Acute Care Common Stem Training in Northampton

Specialty School of Medicine, East Midlands Deanery (South)

ACCS Rotation Northampton

ACCS Northampton General Hospital has one of the longest established ACCS rotations in the country. A critical care rotation was established which comprised EM, AM, Anaesthetics & ITU in a two year rotation in 2002, this was latterly converted into the ACCS training rotation. Trainees who have undertaken this rotation have all enjoyed their time at the hospital, developed excellent clinical skills, independent decision making & have secured the training posts of their choice at the end of their time here.

The area & Hospital

Northampton General Hospital NHS Trust serves a population of 350,000 in the area of Northampton and South Northamptonshire. This is one of the largest district general hospitals in the country & occupies a large site in the centre of the town.

There is an excellent Recreation Centre at the hospital for the use of staff; facilities include a swimming pool, squash and badminton courts and other leisure amenities. The standard of staff accommodation in the hospital is good.

Situated in the centre of England, Northampton is rapidly increasing in size and importance. Northamptonshire itself has some of the most beautiful countryside in the UK & is often quoted as being like an ‘undiscovered Cotswolds’

The Emergency Department

In the last twelve months the Department dealt with approximately 68,000 new attendances, children comprise approximately a quarter of total new attendances. Daily consultant review clinics are held. Staffing comprises 4 Consultants, 9 middle grade Doctors & 9 Junior doctors. The 9 middle grade Doctors provide 24 hour cover in the department. All doctors’ work a Band 1a rota. There is a highly motivated & skilled team of nurses & ENP’s.

An excellent weekly teaching programme takes place both for junior & middle grade doctors. Audit, teaching & presentations are encouraged from all doctors. The department is a happy place to work & juniors generally feel well supported.

Doctors in training from ACCS rotations & Emergency Medicine SpR’s have much to gain from this department, independent but supported decision making & practical procedures are encouraged. Senior trainees are given the opportunity to be involved in management activities & also have weekly timetabled non-clinical shifts, which include teaching in review clinics & time for personal study. Ultrasound Training is also due to begin in 2008.

Anaesthetics & ITU

The ACCS anaesthetic/ITU year is split into 9 months general anaesthetics & 3 months ITU, so that maximum competence can be gained in anaesthesia in the one-year training period. The department is fully geared to training both ACCS and anaesthetic trainees. An initial 3 month fully supervised period is followed by gaining basic competencies. Once competent the trainee will have the opportunity to become involved in the on call rota & do their own theatre lists (obviously supervised when necessary). Teaching is usually 1:1 with a consultant plus a weekly departmental teaching programme. On ITU the trainee will be involved in daily ITU ward rounds, cover the hospital cardiac arrest & trauma teams & have some involvement with the outreach team carrying out patient assessments on the ward with a view to critical care support. There is ample opportunity to gain experience in central & arterial line insertion as well as many other critical skills.

Acute Medicine

ACCS trainees spend their 6 month medical post split between working on the Emergency admissions unit & with specialist acute firms. Trainees also work as part of the night team with training opportunities to raise their skills in the management of all acute medical emergencies. The Emergency Admission unit has 28 beds with a 6-bed assessment bay for GP admissions. Links with the adjacent A&E help to streamline patient management. 

There is a well established Coronary Care unit on the 28 bed cardiac ward. Elective angiography has been performed at Northampton for many years with the interventional work done at Oxford or Harefield. The opening of the new interventional cardiology unit at NGH will allow in- house PCI from summer 2008. A Rapid Access chest pain unit and chest pain nurses in A&E facilitate rapid assessment of cardiac patients and there are links with a nurse and pharmacist run heart failure team. There is ample opportunity for trainees to gain a wide range of experience in the management of cardiac patients with excellent training opportunities.

Regular medical teaching takes place on Wednesday afternoons; the afternoon starts with a clinical meeting followed by a formal lecture for the next hour. There is then membership coaching at the level appropriate to the needs of the trainee. Attendance is expected at this meeting and presentations from trainees are an integral part of the clinical meeting. In addition there are fortnightly cardiology meetings run by the consultants and Sprs.

There is also a regular MRCP Part I Teaching course and clinical teaching directed towards the clinical part of Part II occurs after the formal part of the academic afternoon. There is a good pass rate for PACES with 7 consultants active PACES examiners and the examination is held regularly at NGH.