Core Medical Training – Northampton Posts

Specialty School of Medicine,

East Midlands Deanery (South)

 

General Medicine in Northampton

 

General Medicine at Northampton General Hopsital provides a broad experience

in acute general medicine and training in the full range of medical specialties.

The hospital has a number of new developments including interventional cardiology,

an acute stroke unit and a new acute renal unit opened in 2008.

 

The directorate has recently changed to a ward based structure for the junior

doctor teams led by 3/4 consultants. Each allocation includes duties as an admitting

medical team joining the Emergency Assessment Unit (EAU team) and there is a period of duty on the emergency assessment unit

           

The EAU has an assessment area for GP admissions and once patients have a clear management plan they are transferred to the appropriate specialist ward

 such as cardiology, respiratory,stroke and general medicine.

All wards will continue the care for patients transferred from EAU through to

discharge.

 

Each ward team will have 1-2 SpRs (ST3+)2-3SHOs and 1 FY1s. This allows

CMT trainees to gain specialist experience off the ward with the security that

the inpatient work is covered. Trainees on  wards admitting predominantly

GIM patients  gain experience in a range of specialties as outlined in the

 specialty details listed.

 

Trainees choosing predominantly outpatient based specialties such as Dermatology

Rheumatology & Neurology will not have acute medicine duties during that period.

 

This ensures that the outpatient experience is not disrupted.

During this allocation the trainees will have out of hours duties covering

more specialist areas within the hospital such as renal and Haematology / Oncology

who have direct admissions and this is recognised for acute medical training

 

 

There is a well established night team comprising an SpR or, a medical SHO (F2 ST1), a surgical SHO, and an F1 with support from a night nurse practitioner who takes all the calls  and allocates the duties.

The night team is responsible for all admissions and for problems arising from inpatients.

The team  works 3/4 nights at a time

 

The rotations are combined with posts in Leicester to create rotations with 1 year in Northampton and 1 year in Leicester.

 

Details are in a linked document on this website

 

General practice Trainees

 

There are 6 GP training posts in the Department of medicine, currently 4 are 4 month posts and 2 are 6 month posts

These posts will rotate through acute medicine with specialty interests in Diabetes, stroke, respiratory, gastroenterology and Elderly so that they all include acute medical experience.

 

 

Acute medicine + Specialty

Northampton has a 26 bed Emergency Admission unit with a 6 bed assessment bay for GP admissions. The medical take is usually between 25-45 in a 24 hour period. The EAU team isled by an SpR and there are plans to develop A Lead EAU consultant to oversee the whole area and  will link in with the general medical consultant on take team before hand over to the night team.

Links with the adjacent A&E help to streamline patient management and EAU have a number of senior nurse practioners to faciliate the patient pathway. The trainees on all the acute medicne allocations will  have a period on EAU and  on the night team with training opportunities to raise their skills in the management of all acute medical emergencies.

All these allocations will give the trainees the opportunity to choose which specialty they would like to gain  more experience. Everybody will have the opportunity to incorporate their first choice if not already covered by the rotation.

The options available  are: cardiology, diabetes & endocrinology, gastroenterology, respiratory,stroke and elderly all with regular involvement in the acute medical rota.

 

Cardiology

Dr David Sprigings, Dr Patrick Davey, Dr Dominic Cox, Dr Helen Binns, Dr Jon Timperley

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  new interventional cardiology unit at NGH opened in 2008  allows in- house PCI.

There are 4 Cardiology SpRs

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  heart failure team (nurse and pharmacist).

The implantation of ICds and CRTs started in 2008 has increased the range of services offered within Northampton Heart Centre

There is ample opportunity for trainees to gain a wide range of experience in the management of cardiac patients with excellent training opportunities.

 

Respiratory

Dr Andrew Jeffrey, Dr Brian Richardson, Dr Josephine Ojoo

The chest service has a long standing chest clinic for outpatients with respiratory problems. More recently  a respiratory ward  has developed the nursing

expertise to manage a wide range of respiratory inpatients with Non - invasive Ventilation taking place on this ward. There are 3 Respiratory SpRs with some duties linked with ITU.

There are a number of specialist nurses to facilitate timely discharge of patients with Asthma and COPD. A well established home community COPD team, RESTART, coordinates discharge and  the team visit patients in the community.

Dr Richardson is the lead clinician for the manegement of Tuberculosis and has a weekly clinic supported by a specialist nurse. There is a regular MDT for lung cancer patients and well established links with Leicester cardiothoracic surgeons

The trainee will have the opportunity to gain experience in the management of acute and chronic respiratory problems in the context of acute general medicine

 

Diabetes and Endocrinology

Dr Charles Fox (part time), Dr Anne Kilvert, Dr Jonathon Rippin

The Diabetes centre is nationally recognised in its approach to the delivery of care for Diabetes and Northampton has taken part in many large trials on the management and outcome of diabetic treatment regimes.

There are daily clinics supported by specialist nurses, dietitians and podiatrists to provide true multidisciplinary assessment. The service supports inpatient Diabetics and all wards have access to this expertise.

There is a regular foot clinic, adolescent clinic and combined renal clinic- the trainee has the opportunity to gain expertise in all these areas.

There are strong links between the vascular surgeons and the Diabetologists for more complex foot problems.

Most endocrine patients are managed as outpatients and the full range of endocrine problems are seen with day case investigations if needed.

 

Gastroenterology

Dr Alan Ogilvie, Dr Udi Shmueli, Dr Paul Sherwood, Dr Iqbal Khan

There is a busy endoscopy unit shared with the surgeons near the integrated surgery part of the hospital. The full range of diagnostic endoscopy is undertaken with expertise to perform oesophageal dilatation, ERCP and oesphageal laser treatments.

There is a wide range of outpatient clinics run by all consultants and a regular liver biopsy list within the radiology department.

All aspects of acute and chronic disease management of GI and Hepatology are undertaken in the department giving trainees excellent exposure to this specialty.

 

Elderly

Dr Roger Morgan, Dr Lyndsey Brawn, Dr Angela Kannan / Dr Melanie Blake, Dr Parul Shah, Dr Balakrishnar Manivannan (Mani)

The purpose built Centre for Elderly medicine opened in 1999 and has 2 well designed elderly rehabiliation wards  which have access to the full range of diagnostic facilites of an acute hospital and its own outpatient and therapy area.

Rehabiliation patients who have intervening acute medical problems are managed on these wards limiting unecessary transfers.      

There is a range of expertise within the department with Dr Morgan running a regular Parkinsons disease clinic supported by a specialist nurse. Dr Shah has a weekly Falls clinic held in the community and links in with tilt testing and CSM at NGH. Dr Mani has an interest in the management of osteoporosis and has developed a fracture liasion service with Trauma and orthopaedics and Dr morgan does a regular ward round of fractured neck of femur patients on the Trauma wards.

The trainee sees a wide range of medical problems and has the opportunity to gain experience in all areas within elderly medicine.

 

Stroke

Dr Lyndsey Brawn, Dr Angela Kannan/ Dr Melanie Blake, New Stroke Consultant post

There is a 27 bed acute and rehabiliation unit with a stroke assesment area on the medical short stay ward. Patients are identified as soon as they arrive in hospital and fast tracked to the assessment area.

Plans to commence thrombolysis in 2009 and linking with Kettering General Hospital to provide a countywide service.

There is a well established rapid access TIA/ Stroke clinic  5 times per week with one stop CT scanning and carotid duplex scanning and this will be extended to 7 days a week in line with the National Stroke Strategy. Good links exist with the vascular  surgeons who perform carotid endarterectomies under local or general anaesthetic.

The stroke unit has links with the Neurologists with a weekly SpR ward round.

The community rehabilitaiton team assist with patients' discharge but an Early Supported Discharge Team is planned for 2009.

 

Haematology & Oncology

Haematology

Consultants: Dr H.Ross, Dr A.Haines, Dr S.Swart, Dr A.Bowen, Dr J.Parker

The Department is a busy Level 3 Unit providing comprehensive care in all areas of haematology with a dedicated inpatient and day case area.. The unit provides training in general haematology, haematological oncology and autologous transplantation. Trainees will gain experience in managing haematological disease in the in- and out-patient setting. Individual doctors should become competent in the management of the acutely ill septic patient, the side effects of chemotherapy, acute crises in sickle cell disease and bleeding in patients with coagulation defects. There will be opportunities to gain experience in palliative care and laboratory  haematology.

The Department comprises 5 consultants, 2 FY1, 2 FY2, 4 ST1, 2 ST3(+) doctors and  haematology clinical nurse specialists.

Oncology

Consultants: Dr C.Elwell, Dr C.Macmillan, Mr L.Houghton, Dr H.Elbeeb, Dr J.Stewart, Dr R.Matthews, Dr P.Camilleri, Dr K.Patel

The newly built Department is a busy Unit providing comprehensive care in all areas of  oncology. The department provides both chemotherapy and radiotherapy (external beam &  high-dose brachytherapy). Trainees will gain experience in managing oncological disease in the in- and out-patient setting. Individual doctors should become competent in the management of the acutely ill septic patient, the side effects of chemotherapy and radiotherapy and palliative care.

The Department comprises 8 consultants, 1 FY1, 1 FY2, 3 ST1, 3 ST3(+) and 3 Trust Grade doctors as well as clinical nurse specialists & Macmillan/Palliative care specialists.

 

There are weekly MDT meetings and teaching ward rounds in both specialities as well as regular Departmental teaching sessions and a weekly CMT teaching session.

The Haematology/oncology posts are part of an internal on-call rota also covering renal patients out of hours.

 

Rheumatology & Neurology

Rheumatology: Dr James Taylor, Dr Rachael jeffery, Dr Meilien Ho (part time)

Neurology: Dr Paul Davies, Dr Kannan Nithi, Dr Ann Bissessar (Neurophysiology),  Dr Somsuntram Thiyagaraja (Neurorehabilitation)

During this block the trainee will do 3 Rheumatology outpatient clinics per week and 2 neurology clinics. The former includes a specialist Connective Tissue/ Vasculitis clinic. 2 experienced specilaist nurses work in the department.

There is a medical day case areas where lumbar punctures are performed and therapeutic infusions. The trainees have ample opportunity to gain competence in all these procedures including joint injections with training and supervision from the neurology or Rheumatology SpR.

There are a small number of inpatients which the trainee will have day to day involovement.

 

Dermatology

Dr John Mahood, Dr Pick Woo, Dr Christine Soon

There is a newly opened Dermatology and Day case area designed for ease of delivery for a wide range of skin diseases. There are regular minor surgery sessions and specialist clinics including nurse led leg ulcer clinics.

The trainee will gain experience in all aspects of Dermatology and have responsibility for any patients admitted

 

ITU

Dr Richard Marsh, Dr Rae Webster, Dr Gordon French, Dr Peter Jamieson, Dr Andrew Jeffrey

This block provides an excellent opportunity to gain experience in the management of the critically ill patient and training in a range of invasive procedures. This is a popular rotation and  it will be offered to the best candidates at time of interview.

There is a 7 bed ITU and  bed 7 HDU

The first few weeks are spent training in the skills required within the department of anaesthetics Following this the on call is on the ITU SHO on call rota.

They form part of the Trauma team and Arrest team and are supported by Anaesthetic registrars and ITU consultants

ITU has a specialist nurse led Outreach team who review all the sickest patients in the hospital which provides a valuable link beween all departments.

 

Renal medicine

Dr Rob Preston (NGH and KGH), Dr Warren Pickering, Dr Eddie Tan, Dr Michelle Gaffney (from May 2009)

There is a 12 bed renal ward with 6 day case beds for the management of acute renal failure. There is a well- established End stage renal failure dialysis unit at Harborough Lodge in Northampton.

The unit has links with Radiology for day case investigation including renal biopsies. Vascular access and tunnelled lines can be inserted in the nearby. cardiac pacing theatre.

There are weekly teaching sessions and the unit has 2 SpRs in Renal medicine, one of whom links in to the  medical on take rota and covering the renal unit separately.

The unit is fully operational from Septemeber 2008 and offers excellent experience in the management of acute  renal failure and end stage renal disease.

 

 

 

Northampton is a good place for ambitious junior doctors wishing to maximise their experience of acute general medicine. It is a bad place for anyone who wants a quiet life as a clerking machine.

You will be encouraged and supported in decision making and practical procedures. For example we currently teach all medical SHOs to place CVP lines under ultrasound guidance. 

We pride ourselves on the friendly supportive relationship between the Consultants, and between the Consultants and the juniors. Other departments are equally efficient. In particular the radiologists provide a duty Consultant to discuss films, problems and requests, but all the Consultants are readily accessible  and helpful.

The mix of some specialty wards with  mixed specialty wards will increase your exposure to the whole range of general medicine.

 

 

 

Education

 

There are no regular clinical commitments on Wednesday afternoon, which is an

academic afternoon. The afternoon starts with a clinical meeting (from 14.00 to15.00) followed by formal lecture a for the next hour. There is then membership coaching at the level appropriate to the needs of the SHO from 16.00 to 17.30. Attendance is expected at this meeting and presentations from SHOs are an integral part of the clinical meeting.

 

In addition there are  fortnightly meetings from 13.00 –14.00 on different specailties run by the consultants and Sprs.

 

There is 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.

 

We have Medical students from the Leicester and Oxford Medical schools and the

SHOs are expected to contribute to their education

 

 

Department of Medicine

 

Consultant Staff

 

There are currently 18 general Physicians (full time equivalents) with an

interest who between them provide the acute general medical takes.

 

Dr David Sprigings                                         Cardiology

Dr Helen Binns                                               Cardiology

Dr Dominic Cox                                              Cardiology

Dr Patrick Davey                                             Cardiology

Dr Charles Fox (part time)                             Diabetes / Endocrinology

Dr Jonathen Rippin                                        Diabetes / Endocrinology

Dr Anne Kilvert                                                Diabetes / Endocrinology / AIDS

Dr Parul Shah                                                 Medicine for the Elderly

Dr Mel Blake (part time)                                 Medicine for the Elderly

Dr Angela Kannan (part time)                      Medicine for the Elderly

Dr Roger Morgan                                            Medicine for the Elderly

Dr Lyndsey Brawn (Clinical Director)          Medicine for the Elderly

Dr Balakrishnar Manivannan (Mani)          Medicine for the Elderly

Dr Andrew Jeffrey                                           Respiratory Medicine / ITU

Dr Josephine Ojoo                                         Respiratory Medicine

Dr Brian Richardson                                      Respiratory Medicine

Dr Udi Shmueli                                               Gastroenterology

Dr Paul Sherwood                                          Gastroenterology

Dr Alan Ogilvie                                                Gastroenterology

Dr Igbal Khan                                                  Gastroenterology

 

In addition there are other Consultants who are part of the Department of

Medicine and share junior medical staff but do not support the acute medical

take.

 

Dr Paul Davies                                                Neurology

Dr Kannan Nithi                                              Neurology

Dr Ann Bissessar                                            Neurophysiology

Dr James Taylor                                              Rheumatology

Dr Meilien Ho (part time)                               Rheumatology

Dr Rachael Jeffery                                         Rheumatology

Dr John Mahood                                             Dermatology

Dr Pick Woo                                                     Dermatology

Dr Christine Soon                                           Dermatology

Dr Warren Pickering                                       Renal Medicine

Dr Rob Preston                                               Renal medicine (NGH and kettering)

Dr Eddie Tan                                                   Renal medicine

 

 

Junior Staff

 

There are twelve pre-registration (F1)  house physicians, 28 senior house officers

(F2, CT1& CT2) and 14 SpRs within the Department of Medicine ( 4 Cardiology/ 3 Respiratory / 2 Elderly+ stroke/ 1 gastroenterology/ 1 Diabetes and Endocrine/ 2 Renal/ 1 Rheumatology / 1 Neurology)

 

 

THE HOSPITAL

 

Northampton General Hospital is a busy district general hospital serving the town of Northampton and a significant part of the county of Northamptonshire. It has over 600 beds covering all the major acute specialities serving a catchment population of approximately 340,000. In addition there is a sub-regional oncology service based on the site.

 

All the acute beds within the district are based on the General Hospital site. In addition the rehabilitation beds for elderly patients are also based on the General Hospital site in a recently built Centre for Elderly Medicine which has a medical day case unit)

 

The acute and chronic psychiatric in-patient services are based at St. Crispin's and Princess Marina Hospitals on the outskirts of the town.

 

 

LEISURE

 

There is an active junior doctors mess with an active social programme and facilities include a junior doctors' dining room, lounge and medical staff bar.

Single accommodation is provided above the post-graduate centre and also in the old part of the hospital. The standard of accommodation is good and there is an active programme of refurbishment to continually improve the standard of residences. A charge is levied (with appropriate reduction for the duty rota) for single accommodation.  Married accommodation may be available and for those doctors not wishing to reside in hospital accommodation, an on-call room is provided.

 

There is an excellent recreation centre at the hospital with an indoor heated swimming pool, gymnasium, squash and badminton courts, floodlit tennis court, music room, bar and other leisure amenities. Northampton town centre with a range of pubs and restaurants is within easy walking distance.

 

 

THE TOWN

 

Northampton is an historic market town that traces its ancestry back to the Middle Ages. In the 1970s it was identified as one of the "New Towns" and the last 20 years has seen the population of the catchment area of the hospital increase from 251,000 in 1974 to 340, 000 in 1999. The town has two major theatres, a modern cinema complex, a Football League Soccer team, a Premiership Rugby Union team and a First Class County Cricket team. In addition there is a wide range of shops, both within the town centre and in out of town shopping centres.

 

Communications from Northampton are good and consequently it is the national

distribution centre for a number of large commercial concerns. It lies equidistant from London and Birmingham and from Oxford and Cambridge and is close to the heart of the national motorway network. The recent opening of the M1-A1 link has improved road communications from east to west. There is a fast frequent train service to London and an hourly train service to Birmingham.

 

 

Updated: 12 January 2009