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SPECIALTY TRAINING PROGRAMME IN HAEMATOLOGY FOR HEALTH EDUCATION WESSEX

This is a 5 year training programme in Haematology at ST3 aimed at doctors who can demonstrate the essential competencies to enter this level of training. The programme is designed to support training for a CCT in Haematology. Details of essential competences and qualifications are detailed in the HEE person specification for Haematology at ST3 which is available from http://specialtytraining.hee.nhs.uk/ This 5 year Specialty Training programme will allow the successful applicant to achieve the award of a Certificate of Completion of Training (CCT) in Haematology, subject to satisfactory progression. The programme is based in hospitals in Health Education Wessex including:

HOSPITAL LOCATION

North Hampshire Hospital Basingstoke

The Royal Bournemouth Hospital Bournemouth

Dorset County Hospital Dorchester

Poole General Hospital Poole

Queen Alexandra Hospital Portsmouth

Salisbury District Hospital Salisbury

Southampton General Hospital Southampton

Health Education Wessex is responsible for the planning, development, education and training of the healthcare and public health workforce across Hampshire, Dorset, Isle of Wight and Salisbury. We also provide medical training for the States of Jersey and GP appraisal services for Jersey and Guernsey. We believe that the key to improving the health and healthcare of the 2.8 million people living in Wessex is investment in the skills and values of the 52,000 people working in the NHS and in primary care. Within the field of postgraduate medical education and training, we manage across primary and secondary care for these health communities – totalling around 2,400 doctors in training at any one time across 12 Trusts and 160 GP practices. In addition, we support the workforce development for GP Practice Nurses and Public Health practitioners as well managing a bespoke GP appraisal service for established GP Practitioners to meet the requirements for revalidation in accordance with the statutory requirements set by the General Medical Council.

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We manage training programmes for postgraduate medical training according to the statutory standards set by the General Medical Council (GMC) and have responsibility for establishing and maintaining quality management systems for all posts and programmes as required by the GMC. The work of Health Education Wessex is guided by the principles embedded within the NHS constitution. Rotation Information It is usual that trainees will spend two of their five years training at Southampton General Hospital where specialist training in paediatrics and allogeneic transplantation is available. The remaining three years will be spent at the other district general hospitals on the rotation. Rotational placements will be made each year with the training need of the registrar being the most important factor. After this the preference of the trainee for a particular post is taken in to consideration. It may not be possible for a trainee to go to a placement of their choice. Usually each post is for one year’s duration. In exceptional circumstances you may need to rotate for a Shorter period Study and Training

The primary aim of all posts is the training programme developed and there is a region wide syllabus and minimum standards of education agreed by all Trusts within the rotation.

Health Education Wessex is committed to developing postgraduate training programmes as laid down by GMC, Colleges and Faculties and by COPMED - the Postgraduate Deans Network. At local level college/specialty tutors work with the Programme Director and Directors of Medical Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend meetings with their nominated educational supervisor.

All posts within the training programme are recognised for postgraduate training by the General Medical Council (GMC) in accordance with their standards for training.

Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service.

All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals but the list is aimed at covering the majority of duties:




1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached F1.

2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior medical staff.

3. Attend and participate in ward rounds as timetabled

4. Attend outpatient clinics.

5. Take part in rostered emergency work.

6. Dictate discharge summaries.

7. Study for higher examination and maintain continued professional development.

8. Attend weekly educational and multidisciplinary sessions.

9. Undertake audit at various times throughout the rotations.

10. Teach medical students as directed.

11. Co-operate with members of the personnel department when monitoring hours of work and other personnel issues.

12. Attend induction in each hospital or new department

13. Comply with all local policies including dress code, annual and study leave Specialist training may be extended to accommodate less than full time training. One year of specialist training may be approved for research, which is relevant to the specialty and in an area approved by the Chair or Secretary of the Specialty Advisory Committee. Approval will take account will be taken of the generic training value of the research and any clinical experience gained during the period of research. On award of CCT a haematologist will be able to work as a consultant specialist within the National Health Service and will have the competencies required to do so, as well as to develop further special interest expertise if desired. For the full haematology training curriculum please refer to the JRCPTB website specialist haematology page. Teaching The Wessex haematology training programme runs a very successful teaching programme. This involves compulsory ‘training days’ which are held at one of the rotation placement hospitals on a 6 weekly basis. Trainees must attend >75% of these training days to successfully progress though training. In addition ‘on the job’ teaching is provided at all the placement hospitals on a regular basis during a placement.




Information about Hospital Trusts in the rotation

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Clinical Haematology The clinical haematology unit has adjacent inpatient and day wards. Ward 11 is the Haematology inpatient ward and has 15 beds, which include 2 single rooms with laminar airflow and en-suite facilities, 3 single rooms and a 2 bedded room with filtered air, 5 single rooms and a 3-bedded bay. The inpatient unit has facilities for BCSH level 3 and is JACIE-accredited for autologous stem cell procurement and transplantation. The Unit transplants 20-25 patients annually. Ward 10 is the day ward, has two 6 bedded bays and is used for clinical assessments, chemotherapy clinics, administration of chemotherapy, blood products and coagulation factors, diagnostic and therapeutic procedures including venesections, aphaeresis, tunnelled central venous catheter (CVC) removals, bone marrow biopsies and intrathecal chemotherapy. Tunnelled CVC and PICC are inserted in Radiology. The day care facilities on ward 10 are shared with medical oncology. In 2011-12, the day unit managed 7786 Haematology and 8698 Oncology day-case patients. Outpatient clinics include 8 Consultant-led weekly general haematology and disease-specific LPD, myeloma, transplant, haemostasis and thrombosis clinics. There are, in addition, weekly nurse-led chemotherapy, MPN and venesection clinics. The Department has 6 Consultants, a Consultant Nurse and 5 Specialist Nurses. Most nurses working on wards 10 and 11 have post-registration qualifications in haematology, oncology, blood & marrow transplantation and/or care of the dying. The Department has a Clinical Trials Unit staffed by Trials Coordinator, Data




Manager and 3 Research Nurses, and participates in many national and international clinical trials in acute leukaemia, lymphoma, CLL, myeloma, MDS and MPN. The Department houses the Dorset hub of the Wessex Haemophilia Comprehensive Care Network (WHCCN). The Network Comprehensive Care Centre (CCC) is based at Basingstoke and North Hampshire Hospitals NHS Foundation Trust. Comprehensive care for patients with inherited and acquired bleeding disorders in East Dorset is led by a full-time Consultant in Haemostasis and Thrombosis based in Bournemouth. Adult patients are managed in Bournemouth and children are managed in Poole. Elective orthopaedic surgery and GUM services for East Dorset are based in Bournemouth. Paediatrics, ENT and Oral Surgery are based in Poole. The anticoagulation service is led by Consultant Nurse with 4 trained anticoagulation practitioners. There are 4000 patients registered with the anticoagulation clinic. The clinics are managed according to pre-defined algorithms authorised by the hospital’s Thrombosis Committee and Drugs & Therapeutics Committee. Majority of patients on oral anticoagulation therapy are managed by postal dosing using DAWN-AC v7.9 software. The team also runs peri-operative bridging clinics for patients on warfarin. The anticoagulant service is linked to the hospital’s fast-track DVT service which is run from the Emergency Department. Laboratory Haematology

The haematology laboratory is CPA and MHRA-accredited and performs approximately 240,000 blood counts annually using two ADVIA 2120 analysers. About 500 diagnostic marrow aspirates are processed annually. Serum ferritin, B12 and folate levels are analysed on Beckman-Coulter ACCESS 2 analyser. Haemoglobinopathy screening is performed at Poole hospital. The coagulation laboratory uses two ACL TOP analysers. Approximately 100,000 INR samples are analysed annually. Comprehensive thrombophilia screening including molecular tests are performed electively. Thromboelastogram (TEG) is available for 24/7 use. PFA-100 screening test is available at Poole Hospital. Light-transmission aggregometry is performed to assess platelet function on an elective basis. The laboratory has trained personnel to perform a full panel of special coagulation tests e.g. clotting factor assays. The transfusion laboratory performs 25,000 group and screen and 7000 cross matches per year. There is an automated grouping machine and the department uses DIAMED column technology. All of the laboratories use the Telepath 1 system from i-Soft.




A Haematological Malignancy Diagnostic Service (HMDS) for Dorset Cancer Network is being developed and is expected to be fully operational by 2014. Flow cytometry is performed in-house using a FACSCalibur analyser. Bournemouth provides the immunophenotyping service to Dorset Cancer Network. Molecular and cytogenetic laboratories are on site but are used mainly for research. All routine diagnostic cytogenetic and molecular genetic studies are performed at Wessex Genetics Laboratory in Salisbury District Hospital. Research

There is an active laboratory research unit within the department. The main research interests are in diagnosis, genetic abnormalities, prognostic features and management of chronic haematological malignancies, especially chronic lymphocytic leukaemia, low-grade lymphoma and myelodysplastic syndromes. The department attracts funding from the Leukaemia Research Fund as well as other grants and local charities. Duties of specialist trainee in haematology

The Department trains 3 specialist haematology (ST3-7) and 2 core medical trainees (ST1-2). The ST3-7 trainees rotate between inpatient ward, day ward and laboratory every 2 months. The ST1-2 trainees rotate between inpatient ward and day ward every month. The trainees are expected to provide inpatient, day ward, outpatient and laboratory haematology services under Consultant supervision to East Dorset population of 500,000. The Haematology on-call service is non-resident, 1-in-5, first-on-call for periods 3-7.30pm and 8-9am on weekdays, 8am-7.30pm on weekends, and second-on-call for periods 7.30pm-8am. The Hospital-at-night (HAN) will take over the first-on-call clinical duties 7.30pm to 8am. All laboratory and coagulation related out-of-hours calls will bypass the HAN team and will go directly to the Haematology doctor on call. The on-call trainee for Haematology on the previous night will have time off in lieu the next day from 3pm.




Day Ward 11 Ward 10 Laboratory

Monday AM Registrar ward round

Clinic – day ward Haemostasis clinic

PM Ward work Procedures Prescriptions

BM reporting Film Q

Tuesday AM 1245

Consultant ward round Morphology meeting

Day ward clinic Morphology meeting

BM list Morphology meeting

1315 1400 PM

Teach-in session Ward work Film Q

Teach-in session Procedures Prescriptions

Teach-in session HMDS sign-out Consultations Bridging clinic

Wednesday AM Registrar ward round

Day ward clinic Outpatient clinic

PM Ward work

BM list Prescriptions

BM reporting

Thursday AM Registrar ward rounds

Day ward clinic Outpatient clinic

PM Ward work Procedures Prescriptions

BM reporting Consultations

Friday 0830 AM

MDT meeting Consultant ward round

MDT meeting Day ward clinic

MDT meeting Consultations

1245 PM

Grand round Ward work

Grand round Prescriptions Film Q

Grand round BM reporting

Training Opportunities

The post will provide excellent training opportunities for work-based experiential learning in diagnostics and clinical management of haematological disorders through clinics, Consultant-led and personal ward rounds, consultative haematology on other wards, placements in haematology laboratory, multi-disciplinary team meetings, participation in clinical trials as sub-investigators, supervised on-call experience, audits and teaching of junior trainees. Trainees are well-supported by Consultants who will provide clinical supervision at workplace with regular assessments through standard curriculum-approved assessment tools. Trainees are expected to complete at least one major audit in a year. Although the clinical and laboratory experience offered is primarily aimed towards practice of Haematology in district general hospital, the Unit has acquired a




reputation for academic excellence with a sound clinical and laboratory research base, particularly in chronic lymphocytic leukaemia and myelodysplastic syndromes. Trainees will gain excellent experience in clinical management of all haematological cancers in adults including acute leukaemia, lymphoma, myeloma and autologous stem cell transplantation. Diagnostic haematology training will be provided throughout and laboratory placements will allow trainees to acquire expertise in routine diagnostics e.g. morphology, specialist diagnostic techniques e.g. flow cytometry, and laboratory management e.g. NEQAS. In addition, the Consultants will provide regular teaching sessions in morphology, flow cytometry, obstetric haematology, haemostasis and thrombosis. Further Information Detailed information on all aspects of the Department’s activities can be obtained from the Unit’s web page at http://www.rbch.nhs.uk/haematology

Portsmouth Hospitals NHS Trust - Queen Alexandra Hospital

Introduction

Portsmouth Hospitals NHS Trust is a provider of Acute Health Services under contract to a range of Purchasers in the area of the Hampshire basin and Western South Downs. The current main purchasers are the 3 Local CCGs. The catchment population for the Trust extends from Warsash in the West to the Sussex border and its northern boundaries encompass Petersfield and Liss. With the exception of the rural north, it is an essentially urban area, having grown around the Royal Naval establishments of Gosport and Portsmouth. As well as Naval bases it now provides a wide range of modern high-tech industry and the facilities associated with a commercial port and cross-channel ferry terminal. Southsea and Hayling Island are popular holiday resorts and the city of Portsmouth continues to undergo major development along its waterfront including Gunwharf Quays, the Spinnaker Tower and plans for a new stadium for its football club. There is easy access to the many sailing and water sport facilities on the coast, the countryside of the new South Downs National Park and good transport links to the M27, Southampton airport and, via the ferry terminal, to the Continent.

Portsmouth Hospitals NHS Trust provides a range of acute services concentrated at Queen Alexandra Hospital in Cosham. The Queen Alexandra Hospital site has undergone a major redevelopment to create a modern and 'fit for purpose' hospital, which opened in June 2009. This work was done in partnership with 'The Hospital Company', a consortium of Carillion plc and the Royal Bank of Scotland. This

http://www.rbch.nhs.uk/haematology




development includes new spacious ward facilities, a purpose built Main OP department and state of the art pathology laboratories.

The Trust is also home to the Wessex Renal and Transplant Unit and it holds prestigious Cancer Beacon Status for the Head and Neck Cancer Services. Hosting a Ministry of Defence Hospital Unit (MDHU), the Trust enjoys strong military connections and is proud of this association. This means that as a Trust, we have wider responsibilities than those of standard NHS organisations.

Portsmouth Harbour QA main entrance




General Information

Portsmouth Hospitals NHS Trust is one of the largest in England with an annual income of £400 million. It provides acute healthcare services for almost 1,000,000 people, has a regional speciality in its renal and Transplant Unit and is a designated Cancer Centre. It encompasses postgraduate teaching facilities and is involved in training of nurses and undergraduate doctors from the University of Southampton. The Trust is the lead body for the local Research and Development Support Unit and has close links with the University of Portsmouth and its new School of Postgraduate Medicine for both education and research.

The Trust provides most of its services at Queen Alexandra Hospital in Cosham with 1396 beds.

Haematology Services

The Haematology service is based at Queen Alexandra Hospital with peripheral clinics in Gosport War Memorial Hospital, St Mary’s Hospital Fratton, Petersfield Hospital.

The Haematology Department consists of 6 WTE Consultants, a 0.6 WTE consultant with a 0.7 wte Speciality Doctor and two Speciality Registrars from the Wessex Rotation. The post is based at Queen Alexandra Hospital.

The department works as a team, with cross-cover of ward patients, and rotation through laboratory duties, liaison patients, but individual clinic lists. At present all the consultants see the full range of haematological oncology, with the exception of lymphoma which is run as a separate clinic service jointly with oncology.

Haematology Staff

Consultants

Dr Helen Dignum General and Malignant Haematology

Dr Robert Corser General and Malignant Haematology, Lymphoma

Dr Mary Ganczakowski General and Malignant Haematology, CD, Haemoglobinopathy

Dr Hussain Hirri General Haematology, Haemophilia, Thrombosis

Dr Chris James General and Malignant Haematology, Trust IT Lead

Dr Charles Alderman General and Malignant Haematology. CMT lead




Dr Tanya Cranfield Part time - General and Malignant Haematology

Dr Edward Belsham General and Malignant Haematology

Other Staff

Dr Gwynn Matthias Speciality Doctor (0.7 wte)

2 Speciality Registrars from Wessex Rotation, rotating annually

Haematology Clinical Nurse Specialist Donna Burgess

Lymphoma Clinical Nurse Specialist 1 wte.

0.4 wte Haemophilia Nurse Specialists, secondment from North Hampshire Hospitals

3 wte Anticoagulation Nurse Specialists

The size and population base of the hospital mean a busy wide-ranging clinical service. The service is Level 2B, providing the full range of adult haematology care including acute leukaemia induction and complex chemotherapy, as well as the full range of other benign and malignant haematological conditions. Bone marrow transplant referrals are sent to Southampton; the department has an excellent working relationship with the Wessex Bone Marrow Transplant Centre at Southampton which performs autologous, sibling and matched unrelated bone marrow transplants. In future, Portsmouth hopes to become a satellite centre for autologous transplants.

The regional Renal Service is based in Portsmouth giving additional exposure to myeloma patients in renal failure and plasma exchange treatment facilities for TTP. Paediatric haematological malignancy is managed at Southampton with shared care at Portsmouth by the Paediatricians. The lymphoma CNS also provides Teenage and Young Adult Cancer CNS expertise.

Inpatient Facilities

Inpatients are housed on the 45 bedded F5, F6, F7 haematology/oncology ward complex in the new PFI build. F6 has 10 HEPA filtered rooms; further cubicles are on F5 and F7. There are 12-18 haematology inpatients at any time, principally acute leukaemia treatment, myeloma, elderly haematology and non-malignant haematology. The ward consultant manages all the haematology inpatients, assisted by the ward registrar; ward consultant cover rotates every 1-4 weeks. There is a weekly ward multidisciplinary meeting, supported by microbiology and




palliative care. There are seven haematology-oncology SHO doctors covering the 45 beds and day unit..

Outpatient Facilities

Clinics are held in the Haematology Oncology Centre on Level B. All consultants have two main clinics for general and malignant haematology on weekday mornings which include both new and follow-up patients. There are additional emergency/rapid review clinics on Monday and Friday lunchtimes. Specialist thrombophilia and haemophilia clinics are held weekly. There are two nurse-led anticoagulation education clinics week. Additional general haematology peripheral clinics are held at least once a month at other sites: St Mary’s Hospital (Portsmouth), Gosport War Memorial Hospital, Coldeast Hospital (Fareham), Petersfield Hospital.

Lymphoma clinics are run led by Dr Ann O’Callaghan, Consultant Medical Oncologist, and Dr Corser, Haematology, with Dr James, on Tuesday and Wednesday afternoons.

Day Unit

The Haematology Oncology Day Unit is adjacent to Outpatients on Level B and administers intravenous chemotherapy, blood and platelet transfusions, immunoglobulin infusions iron infusions, venesections etc. Bone Marrow Biopsies are performed in the Laboratory with MLA support

Haematology Activity 2011-2012

Outpatient New 757

Outpatient Follow-up 7283

Anticoagulation New 700

Anticoagulation Follow-up 435 clinic, 100,000 Anticoag tests

Thrombophilia New 266

Thrombophilia Follow-up 141

Day Unit Activity 1313

Inpatient numbers: elective 144

Inpatients: non-elective 235




Haematology MDT’s

Haematology has two weekly video conferenced Cancer MDTs with its MDT partner Western Sussex Hospitals Trust, Chichester, supported by an MDT coordinator in a purpose-built MDT room. There is Leukaemia/Myeloma MDT and a Lymphoma MDT which is also attended by a specialist lymphoma histopathologist from Southampton by videoconferencing. Bone marrow transplants are arranged by referral to Wessex Bone Marrow Transplant Centre, with whom there are close working relationships.

MDT new diagnosis 2010 (Jan-Dec) April 2011- March 2012 AML 30 32 ALL 4 4 Myeloma 52 37 CML 2 10 CLL 29 25 Lymphoma 98 132 Hodgkins 13 14 MPD 38 32 MDS 12 10

Haemophilia and Thrombophilia

The department is a District Haemophilia Centre. Dr Hirri leads the service and works with the Regional Haemophilia Network. Haemophilia Clinical Nurse Specialist and A&C are seconded from North Hampshire NHS Trust at Basingstoke. There are 51 Haemophilia A patients on the database, including 9 severe haemophiliacs. Dr Hirri runs a monthly joint paediatric haematology clinics. Dr Hirri and Dr James run a weekly thrombophilia clinic. Research The department actively participates in a number of NCRI haematology and lymphoma trials and is supported by two clinical trials practitioners and a clinical trials assistant. There is excellent administrative support from the Central South Coast Cancer Research Network.




Blood sciences - Automated Haematology Track

Laboratory Haematology

The Blood Sciences Department is an integrated haematology and biochemistry department in a purpose-built PFI laboratory which opened in 2008. There is a high level of automation, with an integrated robotic track system. One of the haematology consultants is the lead clinician for transfusion and attends the Hospital Transfusion Committee, supported by two transfusion nurse practitioners. Currently we have an onsite flow cytometry laboratory. Haemoglobinopathy testing provides a regional service for universal neonatal screening.

Future pathology services may be subject to change, for example a network pathology consortium is under consideration, with some redistribution of services, which could involve increased Blood Sciences at Portsmouth. Training will be given in flow cytometry interpretation, morphology.

Anticoagulation

The department operates a postal anticoagulation service for 8000 patients (2012). Community phlebotomy INRs are analysed in the laboratory and dosed on RAID software by anticoagulation specialist nurses with assistance from the medical staff.

Management Structure Haematology works across administrative boundaries:




Clinical Haematology is part of the Cancer and Surgery Clinical Service Centre. The Chief of Service is Mr Constantinos Yiangou..

Laboratory Haematology is part of Blood Sciences, Clinical Lead Dr David Sinclair, part of the Pathology Directorate, Clinical Director Dr Dr David Sinclair, within the Support Services Clinical Service Centre, Chief of Service Dr Simon Ward.

Clinic Timetable

Mon Tues Wed Thurs Fri

9am Gen Clinic QA Gen Clinic QA Myeloma or

Gen Clinic QA Warfarin clinic QA

9am GWMH OP clinic

9 am Once/month Gen Clinic SMH Thrombophilia

11am Acute FU clinic Haemostasis Acute FU clinic

2pm Lymphoma Clinic Lymphoma clinic General Clinic

Special Clinic alternate weeks,

Duties of the post The Specialty Registrar will be involved in all aspects of clinical and laboratory haematology. Routine laboratory work will include the reporting of blood films, bone marrow aspirate and trephine biopsies together with advising on blood transfusion and haemostatic problems. Routine clinical work will include:

The day-to-day management of Haematology inpatients.

Co-ordinating the treatment of outpatients and day patients.

Management of patients with bleeding disorders. On Call Requirement: The Specialty Registrar will be expected to provide laboratory and ward cover on one Weekend in 4, on Saturday and Sunday.




Current Time Table for Speciality Registrar

Speciality Registrar Ward

AM PM

Monday

Academic Meeting or Business meeting) Day unit review

Multi-disciplinary team meeting Consultant ward round (teaching)

Tuesday Ward Work Lymphoma Clinic (optional – by

discussion)

Wednesday Out patients Clinic Lymphoma Clinic

Ward work / Audit

Thursday Ward Work Consultant ward round

Friday MDT meetings Urgent Review clinic

Day unit review Teaching

Speciality Registrar Laboratory

AM PM

Monday

Academic or Business Meeting Laboratory work Urgent Review Clinic

Multi-disciplinary team meeting Consultant ward round (teaching)

Tuesday Out patient clinic (QAH) or Laboratory Work

Laboratory work or Outpatient clinic Audit

Wednesday Out patient clinic (QAH) Thrombosis clinic Day Unit Review

Laboratory work

Thursday Myeloma or General Out patient clinic (QAH) Haemostasis Clinic

Audit / Bone marrow reporting Outpatients

Friday MDT Meetings Laboratory work

Teaching




Education and Training

In Portsmouth the Specialty Registrar will receive an induction pack and attend Trust induction. The Specialty Registrar will meet regularly with the educational supervisor and the Regional Specialty Education Committee will further assess their progress. The Specialty Registrar will attend the local Wessex training programme and will be encouraged to attend all local and a reasonable number of national meetings. Protected study leave will be given for individual study, research or audit. Teaching will be given for a programme of laboratory procedures. Clinical experience will be gained on a daily basis with consultant supervision. Regular discussions of laboratory findings will take place with the consultant staff. Additional training in blood transfusion will be arranged with the Wessex Blood Transfusion Centre. Research The Specialty Registrar will be encouraged to participate in research. In-patients are entered into the NCRI leukaemia trials. Specialty Registrars are encouraged to develop areas of personal interest where appropriate in active research projects. Recent studies undertaken by the Specialty Registrar and presented at ASH and BSH include: Occurrence of auto antibodies following allogeneic transplantation, Hydroxyurea induced leg ulceration and A Review of Home Chemotherapy for Haematological malignancies. The Specialty Registrar must undertake some specific audit activity either laboratory or clinical. Current and planned audit projects can be discussed with the consultants concerned. Accommodation

The post is non-resident in Portsmouth.




University Hospital Southampton NHS Foundation Trust

The University City of Southampton has a long maritime history and is now a busy container port and cruise liner terminal. It is close to the New Forest and the Cathedral City of Winchester and the area provides excellent housing, schooling and recreational links, particularly for sailing enthusiasts. There are excellent road links via the M3 and M27 and a fast direct rail service to London (Waterloo). Domestic and European air services are provided from Southampton Airport. University Hospital Southampton NHS Foundation Trust (UHS) provides acute healthcare services for the Southampton area (population 550,000). This covers an area bordering on the Solent and extending to the boundary of Winchester in the north, the Wiltshire border in the west and the River Hamble in the east. In addition, many specialist services are provided to a much wider area extending to Chichester, Portsmouth, Winchester, Basingstoke, Salisbury, Bournemouth and Poole, Dorchester, the Isle of Wight and the Channel Islands. These include the defining services of the Trust in cancer, neurosciences, respiratory, gastrointestinal, women and children and cardiothoracic. Southampton is a Regional Cancer Centre and provides comprehensive cancer services for a large population in excess of 3 million. UHS encompasses two sites, Southampton General Hospital (SGH), with 1,200 beds and Princess Anne Hospital (PAH) with 124 beds. UHS is one of the largest NHS Trusts in the country. The University of Southampton is one of the country’s leading research intensive higher education institutions and its strategy is to become world class in all activities. The Faculty of Medicine has a clear strategy to provide a research environment that will allow it to secure a long term future as a leading biomedical research institution. Central to this are the Biomedical Research Units (BRUs), a partnership between the National Institute of Health Research (NIHR), University Hospital Southampton Foundation NHS Trust (UHS)




and the University of Southampton School of Medicine. Southampton is home to two units: the Respiratory BRU and the Nutrition, Diet and Lifestyle BRU. Work is underway on a new 2800m² building on the Southampton General Hospital site which, along with the Wellcome Trust Clinical Research Facility, will form a focal point for research at the heart of the hospital, with a total area of 4000 m². This will help to bring more research activity to Southampton and foster a centre of excellence, bringing the best of new research ideas into clinical care. There is an active research program in Haemato-Oncology attracting funds from the LLR and CRUK. The department of Haematology is committed to providing a high quality clinical service and to develop the R&D potential through collaboration with existing successful R&D activity areas.

UHS Department of Haematology Medical Staff

Consultant Dr M W Jenner Myeloma, Haematological Malignancies and Transplantation Clinical Lead for Haematology Consultant Dr A S Duncombe Haematological Malignancies Consultant Dr S Narayanan Haematological Malignancies, Haemoglobinopathy and General Haematology Senior Lecturer and Honorary Consultant Dr F A Forconi Haematological Malignancies Senior Lecturer and Consultant Dr K H Orchard Haematological Malignancies and Transplantation Director Wessex Blood and Marrow Transplant Unit Consultant and Honorary Senior Lecturer Dr D S Richardson Haematological Malignancies and Transplantation Associate Specialist Dr K S Hill Stem Cell Transplantation Consultant Dr R S Kazmi Transfusion Medicine, Haemostasis and General Haematology Locum Consultant Dr S R Boyce Transfusion Medicine, Haemostasis and General Haematology




Locum Consultant Dr T A Burt General Haematology and Myeloid malignancies Consultant Dr M A Morgan Paediatric Haematology Consultant Dr V Bharadwaj Paediatric Haematology 6 Specialty Registrars on Wessex rotation 1 BMT Clinical Fellow 1 Haematology Clinical Trials Fellow SHOs/Trust fellows – on rotation working shift system with oncology SHOs UHS Clinical Haematology Clinical Haematology is part of the Cancer Care Group. The Care Group Clinical Lead is Dr Chris Baughan and the Care Group manager is Linda Sayburn. The Cancer Care Group is within Division A and is led by Divisional Clinical Director Dr Andrew Webb and Divisional Director of Operations Dan Bradbury. Clinical Haematology incorporates Haematological Malignancies, Stem Cell Transplantation, General Haematology, Haemoglobinopathy and Haemostasis & Thrombosis services. The Haematology service is subspecialty based and provides a comprehensive clinical and laboratory service both to the local population in Southampton and South West Hampshire as well as tertiary referrals for specialist opinions for complex cases, for transplantation and for clinical trials. There is a rapidly expanding portfolio of haematology clinical trials in Southampton including both NIHR portfolio studies and both early and late phase commercial studies and investigator led studies. Southampton is both an LLR TAP centre and member of the Myeloma UK Clinical Trials Network. Consultants from Southampton have presence on the NCRI subgroups in myeloma, CLL and myeloproliferative neoplasms and are involved in the design and delivery of NCRI portfolio trials. Clinical research in haematology is supported by a team of 4 clinical trials practitioners and 3 clinical trials assistants. All Clinical Haematology services including inpatients, day cases, chemotherapy and apheresis services are located on the SGH site. There are well-developed services for patients with myeloma, lymphoproliferative disorders, acute and chronic




leukaemias with the emphasis on a multi-disciplinary approach to care. There is on site immunophenotyping and molecular diagnostics. There are also comprehensive clinical and laboratory services in haemoglobinopathy, coagulation and general haematology. There are nurse specialists supporting the subspecialty services in myeloma, leukaemia, BMT, haemostasis, haemoglobinopathy, anticoagulation and thrombosis. All outpatient haematological malignancy services transferred to the SGH site in March 2010 in to a new purpose built facility. There are dedicated specialist clinics in myeloma, lymphoproliferative disorders, myeloid disorders and transplantation. There is also a weekly general haematology clinic at Lymington New Forest Hospital. These are supported by clinical nurse specialists in haematological malignancies, myeloma and transplantation. There is a core of haematology/oncology trained nursing staff, specialist haematology pharmacist, on site cytotoxic pharmacy services with a centralised intravenous additive service and nurse/counselling support. A purpose built Haematology Day Care Unit (C7) opened in 2013 providing transfusions, chemotherapy, apheresis and minor procedures such as venesection and bone marrow biopsies. There is a consultation room for ad hoc and short term clinical reviews. There are 7 chair spaces and 2 beds on the day unit plus a three-bedded apheresis suite which is an integral part of the day unit. Following the opening of the purpose built extension to C6L in 2010, there is currently a 21 bedded acute leukaemia and transplant ward at Southampton General Hospital, providing level 4 care for patients with Haematological Malignancies (BCSH Guidelines 1995). The unit provides level 2 care for acute leukaemia for neighbouring NHS Trusts. There is an adjacent 6 bedded teenage and young adult inpatient unit alongside a dedicated TYA day case unit and the Haematology Day Care Unit. Ward D2 is a 20 bedded ward for patients with a wide range of haematological disorders as well as other malignancies. Clinical Haematology patients are also managed within other wards within the Care Group, C4 and D3. Emergency admissions are managed via the Acute Oncology Service which has 6 beds for initial assessment and management. The Wessex Blood and Marrow Transplant Service The JACIE accredited Wessex Blood and Marrow Transplant has been providing an allogeneic transplant programme to a large geographical area encompassing the Wessex region since 2001 to supplement the existing autologous transplant service established in 1989. The programme performs approximately 60 autologous transplants per annum, mainly for patients with myeloma or lymphoma, and approximately 50 allogeneic transplants per year, including unrelated donor transplants. There is active collaboration with other haematologists within the region




and a thriving clinical network specifically relating to transplantation. The unit delivers outcomes that are some of the best in the UK. The stem cell collection facilities are accredited with the Human Tissue Authority (HTA). There is an integral Apheresis service with a lead Apheresis nurse with the support of additional trained nurse operators. This busy unit performs over 300 procedures per year providing peripheral blood stem cell harvesting, plasma exchange, therapeutic leucopheresis and extra corporeal photopheresis procedures. The Apheresis service received a licence from the Human Tissue Authority in September 2008 which was renewed in 2014. The Wessex Blood and Marrow Transplantation Service works closely with the NHSBT Steve Mills Laboratory which provides stem cell processing and storage services on site. The NHSBT laboratory has MHRA and HTA licences and JACIE accreditation. Haemostasis & Thrombosis Centre University Hospitals Southampton NHS Foundation Trust is a Haemophilia Comprehensive Care Centre. It mainly serves patients from Hampshire and the Channel Islands although patients from further afield are also registered. At present there are more than 420 congenital bleeding disorder patients including approximately 50 patients with a severe bleeding disorder. A fully comprehensive service from initial diagnosis to the subsequent care in the hospital and community is provided. The Haemostasis & Thrombosis team includes two adult and two paediatric haematologists. The Director of Haemostasis and Thrombosis Centre is Dr Rashid Kazmi who oversees the adult and paediatric service. Together with Dr Kazmi the post holder of this job will be responsible for the management of adult patients with congenital and acquired bleeding and thrombotic disorders including both inherited and acquired platelet disorders. Dr Mary Morgan and Dr Vandana Bharadwaj are paediatric haematologists primarily responsible for paediatric haemophilia care. There is close liaison between the paediatric and adult services. The haemostasis service is supported by two haemophilia clinical nurse specialists and two anticoagulant/VTE nurse specialists and a data manager. A part time clinical trials practitioner post has recently been developed to further develop the portfolio of clinical trials and research collaboration with the University The outpatient facilities in the Haemostasis and Thrombosis Centre were fully refurbished in 2013 with the creation of dedicated outpatient and treatment facilities for both adult and paediatric patients. The centre also provides diagnostic services for thrombophilia, and follow-up anticoagulation service for outpatients who are not managed in the community. There is also a joint haematology/obstetric clinic for the




management of high-risk bleeding or thrombotic pregnancies, every two weeks. A weekly platelet disorder clinic has been developed to optimise the management of patients with both inherited and acquired platelet disorders. UHS has been designated as on of 29 ITP Clinical Centres across the UK. A new inpatient ward D2 has recently been opened which will accommodate those patients with non-malignant haematological disorders including hereditary bleeding disorders alongside other haematology patients. Haemoglobinopathy Southampton has a growing Asian and Afro-Caribbean population with approximately 70 to 80 patients with haemoglobinopathy using the service. There is a regular haemoglobinopathy clinic supported by a CNS, a dedicated haemoglobinopathy laboratory service including antenatal screening and plans to further develop the adult haemoglobinopathy service including transitional care from paediatrics. Patients with haemoglobin disorders requiring inpatient admission are admitted via the acute medical unit and transferred to D2 the following day if admission is required. Paediatric Haematology There is a regional paediatric oncology/haematology service at Southampton General Hospital which covers the Wessex region. The service is responsible for the diagnosis and treatment of children with acute leukaemia, bone marrow failure syndromes, haemoglobinopathies, bleeding disorders and non-malignant haematological disorders. Paediatric haemophilia clinics are provided at UHS and neighbouring hospitals. The paediatric haematologists Dr Mary Morgan and Dr Vandana Bharadwaj provide a consultative service for the regional PICU, NICU, paediatric cardiology and child health departments as well as the 10 district hospitals. The department performs high dose chemotherapy with stem cell rescue; allogeneic transplants are referred to Bristol Children’s Hospital but the immediate aftercare is undertaken at Southampton. The haematology StR is attached to the department for 3 months. Haematological Malignancies Clinical Trials Team The Haematological malignancies clinical trials team has expanded rapidly over the last five years and is led by Jocelyn Walters, Research Delivery Manager, who has overall responsibility for Division 1 & 3 of the Wessex Cancer Research Network. The Haematological malignancies clinical trials team includes all consultants who each have responsibility for clinical trials in their diseases of interest. At present




there are four Clinical Trials Practitioners and three Clinical Trials Assistants who oversee the management of patients across the portfolio which is separated into myeloma, lymphoproliferative disorders, myeloid disorders and transplantation/acute leukaemia. There is close liaison between the clinical trials team and clinical teams in managing clinical trial participants whether managed as outpatients or via the inpatient or day case wards. Laboratory Haematology services Haematology is part of the Blood Sciences laboratory, part of the Radiology and Pathology Care Group within Division B, alongside the Emergency Medicine, Specialist Medicine and Ophthalmology Care Groups. The Head of Pathology is Nick Hurlock. The Clinical Director is Dr Derek Sandeman. Haematology laboratory facilities are provided at Southampton General Hospital. The laboratory has full CPA/ISO accreditation and HPC approval for the training of BMS staff. The SGH site has been equipped with the latest instrumentation and has the CliniSys Labcentre laboratory computer system. The laboratory has a high degree of automation and recent benchmarking shows its workload and efficiency to be in the upper quartile in the teaching hospital peer group. The services provided are excellent. Diagnostic bone marrow services are carried out at SGH. The department of cellular pathology processes trephine biopsies which are then returned to Haematology for reporting or reported in conjunction with the cellular pathologists. Regular regional multidisciplinary diagnostic team meetings are held; Monday for immunophenotyping/morphology reviews, Thursday mornings for Paediatric reviews and Friday mornings for Adult Haematology. UHS also hosts the Central South Coast Cancer Network (Western) MDT meeting for Leukaemia and Myeloma. Molecular Pathology and Immunophenotyping In addition to the routine haematology laboratory services there is a specialised molecular pathology laboratory under the supervision of a Consultant Clinical Scientist Dr Elizabeth Hodges. The laboratory provides essential diagnostic and molecular monitoring assays including chimerism, BCR-ABL quantification by PCR, minimum residual disease analysis, B and T cell clonality. The immunophenotyping laboratory provides a full repertoire of diagnostic and MRD immunophenotyping for haematological malignancies. Cases are jointly reviewed at the diagnostic MDTs. The Wessex Regional Genetics Laboratory is located at Salisbury District Hospital. There is a close working relationship between Dr Laura Chiecchio and Prof Nick




Cross at WRGL and the Haematology Consultants at UHS with regular clinical meetings. There are advanced plans to fully integrate reporting of haematological Malignancies specimens with the aim of developing IOG compliant integrated haemato-pathology reporting.

Role of the Speciality Registrar

Clinical Duties There are 6 Specialty Registrars based at UHS at any one time each with individual timetables. The Speciality Registrars will be trained and involved in all aspects of clinical and laboratory haematology and blood transfusion. The timetables will vary depending on individual posts but over 12 months will encompass a full range of haematology experience. Clinical work includes:

The day to day management of Haematology inpatients with both malignant and non-malignant conditions

Co-ordination of the treatment of outpatients and inpatients including prescribing of treatments

Management of patients with bleeding disorders

Investigation of patients with thrombophilias and management, including

The treatment of recurrent miscarriage in the high risk pregnancy clinic.

Supervision of patients receiving plasma exchange (for TTP and inhibitors usually)

Participate in supervised* outpatient clinics (*until final year when expected to work with minimal supervision)

Paediatric haematology




Laboratory Duties: Laboratory work reporting of blood films, bone marrows, other haematological tests. Training in immunohaematology is an integral part of this. The post holder will be required to participate in medical audit. Undergraduate medical students from Southampton University Medical School are taught throughout the Trust and the post holder is required to participate in formal and informal undergraduate clinical teaching but will not be responsible for curriculum organisation development. On call: On call is 1:6 non-resident second on call for haematological malignancies/BMT and first on call for general haematology advice with 24 hour consultant back-up. On call arrangements are currently under review and may change during the course of the rotation.




West Dorset General Hospitals NHS Trust, Dorchester The new Dorset County Hospital was completed in 1997 and achieved the centralisation of all services for acutely ill patients into a modern Hospital on one site, approximately 1 mile from the town centre.

The Trust provides excellent facilities to a largely rural population of 220,000 (with concentrations in Weymouth and Dorchester) and many innovative services such as an award-winning art collection to enhance the environment for patients. Housing 500 beds Dorset County Hospital has been recognised as an Exemplar Site by the Department of Health. There are only eight such sites in the country, which have been chosen because of the high quality of the patient environment. In 2001 the Trust won the national 'Clean Hospital Award'. The Trust currently employs around 2,500 personnel, treating more than 100,000 patients each year and provides a wide range of services. The Hospital is recognised as a Cancer Unit within the Dorset Cancer Network for the provision of services for patients with Breast, Colorectal, Urological, Upper Gastrointestinal, Lung and Haematological Malignancies. While most Chemotherapy is given locally, the Radiotherapy Centre is in the Cancer Centre at Poole

Palliative Care Services are provided by the local hospice (Joseph Weld) where there are 18 beds. Two Consultants regularly visit patients with malignant and non-malignant diseases within the Hospital.

Dorset County Hospital is the hub of the district's inpatient facilities but community Hospitals are situated in the surrounding major towns and provide the spokes to the central unit. These include, Weymouth Community Hospital, Bridport Hospital, Blandford Hospital and Yeatman Hospital, Sherborne. PATHOLOGY STAFF:

General Manager

Head Biomedical Scientist Haematology:

3 X Consultant Haematologist

Speciality Registrar

Staff Grade (Haematology)

S.H.O.




Chemical Pathology:

Consultant Chemical Pathologist

Consultant Grade Biochemist

Microbiology:

3 X Consultant Microbiologist Histopathology/Cytology:

4 x Consultant Histo/Cytopathologist HAEMATOLOGY DEPARTMENT Nursing Staff - Day Chemotherapy Unit:

1 G Grade Sister

1 F Grade SRN

3 Grade E-F Chemotherapy Nurses

Inpatient Nursing with a Ward Sister (Grade G) and 9 Grade D-F Nurses are shared with other medical teams using Ilchester B ward Laboratory Staff:

1 x BMS4

5 x BMS2 (+ funding for Hospital Transfusion Practitioner)

15 x BMS1

4 x Trainee BMS (rotating)

Clinical Haematology

The clinical facilities at the Dorset County Hospital are excellent. Ilchester B Ward, the inpatient area, has a two-bed suite with en-suite bathrooms and WCs and HEPA ventilation. In addition there is 14-bedded unit containing 2 single isolation rooms. We have used intensive chemotherapy for the treatment of Acute Leukaemia and relapsed Lymphoma since 1985. Support facilities within the hospital necessary for the comprehensive care of seriously ill haematology patients include an intensive care unit, the Dorset Renal Unit, full radiology services, echocardiography, bronchoscopy and gastroenterological endoscopy. Consultant Physicians in neurology, rheumatology, dermatology, endocrinology, nephrology, diabetology, cardiology and thoracic medicine are readily available. A palliative care consultant is attached to the unit.




Fortuneswell Day-chemotherapy Unit The Fortuneswell Chemotherapy Unit caters for both haematology and oncology patients. More than 1400 clinical episodes were seen each year. Oncology patients, account for around 20% of the in-patient occupancy. Nursing staff have post-registration qualifications in Haematology, Oncology, chemotherapy and care of the dying. The Unit housed the haematology and oncology outpatient services and is used for the administration of chemotherapy, bone marrow aspirates and trephines, cell separator procedures and clinical assessments. Blood and platelet transfusions, lumbar punctures and IV infusions of Iron and Immunoglobulin are performed in the Day-medicine Unit of the hospital.

Haematology Outpatients Eight outpatient clinics are held weekly. More 500 new haematology patients are seen each year in addition to more that 5000 follow up general haematology and 1300 chemotherapy episodes. The anticoagulant department managed more than 18,000 dosing episodes last year. Specially trained Biomedical Scientists, supervised by medical staff, run the anticoagulant service. An average of 5-7 ward referrals are seen weekly. Around 180 new patients with haematological malignancies are seen annually, the commonest diagnoses being NHL (c 84 cases), Myelodysplasia (c 36), Chronic Lymphocytic Leukaemia (c 30), Myeloma and macroglobulinaemia (c 20) and myeloproliferative disorders (c 10). Around 2 to 4 patients with acute leukaemia are undergoing treatment. One multi-disciplinary meeting and a Friday grand round are held weekly.

The Haemophilia centre with around 10 severe haemophiliacs is based at the Dorset County Hospital. Laboratory Haematology The laboratory is spacious and well equipped. It has full CPA accreditation and participates in all appropriate NEQAS schemes. There are sub-departments of routine and special haematology, coagulation and blood transfusion. Routine laboratories are provided with the Sunquest computer system. Around 500 blood counts are performed per day on two Coulter STKS analysers. Haematinics assays are performed with the Beckman Coulter Access immunoassay system. The coagulation laboratory is equipped with Sysmex 1500 with ACL 1000 machines. The Blood Transfusion Laboratory uses the Diamed system and has recently introduced new automatic Blood Grouping machinery, as well as evaluating the electronic cross match. Immunological, Cytogenetic analysis and molecular investigation are performed at the regional centres in Southampton and Salisbury




Please note laboratory Services may be subject to change as they may be contracted out over the next year. Research The department has an active participation in clinical trials for Leukaemia, Myeloma and Lymphoma. Two research/clinical trial nurses facilitate local entry and documentation of clinical trials. The Role of The Speciality Registrar This post gives good training in laboratory and clinical haematology. Its strengths are the wide experience gained in the management of haematological malignancies, including lymphomas, myeloma and acute leukaemia. The Speciality registrar is expected to attend the MDT and departmental grad round. You will have weekly outpatient clinics and will have responsibility for the day-to-day management of in-patients and for the training and instruction of the SHO who works with them. At least one of the consultants will work closely with the Speciality Registrar and will always be available for consultation. The Speciality Registrar will have laboratory sessions for training and for providing a service to other departments in the hospital. The three consultants, the associate Speciality and the staff grade are all responsible for the laboratory for one day in the week, and each will work closely with the Speciality Registrar. Example Timetable – Speciality Registrar

AM Lunch PM

Monday Ward Work MDT / Ward Work

Tuesday OPD Bone Marrow Clinic

Laboratory Session

Wednesday Chemotherapy Clinic / Ward Work

Teaching

Thursday OPD SHO teaching / Ward Work

Friday Regional MDT Consultant Ward Round

Ground Round /Teaching

Laboratory Session

Audit and Continuing Professional Development Time will be allocated in the job plan for audit and CPD activities. There are regular haematology journal clubs, multidisciplinary meetings, a weekly medical journal club, grand round case presentations and an active post graduate society hosting weekly lectures for all hospital staff and local general practitioners. There is also a “Wessex” haematology group that meets regularly for educational purposes. Apart from regular




local teaching there will also be release for the fortnightly regional teaching sessions that rotate between the hospitals that currently make up the Wessex rotation. On-Call One Saturday every 4 weeks

Hampshire Hospitals NHS Foundation Trust

Hampshire Hospitals NHS Foundation Trust came into being in January 2012 as a result of the integration of Basingstoke and North Hampshire NHS Foundation Trust, which achieved Foundation Trust status in 2006, and Winchester and Eastleigh Healthcare Trust. Hampshire Hospitals NHS Foundation Trust serves a population of approximately 600,000 across North and mid-Hampshire and parts of west Berkshire. The population is predominantly centred around Basingstoke, Winchester, Eastleigh and Andover as well as the surrounding towns and villages across Hampshire and parts of west Berkshire including Tadley to the north; Alton and Bordon to the east; Romsey and Chandlers Ford to the south, Stockbridge, Bishops Waltham and Alresford. It is a fundamental principle of the new combined Trust that it will provide fully integrated clinical services across the two acute hospitals in Basingstoke and Winchester, with the provision of outpatient services within community hospitals at Andover and Alton and the future development of services within primary care. Clinical Haematology is managed within Cancer Services, which includes clinical and medical oncology, clinical haematology and palliative care. These services are currently provided at both BNHH and RHCH sites. At the BNHH site it is within the Basing Unit (Outpatients and Day Unit) and Wessex Ward (inpatients) and at the RHCH site it is provided on the Nick Jonas Ward (Outpatients and Day Unit). Palliative care is also provided at St Michael’s Hospice, which is on the BNHH site. Currently radiotherapy provision is from Southampton University Hospital. Plans for an Associate Cancer Centre with radiotherapy provision are at an advanced stage. Clinical Haematology Medical Staff

6 Consultants

1 Associate Specialist

1 Speciality Registrar (one year rotation)

1 CT1/2 / GP trainee on 4 monthly medical rotation

1 FY1 on 2 monthly medical rotation Nursing Staff

1 Clinical Service Manager Cancer Services

1 Haematology Nurse Practitioner




2 Haematology CNS

1 part time Haematology Research nurse

1 part time Clinical Trials Administrator

2 Ward Sisters

2 Transfusion Practitioners

Team of chemotherapy trained nurses The Elizabeth Hall Centre in BNHH consists of a purpose built in-patient unit (Wessex Ward) and day care unit (Basing Unit). The Wessex ward is an 11bed ward providing isolation rooms with positive pressure ventilation and HEPA filtration and en-suite facilities for patients receiving intensive chemotherapy. The Basing Unit is used for outpatient clinics, chemotherapy, venesections, bone marrow biopsies, intrathecal chemotherapy, line insertions and all supportive care. The Nick Jonas ward at RHCH provides outpatient clinics, day case chemotherapy and supportive care as well as bone marrow biopsies and venesections. It is envisaged that all these services will be provided within an Associate Cancer Centre once it is built. Services for malignant haematology are provided to BCSH level 2b. Referrals for autologous and allogeneic stem cell transplant are predominantly to the regional stem cell transplant centre in University Hospital Southampton and occasionally to other transplant centres.

Clinical Activity

No. of New Cases 2010/2011*

CML 8

CLL 56

NHL (low grade) 66

NHL (high grade) 74

Hodgkin Lymphoma 6

Myeloma 40

MDS/MPD 108

AML/ALL 20

TOTAL 378

*based on MDT registration for BNHH and RHCH sites

All cases of haematological malignancy are reviewed and discussed locally with regular bone marrow, radiology and histology meetings. Regionally the unit lies within the Central South Coast Cancer Network (CSCCN). Network MDT




management meetings are run twice weekly by video-conference with network leads in Southampton. There is a weekly MDT ward round with participation from the nursing staff, haematology CNS, oncology pharmacist, consultant microbiologist, oncology dietician, and palliative care and haematology doctors. BNHH is also a designated site for treatment of Teenage and Young Adult patients (TYA). The conditions treated include acute and chronic leukaemia, lymphoma (including primary CNS lymphoma, Burkitt’s Lymphoma and relapsed lymphoma), myeloma, myelodysplasia, myeloproliferative disorders and non-malignant haematological disorders. There is a strong commitment to clinical trials with participation in many NCRI trials. The current clinical trials portfolio (active recruitment and follow up) within the trust include: AML17, AML16, LI-1, AML HR, AML 15, UKALL14, Myeloma X, SPIRIT 2, SPIRIT 1, PT1, InCiTe, , RIAltO, REMODL-B, PACIFICO, RATHL, RENEW, Symphony, Familial CLL Study, NSHLG, EBV-NK/T, WM1. Haemophilia, Haemostasis and Thrombosis Centre There is a specialist Haemophilia, Haemostasis and Thrombosis Centre within the BNHH site that is purpose-designed and separate from the hospital with good flexible clinical facilities and dedicated parking. The multidisciplinary team provides comprehensive care for patients with congenital and acquired bleeding disorders. It is also the site for the thrombophilia and anticoagulant clinics. Laboratory Haematology Currently there are fully CPA accredited laboratories offering a full range of services on both the BNHH and RHCH sites. These services include routine haematology (FBC and ESR automation, blood film, blood parasitology, haemoglobinopathy, bone marrow aspirate processing and reporting), blood transfusion and routine coagulation. There are also specialist services available on the BNHH site including specialist haemostasis and thrombosis and immunophenotyping. The blood transfusion service provides full genotyping where required and complies with MHRA. It is well represented in the Trust’s transfusion committee and laboratory management meetings. Clinical haematology input is provided for the issue of blood products to enable appropriate use of these products. The laboratory out of hours service provides 24hr cover for both the laboratories enabling provision of all tests required for the immediate clinical management of patients. Specialist or batched tests are completed in normal working hours. There are well developed referral pathways for complex investigations not provided locally. Equipment The BNHH site currently has two ADVIA 2120i analysers with slide makers, two Destiny Max, two Biorad variant II, Flex 900 post analytical sorter, Vitech ESR, two Diamed gel station, PFA100, PAP8, blood coagulometer, Sebux Hydrasis. The RHCH site has one Sysmex track, two Sysmex FBC analysers and one slide maker,




two Diamed gel stations, two Menarine 8160, two ESR analysers, plasma viscometer. Work load and staffing

Annual Workload (2010/2011) BNHH and RHCH sites

FBC 382,166

Films 35,120

ESR 93,359

Bone Marrows 618

Coagulation Screens 62,071

Factor Assays 1,069

-Lupus 797

-Antithrombin 466

-Protein C 468

-Protein S 470

-P mutation 369

-FVL 369

Blood Transfusion requests 37,939

Units of blood crossmatched 12,254

Staffing (WTE) BNHH and RHCH sites

BMS Band 8 4.5 BMS Band 4 3

BMS Band 7 7 BMS Band 3 1.5

BMS Band 6 20.2 MLA 5

BMS Band 5 3

The laboratory has full CPA accreditation and MHRA approval for blood transfusion and participates in all relevant NEQAS EQA schemes. The laboratory is recognised by the College and Council for Professions Supplementary to Medicine (CPSM) for training. Role of the Speciality Registrar This post provides an excellent training in clinical and laboratory haematology. The post holder will be based in Basingstoke and North Hampshire Hospital. The Speciality Registrar will gain the wide experience in the treatment of haematological malignancies, the management of haematological emergencies, full range of diagnostic and therapeutic procedures, an understanding of palliative care, the management of non-malignant haematological conditions, the management of bleeding disorders and a full range of laboratory and management training. At least one of the consultants will always be available for advice. The Speciality




Registrar will be responsible for day-to-day management of haematology inpatients and day patients, reviewing ward referrals and responding to clinical and laboratory enquiries. The Speciality Registrar will attend the multidisciplinary meetings and outpatient clinics. The Speciality Registrar will participate in teaching of medical, nursing and laboratory staff. There are regular haematology and medical journal clubs and grand round case presentations. On call: 1:4 weekends with Consultant cover Management Specialty Registrar will further develop an understanding of the key management areas, including the management structure of an NHS Foundation Trust, clinical governance, risk management, CPA and MHRA accreditation, internal and external quality assurance including NEQAS schemes. Audit Specialty Registrar will undertake at least one audit annually.

Salisbury NHS Foundation Trust

Medical Staff 4 Consultants (3.25 WTE)

1 Speciality Registrar (one year rotation)

1 CMT and 1 FY2 doctor (4-monthly medical rotations)

5 Medical / Clinical Oncologists

1 Staff Grade doctor, Oncology

Nursing Staff

1 Haematology CNS

1 Lead Cancer Nurse

Sister, Pembroke Ward

Sister, Pembroke Suite

Sister, Mobile Chemotherapy Unit

1 TP

5 Anti-Coagulation Nurses

3 Clinical Trials Practitioners (2 WTE)

2 Acute Oncology Team Nurses

1 Chemotherapy Nurse Practitioner




Scientific Staff BMS3 haematology

1 BMS 3 blood transfusion

BMS 2 haematology

1 BMS 2 blood transfusion

9.5 wte BMS1 + trainee

6 MLA (haematology&biochemistry)

Clinical Haematology The Haematology/Oncology Department combines Clinical Haematology and Medical Oncology services and operates from the Pembroke Unit: this comprises Pembroke Ward, a 10-bed (6 siderooms) ward housing Haematology and Medical Oncology inpatients, as well as other inpatients with cancer-related problems and general medical patients, and the Pembroke Suite, where day case investigations and treatments, including outpatient chemotherapy and blood component transfusions are administered. Facilities include a Spectra Optia cell separator for plasma exchange and blood stem cell collection. A weekly venesection clinic is run by a Clinical Assistant, and a weekly Myeloproliferative Neoplasma clinic is run by a phrmacist. There is a team of Oncology trained nurses fully experienced in cannulation and administration of cytotoxic drugs. The Trust also providses a Mobile Chemotherapy service which visits local areas on 4 days of the week. The Clinical Haematology service provides care at BCSH Level 3 for adult patients from beyond the whole catchment area of Salisbury Healthcare NHS Trust with a wide variety of malignant and non-malignant haematological conditions, and includes a satellite service (in conjunction with UHS) for autologous peripheral blood stem cell transplantation. Peripheral blood stem cell mobilisation and collection is performed in Salisbury, and cell processing and storage is arranged through the NBTS Steve Mills Stem Cell Laboratory. This service is HTA-accredited. JACIE accreditation is as a satellite centre with the Wessex Blood and Marrow Transplant Unit. Patients are admitted to UHS for conditioning and stem cell return, and then return to Salisbury for the remainder of their in-patient stay (and subsequent follow-up). Dr T Everington (0.4 WTE) manages patients with bleeding / clotting disorders, with the involvement of the Anti-Coagulation team. Patients requiring allogeneic transplantation or radiotherapy are referred to UHS. There is active recruitment to national clinical trials for patients with both malignant and no-malignant haematological conditions.




Salisbury participates in the Western Multidisciplinary Teams to comply with the NICE Improving Outcomes Guidance in Haematological Malignancies. MDT meetings are held every week in Southampton with video-conferencing links to Salisbury/Basingstoke/Winchester/IoW. Separate meetings are held for Lymphomas and Leukaemias/Myeloma. The Department of Clinical Radiology provides a full range of diagnostic and therapeutic modalities, including CT and MRI, as well as insertion of indwelling venous catheters. Patients requiring PET/CT scans are currently sent to the InHealth NHS PET/CT Diagnostic Centre in Southampton. There is a Medical Microbiology service on site. Eleven outpatient clinics are held weekly, including 2ww referrals, haemophilia / thrombophilia, myeloproferative disorders, and pre-chemotherapy holistic needs assessment clinics. Daily anticoagulant clinics are run by specially trained nurses. Clinical Haematology workload figures for 2005 are shown below:

New outpatients 611

Total outpatients 5048

Inpatient episodes 141*

Day case attendances 2940 *Average inpatient numbers at any one time 5-10.

Paediatric haemato-oncology cases are referred to University Hospitals Southampton NHSFT for investigation and management.

The Medical Oncology service is led by 3 Medical Oncologists and 2 Clinical Oncologists who divide their time between Southampton and Salisbury. The majority of their work is out-patient based, with chemotherapy being administered on Pembroke Suite. Oncology patients who require in-patient care are admitted to Pembroke ward under the care of the medical team, with the exception of patients with febrile neutropenia who are cared for by the Haematology team.

Junior medical staffing for Pembroke Ward is provided by a CMT and an F2 doctor working a ward-based system.

There is a hospice on-site, with excellent working relations with the Palliative Care team.




The department is committed to providing flexible and high quality care for patients that meets locally and nationally identified standards. Laboratory Medicine The Department of Laboratory Medicine was created in 1995 by a merger of Haematology and Blood Transfusion with Chemical Pathology, and provides an analytical service to Salisbury, South Wiltshire and parts of Hampshire and Dorset. The department is housed in modern laboratories and has full CPA accreditation. The Transfusion Laboratory has full MHRA accreditation (inspected 2014). The routine haematology laboratory is equipped with Beckman DXH FBC analysers . Blood film and bone marrow staining are carried out using an automated slide maker stainer. Blood coagulation uses Sysmex CA1500 analysers for both coagulation screens and for the monitoring of anticoagulant therapy. The department currently operates a postal service for monitoring of anticoagulant therapy. Investigation of haemostasis and thrombophilia are carried out in the laboratory. The laboratory processes approximately xxxxx requests per annum for Antenatal screening for Sickle cell & thalassaemia. Haematinic assays are carried out within Laboratory Medicine using the Roche modular system and the Beckman Access. Samples for Factor V Leiden, Prothrombin G20120A or cytogenetic malignancy markers are referred to the Regional Genetics department here at Salisbury. The department is enrolled in all relevant NEQAS EQA schemes. Cell markers for both lymphoid and myeloid malignancies are sent to the Wessex Immunology department at University Hospitals Southampton NHSFT General Hospital. Blood Transfusion uses the Ortho Innova blood grouping analyser and is working towards the imminent introduction of electronic blood issue. The Genetics service is adjacent to Laboratory Medicine and is headed by Professor Nick Cross: there is an extremely strong research element and the two departments have close liaison and offer excellent opportunities for collaborative research. The Anticoagulant Service is run using the Dawn computer package by xxxx WTE Anticoagulation Nurse Specialists. The department received xxxxx new referrals for anticoagulation last year, and currently monitors xxxxx patients. There is also a nurse-led thrombophilia clinic alongside the consultant thrombophilia clinic. A full-time Transfusion Practitioner is in post. . The Role of the Speciality Registrar




This post gives excellent training in laboratory and clinical haematology. Its strengths are the wide experience gained in the management of haematological malignancies, including lymphomas and the close contact with high quality research. Only one Speciality Registrar is in post and therefore gains experience in all aspects of clinical and laboratory activity. The Speciality Registrar is expected to attend the multidisciplinary meetings on Tuesdays and Thursdays, weekly outpatient clinics and is responsible for the day-to-day management of in-patients and for the supervision of the CMT and F2 doctors who work with them. The consultants rotate each month through inpatient, outpatient (Pembroke Suite) and laboratory roles. At least one of the consultants is always be available for consultation. The Speciality Registrar is expected to report all his / her marrows and to present these at a weekly morphology session and also receives blood films on a daily basis for reporting. The Speciality Registrar is expected to present cases at the fortnightly joint Haematology / Radiology meeting. The Speciality Registrar is also expected to present at the Grand Round. The StR is also expected to perform at least one high-quality audit during their attachment here. The StR is expected to attend all the regional training days and time is allowed in their programme for this. Additional study leave time and funding are granted as per Deanery guidelines. The StR is also expected to attend (and, frequently, to present a case) at the twice-yearly regional Wessex Blood Club meetings which are organised by Dr Grand. The StR delivers a 1:4 share of the on-call rota (weekends only) as first on-call with a second on-call consultant. The StR is not expected to be resident on call.




Poole Hospital Acute NHS Foundation Trust

Department of Haematology Medical Staff: 5 Consultant Haematologists (3 full time, 2 part time) – Dr Fergus Jack, Dr Rebecca Maddams, Dr Darshyani Furby, Dr Ram Jayaprakash, Dr Louise Fraser (currently on maternity leave) Dedicated SHO 1 Specialist Registrar Haematology Laboratory Staff: 1 Haematology Laboratory Manager 2 BMS Grade 3 4 BMS Grade 2 13 BMS Grade 1 2 Trainee BMS 8 MLA 28 Phlebotomists (Most part time) 2 Secretaries Nurse Specialists: 2 Anticoagulation 2 Clinical Haematology Nurse Specialist 0.5 Research nurse




Department Statistics: Haematology workload for 2012-13 was:

Elective inpatients 172

Emergency admissions 257

Day cases 2440

New outpatients 687

Follow up outpatients 4896

Bone marrows 376

Laboratory Services The haematology laboratory provides all the usual routine and specialist diagnostic tests including, specialist haemostasis and thrombosis investigations, haemoglobin electrophoresis, haematinics, and PCR for thrombophilia-associated mutations. About 35% of the workload is from GP users. Poole is the Wessex centre for antenatal haemoglobinopathy screening. The laboratory is fully CPA-accredited. It is well-equipped and provides a complete range of general haematological as well as more specialised investigations, such as immunophenotyping, specialist coagulation, FMH and haemoglobinopathy screens. Analysers used include 2 Abbott Sapphire FBC Analysers, 2 Tosoh G7 HPLC analysers and 1 Alifax automated ESR machine. Haematinics are performed on the Bio Roche platform, red cell folates on an Abbott Architect analyser. The anticoagulation laboratory has two ACL TOPS coagulation stations and a PFA-100 platelet function screen analyser. Full thrombophilia screening is undertaken including genetic testing using an ABI Prism 7000 thermo-cycler. Detailed platelet aggregometry is currently referred. The transfusion laboratory is equipped with two fully-automated Ortho Autovue Innova blood group analysers. A plan to complete Vein to Vein blood tracking using the Blood track System is currently being introduced.Roll out is beginning with fridge control within the lab and will expand to include bedside tracking in the coming months. Two Fresenius intra-operative blood salvage machines are operated by trained theatre staff. The laboratory performs on average, 240 000 FBCs, 110 000 INR/clotting screens, 29 000 transfusion requests, 15 000 haematinic assays and 330 bone marrow aspirates annually. Stem cells are processed and stored at the NBS NBTS Steve Mills Stem Cell Laboratory in Southampton. Basic diagnostic support is offered to paediatric cases. Haemophiliac paediatric cases are managed at Poole but paediatric oncology by local Paediatricians in conjunction with Southampton. There is full participation in NEQAS across the laboratories with excellent performance.




Inpatient Services

Clinical Haematology is part of the Oncology Directorate, laboratory part of the Pathology Directorate. Poole Hospital forms the hub of the Dorset Cancer Centre, comprising Poole, Dorset County Hospital and the Royal Bournemouth and Christchurch Foundation Trust. Haematology shares two dedicated wards with Clinical and Medical Oncology. There are two HEPA filtered isolation rooms. The unit provides a comprehensive service for haematological disorders including acute and chronic leukaemia, lymphoma and myeloma. The autologous transplant unit if fully JACIE accredited. Allogeneic transplants are referred to Southampton Hospital. There is also a busy day case facility for the outpatient treatment of patients with haematological and oncological disorders. Specialist nurses are fully trained in venepuncture, chemotherapy administration, venesection and PICC-line insertion. There are facilities for stem cell harvesting and plasma exchange. Hickman line insertion is provided by radiology. The Haematology department is supported by a dedicated SHO on the general medical rotation and 2 Haematology Nurse Specialist. There is a weekly multidisciplinary meeting video-linked to RBH and DCH. Poole is consistently one of the busiest District General Hospitals in the region Outpatients There are 8 regular outpatient clinics per week at Poole and alternate week clinics at Swanage Hospital and at the Victoria Hospital, Wimborne. There is a coagulation clinic once a week run my Dr Mainwaring as part of the comprehensive haemophilia services. There are monthly Paediatrics Haemophilia clinics .There will be ample opportunity for the Specialist Registrar to attend any of these clinics. Anticoagulant dosing is performed by 3 dedicated staff using Dawn 4S software. Role of the Specialist Registrar The role of the Specialist Registrar will include:

Day-to-day management of Haematology inpatients, day patients and outpatients.

Haematological advice to GPs and hospital staff including seeing ward referrals.

Practical procedures including: bone marrow aspiration and biopsy, pleural and ascetic aspiration, lumbar puncture, and intrathecal administration and removal of lines.

Laboratory duties including the reporting of blood films and other laboratory results, and advice on specialist further investigations and transfusion issues.

Ward supervision of the Haematology SHO




Teaching of SHOs, medical students and other clinical staff.

Presentation of at least one audit.

A research interest leading to a publication would be strongly encouraged.

Management The post holder will be managerially responsible to the Specialty Clinician for Pathology. Timetable The proposed timetable for the Specialist Registrar is:

AM PM

Monday

Morphology Teaching from Consultants on a

Rota

Laboratory / ward work

Lab / ward work/FJ/DF ward

round

Tuesday General Haematology Clinic (RLM) RLM Ward Round /ward reviews

Wednesday STR lead ward round Bone marrow clinic on MIU

Thursday General haematology clinic (FJ) Laboratory / ward work

Friday

Haemato-oncology multidisciplinary meeting

Autologous Stem Cell transplant planning

meeting

Journal Club

Joint Consultant Ward Round

Oncology Clinical Governance/Education

meeting

Histology MDT

Lab reporting

On Call Commitments

1 in 4 weekends on call Answering the bleep within working hours Mon-Fri Audit and Continuing Professional Development

Time will be allocated in the job plan for audit and CPD activities and the registrar will be expected to present at least one audit. There are weekly multidisciplinary meetings, a weekly medical journal club, weekly Grand Round case presentations in term and excellent facilities for reading and on-line research based in the




Postgraduate Medical Centre Library. Apart from regular local teaching, attendance at the regional training days is expected.

Main Conditions of Service

The posts are whole-time and the appointments are subject to:

1. The Terms and Conditions of Service (TCS) for Hospital Medical and Dental

Staff (England and Wales)

2. Satisfactory registration with the General Medical Council

3. Medical Fitness – You may be required to undergo a medical examination and

chest x-ray. Potential applicants should be aware of the Department of Health

and GMC/GDC requirements with regards to HIV/AIDS and Hepatitis viruses.

Candidates must be immune to Hepatitis B. You will be required to provide, in

advance of appointment, evidence of immunity or have a local blood test (as

deemed necessary by the Occupational Health Department)

4. Right to work in the UK

5. Criminal Records Check/POCA check carried out by the Trust Medical HR

department.

6. Pre-employment checks carried out by the Trust Medical HR department.

Hours The working hours for junior doctors in training are now 48-hours 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

http://www.nhsemployers.org/your-workforce/need-to-know/european-working-time-directive

http://www.nhsemployers.org/your-workforce/need-to-know/european-working-time-directive




from time to time. The pay scales are reviewed annually. Current rates of pay may be viewed at: http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/agenda-for-change-pay. 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 pay scales may be viewed at: http://www.nhsemployers.org/ . 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. Annual leave Your entitlement to annual leave will be five or six weeks per annum depending upon 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. Sick pay Entitlements are outlined in paragraphs 225-240 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 your induction. Travel expenses

http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/agenda-for-change-pay

http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/agenda-for-change-pay

http://www.nhsemployers.org/

http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars





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 will 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 will be explained at induction. Relocation expenses The employer will have a local policy for relocation expenses based on paragraphs 314 – 315 of the TCS and national guidance at: http://www.nhsemployers.org/your-workforce/pay-and-reward/nhs-terms-and-conditions/junior-doctors-dentists-gp-registrars. You are advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure. In addition to local policy there is Deanery guidance which can be viewed on www.wessexdeanery.nhs.uk Pre-employment checks All NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements expected to be in line with national guidance at: http://www.nhsemployers.org/your-workforce/recruit/employment-checks. Professional registration It will be a requirement of employment that you have professional registration with the GMC for the duration of your employment. Health and safety All employers have a duty to protect their workers from harm. You will be advised by the employer of local policies and procedures intended to protect your health and safety and to comply with these. Disciplinary and grievance procedures The employer will have local policies and procedures for dealing with any disciplinary concerns or grievances you may have. They will advise you how to access these, not later than eight weeks after commencement of employment. Educational supervisor




http://www.wessexdeanery.nhs.uk/

http://www.nhsemployers.org/your-workforce/recruit/employment-checks




The employer will confirm your supervisor on commencement. General information Health Education Wessex’s management of Specialty Training programmes, including issues such as taking time out of programme and dealing with concerns or complaints, is available at www.wessexdeanery.nhs.uk and in the national ‘Gold guide’ to Specialty Training at: http://specialtytraining.hee.nhs.uk/news/the-gold-guide/.

http://www.wessexdeanery.nhs.uk/

http://specialtytraining.hee.nhs.uk/news/the-gold-guide/

http://specialtytraining.hee.nhs.uk/news/the-gold-guide/

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