CONSULTANT IN PAEDIATRIC ALLERGY WITH GENERAL PAEDIATRICS
royal hospital for children, glasgow
INFORMATION PACK
REF: 39116D
cLOSING DATE: nOON on 16th october 2015
SUMMARY INFORMATION RELATING TO THIS POSITION
Post: CONSULTANT IN PAEDIATRIC ALLERGY WITH GENERal PAEDIATRICS
Base:royal hospital for children, glasgow
The Women & Children’s Directorate (An Acute Operating Division of Greater Glasgow & Clyde, NHS Board) is a world leader in child and maternal health services. Recently colocated on the New South Glasgow Hospitals campus, adjacent to the newly built Queen Elizabeth University Hospital, the new, state of the art, Royal Hospital for Children hosts many national and regional specialist services. The Directorate also supports an extensive array of community child health services.
This is an exciting opportunity to belong to a dynamic team including 3 consultants within the department of infectious diseases, immunology and allergy. The major remit of this full time post is to lead the allergy component of the service, maintain excellence in Paediatric Allergy and further to develop the managed clinical network in paediatric allergy within the West of Scotland. The post holder will also contribute to provision of general paediatric services to the children of Glasgow.
This is an exciting opportunity to belong to a dynamic team including 3 consultants within the department of infectious diseases, immunology and allergy.. The major remit of this full time post is to lead the allergy component of the service, maintain excellence in Paediatric Allergy and further to develop the managed clinical network in paediatric allergy within the West of Scotland. The post holder will also contribute to provision of general paediatric services to the children of Glasgow.
Applicants must have full registration with the General Medical Council, a licence to practise and be eligible for inclusion in the GMC Specialist Register. Those trained in the UK should have evidence of higher Specialist Training leading to a CCT in General Paediatrics or eligibility for specialist registration (CESR) or be within six months of confirmed entry at the date of interview. Candidates should ideally have spent at least 2 years in approved posts/programmes in paediatric allergy. However, candidates trained in general paediatrics with some allergy experience are invited to apply. Non UK applicants must demonstrate equivalent training.
For informal enquiries and further details please contact:
Dr Rosie Hague, Consultant in Paediatric Infectious Diseases and Immunology, Royal Hospital for Children 07855107094
NHS Greater Glasgow & Clyde
Women and Children’s Directorate
Information Pack
for the post of
Consultant in Paediatric Allergy with general paediatrics
RoyalHospital for Children, Glasgow
REF:39116D
CONSULTANT IN PAEDIATRIC ALLERGY
JOB DESCRIPTION
REF: 39116D
THE POST
This post is a replacement post to maintain excellence in Paediatric Allergyaims to develop further the managed clinical network in paediatric allergy within the West of Scotland (WoS).
Candidates should be trained in general paediatrics and ideally will have spent at least a year in approved posts/programmes in paediatric allergy. However, candidates trained in general paediatrics with some allergy experience are invited to apply. Applicants should possess, or be within six months of receiving CCST/CCT in general paediatrics
Any Consultant who is unable for personal reasons to work full-time will be eligible to be considered for the post; if such a person is appointed, modification of the job content will be discussed on a personal basis with the directorate in consultation with consultant colleagues.
Section 1Children’s Services across NHS Greater Glasgow and Clyde
The post is based at the NewRoyalHospital for Children, South Glasgow (RHC).The hospital was founded in 1883 and the new building opened in June 2015. The hospital forms part of the NHS Greater Glasgow and Clyde Women and Children’s Directorate, Acute Division. The RHC is one of the largest children’s’ hospitals in the United Kingdom and the largest in Scotland. The Division provides secondary health care to a local population of 900,000, but tertiary paediatric services to the entire West of Scotland, population 3 million. Several national services are provided, including Renal Transplantation, Paediatric Cardiac Surgery, Complex Airway, Bone Marrow Transplant, Erbs Palsy and ECMO (Extracorporeal membrane oxygenation).
All paediatric medical and surgical subspecialties are represented, including general medical paediatrics, cardiology, neonatology, neurology, nephrology, respiratory, endocrinology, gastroenterology, immunology and infectious diseases, dermatology, haematology/oncology, rheumatology, metabolic medicine, audiology, ophthalmology, ENT surgery, orthopaedics and general paediatric, neonatal surgery and neurosurgery. A selection of child and adolescent psychiatry facilities are located within the campus along with a recently opened Child Protection Unit. There is an Emergency Department at RHC which sees 45,000 new patients annually. There is also a 24 bed Paediatric Intensive Care Unit. . It comprises eleven operating theatres, a dedicated endoscopy room and a dental suite. The complex also includes a spacious Day Surgery Unit.
The diagnostic imaging facilities available on-site include MRI, CT, ultrasound and nuclear medicine, and a fluoroscopic digital screening room. A Scotland-wide PACS for transmission of digital diagnostic imaginghas been rolled out. Virtually all the hospitals in Glasgow, are filmless. Laboratory provision includes a Department of Paediatric Pathology and the regional Department of Medical Genetics.There is on site clinical audit and research and development support to assist with departmental research projects.
The RoyalHospital for Children is a major centre for research and education. The hospital provides the major Undergraduate Paediatric Teaching facility for the University of Glasgow and accommodates the University Departments of Child Health, Child and Family Psychiatry, Medical Genetics, Human Nutrition, Paediatric Pathology, Paediatric Biochemistry and Paediatric Surgery. There are also links with both Caledonian and StrathclydeUniversities. The Research and Development Department and the Department of Clinical Audit provide assistance with research projects. A Scottish Medicines for Children Network (SMCN) supports research projects adopted through Clinical Studies Groups of UK based Medicines for Children Research Networks.
Other Paediatric Services in Glasgow and Clyde
Maternity services are delivered at the Southern General Hospital, the Princess Royal Maternity Hospital andRoyalAlexandraHospital, Paisley, all with neonatal facilities. There is also a Paediatric Ward in the RoyalAlexandraHospital.
Paediatric Radiotherapy (under general anaesthetic) is completed at the Beatson Oncology Centre (located at the Gartnavel campus).
There is an extensive range of specialist community based children’s services across NHS Greater Glasgow and Clyde. Managed within Community Health and Social Care partnerships, these services are integrated with Primary Care and Social Care Services. Well established clinical links across combined Acute and Community settings within the NHS Board are in place.
Section 2Paediatric Services
Clinical Leadership
The paediatric allergy service is a key component of integrated hospital paediatric services within the Women and Children’s Directorate (of Acute Operating Division, NHS Greater Glasgow and Clyde)
- Dr. Phil Davies is the clinical director for specialist medical services. Dr Christine Gallacher is clinical director for general paediatrics.
They are supported by a number of link clinicians.
For paediatric allergy this is:
- Dr Rosie Hague(Consultant in Paediatric Infectious Diseases and Immunology)
Link clinicians support general and paediatric sub-speciality services.
The structure of clinical leadership is mirrored within surgical services.
National Service Contracts
The RoyalHospital for Children hosts a number of paediatric national services. These national services are listed in box 1 below:
Box 1 / Paediatric National Services
Future Service Developments
Section 3 The Work of the Paediatric Allergy Service
The Royal Hospital forChildren, provides secondary paediatric services for the children of Greater Glasgow, and specialist services for the West of Scotland, together with some national services. The current model of provision for allergy reflects this pattern of care.
The specialist allergy service was established with the appointment of a consultant in infectious diseases and immunology in 1994. Initially, because of the lack of provision of allergy services generally, referrals were accepted from throughout the West of Scotland and beyond. More recently, however, links have been made with local paediatricians to ensure good quality of secondary allergy care within district general services. Currently, therefore referrals are accepted from primary care for children residing in Greater Glasgow, and from general paediatricians throughout Scotland – but chiefly the West.
Not all children with atopic disease are seen within the specialist allergy service. Services are also provided by various system speciality services (eg dermatology, respiratory, GI, ENT) , as described below.
The specialist allergy service
The major remit of this service is assessment and management of children who may be at risk of anaphylaxis. Referral criteria are therefore: children up to the age of 16 ; symptoms compatible with type 1 immediate hypersensitivity reactionsfollowing exposure to a potential allergen, which in the majority of cases is food. Referrals of children with histories suggestive of other forms of food intolerance are directed to general paediatrics and dieticians. Children with suspected allergic asthma or allergic rhinitis are managed by the appropriate general paediatrician or organ-based specialist.. Children with severe or complex multiple allergy are seen, as are children who may be candidates for immunotherapy, such as those with severe aero-allergen induced symptoms. A service for the investigation and management of drug allergy has been developed, and we offer sub-cutaneous immunotherapy according to the criteria set down by the Scottish Medicines Consortium. There is no SMC approved sub-lingual immunotherapy in Scotland.
In addition to general medical and nurse-led allergy clinics which cater for the majority of patients, there is a multi-disciplinary complex allergy clinic, and a specific teenage allergy clinic is due to commence shortly.
Current personnel
2 full time consultants in paediatric infectious diseases and immunology providing 1-2 clinics/month each
1 full time consultant in general paediatrics with an interest in allergy (advertised post)
1 consultant general paediatrician who provides secondary allergy services in Clyde and 1 clinic/month average in RHC.
1 consultant general paediatrician from Dumfries and Galloway who provides monthly in-reach.
1 middle grade trainee providing supervised clinic sessions in association with consultant led clinic
2 nurse practitioners sharing 1 nurse led clinic per week
1 specialist nurse practitioner in allergy providing 2 clinics per week, support for the nurse led allergy diagnostic service and mmunotherapy and drug allergy service.
Services involved
Nurse led allergy diagnostic service (see below)
Dietician:
Out patient phlebotomy
Community liaison: health visitor/ school nurse + administration
Allergic eczema service
Atopic children commonly present initially with their infantile eczema to the dermatology service. Over the last few years close links have been developed between the dermatology and specialist allergy service, aiming to ensure a common approach to care, with agreed guidelines and well defined pathways between the 2 services. All paediatric dermatologists see children with allergic eczema, and when appropriate, children are investigated within this service for specific allergen triggers to their eczema. If potential food allergens are identified, their diets may be restricted, with input from the dietician. Some of these children also have type 1 immediate hypersensitivity reactions to the same foods. While such children may be referred to the allergy service at any point, many of these children continue to be managed by the dermatologists, who address this aspect of their care, and ensure that a management plan is in place. As their eczema improves, to the point when they no longer need specialist dermatology input, those who remain on restricted diets are assessed to establish whether they are at ongoing risk of type 1 reactions. If this is the case, they are referred to the allergy service.
Contact dermatitis and its potential triggers is investigated by the dermatology service, which provides patch testing when required. The dermatology service also sees children presenting with unexplained urticaria if they meet the criteria outlined by a published urticaria management pathway
Nurse led allergy diagnostic service
This is based on the ambulatory unit, ward 1C, and involves all the nursing staff on the unit. It is led by the ambulatory care nurse practitioners, and the allergy nurse practitioner. Referrals are accepted from general and specialist services in Yorkhill. It also supports allergy services elsewhere in the West of Scotland by arranging investigations, which are not available locally. It currently provides:
- Skin prick testing
- Oral challenge sessions.
- Support and advice for all other hospital departments in aspects of allergy
- Antibiotic and other drug sensitivity testing
- Immunotherapy
The ward based staff involved in this service have many other roles in provision of ambulatory care, in addition to their responsibilities for allergy.
The allergy nurse practitioner has a major ongoing role in the development of the drug allergy service and immunotherapy.
Skin prick testing for the allergy clinics is provided by outpatient nursing staff, supported by the nurse led service.
Allergy provision in other services
The respiratory service may initiate investigations for allergy, particularly to inhaled allergens, as part of the holistic assessment of asthma. Skin prick testing requests generated are managed by the outpatient department and nurse led service. Children identified with food allergies will be referred to the specialist allergy service.
The ENT service sees the majority of children referred with allergic rhinitis, supported in SPT by the outpatient staff and the nurse led allergy service. While for the majority, treatment is symptomatic, or occasionally surgical, with the evolution of immunotherapy, it is anticipated that this service may generate an increasing number of requests for consideration of this treatment.
The GI service sees some children in whom non-IgE mediated allergy or food intolerance may be included in the differential diagnosis.
At present, most questions regarding possible non-IgE mediated food intolerances are addressed by general paediatricians. General paediatricians may also identify children with other forms of allergy, and either manage with input from the specialist service, or refer.
Relationship with regional and national service
Informal links with the general paediatric services providing local care for children attending their local district general hospitals with allergy are already well-established. The breadth of service provided locally is still variable, with some sites not being able to provide the full range of diagnostic services.
Nationally, the service supports the Children and Young People’s Allergy Network (CYANS) created as part of the National Delivery Plan for Specialist Children’s Services. It is anticipated that the post-holder will have a major role in the function of this network.
Medical Staff:
Dr Rosie Hague, Consultant in Paediatric Infectious Diseases and Immunology (link clinician)
Dr Conor Doherty, Consultant in Paediatric Infectious Diseases and Immunology
Members of Multi-disciplinary Team
Sister Maureen Lilley, Ambulatory Paediatric Ward
Sister AllisonAmbulatory Paediatric Ward
Sister Elizabeth Morton, Paediatric Allergy Nurse Practitioner
Paediatric dieticians support this service
Non Consultant Career Grades & Trainees
In general there is one designated middle grade trainee in the paediatric allergy, infectious diseases and immunology service. Glasgow is not currently accredited by CSAC for tertiary training in paediatric allergy, nor in infectious diseases and immunology. All trainees participate in the general medical on call rota and when on call are not available for subspeciality work.
Consultant Staff in Allied Departments
Dermatology
Dr Paula Beattie
Dr Catherine Jury
Transition arrangements
Young people requiring ongoing specialist input are referred to the West of Scotland anaphylaxis service, based in Gartnavel GeneralHospital. It is hoped the teenage clinic will be a base to form closer links with this service.
Support Facilities (Offices/Secretary):
Shared office accommodation, secretarial and IT support will be available. HISS, Clinical Portal and PACS providesan automatic download facility of chemical pathology, haematology, radiology and histopathology results.
DUTIES AND RESPONSIBILITIES
a)Clinical
The consultant will take responsibility for the majority of the allergy workload, with some input from the 2 ID/Immunologyconsultants. . The existing consultants will, give support to the allergy service, at a level appropriate to the experience of the successful candidate.
The post holder’s responsibilities will include outpatient clinics, provision of a consultation service for children admitted acutely with allergic disease, and advice to other departments within RHC, telephone advice for other clinicians in the West of Scotland and occasional emergency referrals. The postholder will be expected to work closely with the nurse practitioners in allergy and ambulatory care as part of a multidisciplinary team who provide the diagnostic service, supervise food challenges, and drug allergy testing. They will be expected to lead the immunotherapy service, andthe drug allergy service. The post holder will be expected to develop and implement appropriate evidence based policies, pathways, protocols and guidelines to support allergy practice and to support both general paediatric and specialist services patients with allergy.
In addition to the requirement to participate in the general paediatric on call rota (see below), sessions may be available to maintain skills in general paediatrics, or in infectious diseases and immunodeficiency. It is not envisaged that these would exceed 2PAs per week, and would be dependent on negotiation of a job plan which satisfied the primary goal of allergy service provision.