HEALTH EDUCATION THAMES VALLEY - SPECIALTY TRAINING PROGRAMME IN GERIATRIC MEDICINE
About Health Education Thames Valley
We are the Local Education and Training Board (LETB) for Thames Valley covering Berkshire, Buckinghamshire and Oxfordshire. Our vision is to ensure the delivery of effective workforce planning and excellent education and training to develop a highly capable, flexible and motivated workforce that delivers improvements in health for the population of Thames Valley. Thames Valley LETB is responsible for the training of around 2000 Foundation and Specialty trainees.
Health Education Thames Valley is a relatively small organisation with a defined geographical area which serves as a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some programmes will require successful candidates to indicate a location and specialty. Future placements will usually be based on individual training and educational needs. Please note that applications are to the Health Education Thames Valley as a whole. This may mean that you may be allocated to any geographic location within the deanery depending on training needs.
The Geriatric Medicine Training Programme
The Geriatric Medicine training programme is a five year programme, starting at ST3, during which time General (Internal) Medicine training is also undertaken. Throughout the 5 years the trainee's work will be monitored for satisfactory progress and subject to annual reviews in the form of ARCPs. Progression on the programme will be dependent upon these reviews.
The posts on this rotation have been approved for Specialist Training by the Royal College of Physicians. The posts attract National Training Numbers and provide training towards a dual Certificate of Completion of Training (CCT) in Geriatrics and General (Internal) Medicine.
The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals.
The programme is based in several different Trusts throughout Health Education Thames Valley so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:
Trust / Hospitals and LocationsOxford University Hospitals NHS Foundation Trust / John Radcliffe, Oxford
http://www.ouh.nhs.uk/
The Horton Hospital, Banbury
http://www.ouh.nhs.uk/
Local Community Hospitals
Buckinghamshire Healthcare NHS Trust / Stoke Mandeville, Aylesbury
http://www.buckshealthcare.nhs.uk/
Wycombe Hospital, High Wycombe
http://www.buckshealthcare.nhs.uk/
Royal Berkshire NHS Foundation Trust / Royal Berkshire Hospital, Reading
http://www.royalberkshire.nhs.uk/
Rotation Information
Trainees will spend some time in Oxford and the remainder of their training across the other different hospitals. Rotations will be decided annually according to the trainee’s educational requirements. All trainees will spend some time specifically in general internal medicine either exclusively or as part of their geriatric medicine attachment. The majority of the curriculum is covered at all Trusts. As a small deanery we know our trainees well, and encourage each to develop their own interest. We are supportive of flexible trainees, aiming to pair them wherever possible to improve both service and training. It is possible to live in one place for the whole training programme, commuting to each Trust.
Trust Information
Oxford University NHS Foundation Trust
John Radcliffe Hospital, Oxford
Horton General Hospital, Banbury
There are twelve posts based in Oxford:
- Two posts in acute general medicine, undertaken with a Geriatrician. These posts often involve door to discharge care of patients, including input to ITU.
- Two posts in the Acute Geriatric Wards; these trainees also input to the EMU (admission avoidance) units and specialty clinics and have opportunities to work with the liaison psychiatry team.
- One Orthogeriatric post with opportunities to attend osteoporosis clinics and complete higher level training.
- One Stroke post, in an 18-bedded Acute Stroke Unit; this trainee also attends weekly regional neuroradiology and stroke educational meetings
- Two community posts based in Abingdon and Witney Community Hospitals, where the medical staffing is from Geriatricians. These trainees will input to the locality EMU (admission avoidance) units, and have opportunities to spend time in care homes and with the falls service.
- One Day Hospital post with extensive clinic experience (Multi-disciplinary, General Geriatric, Rapid Assessment, TIA, Falls, Movement Disorders and Memory Clinics).
- One interface post, allowing experience in the developing area of interface Geriatrics, along with time in a surgical liaison role (where the new peri-operative curriculum will be covered.)
- Two posts at the Horton Hospital, working in General Medicine and General Geriatrics, with opportunities in Community Geriatrics.
Trainees (apart from those at the Horton and in General Medicine) participate in the Thrombolysis and Geratology on-call rota.
Trainees are encouraged to develop their research, governance and management portfolios whilst they are with us. Senior SpRs are encouraged to ‘act up’ before completing their CCT.
Geriatricians in Oxford have an active role in teaching and training Oxford University Medical Students, and trainees are encouraged to get involved. There is an opportunity to develop teaching ability with the Oxford Learning Institute.
There are many research groups working in Oxford, and there are links with several leading to Out of Programme Research opportunities for a number of trainees.
Oxford Geriatricians are at the forefront of clinical work in many areas, and we have appointed four new consultants in the last year. It is an exciting and dynamic place to work.
Buckinghamshire Healthcare NHS Trust
- Stoke Mandeville Hospital, Aylesbury
- Wycombe General Hospital, High Wycombe
Buckinghamshire Healthcare NHS Trust has recently undergone a major reconfiguration that has opened new avenues for training in acute geriatrics, day assessment, ambulatory care and community geriatrics
Acute Medicine for Older People services are offered out of Stoke Mandeville Hospital which hosts the only A&E, with an acute unselected medical take.
There are two MfOP teams with four MfOP Consultants and four trainees.
During their attachment they have the following opportunities:
- Acute Medicine for older people in-patient work
- Acute medical on calls.
- Day Hospital
- Neurology clinics
- MfOP Clinics
- PD clinic
- Orthogeriatrics
- Medical Unit Day Assessment Service for a next day assessment of frail older pts. The unit also offers other services such as transfusions, day procedures, lumbar punctures etc.
- Geriatric Liaison Service to provide CGA at the front door
- Old Age Psychiatry, Palliative Care, ITU and Incontinence attachments
Stroke services are based at Wycombe. There is an 8 bedded HASU and 22 bedded ASU. There are two SpRs based in Wycombe. They do their on calls for Stroke (including Thrombolysis) there. The take at Wycombe is for cardiac & Stroke patients only. There is a Cardiac & Stroke Receiving Area (CSRU) run by the two specialties. These two SpRs also get an opportunity to see pts on MuDAS and a Step-Down rehabilitation ward.
There is a newly appointed community & interface geriatrician, with responsibility for 40 beds in Amersham Community hospital. Community training for the SpRs will be incorporated into the timetable soon.
Royal Berkshire NHS Foundation Trust – Reading
There are six posts in Reading, each lasting six months, during which time the trainees will also take part in the acute general medicine rota. Working within a multidisciplinary team, the trainees will achieve core competencies in Geriatric medicine .There will be an opportunity to consolidate subspecialty experience in Falls, Orthogeriatrics, Movement disorders, Surgical Liaison, Interface and Community Geriatrics, Dementia care, Palliative care and Incontinence management. Trainees will gain experience in Comprehensive Geriatric Assessment by reviewing frail older patients attending the RACOP (Rapid Access Clinic for Older People)
There are two academic Professors within the department. Professor Margot Gosney works part time in the University of Reading and is the Head of School of Medicine at Health Education Thames Valley. She has a research interest in Cancer of older people as well as nutrition.
Professor David Oliver was the outgoing National Clinical Director for Older People and now works part time for the King’s Fund and is president elect of the British Geriatrics Society.
It is envisaged that all trainees working in Reading will undertake research of a sufficient standard to be presented nationally and published in peer reviewed journals
The posts are:
- Burghfield – where trainees will develop skills in General Geriatric Medicine, Rapid Access Clinics, Falls Clinics, General Geriatric Outpatients, continence and GIM
- Mortimer – where trainees will have develop skills in General Geriatric Medicine, Rapid Access Clinics, Parkinson ’s disease by attending the Multidisciplinary Movement Disorders Clinic for older people, General Geriatric Outpatients and GIM
- Emmer Green – where trainees will develop skills in General Geriatric Medicine, Rapid Access Clinics and Specialist Dementia Care. They will also have an opportunity to work with the Older People’s Mental Health Liaison team, attend the Dementia Steering group meetings, Rapid Access clinics and GIM
- Orthogeriatrics – where trainees will develop skills in Preoperative assessments in Hip fractures and Care of older patients with Fragility fractures, Osteoporosis management and discharge planning , Rapid Access Clinics and GIM
- Interface and Community Geriatrics – where trainees will develop skills in doing General Geriatric Medicine, Rapid Access Clinics and GIM
- Surgical Liaison/Oncology – where trainees will be able to apply CGA to two new areas, have experience in oncology and old age, palliative medicine, end of life decision making and surgical liaison. They will be able to apply geriatric medicine principles to optimise older patients for surgery and cancer treatment. They will gain experience in the coordination of cancer care including liaison with the voluntary sector
Teaching
There is a monthly teaching day and all trainees are expected to attend the General Internal Medicine monthly training.
Both training days are held either in Oxford or by rotation throughout the Deanery.
There is academic expertise in Oxford and Reading with links to local Universities. The CLRN Age and Ageing group for Thames Valley is organised in Reading. There is planned expansion in Consultant posts across the Deanery. Within the next three months two further Consultant appointments are due in Reading (Community and Hospital) and an enhanced liaison psychiatry service will also have started in Reading.
There is time available on all timetables to undertake specific special attachments within Health Education Thames Valley. Checklists of expected competencies are available and trainees are encouraged to use local, national and online facilities to fulfil the educational criteria. All hospitals have dedicated geriatric medicine teaching and trainees are expected to undertake audit and research as part of their training.
Main Conditions of Service
Appointments to this programme are subject to the Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales). In addition appointments are subject to:
· Applicants having the right to work and be a doctor or dentist in training in the UK
· Registration with the General Medical Council
· Pre-employment checks carried out by the Trust HR department in line with the NHS employment check standards, including CRB checks and occupational health clearance.
The employing Trust’s offer of employment is expected to be on the following nationally agreed terms:
Hours – The working hours for junior doctors in training are now 48-hours (or 52-hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors in training also have an individual right to opt-out if they choose to do so, but they cannot opt-out of rest break or leave requirements. However, the contracts for doctors in training make clear that overall hours must not exceed 56 hours in a week (New Deal Contract requirements) across all their employments and any locum work they do.
http://www.nhsemployers.org/your-workforce/need-to-know/european-working-time-directive
Pay – you should be paid monthly at the rates set out in the national terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service (England and Wales), “the TCS”, as amended from time to time. The payscales are reviewed annually. Current rates of pay may be viewed at
http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/pay-and-conditions-circulars/medical-and-dental-pay-and-conditions-circulars Part time posts will be paid pro-rata
Pay supplement –depending upon the working pattern and hours of duty you are contracted to undertake by the employer you should be paid a monthly additional pay supplement at the rates set out in paragraph 22 of the TCS. The current payscales may be viewed at
http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/pay-and-conditions-circulars/medical-and-dental-pay-and-conditions-circulars
The pay supplement is not reckonable for NHS pension purposes. The pay supplement will be determined by the employer and should be made clear in their offer of employment and subject to monitoring.
Pension – you will be entitled to join or continue as a member of the NHS Pension Scheme, subject to its terms and rules, which may be amended from time to time. If you leave the programme for out of programme experience you may have a gap in your pension contributions. More information can be found at http://www.nhsbsa.nhs.uk/pensions
Annual Leave – your entitlement to annual leave will be five or six weeks per annum depending on your previous service/incremental point, as set out in paragraphs 205-206 of the TCS. The TCS may be viewed at
http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars/junior-doctors-terms-and-conditions-of-service-and-associated-documents
Sick pay – entitlements are outlined in paragraph 225 of the TCS.
Notice –you will be required to give your employer and entitled to receive from them notice in accordance with paragraphs 195-196 of the TCS.
Study Leave –the employer is expected to offer study leave in accordance with paragraphs 250-254 of the TCS. Local policy and procedure will be explained at induction.
Travel Expenses – the employer is expected to offer travel expenses in accordance with paragraphs 277-308 of the TCS for journeys incurred in performing your duties. Local policy and procedure should be explained at induction.
Subsistence expenses – the employer is expected to offer subsistence expenses in accordance with paragraph 311 of the TCS. Local policy and procedure should be explained at induction.