Oxford Deanery Specialty Training Programme in Genitourinary Medicine

OXFORD DEANERY SPECIALTY TRAINING PROGRAMME IN GENITOURINARY MEDICINE

About Oxford Deanery

The Oxford Deanery covers the counties of Oxfordshire, Berkshire and Buckinghamshire, with Banbury and Milton Keynes in the North, to Reading and Slough in Berkshire and High Wycombe and Aylesbury in the West.

The Oxford Deanery is part of NHS South of England which comprises South Central, South West and South East Coast Strategic Health Authorities. The Oxford Deanery is responsible for the training of some 1500 trainees.

The Oxford Deanery is a relatively small deanery 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 Oxford Deanery as a whole. This may mean that you may be allocated to any geographic location within the Oxford Deanery depending on training needs.

The Genitourinary Medicine Training Programme

The Genitourinary Medicine training programme is a 4 year programme, starting at ST3. During this time, 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 Certificate of Completion of Training (CCT). The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approvals.

The programme is based in several different Trusts throughout the Oxford Deanery so trainees may find themselves employed by any of the following Trusts and placed in any of the following hospitals:

Trust / Hospitals and Locations
1)Oxford University Hospitals NHS Trust - Oxford / ChurchillHospital, Oxford

The Orchard Health Centre, Banbury
The Garden Clinic
2)(NHS Berkshire East) –Slough / UptonHospital, Slough

Skimped Hill Surgery, Bracknell

St Marks’ Hospital, Maidenhead

3)Florey and Contraceptive Service (Royal Berkshire NHS Foundation Trust) – Reading / RoyalBerkshireHospital, Reading

WestBerkshireCommunityHospital, Newbury

Rotation Information

It is envisaged that trainees will rotate through all 3 centres e.g.

Year 1 – Oxford; Year 2 – Slough; Year 3 – Reading; Year 4 –Oxford

The exact rotation will be planned on an individual basis with the trainee and the Specialty Training Committee.

The overall objectives of the training schemes are to produce competent, knowledgeable and highly motivated genitourinary physicians by offering a wide experience in all areas of the specialty as well as appropriate exposure to research, audit and management.

The training programme is over four years. Competency will be acquired in GUM, HIV, dermatology, gynaecology, microbiology as relevant to GUM, contraception, management, public health and epidemiology. Some specialist experience will be gained by attachments to other services.

Out patient HIV experience will be gained through training at all centres on the rotation. In addition trainees will be encouraged to spend up to 3 months in a large HIV patient centre in the latter part of their training to consolidate this experience.Experience in an integrated sexual health service and contraceptive training will be provided by rotation to the Garden Clinic, Slough.

Trust Information

Oxford

The Oxford Department of Genitourinary Medicine is the largest department in the Deanery and is the only teaching Department, seeing some 30,000 outpatient attendances per annum. The main service is delivered at the ChurchillHospital, Oxford. There is a satellite clinic in Banbury at the Orchard Health Centre which operates daily, except Wednesdays.

The arrangement of services is as follows:

ChurchillHospital, Oxford

The main service, based at the Churchill Hospital, is open from Monday to Friday between 8.30am and 7pm. Patients are seen from 9.15am, with clinic closing at 6.30pm on Monday and Tuesday, 7pm on Wednesday and Thursday and 4.30pm on Fridays. Routine booked and walk in clinics run daily.

Orchard Health Centre, Banbury

Clinics are held four days a week in dedicated space, shared with Reproductive healthcare. There is a walk in service on Mondays and Fridays and predominantly an appointment service on Tuesdays and Thursdays.

The outpatient services covered

Both sites offer a full service for the management of sexually transmitted infections including HIV infection, emergency and some routine contraception services and other genital conditions. There are nurse-lead wart treatment and Hepatitis B immunisation clinics.

Specialist clinics

Young persons

There is a weekly drop-in Young Persons Clinic on a Wednesday afternoon

Genital Skin Disease and complex GUM

Weekly clinic run by the speciality registrars

Vulval

There is a weekly clinic run by one of the consultants

Psychosexual (including Erectile dysfunction)

There is a weekly psychosexual medicine clinic run by a General Practitioner with a special interest

Contraception

The Genitourinary Medicine department provides emergency contraception services and a weekly one stop young persons walk-in clinic. In addition there are close links with the local Family Planning service. Trainees will be expected to obtain their DFSRH and participate in the Family Planning clinics.

Prison

A weekly in reach genitourinary medicine clinic is provided to Bullingdon Prison, a male category B / C prison and a monthly in reach clinic is held in Huntercombe prison, a category C prison for men awaiting deportation.

HIV

The department has an increasing cohort of patients and provides regular care for approximately 320 patients. There are three dedicated HIV clinics held weekly, supported by a specialist pharmacist. Inpatient care is provided by the Infectious Disease service. There is a weekly MDT to review difficult cases and there are joint monthly meetings with Infectious Diseases, and routine Infectious Disease ward rounds on a Tuesdays and Friday mornings. The specialty registrar is responsible for liaising between the ward and the department in relation to shared patients. When there are Genitourinary Medicine HIV in-patients specialist registrars are expected to visit regularly and contribute to management.

HIV In –patient care

Training in HIV in-patient care will be provided by regular attendance at the Infectious Disease Unit, liaising with Infectious Disease and GUM when GUM patients are admitted and during the rotation to Reading. The Reading Genitourinary Medicine department has responsibility for HIV in and out-patients and the in-patient experience is recognised for training purposes by the SAC in Genitourinary Medicine.

Medical Staff Members

ConsultantsDr L. Dorrell (Honorary consultant)

Dr A Edwards

Dr R Malet

Dr H McShane (Honorary consultant)

Dr J Sherrard

Associate SpecialistsDr L Sands

Specialty doctors3 Whole time equivalent

Specialist Registrars2 Whole time equivalent

GP SpR1.0 wte

FY2 (academic)0.5 wte

Slough

The Sexual Health Service in East Berkshire, known as the Garden Clinic, was formed in 1993 by the integration of the clinical services of Genitourinary Medicine, HIV and Reproductive healthcare. The philosophy of the service isto provide holistic sexual healthcare in one visit, on one site by one clinical team. Berkshire Healthcare Foundation Trust (BHFT) is the NHS provider. East Berkshire has a catchment population of 360,000, predominantly in the towns of Slough, Windsor, Maidenhead and Bracknell. The Garden Clinic in Slough is the central clinic, with satellite,locality clinics in Bracknell and Maidenhead

The Garden Clinic, Slough – this is a Level 3 service based in a community hospital, UptonHospital, located in the town centre. The clinic has undergone a major extension and refurbishment to increase the number of clinic rooms and improve the reception, waiting room, and laboratory. The Service is supported by the Preview Clinical Management IT system and there is an active programme for developing an electronic patient record. A fully equipped in-house laboratory supports the investigation and management of STIs, with back up facilities provided by the laboratories at WexhamParkHospital. This is a dispensing service, with on-site pharmacy support.The service has excellent relationships with General Practice and is a well-recognised centre for training in particular for reproductive health care.

It is a busy service, with some 20,000 annual attendances for STI care across the services, 12,000 attendances for contraception care and 4,000 attendances for HIV. The Garden Clinic offers a full service for the management of STIs including HIV infection, a full range of contraceptive services, sexual dysfunction and psychosexual problems. Integrated walk-in (WI) GUM and reproductive healthcare ie Sexual Health clinics run daily from 8.30 to 16.00. Specialist booked clinics run concurrently. Integrated walk-in services for young people run at all 3 Garden Clinic sites.

The Garden Clinic, Bracknell – provides Level 3 contraception and Level 2 STI services twice a week in a Health clinic in Bracknell town centre. This service is currently under review, with the aim of broadening its service delivery.

The Garden Clinic, Maidenhead – provides weekly Level 2 contraceptive services in St Mark’s, a community hospital. This service is currently under review, with the aim of broadening its service delivery to include STI services.

Heatherwood and Wexham Park Hospitals NHS Foundation Trust – Close links exist with colleagues in clinical and pathology disciplines in this DGH. This is the first-line in-patient facility for HIV-positive patients or GUM patients requiring admission.

HIV Care

The department has an expanding cohort of approximately 500 HIV-positive patients. Out-patient clinics run daily, with support from clinical nurse specialists, health advisers and a specialist HIV dietician. Virtual HIV clinics have been established for stable patients on antiretroviral therapy. In-patient care is provided by Heatherwood and Wexham Park Hospital (HWPH) in the first instance, with tertiary specialist support via St Mary’s or ChelseaWestminsterHospitals. There is a weekly multidisciplinary team meeting with colleagues at HWPH to improve the care of HIV in-patients. Ante-natal HIV care has well established links with paediatric and O&G HWPH colleagues, with clear guidelines and patient pathways. A Family Clinic is run in conjunction with paediatricians from HWPH and St Mary’s at the Garden Clinic.

Enhanced Services

• Young persons walk-in, fully integrated GUM & FP service
• Psychosexual counseling service
• Erectile dysfunction / Chronic STI clinic – PEP, chronic HSV, HPV
• Specialist FP services – IUD / IUS / Implant insertions / Deep implant removal
• Nurse led GUM services – Wart treatment, Vaccinations, Symptomatic and asymptomatic STI screens
• Nurse led FP services
• HIV outpatient services (including dietetics, specialist nurse adherence input, sexual health screening and reproductive healthcare)
• Family Clinic (HIV positive)
• Antenatal HIV care

As the Garden Clinic is an integrated service, trainees will have ample opportunity to obtain Reproductive healthcare training to DFSRH level & LOC in IUDs & Implants. There is a rolling education programme on Wednesday afternoons including,external speakers, audit, case review etc

Timetable of Dr Clinics

8.30 WI start / 16.00 WI close / 17.00-19.00
Mondays / (Business meetings) / (12.00-14.30)
Sexual HealthWI / HIV
GUM specialist
FP specialist
Bracknell FP
Tuesdays / Sexual HealthWI & booked
HIV / Sexual HealthWI & booked
HIV
Wednesdays / Sexual HealthWI & booked
FP specialist (2)
HIV
HIV Wardround / HIV MDT
Education / Clinical Governance meetings
(15.00-17.00)
Young Persons walk-in
Thursdays / Sexual HealthWI & booked
HIV / Sexual HealthWI & booked
HIV
Sexual dysfunction
Bracknell GUM/FP
Bracknell Young persons walk-in / (17.30-19.00)
Maidenhead FP
Fridays / Sexual HealthWI & booked
HIV / Sexual HealthWI
Maidenhead Young persons walk-in

MEDICAL STAFF in the sexual health team

• Dr Stephen DawsonConsultant in GUM/HIV (Clinical Lead)

• Dr Noreen DesmondConsultant in GUM/HIV (Educational Supervisor)
• Dr Jane AshbyConsultant in GUM/HIV
• Dr Liz AzzopardiAssociate Specialist in Reproductive healthcare
• Dr Clare ElliottAssociate Specialist in GUM
• Dr Nisha PalAssociate Specialist in GUM
• Dr Nina RadhakrishnanStaff Grade in Reproductive healthcare
• Clinical Assistants/hospital practitioners 1.27 WTE
• StR in GUM
• GP VTS

Close links have been established with many different specialities in the Acute Trust - medical, surgical, A&E, obstetrics & gynaecology, dermatology, pathology, urology and microbiology.

Reading

The RoyalBerkshireHospital is located in the centre of Reading. The population served is approximately 455,000. Reading is about 40 miles from London with ready access by road and rail.

The Department of Genitourinary Medicine is located in refurbished and spacious accommodation. This is a very busy department with some 30,000 GU outpatients attendances per annum. The clinic operates predominantly on a 7am-7pm walk-in basis but with facilities specialist clinics. ReadingUniversity has about 6,000 students of multicultural origin and therefore a full range of sexually transmitted and other conditions are seen in this clinic. Approximately 400 HIV positive patients regularly attend the clinic and the GU Physicians. We care for inpatients regularly (60-80 p.a.). We share inpatient care with our nominated General Physician share and work closely with Microbiology; Intensive Care, Respiratory, Neurology and Radiology departments.

In addition to the core services the clinic also provides Contraception for people aged under 25, Complex contraception for all ages, Psychosexual Counselling, and special clinics for vulval and penile skin diseases.

The department actively supports research and audit activities and participates in

MRC studies (currently both START and PIVOT site), virology/immunology studies (Cytotoxic T Lymphocyte Study with University of Oxford) and drug company trials. There would be ample opportunities for trainees to design and carry out their own projects.

Additional educational/MDT type activities include:

1. Monthly radiology meeting/teaching Consultant Radiologist
2. Monthly TB MDT led Dept of Respiratory Medicine
3. Quarterly joint Dermatology clinic with Consultant Dermatologist
4. Weekly joint Hepatitis clinic with Dept of Gastroenterology
5. Weekly/case presentations and discussions (GUM and HIV)
6. Monthly jointly virtual metabolic clinic with Consultant Biochemist

Medical Staffing in Reading

• Dr Alan TangConsultant in GUM/HIV
• Dr Fabian ChenConsultant in GUM/HIV
• Dr Marta MakowskaAssociate Specialist in GUM/HIV
• Dr Gillian WildmanAssociate Specialist in GUM/HIV
• Dr Caroline RimmerAssociate Specialist in GUM/Contraception
• Dr Judy FeltonAssociate Specialist in Contraception
• Dr Henna KhanSpecialty Doctor
• Dr Ruth ReakesSpecialty Doctor
• Dr Kishore NaranSpecialty Doctor
• Vacant PostSTR in GUM
• Mrs Janice BurnettNurse Consultant in Sexual Health

Duties of the Post, Teaching and Research

Generic information, daily commitments will vary according to centre.

a)Principal Responsibilities:

You will be expected to staff routine Genitourinary Medicine clinics both at the base hospitals and in satellite centres. As training progresses you will also take part in referral clinics, in particular the HIV outpatient clinics. There will also be administrative commitments determined by the level of experience.

b)Daily Commitment:

Routine GUM clinics may run from 7am to 7pm, with variations between centres and days of the week. The appointee will staff on average the equivalent of 6-8 sessions (24-32 hours) per week, as intended in the training programme. These will be flexibly worked and will include late sessions each week (usually completed by 6.30 to 7 pm) as well as sessions in satellite services. The appointee will also staff one HIV clinic each week. Contribution to HIV and GUM in-patient care varies depending on site.

c)Description of Working Pattern

The main commitment will be to the routine Genitourinary Medicine service where excellent supervised experience in all aspects of Genitourinary Medicine can be gained. The clinics offer a daily choice of walk in services and appointments and are achieving the Department of Health target of 100% of patients being offered an appointment in 48 hours.

Specialty Registrars (StRs) are expected to arrange their working day flexibly so that the time worked fits within their contracted hours. This means that they must ensure availability for core clinical commitments but that start and finish times can be arranged flexibly, with the rota co-ordinator, so as to fit with a 40 hour working week. The specialty registrar will have responsibility for advising on the management of emergency Genitourinary Medicine including HIV problems presenting through other services such as Accident and Emergency and Gynaecology or directly referred by general practitioners during clinic hours.

Training and Research

d)Teaching

The post-holder will play an active part in local and regional seminars, journal club, grand round presentations and training sessions for medical students, visiting doctors, other medical staff and allied health professionals. On the Oxford years of the rotation, trainees are responsible for organising the medical student 5th year attachment in Genitourinary Medicine and for supervising students who select the Special Study Module in the 6th year. They are also expected to facilitate on the formal teaching and assessment sessions for medical students.

In addition Foundation Year 2 doctors and trainees on GP training scheme rotate through all three departments. The StR will be required to take part in the supervision and assessment of these doctors. Training in the Foundation assessment procedures is available through the Postgraduate Centre.

e)Audit and data collection

The post-holder will be expected to contribute to ongoing data collection and audit within the GUM service including participation in regional and national audits.

f)Research

The post-holder will be expected to take an interest in ongoing clinical trials and research projects and will be encouraged to participate in the design and conduct of new research projects wherever possible and submit these for presentation at academic meetings.

g)Administration/Management

The post-holder will be expected to ensure that accurate clinical records are kept and that timely GP letters are produced where appropriate. In addition, the post-holder will be expected to organise seminars and other administrative tasks as determined by the supervising consultant and/or Lead Clinician. During year 3-4 of training, if based at Oxford, the postholder will organize the departmental rota.