Health Education Thames Valley: Academic Clinical Fellowship in Emergency Medicine



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Health Education Thames Valley: Academic Clinical Fellowship in Emergency Medicine (CT1, CT2, CT3 or ST4 entry)

Academic Clinical Fellowship (ACF) posts have been awarded by the NIHR to University/NHS Trust/Deanery partnerships nationally through competition. Oxford has been very successful attracting 79 ACF and 30 Clinical Lecturer posts previously. These posts form part of the NIHR Integrated Training Pathway, further details of which can be found on the NIHR TCC website http://www.nihrtcc.nhs.uk/intetacatrain/ All ACF posts attract an NTN-A.



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About Health Education Thames Valley

We are the Local Education and Training Board (LETB) for Thames Valley covering Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of effective workforce planning and excellent education and training to develop a highly capable, flexible and motivated workforce that delivers improvements in health for the population of Thames Valley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.



Health Education Thames Valley is a relatively small organisation with a defined geographical area which serves as 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 programmes will require successful candidates to indicate a location and specialty. Future placements will usually be based on individual training and educational needs. Please note that applications are to the Health Education Thames Valley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs.
ACF in Emergency Medicine Training Programme
The posts on this rotation have been approved for Specialist Training by the College of Emergency Medicine. The posts attract National Training Numbers and provide training towards a Certificate of Completion of Training (CCT).
The ACF post may be awarded to doctors starting at CT1, CT2, CT3 or ST4 level. Successful applicants must have the essential competences to enter training at an equivalent level to Acute Care common Stem (ACCS) CT1, CT2, CT3 or ST4. Details of these essential competences and qualifications are detailed in the MMC person specification for ACCS which is available from www.mmc.nhs.uk Candidates entering at ST4 level must have been successful in their MCEM examination parts A,B and C.
The ACF would be expected to intercalate the majority of their 9 months academic time in blocks either before or after their ACCS CT3 year. Details of the rotation will be tailored to the educational needs of the ACF within the constraints of the Health Education Thames Valley ACCS rotation.
During this time, the trainee's work will be monitored for satisfactory progress and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews.
The programme is designed to support academic clinical training alongside clinical core or higher specialty training in Emergency Medicine. It is anticipated that completion of this three year programme will allow doctors to complete the competences required for Core Training in Acute Care Common Stem and necessary for the Emergency Medicine Higher Specialty Training programme at ST4 level. At the end of the ACF post as long as all the required clinical competences are met the trainee will take up a place within the clinical training programme without the need for competitive entry.
The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals and the post will attract an NTN (a).
The programme is based in several different Trusts throughout Health Education Thames Valley so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:


Trust

Hospitals and Locations

Oxford University Hospitals NHS Trust

John Radcliffe Hospital, Oxford

Horton Hospital, Banbury

http://www.ouh.nhs.uk/


Buckinghamshire Healthcare NHS Trust

Wycombe General Hospital, Wycombe

Stoke Mandeville Hospital, Aylesbury

http://www.buckshealthcare.nhs.uk/


The Royal Berkshire Hospital NHS Foundation Trust

Royal Berkshire Hospital, Reading

http://www.royalberkshire.nhs.uk/




Milton Keynes Hospital NHS Foundation Trust

Milton Keynes General Hospital, Milton Keynes

http://www.mkgeneral.nhs.uk/




Heatherwood and Wexham Park Hospital NHS Foundation Trust

Wexham Park Hospital, Slough

http://www.heatherwoodandwexham.nhs.uk/location/wexham-park-hospital-slough



Expected rotation arrangements for this programme are:




  • Acute Care Common Stem training aims to provide trainees with a broad base of training in Acute Medicine, Anaesthesia, Emergency Medicine and Intensive Care Medicine.




  • Depending on prior experience, trainees will be attached to each of the four specialties; spending one year in Acute Medicine and Emergency Medicine and one other year in Anaesthesia and Intensive Care Medicine.




  • The CT3 year will be spent in Emergency Medicine and Paediatric Emergency Medicine




  • Trainees will be expected to rotate within the LETB. Rotations depend on

vacancies available and the training needs of the individual.
Anaesthetics/ITU Rotations usually begin the programme in an Anaesthetics/ITU post in either Reading; Wexham Park; Milton Keynes for a period of 12 months.

Emergency Medicine Rotations usually begin the programme in an Emergency Medicine post for 6 months in either Reading; Wexham Park; Buckinghamshire (Wycombe/Stoke Mandeville) Trust.

Acute Medicine Rotations usually begin the programme in an Acute Medicine post for 6 months in either Reading; Horton (Banbury); Milton Keynes


  • Successful applicants to the post who have achieved their MCEM part C and have the required competences will enter HST at ST4. They will rotate throughout the LETB and their placements will again be balanced between the vacancies available and the needs of the individual.


Please note: rotations may have to change in response to clinical need within a Trust.

Research Training
A key goal of the Academic Clinical Fellowship (ACF) programme is to provide the applicant with appropriate research experience and training, to enable the successful application for an externally funded Clinical Training Fellowship, usually of 3-year duration and leading to a higher research degree or equivalent further postgraduate experience. If at the end of the ACF post, if funding applications are not successful and clinical competencies are met, a place will be available on the clinical training programme.
Research

The ACF will have 9 months of laboratory or clinical research leading to an application for a Clinical Training Fellowship leading to a DPhil/PhD. The ACF will spend their research time with the academic group they have chosen to work with. Initially the key aim is for the head of the research group and the ACF to jointly develop a PhD project that draws on the strengths of the ACF and the host group. Practically, the ACF will do a focused project, much like a BSc student. A secondary aim is for the ACF to become involved in projects that lead to publication. In the latter part of research time, the major aim is to write the Clinical Training Fellowship application. Prior to this, the supervisor and ACF will be aware of the timelines for applications.



Trust Information
Buckinghamshire Healthcare NHS Trust

General Information
Buckinghamshire NHS Trust, the major acute provider for Buckinghamshire County, has around 780 beds across three sites in Amersham, Wycombe and Stoke Mandeville. About 4,500 people are employed. As well as services to local people, such as accident and emergency services, and all branches of surgery and medicine, the Trust has specialist services including burns and plastic surgery, dermatology and accredited centres for urology and skin cancer. Alongside these services the Trust provides the internationally acclaimed National Spinal Injuries Centre at Stoke Mandeville offering care to adults and children with acute spinal cord injury and life-long complications of cord injury.
The current configuration of the clinical services reflects changes that have been made in order to focus specialist expertise from across the Trust into single in-patient units. This has allowed for more comprehensive sub speciality cover, development of expertise and better multidisciplinary working whilst retaining local access for the majority of acute care and hospital visits. As a result of a visit by Lord Darzi the Trust development of its philosophy of “localise if possible, centralise only where clinical necessary” was central to the reconfiguration proposals. Subsequent changes have allowed the Trust to meet the national strategic direction within the Next Step Review without need for further major services reconfiguration.
The Trust’s service configuration affords highly integrated team-working across sites with specialist inpatient care provided from centralised inpatient units. These units are distributed across the Trust reflecting the need to serve the two major Buckinghamshire population centres of Wycombe and Aylesbury. Women and Children’s care was realigned to this model by the end of 2009 and new facilities have been provided at the Stoke Mandeville hospital.
Our hospitals each have lead roles alongside the provision of general acute care:


  • Stoke Mandeville Hospital has a lead role in providing emergency and specialist surgery including trauma, general surgery, ophthalmology, burns, plastics and the National Spinal Injuries Centre.

  • Wycombe Hospital is the centre for elective surgery as well as providing an Emergency Medical Centre and specialist inpatient medical services including: cardiology, respiratory medicine and haematology units

  • Amersham Hospital provides inpatient rehabilitation and specialist dermatology services

  • All three hospitals provide a wide range of ambulatory care, clinic and diagnostic services.


Information on Emergency Departments
The Emergency Department at Stoke Mandeville cares for about 53,000 patients annually of which about 50,000 are new and include GP referrals. There are four resuscitation bays and eleven ‘major’ cubicles. A separate Minor Injuries Unit has been created adjacent to the Majors area. The Minor Injuries Unit comprises a sub-waiting area, 3 assessment/treatment rooms, a Doctors’/Nurses’ work area, and a dedicated eye room equipped with a slit lamp. The Minor Injuries Unit is staffed by Emergency Nurse Practitioners covering up to 12 hours a day, seven days a week, and their work is complemented by Emergency Department doctors. There is also a purpose-built Paediatric Decisions Unit which caters for children presenting through the Emergency Department and for children referred by GPs. A six bedded Observation ward completes the existing Emergency Department.
An integrated front door bringing together in a collaborative manner primary care and the Emergency Department is scheduled for the latter part of 2010. This will expand the existing area by a further 3 clinical rooms. Further development of the department is scheduled for 2011 with plans to extend the resuscitation room, current major’s area, and current x-ray area. Additionally a Clinical Decisions Unit will be provided.

The Emergency Department at Stoke Mandeville Hospital is a designated major incident unit. Major trauma is attended by the trauma team which is complemented by the Emergency Department Consultants as required.


The Emergency Medical Centre at Wycombe cares for about 48,000 patients annually of which about 45,000 are new and include GP referrals. There are four resuscitation bays, nine ‘major’ cubicles, dedicated paediatric assessment and a minor injuries unit with seven cubicles, including eye examination facilities. The Minor Injuries service is currently staffed by Nurse Practitioners covering up to 12 hours a day, seven days a week, and their work is complemented by Emergency Department doctors. There is also a three-bedded observation bay.
Both Emergency Departments within Buckinghamshire Hospitals NHS Trust have a digital imaging system which can be accessed from either site enabling efficiency of patient care.
In addition, there is a newly purchased portable ultrasound scanner in the Emergency Department at Stoke Mandeville.
Following reconfiguration of health services in 2005, emergency surgery and trauma were consolidated on the Stoke Mandeville site whilst acute medicine, cardiology and respiratory services are based at Wycombe. Stoke Mandeville Hospital retains all acute services. Women’s and Children’s services have been centralised at the Stoke Mandeville site since October 2009.
Consultants:
Dr S McMorran (Service Delivery Unit Director), Mr G Thirumamanivannan, Mr D Potts, Mr A Oludemi, and Dr A Alani.
Middle Grade Tier (rotating):
Registrars (SpR, ST3 and above) 4

Specialty Doctors 11

Associate Specialist 1
Junior Tier (rotating):
F2, CT1, CT2, ACCS & VTS 16
Service Manager: Mary Frewer
Lead Nurse: Esa Rintakorpi

Higher Training in Emergency Medicine
Currently four higher trainees (SpR, ST3 and above) are placed at Stoke Mandeville Hospital as part of Oxford rotation. Secondment to other specialties or the Emergency Medical Centre at Wycombe can be arranged as required to meet the training requirements.
The trainees are on an attractive Working Time Compliant rota of 48 hours per week. They work one in seven weeks of night shifts, Monday to Thursday, and two weekends in seven weeks (one 0800-1800 and the other 1200-2200). During weekdays the rota allows for the trainees to attend the Regional Training Days on alternative Tuesdays. They also get a CPD day in the weeks with no training day.
The trainees will be expected to become involved in various clinical governance activities, in addition to their service commitments from leading the team in resus to providing support for minor injuries.
Teaching and Training
All the trainees have a designated Educational Supervisor and receive mentoring and pastoral care from the consultants. In addition to the Regional Training Days Middle Grade teaching is provided on the last Thursday of each month from 1400-1700. Trainees are actively encouraged to participate in both the Middle Grade and first tier teaching programmes, including induction training. Ample opportunities are available to become involved in postgraduate medical education, such as teaching on resus courses, the ALERT course, and various Trust-level multi-disciplinary teaching sessions. A Sim-Man is available at the postgraduate centre.
Necessary support will be provided for audit and research activities both from the Emergency Department and our friendly Clinical Audit and Effectiveness Department.
Oxford University Hospitals NHS Trust
General information
The Oxford University Hospitals NHS Trust is one of the largest acute teaching trusts in the UK. We have a national and international reputation for the excellence of our services and our role in teaching and research.
At the end of the financial year 2008/9 the Trust employed a total of 10,283 people (equivalent to 8,052 full-time employees), making us one of the largest employers in Oxfordshire, with a turnover of £614 million.
The Trust provides high quality general hospital services for the local population in Oxfordshire and neighbouring counties, and more specialist services for patients from a wide geographic area.
We have around 1,500 inpatient beds across our three sites. In 2009/10 there were:

123,592 attendances at the emergency departments, 87,275 admissions for emergency assessment and treatment, 614,056 outpatient appointments, 19,688 admissions for treatment as inpatients, 62,062 admissions for treatment as day cases (108,308 if renal dialysis is included) and 8,077 babies delivered.


The Trust is split across four large sites:

John Radcliffe Hospital, Churchill Hospital, Nuffield Orthopaedic Centre and Horton General Hospital (Banbury)


As a teaching Trust, we have a vital role to play in the education and training of doctors, nurses and other healthcare professionals. We do this in close partnership with the Oxford University and Oxford Brookes University. The Trust is also involved in a wide variety of research programmes, in collaboration with the University of Oxford and many other research bodies.
The Emergency Departments
There are 2 Emergency Departments, one at the John Radcliffe, and one at the Horton Hospital. The Emergency Medicine HST trainees all work at the John Radcliffe site. The John Radcliffe became a Level 1 trauma centre in April 2011. There is a full range of tertiary services at the John Radcliffe site.
The Emergency departments have 12 Consultants, 12 middle grades and 12 junior grade doctors at the John Radcliffe, and 7 middle grades and 8 junior grade doctors at the Horton. Further information can be found at: http://www.ouh.nhs.uk/


Local teaching
In addition to a 1-2 day induction, the teaching at the ORH for the EDs is as follows.

The local training at the John Radcliffe ED occurs on the second Wednesday of each month, and lasts for a whole day; trauma meeting in the morning and clinical governance in the afternoon. The teaching programme is currently concentrating on critical appraisal skills, OSCE preparation and management teaching.

There are also dedicated sessions in Paediatric EM, and on the ECRU (prehospital land vehicle), together with opportunites within helimed.

First tier teaching at the John Radcliffe occurs twice a month for a half day.

The first tier teaching at the Horton occurs on Friday mornings between 9am and 12. It comprises teaching with Paediatrics in the ED, followed by sessions delivered by Dr George (consultant), and ending with Radiology teaching. The weekly middle grade teaching is on Thursday afternoons

.
The Royal Berkshire NHS Foundation Trust



General information
The Royal Berkshire NHS trust is a foundation hospital and provides a wide range of services for a population of about 600,000 people living in the west of Berkshire, purchased mainly by the PCTs of West Berkshire. The area extends as far as Hungerford in the west to Henley on Thames and Bracknell in the east, parts of Hampshire to the south and parts of Oxfordshire to the north.
Emergency Department
The department is the main ED in West Berkshire, serving a population of 600,000 and sees approximately 100,000 new patients a year about 25% of these being under 16 years old. It is a consultant led service with consultants providing leadership and patient care on the ‘shop floor’ into the evenings 7 days a week.
On the RBH site there is also a dedicated ophthalmic casualty department, which is open daily, there is also an out of hours GP cooperative with which we have excellent relations. Within the region there is a WIC in Reading town centre and MIU in Newbury and Henley.
The department has excellent links with inpatient hospital teams with two of the consultant appointments being joint posts with the Intensive Care Unit. We work collaboratively with other inpatient teams as demonstrated by our award of a HSJ patient safety award for work on neutropenic sepsis and falling door to balloon times for PCI. We are keen to promote further collaborative working and work collaboratively with the stroke team to provide extended hours stroke thrombolysis

The Emergency Department is a purpose built unit opened in 2002 comprising four resuscitation bays (3 adult and 1 paediatric) equipped to provide state of the art care to critically ill and injured patients. There are 12 majors’ assessment bays, a 3 bedded rapid assessment area and a dedicated minor area – with treatment bays and a plaster room.


The new paediatric emergency department opened in 2010 has a dedicated waiting room, 4 major assessment bays, minor injury assessment cubicles and 2 treatment rooms.
In addition there are 4 observation beds for ED patients on the adjacent Clinical Decision Unit, a decontamination unit within the ED, and two dedicated X-ray rooms. We are undergoing a further refurbishment this winter 2014 which will increase our observation bed capacity and increase our ability to see and manage our ambulatory care pathways more efficiently.
The main radiology department with CT, US and MRI scanning facilities is directly opposite the department.
The department has a computerised registration, tracking and clinical audit system as well as a computerised radiology PACS system. We are currently developing and implementing a purpose designed Electronic Patient Record system, which will integrate many of these functions and provide seamless record keeping throughout the trust. Phase one is due to be implemented in the spring of 2011.
These other services mean that we see a higher than average acuity of patient in the ED and the vast majority of patients have genuine emergency medicine problems. Our admission rate is approximately 20%. Over the last year we have introduced a new Emergency Nurse Practitioner service. There is a consultant led ED review clinic held every weekday morning.
We have a newly developed Psychological Medicine Service in place and work closely alongside the team both to assess patients with mental health needs in a timely fashion and allow greater integration of mental and physical co-morbidities.
Staffing of the Emergency Department
Consultants in Emergency Medicine: Dr David Mossop (EM / ICU) (Clinical Director), Dr Racheal DeCaux, Dr Liza Keating (ICU / EM), Dr Rob Slater, Dr Rob Tan, Dr Lisle Blom, Dr Rosie Hancock, Miss Maria Dudek, Mr Sreenath Reddy, Dr A Hinterholzer, Dr Omar Nafousi (PEM), Dr Manish Thakker, Dr Jane Brenchley (Training Programme Director for the Oxford School of Emergency Medicine) and Dr David Clarke. Consultant in Psychological Medicine: Dr Matt Lowe.
Associate Specialists Dr P Jeyakumar

Dr B Sharma

Dr S Myint

Mr J Nagaraj


ST3 – ST6 Five – Oxford rotation
Speciality Doctors Dr A Donohoe

Dr T Perry

Dr B Gerov

Dr V Dimitrov

Dr R Weldon (part time)

Dr A Sandercott (part time)

Junior doctors 1 ACCS ST1

5 GP VTS ST1

4 F2
Emergency Nurse Practitioners 7 WTE
Matrons Brenda Morton

Georgina Brown



Teaching, Research and Audit
The department has an active and well-received educational programme.

We have received a grade A from the Deanery Approval Committee for the last three years for the Royal Berkshire Hospital NHS Trust for both Emergency Medicine and our ACCS programme. For junior doctors a weekly programme based on the new CEM ACCS curriculum has been developed which makes good use of the simulation centre. There is a monthly middle grade educational after-noon, we regularly host regional training days for ST3 and ST4 – 6 EM trainees which receive excellent feedback. The trust regularly holds regular life support courses (including ATLS, ALS and APLS). We undertake regular simulation training both in the resus training department as well as in the department.


The trust has an excellent reputation for education, as measured by its PMETB report and regular responses from trainees and medical students. It has a recently upgraded medical library and an active clinical librarian service, a clinical skills unit and a state of the art simulation centre opened in 2009.
Wexham Park Hospital
The population & district

East Berkshire has a population of 380,000 and covers the Boroughs of Slough, Windsor & Maidenhead, and Bracknell, but together with an overlap zone in South Buckinghamshire, the true catchment area of the Trust is nearer to 430,000, of whom 90 000 are children. This is a large and diverse population and includes affluent areas such as Ascot, Windsor, Gerrards Cross and Maidenhead, but also the larger urban area of Slough. The towns of Bracknell, Maidenhead, Slough and Windsor house two-thirds of the total population, the remainder living in rural areas or small towns. Much of the District lies within the designated Green Belt areas.



The Trust

The Trust is an Acute Hospital Trust and achieved Foundation status in 2007. It has 750 beds and provides in-patient services on two sites: Heatherwood in Ascot and Wexham Park, north of Slough - essentially, one hospital on two sites. In addition, the Trust provides outpatient and diagnostic facilities at St Mark’s Hospital (Maidenhead), King Edward VII Hospital (Windsor) and Upton Hospital (Slough). This post will work exclusively at Wexham Park Hospital.



The hospitals

Wexham Park Hospital, Slough, has 520 beds with a full range of services including general medicine and its sub-specialities, paediatrics, general surgery, vascular surgery, urology, orthopaedics, obstetrics and gynaecology, otolaryngology, oral surgery, and also a sub-regional plastic surgery unit with an extensive catchment area. There is an active programme of building and development. The Emergency Department underwent a major rebuild and enlargement, with a self-contained children’s area, in 2003, and is due to have further capital development in the next 2-3 years, to include an integrated Clinical Decision Unit and improved children’s facilities.. There are well developed intensive care and cardiac investigation and treatment units, with developing links with the ED. There is also an excellent new rehabilitation department, a centralised laboratory, and diagnostic imaging including a new spiral CT scanner and MRI. A new theatre complex opened in 2004 and a surgical assessment unit.

There is a large purpose built post-graduate centre with skills lab, which runs regular ATLS, ALS, and APLS courses. The extensive library has an intranet connection to the wards for accessing guidelines, Medline etc.

Heatherwood Hospital, The minor injuries unit, which comes under the auspices of the main ED, is staffed by Nurse Practitioners who care for 20,000 attendances per year. The hospital in Ascot, has 230 beds including general medicine and its sub-specialities, elective orthopaedics, urology, otolaryngology, oral and general surgery, elective and emergency gynaecology and a midwifery-led low risk maternity unit plus a children’s centre. A superb diagnostic imaging unit opened in August 1998.



The Emergency Department

The staff in the Emergency Department deliver care to in excess of 90 000 new patients a year, with an additional 4000 returns. Approximately 25% of patients are children and the overall admission rate is 21%. There are excellent facilities comprising a five bedded resuscitation unit plus a well-resourced trauma bay equipped with overhead X-ray gantry. There is an 8 bedded majors unit and a 6 bayed minors area plus dedicated ENT / Eyes and Gynaecology examination cubicles. Children are cared for in a separate unit, which is open for between 12-14 hours a day and contains a waiting area (often supervised by Play Specialist), triage room, teenage room, treatment room and three bays. Each area of the department has a bay, which has additional resources to meet the needs of children attending when the Paediatric unit is not open. A four bedded observation facility is within the department and patients are admitted there under the care of the Emergency Physicians for periods of up to 12 hours.

At Heatherwood Hospital there is a Minor Injuries Unit, which sees approximately 24,000 – attendances a year. One consultant undertakes review clinic at Heatherwood on a weekly basis. There is also a Walk In Centre at Upton Hospital, Slough and discussions are underway regarding provision of primary care practitioners at Wexham Park site. The new MIU at St Marks opened in September 2008.

The current establishment includes 6 Consultants, 1 Associate specialist, 2.5 Staff Grades, 2 Senior Clinical fellows and 9 ST3 - 6 / SpRs, (who are part of the Oxford Regional Training Programme). The junior tier consists of 5VTS, 4 FY2, 1 ACCS and 4 junior clinical fellows. The nursing establishment is overseen by a modern matron supported by a team of senior nurses and a Practice Development Nurse. Much of the care of patients presenting with minor injuries is delivered by Emergency Nurse Practitioners, who contribute to the training of junior doctors and nursing colleagues. The Paediatric area is run by a band 7 RSCN, and there is a commitment to having either a fully trained paediatric nurse, or one with agreed competencies, on every shift.



Support Services

At Wexham Park there is a full and comprehensive Pathology, Diagnostic Imaging (including CT and MRI), Diagnostic Cardiology and Endoscopy Service. At Heatherwood Hospital there are routine Pathology Services 9.00am – 5.00pm, Diagnostic Imaging, Diagnostic Cardiology & Endoscopy with plans for continued re-development and upgrading of these services. The Trust opened an MRI Suite on the Wexham Park site in 2004.


Milton Keynes Hospital NHS Foundation Trust
General information
Milton Keynes Hospital Foundation Trust provides a comprehensive range of services to the local population. The vast majority of our activity comes from the immediate local area of Milton Keynes and our vision as an organisation is to be the health care provider of choice.
Milton Keynes Hospital has come a long way in a short amount of time. We are a relatively new hospital, opened in 1984 following a successful campaign by local people to secure a hospital for Milton Keynes which had been established as a new town. Since then, the town has continued to grow at a rapid pace. Our local catchment population now stands at 267,000 and is forecasted to grow to 412,000 by 2031. A key part of our service strategy therefore is to grow our services in response to the population growth in order that we can best meet the needs of the local community. Although our strategy is to grow services, we intend to remain a general provider of services rather than become a tertiary provider.
Milton Keynes is a rapidly developing, dynamic and unique city situated on the doorstep of beautiful Buckinghamshire countryside. It lies mid-way between Northampton and Aylesbury and is traversed by the M1. It is on the West Coast Main Line (fast train to Euston currently 35 minutes) and (for those in less of a hurry) the Grand Union Canal. The city lies in attractive countryside, with a wide variety of housing both new and old in the city and in the surrounding small villages.
Milton Keynes is not only famous for its concrete cows but also for its first class facilities. Shopping is provided by “The Centre MK”, a well-known large and comprehensive modern retail development, as well as a plethora of specialist retailers in the older parts of the city and three large out-of-town developments.
Sporting facilities are exceptional. There are leisure centres, a David Lloyd Racquet and Fitness Centre, a large water sports facility and the longest real snow indoor ski slope in Europe. The National Centres for Hockey and Badminton are sited in Milton Keynes and there is a major equestrian centre in Hanslope. There are public and private golf courses to suit all abilities. Sport is angled more at participation but for those who prefer to watch, the MK Dons provide league football.
Milton Keynes is home to an excellent theatre, part of the Ambassador group which guarantees a consistently high standard of production. It is the best attended regional theatre in the country. The MK Bowl is both famous and notorious as a pop venue. There are two multiplex cinemas and numerous restaurants cafes and bars.
Emergency Department Staff


Consultants

Interests

Mr Peter Thomas

Associate Medical Director (Education)

Head Oxford School of Emergency Medicine.



Mr Richard Ajuwon

Clinical Director, Emergency Planning and Emergency ultrasound

Mr Ikenna Ezeilo

Information Technology & Primary care

Mr Riaz Khan

Clinical Governance and Paediatrics

Dr Vimal Desai

Medical education




Grade

Number

Specialty Doctors

3

Specialist Registrars

4.7 WTE

Trust Doctors

3

FY2/GPVTS/ACCS

8

Modern Matron: Julie Orr


The Emergency Department is a purpose-built modern unit commissioned in 1984. The accommodation and facilities are constantly upgraded to deal efficiently 24 hours a day with major and minor medical, surgical, orthopaedic, paediatrics, obstetrics, and gynaecology and trauma emergencies. The department has recently been refurbished to facilitate the increasing demand for the service. The Department currently sees 69,000 new patients per year. Approximately 30% of these are children. It is the only Emergency Department for the Milton Keynes district and currently serves a population of 250,000. It is a designated major incident centre.
Follow-up clinics are conducted in the Department by the Emergency Department consultants for continuing treatment of minor conditions.
a] The reception area is staffed 24 hours a day by two receptionists. The ED records are computerised. The computer works on an integrated system – ED being part of CRS.
b] Waiting Area – there are separate children and adult waiting areas. The ambulance patients are brought in through a separate entrance. Initial assessment is performed in a designated room
c] There are nine multipurpose major examination and treatment cubicles, of which one is adopted and equipped for obstetric and gynaecology patients.
d] Fully equipped resuscitation room with 5 bays, one of which is equipped primarily to resuscitate children and one equipped to receive major trauma. There is an overhead X-ray facility, a blood gas machine and portable ultrasound machine.
e] In 2000 a new purpose built paediatric area for patients attending Emergency Department was completed. The area incorporates waiting area, treatment/isolation rooms and 3 separate cubicles.
f] An ED observation ward, equipped with 7 trolley beds, piped gases and suction.
g] A Departmental seminar room with usual audio-visual teaching aids, boards and a small library exists.
h] A well-furbished room with its own TV, fridge and other amenities for distressed relatives/viewing.
i] Plaster room. Trained nurses and health care assistants provide a plastering service.
j] A dedicated treatment room
k] Seven examination and treatment bays for the walking wounded which like all clinical areas, have piped gases and suction. Two clinic rooms, a “see & treat” room and a triage room
l] Eye/ENT and dental room - which is equipped with slit lamp, magnifying lamp and various other diagnostic tools.
m] There are Minor Trauma and Review Clinics [MTRC] three times a week, a weekday ED eye review clinic and a weekly hand clinic. Extensive physiotherapy and hand therapy facilities are easily accessible to the ED patients. A trained Hand Therapist assists in the Hand Trauma Clinic.
n] Emergency Nurse Practitioner’s room.
o] Office accommodation for doctors, nurses and secretaries.
p] A staff common room equipped with TV, microwave and other amenities is shared by all ED staff.
q] A helipad is located just across the car park near the Department.
r] A dedicated car park bay for disabled drivers and short stay wait of 30 minutes is reserved for free use by ED patients just outside the department. The rest of the car parks operate a pay and display system.
s] There is an Emergency Department satellite X-ray Unit which operates a PACS system. There are 24-hour CT scan facilities available from a well-equipped Radiology Department. The scan can be transmitted to the Regional Neurosurgical Unit, which is at Oxford.
t] Ophthalmic, Plastic and Burns in-patients facilities are provided in the neighbouring Stoke Mandeville Hospital. Maxillo-facial services are provided during weekdays on site, and out of hours at Luton and Dunstable Hospital.
u] ITU and Phase I Operating Theatres are situated directly above the department and are easily accessible.
v] CCU and Clinical decision Unit are situated on the ground floor.
w] There is a sub-pharmacy within the department which houses most of the commonly used drugs for after-hours dispensing. A very prompt service from a fully trained Pharmacist is available during normal working hours and a Pharmacist is on-call if necessary.
x] Community liaison with Paediatric and Geriatric Health Visitors exists. The liaison Health Visitor and District Nurse visit the department on a daily basis accepting referrals and relaying information to Health Visitors, School Nurses, Community Paediatric sectors for children 0-16 years and another Community Liaison for patients aged 65 years and over. A Community Psychiatric Nurse is available in the Department between 5pm and 1 am. The Emergency Department has an Occupational Therapist whose key role is in facilitating patients’ discharge.
y] There is a small departmental library with some useful books and extensive library facilities in the postgraduate centre.
Teaching
The weekly middle grade teaching is attended by all consultants. Trainees are released for regional training days.

There is an active Postgraduate Education Centre, which houses the hospital library. There is a programme of clinical meetings and lectures. The medical library is jointly funded and has regular supplies of most general medical journals. It has a good selection of books and CD ROM facilities are available on site. There are also on-line search facilities. The Associate Medical Director (Education), Mr Pete Thomas is responsible for organising the programme, and active participation of Consultants, Trainees and General Practitioners is strongly encouraged. There is an active Speciality Tutors Committee that meets regularly.

There is a newly built simulation centre.
Teaching
The primary aims of the three year programme is to deliver ACF academic training alongside the ACCS curriculum and to provide trainees with the opportunities to gain the necessary competences required to be for higher training in Emergency Medicine.
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.


  • There is a regional training programme for trainees, which runs on 2 days per month, with the location of the day rotating around the region.

  • Trainees are expected to attend the training days, with the exception of when they are on night shifts.

  • The programme is coordinated by one of the trainees, with regular input into the training days from the local consultants.

  • Training is aimed towards successful completion of the FCEM examination as well as general continuing professional development needs.

  • In addition, each hospital has its own programme of in-house middle grade teaching.

  • Further information can be found on the trainee website www.oxem.org.uk


Curriculum
The clinical competencies required at the completion of this ACF post are described in the curriculum for Acute Care Common Stem, found on the ACCSUK website:

http://www.accsuk.org.uk/


Duties of Post
All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals and during different attachments. The list below is not exhaustive but is aimed at covering the majority of duties:


  1. To take part in the day to day management of patients under the care of their Consultant(s), supervise the F1/F2 where necessary and in turn be supervised by the more Senior ST and Consultant(s).

  2. Perform, with supervision, procedures appropriate for their level and experience.

  3. Be expected to be competent in all general areas of the specialty consistent with training and experience and to cover the work of colleagues as appropriate.

  4. Pre-operative assessment, management of pre-medication of patients scheduled to undergo routine and emergency surgery.

  5. Administration of Anaesthetics (local and general).

  6. Post operative assessment and management of postoperative problems in conjunction with surgical colleagues.

  7. Liaise with nurses, doctors, allied health professionals, patients, relatives and senior medical staff

  8. Attend and participate in ward rounds as timetabled

  9. Attend outpatient clinics as timetabled

  10. Take part in rostered emergency work.

  11. Complete discharge summaries.

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

  13. Attend weekly educational and multidisciplinary sessions

  14. Undertake audit at various times throughout the rotations

  15. Teach medical students, nurses and allied health professionals as directed.

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

  17. Attend induction in each hospital or new department

  18. Maintain appropriate training documentation.

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


Main Conditions of Service

Appointments to this programme are subject to the Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales). In addition appointments are subject to:



  • Applicants having the right to work and be a doctor or dentist in training in the UK

  • Registration with the General Medical Council

  • Pre-employment checks carried out by the Trust HR department in line with the NHS employment check standards, including CRB checks and occupational health clearance.

The employing Trust’s offer of employment is expected to be on the following nationally agreed terms:


Hours – The working hours for junior doctors in training are now 48-hours (or 52-hours if working on a derogated rota) 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/your-workforce/need-to-know/european-working-time-directive


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

http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/pay-and-conditions-circulars/medical-and-dental-pay-and-conditions-circulars 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/your-workforce/pay-and-reward/pay/pay-and-conditions-circulars/medical-and-dental-pay-and-conditions-circulars

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. If you leave the programme for out of programme experience you may have a gap in your pension contributions. More information can be found at http://www.nhsbsa.nhs.uk/pensions
Annual Leave – your entitlement to annual leave will be five or six weeks per annum depending on 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/your-workforce/pay-and-reward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars/junior-doctors-terms-and-conditions-of-service-and-associated-documents


Sick pay – entitlements are outlined in paragraph 225 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 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 should 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 should 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/JuniorDoctorsDentistsGPReg/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx

You are advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure.
Pre-employment checks – all NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements, which are expected to be in line with national guidance at

http://www.nhsemployers.org/your-workforce/recruit/employment-checks/nhs-employment-check-standards


Professional registration – it will be a requirement of employment that you have professional registration with the GMC/GDC for the duration of your employment. Though the post is covered by NHS Indemnity, you are strongly advised to register with the MPS for professional indemnity.
Health and Safety – all employers have a duty to protect their workers from harm. You should be advised by the employer of local policies and procedures intended to protect your health and safety and expected 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 should advise you how to access these, not later than eight weeks after commencement of employment.
Educational Supervisor – the employer or a nominated deputy (usually the Director of Medical Education) will confirm your supervisor on commencement.
General information on the LETB’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.oxforddeanery.nhs.uk and in the national ‘Gold guide’ to Specialty Training at http://specialtytraining.hee.nhs.uk/. Please ensure that you inform Health Education Thames Valley of any changes to your contact details.
September 2014

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