Surgical Directorate

Specialty training registrar posts

(StR)
ST1/ST2 Anaesthetics Programme

Specialty Training Registrars Anaesthesia Aug 2007

The History of the Whittington Hospital
Medical services have been delivered on the Whittington site for over 500 years. In 1473 a
leper hospital was founded, which later cared for the poor chronic sick transferred from
hospitals in the centre of London. In 1848 a smallpox and vaccination hospital was built on
the St Mary’s site and independently managed hospitals were opened on the Highgate site
in 1866 and the Archway site in 1877. In 1900, the Highgate Hill Infirmary opened adjacent
to the smallpox hospital and the two soon merged, with the smallpox hospital becoming a
nurses’ home. In 1946, the hospitals on all three sites were brought together with a total of
almost 2000 beds. Following the introduction of the NHS in 1948, they jointly became the
Whittington Hospital.

The past 50 years have seen the consolidation of all clinical services onto the St Mary’s site
with a reduction of beds to approximately 500. In 1977 a new wing was opened which
currently houses the emergency department, outpatients clinics and the pathology
laboratories and in 1992 the Great Northern Building opened providing modern inpatient
accommodation and education facilities.

In 1999, the hospital embarked on an ambitious site redevelopment programme to

modernise its facilities. Stage one, which involves the relocation of many of its clinical
services into purpose-built accommodation was completed in 2006 The new building is
equipped with the latest medical equipment and provides patients with some of the most
advanced hospital facilities in London. Stage two of the redevelopment, which involves the
refit of part of the Great Northern building into a day treatment centre, is due to be
completed by the end of 2007.

The Highgate site is now home to Camden and Islington Mental Health Trust. The Archway
site has been purchased by University College London and Middlesex University and is one
of the largest centres for the training and accreditation of health professionals.

The Hospital Today

The Whittington Hospital is a medium-sized district teaching hospital. It aims to provide high
quality services in a caring, friendly and efficient way and wants to be selected as the local
hospital of choice. The hospital aims to be recognised for excellence in day surgery, the care
of long-term conditions, the treatment of common cancers, the care of women and children
and the provision of first class undergraduate and postgraduate training.

We are located in Archway, Islington and serve the people of north Islington and west
Haringey, as well as those from Camden, Barnet and Hackney, giving a combined
population of approximately 300,000. We have 467 beds and employ over 2,000 staff. We
have close working relations with tertiary centres at the Royal Free Hospital and the UCLH
group of hospitals.

All main branches of medicine and surgery are provided at The Whittington Hospital with the
exception of neurosurgery and cardiothoracic surgery. Plastic surgery and ophthalmology
are represented by outpatient services.

Our new building houses one of the most advanced imaging departments in the UK. It is
equipped with state-of-the-art digital x-ray equipment, high tech ultrasound scanners and
specialist imaging equipment that includes a 64-slice CT scanner, a 1.5 tesla MRI scanner

Specialty Training Registrars Anaesthesia Aug 2007

and a gamma camera for nuclear medicine. The following have also moved to purpose-built
accommodation in the new building:

• the critical care unit (15 beds)

• the medical assessment unit (15 beds)
• the cardiology ward (18 beds)
• the respiratory ward (21 beds)
• oncology inpatient (16 beds) and chemotherapy day care facilities (nine bays)
• the thalassaemia unit.

An 89 bedded Mental Health Unit is located adjacent to the hospital and is managed by the
Camden and Islington Mental Health Services Trust. The Sexual Health Clinic, managed by
Camden & Islington Community Trust, is located in the Archway Campus.

The Whittington is one of the teaching hospitals of University College London, providing
clinical placements and training for doctors, and is one of the largest centres for the training
and accreditation of health professionals in the UK.

APPROXIMATE BED NUMBER

Surgery 102
Day surgery 16
Medical 237
Maternity 58
Paediatrics 23
Neonatal Unit 18
ITU 11 (increasing to 15 by the end of 06/07)
Private patients ward 20
TOTAL 485
All figures are approximate because beds are used flexibly and because ongoing strategic
planning processes may affect individual speciality provision from time to time.

Specialty Training Registrars Anaesthesia Aug 2007

Specialty Training Registrars Anaesthesia and
Intensive Care Medicine
Anaesthetic Programme 10 ST1 and ST2 posts

Anaesthesia
THE POST
These are full time ST1 and ST2 Specialty Training Registrar posts providing training
in anaesthesia and/or intensive care medicine in the setting of a District General
Hospital. Rotas operate on a full shift system. The post holder will be trained to
appropriate competency standards by a department of enthusiastic and supportive
consultants.
There are weekly departmental meetings and a weekly, protected time, exam-
oriented teaching programme.

For details of ICM StR 1/2 training see below

THE DEPARTMENT

The Department provides comprehensive services for the following areas:

Inpatient and day surgery

There are 105 inpatient surgical beds including a 5-day ward. There are 6 theatres in the
theatre suite, which are used for elective and emergency in-patient surgery covering
general surgery (including colorectal, benign upper GI/bariatric, vascular and
endocrine) orthopaedics (including spinal), gynaecology and urology.

Day surgery takes place on designated day surgery lists in the main theatre complex, whereby
patients come from and return to the Day Surgery Unit. In addition to the inpatient specialities,
there are lists for ENT and Cardioversion and an expanding Emergency Day Surgery program.
Day Case Anaesthesia is provided for a varied and expanding group of procedures including
laparoscopic cholecystectomy and Nissen’s fundoplication, with partial thyroidectomy and ACL
repair starting soon. A new dedicated Ambulatory Care Unit is due to open early 2008, with
four new day surgery theatres and an interventional radiology suite.

Emergency and Trauma surgery is allocated to a designated theatre all day every
weekday enabling this workload to be dealt with promptly and within NCEPOD
recommendations.

Obstetric Anaesthesia
Six Consultants and one Associate Specialist have sessions to cover the Labour Ward, which
handles 3500 deliveries per year, and has recently been chosen as a centre for high-risk
obstetrics. Dr Sola Makinde leads this service, which has well-established standards and
protocols, and is working towards application for CNST level 3 next year. In addition, there is
24-hour trainee cover at StR 345 level.

Specialty Training Registrars Anaesthesia Aug 2007

Acute Pain Service
Dr Samina Ishaq leads this service and is supported by a team including a full-time Clinical
Nurse Specialist. There are two consultant led rounds each week with trainee participation in
all daily Pain Service rounds.

Chronic Pain Management Service

Dr Gnanie Panch and Dr Sarah Ward provide this consultant led service, which is mainly
outpatient based but also includes in-patients. Referrals originate from general practitioners
and hospital consultants. The Pain Clinic is located in the spacious and well-equipped
Outpatients Department and is supported by clinical psychologists, acupuncturists and a
sports therapist in addition to secretarial and other support staff. There are weekly theatre lists
for nerve block procedures. There is opportunity for experienced trainees who require
exposure to this subspecialty to attend both Pain Clinic and theatre sessions.

Trauma & Resuscitation

This is a significant part of the Department's daytime work and on-call cover, and is led by Dr
Catherine Shaw.

E.C.T.
Anaesthesia is provided twice weekly for patients having Electro-Convulsive Therapy at the
recently opened Highgate Mental Health Centre, adjacent to the hospital, on Dartmouth Park
Hill.

THE ESTABLISHMENT

Consultant Staff
1) Dr T. Blackburn Consultant with interest in obstetrics and medical equipment
2) Dr M. Dunstan Clinical Lead for Anaesthetics, with interest in obstetrics and
pre-operative assessment.
3) Dr S. Gillis Consultant in ICU and lead clinician for outreach services
4) Dr C. Hargreaves Director of Intensive Care, lead consultant for nutrition team,
lead for tracheostomy team, risk management
5) Dr N. Harper Consultant in ICU, Anaesthetics College Tutor
6) Dr S. Ishaq Consultant with interest in anaesthesia for older people.
Lead clinician for Acute Pain Service.
7) Dr G. Lim Consultant with interest in obstetrics and difficult airways
8) Dr O. Makinde Consultant and lead clinician for obstetric anaesthesia
9) Dr G. Panch Consultant and lead clinician for Chronic Pain Service
10 Dr J. Powney Consultant with interest in obstetric anaesthesia, Deputy
) Clinical Lead, deputy undergraduate tutor
11 Dr K. Rauf Consultant with an interest in acute pain and regional
) anaesthesia
12 Dr C. Shaw Undergraduate tutor, lead clinician for paediatric
) anaesthesia, trauma and emergencies.
13 Dr S. Walker Clinical Director, Division of Surgical & Cancer services.
) Clinical Lead for Day Surgery. ECT
Specialty Training Registrars Anaesthesia Aug 2007
14 Dr S. Ward Consultant with interest in chronic pain
)
15 Vacancy Consultant General Anaesthetist
)
16 Vacancy Consultant in Anaesthesia and ICU
)
17 Vacancy- New post Consultant in Anaesthesia and ICU
)

Associate Specialist: Dr S. De
Staff Grades: Dr A. Landeck
Dr Y. Zakharchuk (locum 6/12)

Specialist registrars:

3 Year 3-5 StR

5 Year 1/2 StR
10 Year 1/2 StRs Anaesthesia/ICM
1 Year 1/2 StR ACCS Anaesthesia
(New trainees are supernumerary until basic competencies are signed off after 3 months)
All training posts are incorporated into rotations of the Central School of Anaesthesia.

Intensive Care
THE CURRENT ESTABLISHMENT:

Consultants
Dr Chris Hargreaves Consultant Anaesthetist & Director of ICU
Dr Nick Harper Consultant Anaesthetist
Dr Sarah Gillis Consultant Anaesthetist
Dr Mike Grocott Academic Senior Lecturer in ICM ) jobshare
Dr Hugh Montgomery Reader in Medicine, ICU Consultant ) jobshare
Locum Post Substantive post due to be appointed February 2007
6th Consultant Substantive post due to be appointed February 2007

Middle grade clinical fellows

6 Middle grade clinical fellows (6 month posts)

Specialty Training Registrars

3 StRs 1/2 anaesthetics programme (3 month posts)
2 StRs 1/2 acute care common stem programme (6 month posts)
2 StRs 1/2 core medical training programme (3 month posts)
1 stand alone trust posts (StR level) (6 month post)

Foundation Year Trainees

1 FY 2 trainee (shared with microbiology in 3 month blocks)
1 FY 1 post (4 month blocks)

Specialty Training Registrars Anaesthesia Aug 2007

THE POST
These are full time ICU StR 1/2 posts providing training in intensive care medicine in
the setting of an adult District General Hospital Unit. Duties are mainly in the Critical
Care Unit but also with the Outreach service.

There is a weekly training session, currently held on a Friday morning, which all
intensive care trainees are required to attend. There is a consultant-led ward round
every morning. There is close consultant supervision with a dedicated rota as well as
middle grade support from a Registrar level, Trust Grade ICU Anaesthetist.

All 8 StRs participate in a 1 in 8 rota, which is consistent with EWTD and Band
1A. The eight-weekly rota is designed on a full shift basis, and includes internal
cover for annual leave. There is ample time for private study for those pursuing post-
graduate examinations.

THE DEPARTMENT
The Intensive Care Unit is part of the Surgical Directorate.

A new state of the art critical care Unit, located conveniently for Emergency Department,
Theatres and Imaging, was opened in November 2006. The Unit has capacity for 15
patients, combined Level 2 (high dependency) and 3 (intensive care). The Intensive Care
team is responsible for all patients in the unit. Capacity will increase from the current 11
beds up to a maximum of 15 once additional staff recruitment is complete.

Patients admitted to the Unit are nominally under the care of their admitting consultant. The
ICU staff advise on and co-ordinate the management of the patients so that there is a multi-
disciplinary approach to care.

DUTIES OF THE POST

The clinical duties of the post include management of inpatients within the Critical
Care Unit and assessment of patients on wards and in the Emergency Department
with the Critical Care Outreach Team. The trainees are expected to co-ordinate the
management of the patients in discussion with more senior ICU staff and the
admitting team.

AUDIT
There is ongoing audit within the unit and the outreach service, in conjunction with a
computerised database. The post holder is required to participate in this audit and
routine data collection. There are also opportunities for trainees to undertake their
own projects.

POST GRADUATE EDUCATION

The Acting Director of Medical Education is Dr Anna Kurowska.

The Postgraduate Centre runs on site ALS, ATLS, APLS, ALSO life support courses
in addition to a variety of other postgraduate training programmes

There is a multidisciplinary library in the Archway Wing that also gives full-text electronic
access to some journals

Specialty Training Registrars Anaesthesia Aug 2007

Attendance at the Induction Days is mandatory and a condition of acceptance of the
post. New trainees will be oriented and Department and Hospital policies outlined.

TEACHING
Medical students are regularly allocated to the Theatres and the Intensive Care Unit,
as are student nurses and trainee paramedics. The postholder is expected to
participate in the teaching of these groups.

HOURS OF DUTY
The hours of duty are New Deal & EWTD 2009 compliant.
The postholder should be prepared to perform duties in occasional emergencies and
unforeseen circumstances. Commitments arising in such circumstances are, however,
exceptional and the postholder will not be required to undertake work of this kind for
prolonged periods or on a regular basis. All efforts will be made to ensure that work of this
kind does not result in continuous hours of duty that exceed the New Deal continuous hours
of duty limits.

CONDITIONS OF APPOINTMENT
1. Medical Clearance is required prior to the commencement of appointment
2. The posts are available from August 2007
3. No canvassing of consultants is permitted.

TERMS AND CONDITIONS OF SERVICE

This post is subject to the Terms and Conditions of The Whittington Hospital NHS Trust and
in particular to the Pay and Conditions of Service relating to the Medical and Dental Staff
group as set out in the relevant handbooks. Copies of these may be seen in the Human
Resources Department. The appointment is superannuable, unless you choose to opt out of
the National Health Service Superannuation Scheme.

Offers of employment are subject to the Occupational Health Service clearing you as fit for
the post. If successful you will be given a health questionnaire, which should be completed
fully and mailed, to the Occupational Health Service by return of post; you will not be able to
take up employment with the Trust until clearance has been given.

Because of the nature of the work of this post, it is exempt from the Section 4(2) of the
Rehabilitation of Offenders Act (1974) by virtue of the Rehabilitation of Offenders Act
(Exemption Order 1975). Applicants are therefore not entitled to withhold information about
convictions including those, which for other purposes are “spent” under the provisions of the
Act and in the event of employment any failure to disclose such convictions could result in
dismissal or disciplinary action by the Trust. Any information given will be completely
confidential and will be considered only in relation to application for positions to which the
order applies.

MEDICAL AUDIT

The appointee will be required as part of their duties to take part in the audit and clinical
effectiveness activities overseen by the CREED department to attend the Training and Audit
half days and to ensure that trainees within the department also take part in these activities.

RESEARCH AND DEVELOPMENT

Specialty Training Registrars Anaesthesia Aug 2007

The Trust has a very large research programme for a district general hospital and revenues
a levy I funding of £750k that is spent specifically on the support of R&D. All staff are
actively encouraged to undertake R&D. There are particular strengths in Health Care
Informatics, Diabetes, Lipids and Women’s Health.

Annual Leave

Annual leave is given in accordance with the Terms and Conditions of Service relating to
Medical and Dental staff.

All medical staff have a duty to book their leave as far in advance as possible. Trust policy is
that all medical staff must give a minimum of 6 weeks notice of intention to take leave so that
clinical duties can be managed effectively. The Trust policy for all types of leave is
contained within the policy ‘Annual, Study and Sick Leave Protocol for Medical Staff’.

Trainees on an internal rotation will be expected to take leave on a pro rata basis during
their posts. This is equivalent to 9 days annual leave per 4 x month post.

Study Leave

Study leave is given in accordance with the Terms and Concessions of Service relating to
Medical and Dental Staff. All study leave for Trust Grade doctors is granted at the discretion
of the Clinical Director

Rotas and Banding

All rotas worked by junior doctors in training are compliant with the requirements of both the
New Deal for Junior Doctors and the European Working Time Directive (EWTD). Please be
aware that if you are on an internal rotation your banding may change as you rotate into a
different department and rota.

Confidentiality

You are required to maintain confidentiality of any information concerning patients which you
have access to or may be given in the course of your work, in accordance with current policy
on confidentiality in the Whittington Hospital NHS Trust.

Protection of Children

In order to protect children from the risk of abuse some posts are offered subject to the
appointee’s agreement to the police being approached for the disclosure of any criminal
record. If your post falls into this category you will be asked to complete a form giving this
permission for the check to take place.

Personal Conduct

All staff within the Trust are expected to treat other members of hospital staff with courtesy
and respect. The Trust’s rules and policies including the disciplinary procedure apply to all
staff without exception. The attention of medical staff is drawn to the GMC document, ‘The
Duties of the Doctor’ and the hospital’s policy on ‘Maintaining Medical Excellence’. The
Trust will take this into account when considering the conduct of medical staff in relation to
any incident.

Specialty Training Registrars Anaesthesia Aug 2007

Health & Safety Policy

Employees must be aware of the responsibilities placed on them under the Health and
Safety at Work Act 1974, to ensure that the agreed safety procedures are carried out to
maintain a safe environment for employees and visitors. The appointee will be required to
provide evidence of his/her Hepatitis B immune status before employment.

Security

It is the responsibility of all employees to work within the security policies and procedures of
the Whittington Hospital NHS Trust to protect the patients, staff and visitors and the property
of the Trust. This duty applies to the specific work area of the individual and the Hospital in
general. All staff are required to wear official identification badges.

Data Protection

This post has a confidential aspect. If you are required to obtain, process and/or use
information held on a computer or word processor you should do it in a fair and lawful way.
You should hold data only for the specific registered purpose and not use or disclose it in
any way incompatible with such a purpose and ought to disclose data only to authorised
persons or organisations as instructed. Breaches of confidence in relation to data will result
in disciplinary action.

No Smoking

The Hospital has promoted a No Smoking Policy as part of its responsibility for the provision
of health. You will be expected to work within the framework of this policy and to give advice
on its development. Smoking is not permitted in offices.

Equal Opportunities

It is the aim of the Trust to ensure that no job applicant or employee receives less than
favourable treatment on grounds of sex, race, colour, nationality or national origins and is
not placed at a disadvantage by conditions or requirements that cannot be show to be
justifiable. To this end the Trust has an equal opportunities policy and it is for each
employee to contribute to its success.

Method of Payment

Payment of salary is made into bank account/building society account by direct bank system.
Details of a bank account or building society account will be required on the first day at work.
There is no facility for any other form of payment.

Specialty Training Registrars Anaesthesia Aug 2007