all sorts (1304 procedures in 2003), balloon valvuloplasty, embolisation, ASD closure etc. The Unit also has an active electrophysiology programme including AV node, accessory pathway, AF and VT ablation, AICD implantation etc. (487) and insertion of permanent pacemakers (593). The results of cardiac surgery undertaken in the unit over the last 22 years are held on a database, as are all the results of coronary intervention and electrophysiology. Non-invasive cardiological investigation plays a large part in the activities of the unit and includes trans-thoracic and transoesophageal echocardiograms, ambulatory ECGs, exercise ECGs, ambulatory BP recordings and Tilt Tests.

Medical Staff

5 Consultant Cardiologists / Intervention



3 1 5 1 5 1 2 3 1010

3 1 1

4

Consultant Cardiologists / Electrophysiology Consultant Cardiologist / Heart Failure Consultant Paediatric Cardiologists Consultant Paediatric Cardiologist / Adult Congenital Heart Disease Consultant Cardiac Surgeons Consultant Thoracic Surgeon Consultant Cardiothoracic Surgeons Consultant Radiologists Specialist Registrars in Adult Cardiology (NTN) Senior House Officers in Adult Cardiology Specialist Registrars in Paediatric Cardiology (NTN)

Specialist Registrar in Adult Congenital Heart Disease (NTN)Trust Fellow in Paediatric Cardiology Senior House Officers in Paediatric Cardiology

Duties of the Post

Clinical responsibilities include the care of adult inpatients undergoing cardiac investigation, management of patients on the coronary care unit, the medical aspects of some patients returning from open heart surgery, and outpatient clinics. The appointee will also undertake cardiac catheterisation, pacemaker procedures, echocardiography, stress testing, ambulatory ECG monitoring. There are also responsibilities for administrative work generated by clinical activities and the teaching of medical, nursing and technical staff, and medical students. Full training in all aspects of cardiological practice will be offered as outlined in the current “Guidelines for Specialist Training in Cardiology” published by the Royal College of Physicians.

Visiting

For more information or to arrange visits to the Unit candidates should contact the Cardiology Office (telephone 02380 794703).

West Dorset General Hospitals NHS Trust

The Department of Cardiology

The West Dorset Cardiology Department is located at Dorset County Hospital. The dept provides full non-invasive investigations including treadmill exercise testing, transthoracic and transoesophageal echocardiography, 24 hour Holter and patient activated arrhythmia monitoring. The West Dorset Cardiac Catheter Lab opened in Oct 2004 and provides diagnostic angiography for outpatient day cases and urgent inpatients with plans for a local PCI service from April 2007. Pacing implant and follow up is provided at Dorset County for approx 150 new implants per annum, including biventricular devices and implantable loop



recorders. ICD implants are performed by the West Dorset team at the Royal Bournemouth hospital with plans for local implant and follow up service from April 2007. A full cardiac rehabilitation service, a nurse led heart failure clinic, an open access echo and a rapid access chest pain service are also provided.

Medical Staff

2 Consultant Cardiologists

2 SpRs

1SHO

2PRHO

1 Clinical Assistant – 2 sessions

Technical staff

1 Senior Chief (MTO5)

1 Part Time Senior Chief

3.5 Chiefs (MTO4)

1 Senior (MTO3)

2 Students (MTO1) (Degree Course)

3 Full Time Cardiographers

Provisional Timetable

AM PM

Monday CCU round and ward workEchocardiography

Cath lab – angioAdmin, audit, research

Tuesday CCU and Consultant round Cath lab

Cath lab – pacingRapid access chest pain clinic

Wednesday

CCU round Outpatient clinic Dorchester

Postgraduate TeachingAudit, ResearchGeneric teachingTOE

Thursday CCU round and PTWRCath lab

Outpatient clinic Weymouth

Friday CCU round and ward work Rapid access chest pain clinic



Cath lab Admin, Audit, Research

Clinical - General Medicine

The SpRs currently work a partial shift system on call. The on call Specialist Registrar will be responsible for supervising the medical intake and for first-line management of medical emergencies, under supervision of the Consultant on-call. The SpR on call during the day will attend the post take ward round the following morning. The SpRs are expected to attend 2 outpatient clinics per week. The outpatient workload is mostly cardiac but any general medical patients will be seen in the cardiology clinic. The General medical education program occurs every Wednesday afternoon with further tutorials and grand round cases Friday lunchtime

Clinical – Cardiology

The SpRs will be responsible for the day to day management of the patients on CCU and the cardiology ward. This will include the assessment, investigation and management of all cardiology emergencies and the management of routine cardiac admissions. A nurse specialist will be responsible for the routine preclerking of cardiac catheter and pacing patients. The trainee will provide a cardiology consultant service for the whole hospital under the supervision of the Consultant Cardiologists and be expected to provide cardiological advice at the request of surgeons and anaesthetists as well as medical colleagues, again under the direction of the Consultant Cardiologists. The SpR will be trained in Swan-Ganz Catheterisation, temporary pacing, cardioversion and pericardial aspiration.

There will be specific training in basic and advanced life support techniques via the Resuscitation Training Department. The SpR will be expected to attend 2 cardiology outpatient clinics (Dorchester and Weymouth) and will see new patients under supervision as well as follow ups. The SpR will also be responsible for one rapid access chest pain assessment clinic per week. Training will be provided in Transthoracic echocardiography (and TOE if/when trained in TTE). Each SpR will have the opportunity to attend one or two angiography sessions per week and at least one pacing session alternate weeks. Weekly cardiology meetings provide further education in echocardiography and pacing and review of interesting/complex angios

Teaching

The SpR will be responsible for the supervision and training of the junior staff as well as presenting cardiology cases and teaching as part of the medical directorate education program



Management

The trainee will be required to undergo training in management. This will take the form of day-to-day involvement in administration of the unit and the Medical Directorate.

Audit

The trainee will be encouraged to be involved in departmental audit throughout the post and responsible for the audit of pacing and angiography which will be reviewed six monthly.

Research

There are facilities for clinical research. The trainee will be encouraged to be involved in research throughout the period. This research is likely to continue throughout the whole trainee period of six years but there will be protected time built into the Trainee’s programme at all stages. There is co-ordination of research by Cardiac Specialist Registrars/Trainees in Wessex supported by the Specialist Training Committee (STC) in Cardiovascular Medicine.

Other Education

The trainee will be encouraged to attend at least one relevant international or national meeting each year and encouragement will be given to the Trainee to submit and to present research at these meetings. The trainee will attend at least one course each year of special interest as deemed appropriate by trainee and trainer.

Winchester and Eastleigh Healthcare NHS Trust

The Post

The Specialist Registrar in Cardiology, is one of eleven registrars in the Medical Unit of the RHCH. There are 9 other registrars, and one other Flexi registrar. In addition, there are 15 SHO’s in the department, and one additional SHO in the elderly care ward call the Mount at RHCH. There are 10 house officers.

Duties of the Post

The Medical Registrar is responsible on a day-to-day basis for the clinical care of the patients under the two consultant cardiologists and other consultant physicians with specialist interests. There are 6 consultant ward rounds each week, although the team often splits for these. Care of acute general medicine in-patients is an essential part of this post. Attendance at one cardiology clinic and one Post-MI Clinic a week. Performance of DCC sessions (alternating with the



Acute Medicine SpR). On-Call duties in the general medical acute unselected take to EMAU as below. Seeing cardiology in-patient referrals.

The Team comprises two consultant cardiologists with one Consultant Care of the Elderly Physician; two SpR (this post, and an Acute Medicine SpR); two SHO and two PRHO.

Coronary Care Unit. This is a 6 bedded unit on Clarke ward with the usual monitoring facilities. In addition there are 8 channels of telemetry on the cardiac ward. The two cardiologists take a morning CCU ward round in rotation by week, and on occasion of absence this is taken by the Cardiology SpR.

There are 3-4 outpatient clinics per week including 2 rapid access chest pain clinics and a cardiac rehabilitation exercise class on Wednesday evenings. The Cardiac SpR together with the SpR in Acute Medicine on the team run a weekly DCC session, and a weekly Post-MI Clinic. Of the other consultant OPD’s, the cardiac SpR attends 1 per week, seeing some new and follow-up patients of the two cardiologists.

Medical Staff

2 Consultant Cardiologists2 Consultant Physicians, Diabetes/Endocrinology3 Consultant Physicians, Gastroenterology2 Consultant Physicians, Respiratory Medicine1 Consultant Physician, Elderly Care and Rehabilitation4 Consultant Physicians, Elderly care2 Consultant Dermatologists2 Consultant Rheumatologists1 Consultant Neurologist (2 sessions per week)11Specialist Registrars (including this post)12Senior House Officers2 GPVTs SHOs7 House Officers1 CMO 1 Staff Grade (based in A & E)


The department is situated in a modern part of the RHCH adjacent to the cardiology ward. It comprises an office, a large exercise treadmill room, echocardiography room and another large room used for ECG recording and rhythm analysis. Another room for respiratory function is within the same area and the respiratory technician is shared with cardiology. There are currently 1 full time MTO, two part time MTO, and 1 part time temporary MTO performing the duties of cardiac physiology. There is a team of Senior ATO technicians who



record the ECG’s, and also fit and remove the ambulatory devices. The cardiology department has both invasive and non-Invasive facilities as follows:-

1. InvasivePermanent pacemaker implantations are carried out by the two consultant cardiologists at RHCH, average number two per week. Diagnostic angiography is carried out on Winchester patients at North Hampshire Hospital Basingstoke, and at Southampton General. The SpR in Cardiology will arrange honorary contracts at these sites to allow training in angiography.

2. Non-InvasiveThe department at RHCH is well equipped with two echo machines, the GE Vivid-7 and the HP Sonos 5500. Transoesphageal echos are also performed. There is a Cambridge treadmill machine, and Reynolds 24-hour tape, event recording and ambulatory BP equipment. All this equipment is less than 3 years old with the exception of the HP.

Rapid Access Chest Pain Clinic

This clinic is held twice weekly with a capacity of 10 patients weekly. It is multidisciplinary and computerised. There is a GP clinical assistant who assists with this clinic.

Post Myocardial Infarction Clinic

This is held weekly and run by the SpR. It is a vital clinic for the correct follow-up of these patients and assists with the essential audit database work.

Education Opportunities

There is opportunity for the SpR to receive training in the above invasive and non-invasive techniques. There is emphasis on bedside clinical teaching on the ward rounds and also in outpatients. There is a general X-ray meeting on Wednesday lunchtimes and a Unit Medical meeting on Thursday lunchtimes. The Registrar will also help with teaching both medical students on rotation from Southampton University Hospitals and in the training of SMHOs who are planning to sit the MRCP Diploma Examination.

Visiting

Shortlisted candidates may visit the hospital by prior arrangement with:

Dr B C Thwaites Dr Peter GolledgeConsultant Cardiologist Consultant Cardiologist01962 863535 ext 5791 01962 824594

HoursJunior Doctors hours are constantly under review throughout all hospitals in Wessex; on call / shift commitments are therefore subject to change. Banding



arrangements may differ as individual Trusts determine rotas at local level. Full details of banding are available from the Medical Personnel Department of the relevant Trust.

Emergencies

The Specialist Registrar/trainee accepts that he/she will also perform duties in occasional emergencies and unforeseen circumstances at the request of the appropriate Consultant, in consultation, where practicable, with his/her colleagues both senior and junior. It has been agreed between the professions and the Department that while juniors accept that they will perform such duties, the Secretary of State stresses that additional commitments arising under this sub-section are exceptional and in particular that juniors should not be required to undertake work of this kind for prolonged periods or on a regular basis.

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.


http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm


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.

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.




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





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 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


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

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



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/

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