THE ROYAL WEST SUSSEX NHS TRUST

ST RICHARD'S HOSPITAL

 GENERAL PRACTITIONER VOCATIONAL TRAINING SCHEME

ST RICHARD'S HOSPITAL

 St Richard’s Hospital is a 500-bed hospital, which is the main provider of acute hospital services serving a population of approximately 212,000 people in South West Sussex and East Hampshire covering over 450 square miles.  A key characteristic of this catchment population is that nearly 25% are over the age of 65 compared to the national average of 15%.  In the summer months the population increases in excess of 320,000.

 The hospital provides a range of core services including accident and emergency, acute medicine and elderly medicine, general surgery, urological surgery, orthopaedics, obstetrics, gynaecology, paediatrics (including SCBU), rehabilitation and cancer services.  In addition, the hospital provides special expertise in the following areas; maxillofacial surgery, diabetes, vascular surgery, chronic pain relief, aortic aneurysm and colorectal screening, minimally invasive surgery, special back clinic, cardiac catheterisation and pacemaker implantation, and services for the younger physically disabled.  There is a 24 hour Accident and Emergency Department, an 18 bedded Medical Admissions Ward, and supporting diagnostic, physiotherapy and occupational therapy facilities.  A whole body CT Scanner augments the diagnostic facilities and MRI is planned for early 2004.

 A £44 million redevelopment of the hospital was completed in 1996.  Phase I included a Day Surgery Unit, comprising 2 operating theatres, an endoscopy suite, a dental surgery, and associated self-contained recovery and patient care facilities.  This is one of the best units of its type in the South of England where patients can have day surgery, including keyhole surgery, laser treatment, chemotherapy and endoscopy.  Other projects included a new larger Diabetes Centre, a new Doctors' Mess, improvements to the Theatre Sterilisation Unit and improved car parking facilities.  Phase II opened in December 1996 and includes a purpose built two storey building which consists of 16 wards, a 6 bed Intensive Therapy Unit, 6 bed Coronary Care Unit, 6 theatres, a new day hospital for the elderly and a new rehabilitation unit.

A new stage in the hospital redevelopment will open shortly with the building of a Diagnosis and Treatment Centre (DTC) which will replace the present Day Surgery Unit.  This will house 4 operating theatres, an endoscopy suite and a coronary angiography suite.  A new on-site nursery was opened in July 2004.

The number of patients cared for each year is 125,000 out-patients, 26,500 in-patients, 45,000 A & E attendances, 13,000 day surgery procedures and 1,900 births.

The Chichester Suite is a purpose built 12-bedded Private Patients Unit, which opened in July 1997 and in October 1998 expanded to 16 beds.  The suite is an integrated part of St Richard’s Hospital (work in this area may be included within this post).

 The Trust has been awarded a whole hospital Charter Mark for the third consecutive 3 year period and is also holds the Investors in People award. 

THE LOCALITY

The hospital is situated in a very pleasant part of the country, just south of the Downs and about six miles from the Channel coast, where there are excellent facilities for sailing and other water sports, particularly in Chichester Harbour.  As the county town of West Sussex, Chichester is an important administrative, industrial and business centre.  The Cathedral city of Chichester is a local centre of culture as well as a popular tourist venue.  The Chichester Festival Theatre, which is within walking distance of the hospital, is an internationally famous tourist attraction. 

The well-known racecourses of Goodwood and Fontwell are nearby, as are facilities for a wide variety of sporting and other recreational activities, including a local tennis and squash club.

The main shopping centre is within walking distance and there is a public transport service between the hospital and the town and the railway station.  Car parking facilities exist in the hospital grounds.  Both road and rail communications are good with a direct link to Victoria, London and Gatwick Airport. 

THE SCHEME 

There are three posts on the Chichester General Practitioner Vocational Training Scheme, which commence in February,.  The hospital appointments consist of six months in Medicine, six months in Obstetrics and Gynaecology, six months in Paediatrics and six months in Accident and Emergency.  There is an option to undertake six months in Psychiatry if candidates have already completed a SHO in one of the other specialties.  The scheme concludes with a period of one year  as a General Practitioner Registrar.
 

MEDICINE

The successful candidate will spend three months in Medicine for the Elderly working for

Dr Holman on the rehabilitation side of the firm with a significant component of acute general medicine.  The firm consists of the Consultant, one Specialist Registrar, two Senior House Officers (one on the acute side and one on the rehab side) and one Pre-Registration House Physician.  The Senior House Officer duties for the post will fall into the following areas:

• As part of the general medical team the SHO will help supervise the care of emergency admissions under the care of Dr Holman.
   

• Management of in-patients on Ashling Ward.
   

• The Senior House Officer will undertake general medical out-patient clinics plus there is the chance to attend Dr Coburn’s Dermatology Clinics for teaching. 
   

• The Senior House Officer will receive regular tuition from the Consultants, Specialist Registrars on the firms.  There will be opportunities and expectations to present at the regular medical, cardiac and elderly medicine meetings at St Richard’s.
   

• Dr Holman has a special interest in Gastroenterology in the Elderly.

The remaining three months will be spent on the Medical Assessment Unit and the postholder will be responsible for the day-to-day care of patients on the Medical Assessment Unit and will regularly liaise with the on-call teams.  The postholder will undertake on-call duties from 5pm to 9.30 pm to cross cover the on-call commitment of the SHOs on annual leave and study leave and will include some work at weekends.

The acute medical, medicine for the elderly and rheumatology services are fully integrated, with all specialties taking part in the acute general medical rota.  The successful candidate will act as junior SHO on the rota, with supervision being provided by an experienced SHO and a Specialist Registrar.  A full shift system is worked throughout and a system of internal cover is operated. A normal day shift is from 8.30 am to 5.00 pm  Each 24 hour on-call period will be covered by 2 teams.  The first on-call team consists of the Consultant, Specialist Registrar, SHO and House Officer who will admit patients between 8.30 am and 9.30 pm.  The second on-call team will provide ward cover and assist with the acute admissions between 5 pm and 9.30 pm.  The workload at night is covered by one SpR and one SHO from 9.30 pm to 9.30 am and a second SHO covers the ward work from 7 pm to 2 am.

The members of the medical department meet weekly on a Wednesday afternoon.  The sessions include audit, case presentations, topic reviews and outside speakers.  Senior House Officers in Medicine for the Elderly will be expected to present cases at this meeting.  There are regular x-ray and inter-departmental meetings in the Department of Medicine for the Elderly.

The post is recognised for training by the Royal College of Physicians and the Royal College of General Practitioners.
 

OBSTETRICS AND GYNAECOLOGY

The Department consists of five Consultants:

Mr J L Beynon (Oncology)

Mr J G Hooker (Lead Clinician)

Mr Z H Z Ibrahim (Fertility)  (Educational Supervisor)

Mr A M Simons (urogynaecology)

Mr M C Jolly (fetomaternal medicine)

The junior staffing consists currently of one Staff Grade Surgeon (13 sessions), two Specialist Registrars, two Clinical Research Fellows, one Trust Doctor (SpR level), one Experienced SHO (works on middle grade rota), and three junior Senior House Officers, who are usually GP Trainees. 

Each Consultant has a Specialist Registrar or experienced SHO attached to him.  Each SHO will work for two Consultants (three months each).  Mr Beynon and Mr Jolly will be paired as one owing to their commitments in Portsmouth.

Duties are at St Richard's Hospital and include the provision of ante-natal, natal and post-natal care for patients of the local area.  There are forty-seven obstetric beds, with a modern delivery suite and up-to-date foetal monitoring equipment.  There are approximately 2,000 deliveries a year.  There are excellent facilities within the department including two modern ultrasound machines in the ante-natal clinic and a third on the gynaecology ward for use in an early pregnancy assessment clinic.  A detailed ante-natal scan is offered to all women between 18 and 20 weeks. 

There is a Neonatal Care Unit adjacent to the delivery suite, and there are full Paediatric, Anaesthetic and Pathology services available. 

There are fifteen gynaecological beds available for in-patients.  Fertility scanning is provided on the ward and fertility out-patients are held on alternate weeks.  Seven colposcopy clinics we held each month.  SHOs will have opportunities to attend these specialist clinics.

An early pregnancy assessment clinic is held each morning on the gynaecology ward.  There is an out-patient service in the maternity block.  Day cases come either through the gynaecology ward or more usually through the Day Surgery Unit.

From August 2004 the SHO timetable changed to a full shift system.  Each SHO will get exposure to the full range of obstetric and gynaecological work within the department.  One week in three will be predominantly “educational” (clinics, tutorials, etc) while the other two weeks will have a stronger service element (clerking, ward work, administration).  SHOs will no longer work at night.  The standard working day will be 0830 to 1730 hours.  One SHO will remain on duty each week day until 2130 hours but the shift will finish at 1930 hours on Saturday and Sunday.  Each SHO will have one half day a week.  This arrangement will comply with the European Working Time Directive giving an average of 54 hours per week.

The post is recognised for the Diploma of the Royal College of Obstetricians and Gynaecologists.  Wednesday afternoons are given over to teaching beginning with a combined obstetric/paediatric meeting to discuss peri-natal morbidity.
 

ACCIDENT AND EMERGENCY

The staffing consists of three Consultants, Dr A M T Findlay, Dr F M Barratt and Dr A Wellesley, two Associate Specialists, four Staff Grade Doctors, two Specialist Registrars and nine Senior House Officers.

The Accident and Emergency Department provides a 24 hour a day facility for the reception and immediate care of all types of emergency cases.  The case mix includes major and minor trauma, as well as medical, surgical and paediatric emergencies.  The department consists of a 4 bay resuscitation room, 6 bay majors area, 9 bay minors area, 4 bay obs ward, a room for relatives and a dedicated children’s area.  The department is fully computerised (ReMASS System).

Duties include the primary care of Accident and Emergency patients, treatment of trauma cases, major and minor cases referred by General Practitioners, the reduction of closed fractures, minor surgical procedures, etc.  The Department works closely with all other departments of the hospital, and has an Accident and Emergency dedicated Occupational Therapist.

The duty roster is for 51 hours per week.  A system of internal cover is operated to cover annual leave and study leave. 

There is an extensive training programme in all aspects of Accident and Emergency medicine including paediatric, cardiac and trauma life support.  There is a weekly tutorial (protected time) on a Tuesday morning which all Senior House Officers must attend.
 

PAEDIATRICS

Staffing of the Child Health Team is as follows:

Dr L S Lamont, Consultant Paediatrician (part-time)

Dr T M Taylor, Consultant Paediatrician

Prof D C A Candy, Consultant Paediatrician

Dr M Linney, Consultant Paediatrician

Dr A C M Wallace, Consultant Community Paediatrician

Dr M A Bracewell, Consultant Community Paediatrician (part-time)

Dr M Greenwood, Consultant Community Paediatrician (part-time)

Dr Q Spender, Consultant in Child and Adolescent Psychiatry.

Junior staffing consists of one Staff Grade Doctor, two Specialist Registrars, two Trust Doctors (SpR level) and seven Senior House Officers.  The Specialist Registrars and Staff Grades are responsible for supervision of the Senior House Officers.

The acute paediatric services account for 1,800 admissions and 5,000 out-patient attendances per year.  The maternity unit accommodates 1,900 deliveries a year of which 200 babies are admitted to the Special Care Baby Unit.  The unit provides short term intensive care to neonates.  In-patient provision is within

1          A Children's Ward of 24 beds for all Paediatric, Medical, Surgical and Orthopaedic patients.  The Paediatric Department is responsible for the medical patients but plays a supervisory role giving assistance and advice for all patients on the ward.

2          Neonatal Unit of 10 cots, adjacent to the Maternity Ward.

The staffing of the Chichester District Community Child Health Services consists of three Consultant Community Paediatricians and two Senior Clinical Medical Officers and three Clinical Medical Officers.  The district population covered is from the Hampshire/Sussex border in the west to Arundel in the east.  The Community Child Health Services oversee the Early Child Health Programme, Immunisation Programme, School Health Services.  They provide medical advice to Education, Social Services, Adoption and other agencies.  Services for children with special needs, child development team, child protection advice are also provided.  There is a children's palliative care team based in the community.

The post is divided into blocks, each of approximately one month.  These are allocations to the paediatric ward, Special Care Baby Unit, post-natal ward, out-patients and Community Paediatrics.  Within these blocks the specific responsibilities are:

• Responsibility for clerking, investigating and treating all medical admissions to the Children's Ward.
   

• Attendance at abnormal deliveries and at any emergency associated with the birth of a baby, and care of the babies in the Neonatal Unit.
   

• Examination of newborn babies within 24 hours of birth or dealing with neonatal problems arising on post-natal wards.
   

• Preparation of discharge summaries.
   

• Attendance at Out-patient Clinics, baby Follow-up Clinics and Ward Rounds.
   

• Attendance at educational/audit meetings in the Child Health Department and at clinics with visiting Consultants (Cardiology, Neurology, Surgical).
   

• Take part in the assessment/examination of normal children in the community as part of the District Child Health Surveillance programme.
   

• Visit normal and special schools and attend the Child Development Clinic which accepts children referred because of significant developmental delay and/or medical and social handicaps, and be responsible for arranging appropriate investigations.
   

• Attend case conferences.
   

• Work on an audit project under supervision of educational supervisor.

A full shift system with internal cover is currently worked.

The post is recognised for the Diploma in Child Health and for Higher Professional Training by the Royal College of Physicians.
 

PSYCHIATRY

West Sussex Health & Social Care NHS Trust provides mental Health Services in the area.  There are 10 full-time SHO posts in Psychiatry, which include three in Psychogeriatrics, one in Learning Disability and one in Rehabilitation Psychiatry.  Posts in General Adult Psychiatry which are available to GP trainees involve duties on the Centurion Unit, the acute admission unit on the Graylingwell site as well as at the relevant Community Health Centre (Bognor, Chichester or Midhurst) where the Community Mental Health Teams are based and case reviews and outpatient clinics are held.

All posts are fully recognised for the MRCPsych and the Trust is accredited under the New Deal for Junior Doctors.  There is currently a one in ten on-call rota covering inpatients at all 3 sites, as well as psychiatric emergencies at St Richard’s Hospital.

There is a comprehensive in-house training programme in Psychiatry on Monday afternoons from 12:30 to 4:30pm.  This includes journal clubs, case presentations, psychotherapy seminars and training in interview skills.  There are also regular lectures by invited speakers as well as half-day monthly meetings on either clinical or medical audit.  There is a well-stocked specialist Mental Health Library on the Graylingwell in the Dr Peter Sainsbury Education Centre, which has Internet access available.

For further information contact Sam Vaughan, Medical Education Manager (tel:  01243 81334/815321 or ext 4334).
 

GENERAL PRACTICE

There are 12 training practices attached to the scheme which offer full and part-time training. The practices extend from Arundel to Southbourne and include both Chichester and Bognor Regis.  At the completion of the hospital posts, the successful candidate will then join their assigned practice or possibly another of their choice, as a Registrar for twelve months of in-practice training.  During this time they will be expected to attend a day release course which takes place in Worthing and Chichester, and trainer-registrar meetings each week at Chichester Medical Education Centre, St Richard’s Hospital.  They will complete Summative Assessment and be given the opportunity to take the MRCGP examination.
 

TRAINING AND EDUCATION

All posts are recognised for the MRCGP and the individual hospital posts are recognised for the various higher qualifications.  Facilities are given for study leave in accordance with the regulations.

There is an active Medical Education Centre.  A wide variety of courses, tutorials and seminars with local and visiting speakers are held under the auspices of the Postgraduate Clinical Tutor, Dr A G Dewhurst, for clinical staff of all disciplines, including general practitioners.  All categories of medical staff are able to meet in the doctors’ dining room within the centre at lunchtime.  The large lecture theatre has the latest computerised presentation technology.

Library support for clinical activity, research and education is provided by Chichester Health Libraries, one of the largest non-university health libraries on the south coast.  Facilities include 200 journals, multimedia viewing, networked Medline and other databases and internet access. 

There is a Computer Training Centre on site which runs regular courses including the use of Word for Windows.
 

TERMS AND CONDITIONS OF SERVICE

There are local policies for grievance/disciplinary procedures and removal expenses.  The terms and conditions of the appointment otherwise offered are set out in the Terms and Conditions of Service of Hospital Medical and Dental Staff and General Whitley Council Conditions of Service as amended from time to time.

The salary is on the scale of £24,587 – £34,477 per annum and no peripheral allowance is payable.  The payment of out of hours work is currently under review.

The postholder must be registered with the General Medical Council.

The successful candidate will be expected to pass a medical examination.  Applicants for posts which include surgical/invasive work will be asked to supply written evidence of degree of immunity to Hepatitis B.  If not immunised the result of a test which indicates freedom from carrier state will be required and immunisation should then be commenced.

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

St Richard's Hospital operates a No Smoking Policy, to which all staff must adhere.

The Trust is committed to providing safe and effective care for patients.  To ensure this there is an agreed procedure for medical staff that enables them to report, quickly and confidentially, concerns about the conduct, performance or health of medical colleagues (Chief Medical Officer, December 1996).  All medical staff, practising in the Trust, should ensure that they are familiar with the procedure and apply it.

In the event of a major incident or civil unrest all Royal West Sussex Trust employees will be expected to report for duty on notification.  All Trust employees are also expected to play an active part in training for and preparation or a major incident or civil unrest.
 

ACCOMMODATION

Accommodation, both married and single, may be available at St Richard's Hospital, although its availability to any particular doctor must depend on the position at the date they take up their appointment.  Junior medical staff wishing to be non-resident may be allowed to do so, but must always occupy an on-call room when on duty.
 

VISITING ARRANGEMENTS

Arrangements for visiting the hospital and meeting members of the staff may be made with the relevant departments preferably after shortlisting has taken place.

MJC/GPVTS/26.8.04

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