SW Thames Prospectus - South Thames Diabetes and Endocrinology

INTRODUCTION
It is the aim of the London South West Diabetes and Endocrinology Training scheme
to provide the best possible training for consultants in diabetes and endocrinology and
general internal medicine. We aim to do this in a friendly atmosphere in which full
support and encouragement is provided by a team of dynamic innovative and involved
consultant trainers.
This is a 5 year rotation giving wide experience at both teaching hospital and district
general hospital level together with all the common and uncommon aspects of diabetes
and endocrinology. The rotation is designed so that all trainees gain teaching hospital
experience which is based at St George’s Hospital London SW17. St George’s hospital
is one of the biggest Medical schools in London and has pioneered the 4 year post
graduate entry programme putting it at the forefront of medical education. It is also
the regional neurosurgery unit and has an active pituitary service along with close
links to the royal Marsden hospital where adult survivors of childhood cancer are
jointly managed in a Late Effects clinic.. Many of the other hospitals with in the ration
are affiliated to universities such as and Guildford (University of Surrey) and Kingston
(Kingston University) giving excellent opportunities for teaching and research through
out the rotation.
This has been an extremely successful programme and we have over, the last 5 years,
managed to increase the numbers of trainees in there region so that there are now 20
including 2 flexible trainees. We have strong links with neighbouring training
programmes such as the new deanery of Kent, Surrey and Sussex and indeed we
provided a unified programme of formal training in diabetes and Endocrinology across
the region in conjunction with the South East Thames rotation.
HOSPITALS AND POSTS
The London South West Diabetes and Endocrinology Training Programme currently
comprises approximately 20 clinical posts. Each hospital included in the scheme is a
major centre, with a large diabetes and endocrinology service. They offer experience in
both rural and urban communities but are all within commuting distance of London.
The Current posts are St. George’s 5, Guildford 2, Mayday 2, Chichester 1,
Haywards Heath 1, St. Helier 1, Kingston 1, Frimley Park 1, Ashford and
St. Peter’s 1, East Surrey 1 and Epsom 1. The University attached posts
are at St. George’s Hospital (St. George’s Hospital Medical School) and
Guildford (University of Surrey).
All of the posts provide excellent specialist experience and training in diabetes and
endocrinology. Each post is also approved for specialist training in general internal
medicine. Further experience in specialist endocrinology and diabetes is provided at
our teaching hospitals and university associated hospital. St George’s Hospital
provides special experience and training in all aspects of clinical endocrinology,
including gynaecological endocrinology, molecular endocrinology, calcium and bone
disorders, in addition to clinical training in diabetic renal medicine. St George’s is
also the regional neurosciences centre, with a large amount of pituitary surgery.
The rotations will provide a balance of teaching hospital and district general hospital
experience. The centres offer a full range of endocrine experience and educational
opportunities with many unique research opportunities.
2

OVERVIEW OF INDIVIUAL ROTATION SCHEMES
To obtain the combined CST in Diabetes and Endocrinology and General (Internal)
Medicine. It has been specified that a balanced core curriculum that involves a
balance of district general and teaching hospital experience is necessary and this is
provided within the South West Thames rotation. A trainee’s rotation will usually
comprise one to two in at least 3 posts years in teaching hospitals, two to three years
in district general hospitals and hopefully 1 or more years’ research. The first year 2
years of a rotation will be in a DGH, as laid down by the regulations. The actual choice
of posts for a trainee’s rotation will be agreed individually, taking into account their
educational needs individual preferences (e.g. in relation to where they live) and job
vacancies. This provides flexibility so we can provide a broad, based educational
experience tailored to the individuals needs.
Those trainees undertaking at least one year’s research can count one year towards
their CCST and thus will require only four years clinical posts.
RESEARCH
Out of programme experiences (OOPEs) for further medical training in pursuit of a
higher degree is actively encouraged and usually taken in Years 3 or 4. Research is
actively encouraged and there are many opportunities study for higher degrees such
as MD or PhDs within hospitals within the region, e.g. St. George’s (St. George’s
Hospital Medical School), Guildford (University of Surrey) and Registrars also perform
MDs at other academic institutions and all research is encouraged within the rotation.
In the last 3 years 7 trainees have attracted funding and attained a higher degree from
their research programme.
Those trainees undertaking at least one year’s research can count 1 year towards their
CCST, and thus will require only 4 years’ clinical posts. Research opportunities are
largely focussed on the departments at St George’s and Guilford which have a strong
research interest in reproductive endocrinology renal diabetes and metabolic control
respectively. Many of the peripheral hospitals also have extremely active research
portfolios and many of the training consultants either hold dual appointments with
the School of Medicine or are honorary Senior Lecturers.
A regular training programme occurs every third Monday of the month across the
region. In addition the MSc in Diabetes and Endocrinology (run by King’s College
London) is available and participation in this course is highly encouraged – usually
during the first 2 years of the rotation. The MSc is also taught on Mondays but for just
3 out of 4 weeks per month allowing attendance at the other training days.
3

APPRAISAL AND ASSESSMENT
Regular appraisal and assessment will take place to ensure that satisfactory progress
is being made by the trainee and also to ensure that each post provides good
educational experience and also an enjoyable experience. The training committee is
friendly and approachable and if there are any problems we will strive to ensure that
they are rectified as soon as possible. We regularly review our rotation and get trainee
appraisal of the posts to ensure that no post is unduly arduous and that any local
problems are resolved rapidly. The rotation has a reputation of being amongst the
friendliest in the UK.
STRUCTURED TRAINING PROGRAMME
There is a structured training programme and curriculum and this is a joint
programme with South East Thames. During a five year period the curriculum in
diabetes and endocrinology is covered with the least possibility of repetition. Details of
the training programme are enclosed.
STC TRAINING COMMITTEE
We encourage active participation by the registrars on the training committee and
there are two elected representatives that attend every meeting and if individuals
would like to attend at other times this is also possible. The training programme
although hosted by London South West also comprises the Kent, Surrey and Sussex
Deanery.
SUMMARY
The South West Thames Diabetes and Endocrinology Training Scheme has a
reputation for being extremely friendly and providing excellent training in every aspect
of diabetes and endocrinology and general internal medicine. The hospitals are all set
within a pleasant part of the United Kingdom to live. They are all relatively close to
London. The rotation consists of a committed dynamic group of consultant trainers.
We encourage and actively help trainees take time out of the clinical part of the
rotation to perform academic research to ensure that our trainees have the best
possible foundation for a career either as a teaching hospital consultant or a district
general hospital consultant in our specialty. We look forward to meeting you.
DISCLAIMER
All comments on on-call commitment s are correct at the time of going to press but
they are subject to change by individual trusts at any time you must see you contract
of employment to determine your terms and conditions for an individual post
4

THE INSTITUTIONS
INSTITUTION LOCATION CONSULTANTS
Ashford Hospital London Road
Ashford
Middlesex
TW15 3AA
East Surrey
Hospital
Frimley Park
Hospital
Tel No. 01784
884488
Canada Avenue
Redhill
Surrey
RH1 5RH
Tel No. 01737
768511
Portsmouth Road
Frimley
Hampshire
GU16 7UJ
Tel No. 01276
604604
Kingston Hospital Galsworthy Road
Kingston upon
Thames
Kington
Surrey
KT2 7QB
Mayday
University
Hospital
Princess Royal
Hospital
Royal Surrey
County Hospital
Tel No. 0208 546
7711
530 London Road
Thornton Heath
Surrey
CR7 7YE
Tel No. 0208 401
3000
Lewes Road
Haywards Heath
RH16 4EH
Tel No. 01444
441881
Egerton Road
Guildford
Surrey
GU2 7XX
Tel No. 01483
571122
Dr Mike Baxter
mike.baxter@asph.nhs.uk
Dr Helen Ward
helen.ward@asph.nhs.uk
Dr Saf Naqvi
safdar.naqvi@asph.nhs.uk
Dr D K Foster
kenneth.foster@sash.nhs.uk
Dr A Gossage
adrian.gossage@sash.nhs.uk
Dr Emma Bingham
emma.bingham@fph-tr.nhs.uk
Dr Richard Frankel
r.frankel@btinternet.com
Dr Jenny Tringham
jennifer.tringham@fph-tr.nhs.uk.
Dr Mark Spring
mark.spring@kingstonhospital.nhs.uk
Mr Matthew Oldfield
matthew.oldfield@kingstonhospital.nh
s.uk
Dr Richard Savine
richard.savine@mayday.nhs.uk
Dr Malcolm Prentice
malcolm.prentice@mayday.nhs.uk
Dr Trevor Wheatley
trevor.wheatley@bsuh.nhs.uk
Dr Andrew Smith
andrew.smith2@bsuh.nhs.uk
Professor David Russell-Jones
drj@royalsurrey.nhs.uk
Dr Victoria Hordern
victoria.hordern@royalsurrey.nhs.uk
5

INSTITUTION LOCATION CONSULTANTS
St George’s
Hospital
Blackshaw Road
Tooting
London
SW17 0QT
Tel No. 0208 672
1255
TAU 0208 725 1429
St Helier Hospital Wrythe Lane
Carshalton
Surrey
SM5 1AA
St Richard’s
Hospital
Worthing
Hospital
Tel No. 0208 296
2000
Spitalfield Lane
Chichester
West Sussex
PO19 8SE
Tel No. 01243
788122
Lyndhurst Road
Worthing
West Sussex
BN11 2DH
Tel No. 01903
205111
Professor Stephen Nussey
stephen.nussey@stgeorges.nhs.uk
Dr Arshia Panahloo
arshia.panahloo@stgeorges.nhs.uk
Dr Leighton Seal
leighton.seal@stgeorges.nhs.uk
Dr Kenneth Earle
kenneth.earle@stgeorges.nhs.uk
Dr Andrew Rodin
andrew.rodin@epsom-sthelier.nhs.uk
Dr Stephen Hyer
steve.hyer@epsom-sthelier.nhs.uk
Dr Kenneth Laji
laji@mac.com
Dr Deborah Bosman
Deborah.bosman@nws-tr.nhs.uk
Dr Gordon Caldwell
gordon.caldwell@wash.nhs.uk
Dr Ute Weis
ute.weis@wash.nhs.uk
6

ROYAL SURREY COUNTY HOSPITAL
(linking with the University Surrey).
Consultants
Professor David Russell-Jones (Educational Supervisor)
Dr. J. Wright
Dr Victoria Horden
Tel. 01483 464049;
Fax. 01483 406839
E-mail. DRJ@royalsurrey.nhs.uk
Background information about the hospital:
The Royal Surrey County Hospital is located on the outskirts of
Guildford, close to the A3 with very good links by rail or road. The
hospital is a purpose built modern hospital that is located on
University land close to an up and coming and expanding university.
The facilities of the hospital are excellent with the regional medical
library, minimal access training unit involving video-conferencing and
all the latest hi-tec educational equipment and links around the
world.
The department has a purpose build diabetes and endocrinology
centre with an inbuilt research unit called the Cedar Centre (Centre
for Endocrinology, Diabetes and Research). This has been funded by
charitable donations and research grants and was design Sir Nicholas
Grimshaw (Eden Project and Waterloo International Fame). This unit
was opened by Prince Andrew in 2005 and provides excellent clinical
and research facilities. Professor Russell Jones, is also Clinical
Director of the Wolfson Funded Translational Research laboratories,
housed within the Post Graduate Medical School Building adjacent to
7

Cedar Centre which houses state of the art stable isotope labs.
Professor Russell Jones work closely with Professor Umpleby (chair of
human metabolism). There is ongoing research program and we hope
that every SpR would consider taking an MD Higher Degree.
Educational Activities:
There are many educational activities including an extremely well
attended Journal Club on a weekly basis for the whole of the
Department of Medicine; a dedicated Endocrine/Radiology Meeting
particularly for pituitaries; a Nuclear Medicine Meeting particularly in
relation to thyroid, as well as departmental meetings discussing the
very active research programme of the department. There are other
numerous educational general medical activities, including Chest
Radiology Meetings, CCU weekly teaching, renal teaching, Grand
Round and weekly postgraduate medical meeting.
Personnel: The current department is run by Professor David
Russell-Jones, who has a research interest in metabolism and growth
hormone. In addition, a senior physician from Eli Lily is seconded to
the department on a weekly basis (Anne Kehely) who has a particular
interest in endocrinology. Professor Umpleby, has a particular
academic interest in diabetes and metabolism. There is an ongoing
research programme and joint meetings with her and also with a
special interest group at the university, involved in diabetes and
endocrinology. We are fortunate that Professor Josephine Arrant
(world authority on melatonin) and Dr. Linda Morgan (world authority
on shift work and endocrinological patterns) are located at the
University. In addition to the senior member of the staff there are
currently two research registrars undertaking MD thesis within the
department, two research nurses and three specialist nurses
including the facilitator for the health authority in the implementing of
the National Service Framework. We are also fortunate in having Dr.
Alison Jump who is the lead physician for diabetes of the local PCG
and she is a recognised authority in primary care diabetes. In
addition, there is an SHO and houseman to complement the firm.
We are fortunate that there are other consultants in the hospital with
a particular interest in endocrinology and diabetes and the registrar is
attached to them for training purposes for additional specialist clinics.
These are Dr. Mike Ryalls (Paediatric Endocrinologist. Mike Ryalls’
registrar is the only recognised SpR in Diabetes and Endocrinology for
Paediatrics in the whole region). Joint Adolescent, Young Persons and
Growth Clinics are all undertaken by the adult SpR trainee. Mr. Raj
Nigam is a urologist who runs a dedicated andrology clinic and Mr.
Paul Curtis runs an infertility clinic.
It is expected that the adult endocrine SpR attends all of these in
rotation to complement training. Miss Karen Morton is an
8

obstetrician with a particular interest in diabetes pregnancy and runs
a Joint Ante-Natal Clinic together with Dr. John Wright on a weekly
basis, the registrar will also take part in this. It is also hoped that
every registrar will take part in a research project which will lead to an
abstract or small publication during the year of their stay in the
academic department.
Description of Service:
(a) General Medicine – the on call general medical rota is 1:10.
There is easy access to CT scanning and an enlarging modern
casualty and most people find they enjoy the general medicine as
there is good back up, particularly with on call MRI services, etc.. It is
envisaged that General Medicine does not take up a large part of the
SpRs time during the week as the SpR is encouraged to attend all of
these other specialist clinics, leaving the general medicine to be run
by the SHOs and the consultant, apart from the on take. As there are
two SpR’s one, both rotate on and off the GIM beds, this allows
excellent training opportunities, not too much general medicine.
(b) Diabetes and Endocrinology – there is a general Diabetes Clinic
on a weekly basis which involves the SpR seeing new and follow up
patients, there is full on-line blood testing such that patients are seen
with all of their results whilst they wait (HbA1C, creatinine, lipids,
albumin/creatinine ratio). Every other week there is an additional
Young Persons’ Clinic with similar backup. On alternate weeks there
is a dedicated Pituitary Clinic which is multidisciplinary involving
input from the radiotherapists and neurosurgeons, the hospital has
become a regional centre for pituitary disease and has many patients
who are on growth hormone replacement.
There is an active programme supporting the Pituitary Foundation
self-help group and the referral rate for this dedicated Pituitary Clinic
is increasing, providing excellent training in pituitary disease. This
clinic is supported by a full Investigation Unit Service run by the
chemical pathologists so all dynamic function tests can be performed
easily and efficiently.
There is a general Endocrine Clinic once a week and every fourth week
a Joint Thyroid Clinic with the surgeons. The SpR will take an active
role in the Ante-Natal/Diabetes Clinic run jointly. In addition to these
clinics, it is envisaged that the SpR will on rotation attend the
Andrology Clinic run by Mr. Raj Nigam, a Renal/Diabetes Clinic run
by Dr. Bending from St. Helier and an Intertility Clinic run by Mr.
Paul Curtis.
In addition to these, full paediatric and endocrine training is expected
with the SpR attending Dr. Mike Ryalls for paediatric diabetes and for
paediatric Growth Clinic. If required, the SpR can also attend the
9

chemical pathology renal stones and lipids clinics as an optional
extra.
Research
The department is involved in a lot of different research projects with
particular interest in non radioactive stable isotopes and currently a
whole series of insulin clamp protocols using isotopes are being used
to examine novel insulin analogues. We are fortunate that only two
units in the world are being given these analogues to do detailed
metabolic studies and we are one of those. Research income over the
last two years has been approximately £800,000 worth of grants and
in the recent national university Research Assessment Exercise the
department was rated as five star and on a par with the best units in
the United Kingdom.
Timetable
Morning Lunchtime Afternoon
Monday Ward Round Chest Meeting
X-Ray
Tuesday ON CALL
Chemical Pathology
Case
Meeting.
SpR Training
Wednesday Post take ward round* Research Meeting Young Persons’
Diabetes/Pituitary Clinic*
Thursday * 8.30 Journal Club
9.30 General Diabetes*
Friday
CCU Teaching
General/Endocrine and
Joint Thyroid Clinic*
Weekly Postgrad
Meeting and Grand
Round
• Additional specialist clinics as detailed above.
Menopause
Infertility
Paediatric Growth
Paediatric Diabetes
Andrology
Renal Stone
Lipid
Ward Round with
Neuro/Endocrine/Radiolo
gy Meeting/Nuclear
Medicine Endocrine
Meeting*
Free
10

How To find Us
Royal Surrey County Hospital,
Egerton Road,
Guildford,
Surrey,
GU2 7XX
Tel: 01483 571122
Fax: 01483 537747
Rail Services
Guildford Railway Station is situated on the main line between
London and Waterloo and Portsmouth, with connections to Reading
and Dorking. A fast and frequent service is operated with trains
running approximately every 20 minutes. The station is an
approximate 30 minutes walk from the Royal Surrey County Hospital,
and a street map is available via this Multimap link.
If you require any further information, contact the 24-hour National
Rail Enquiry line on: 08457 48 49 50. The Railtrack website contains
all the latest news and a comprehensive timetable function.
Bus Services
There is a regular bus service directly from Guildford Friary Bus Station
and the rear entrance of Guildford Railway Station along Guildford Park Road, to the hospital:
11

THE THOMAS ADDISON UNIT
ST GEORGE’S HOSPITAL, LONDON SW 17.
Consultants
Professor Steven Nussey Professor of Endocrinology and Diabetes
Dr Arshia Panahloo Lead Clinician in Endocrinology and Diabetes
Dr Leighton Seal Training Programme Director for Endocrinology and
Diabetes in South West Thames
Dr Ken Earl Consultant Diabetologist
Associate Specialist
Dr Gul Bano
Telephone 02087251429 fax 0208 725 3572
Background
St Georges Healthcare NHS Trust
St George’s Healthcare NHS Trust is one of the largest healthcare
units in the United Kingdom accommodating around 1170 beds and
treating around 80,000 inpatient and day cases, and over 300,000
outpatients annually. The Trust employs over 4000 staff
incorporating over 700 Medical & Dental Staff. It provides general
acute services together with speciality services including
neurosciences, cardiothoracic, and specialist children’s services.
St George’s Hospital is the main teaching hospital in the western
sector of the South Thames, and as such has developed links with
most district general hospitals throughout South Thames West, and
supports a significant training programme for junior doctors who
rotate through the Trust.
The Trust is on two sites; St George’s Hospital, the base for acute
general medicine and surgical services, the Wolfson
12

Neurorehabilitation Centre in Wimbledon. In 2003 Atkinson Morley’s
Hospital relocated to the Tooting site. The new purpose-built wing is
shared by Neurosciences and Cardiothoracic Services.
Accommodation is arranged over four floors, around inner courtyards
and incorporates 233 inpatient and day-case beds, eight operating
theatres, and a range of state-of-the-art diagnostic and treatment
facilities. There is a large pituitary surgery service.
The Trust serves a resident population of about 300,000 representing
a diversity of cultures. It sits within the South West London Strategic
Health Authority and serves four local Primary Care Trusts.
Thomas Addison Unit Staff:
Consultant Staff Special Interest
Professor Stephen Nussey
Professor of Endocrinology
Dr Gul Bano
Associate Specialist
Dr Arshia Panahloo
Consultant
Endocrinologist
Dr Leighton Seal
Consultant
Endocrinologist
Dr Kenneth Earle
Consultant Diabetologist
Dr Murray Bain
Paediatric Diabetologist
Dr Assunta Albanese
Paediatric Endocrinologist
Mr Anup Sharma
Consultant Endocrine
Surgeon
General and Specialist Endocrinology;
Genetic Endocrine Disorders; Obesity and
the Endocrinology of Eating Disorders;
Gynaecological Endocrinology including
PCOS; Type 2 DM in Ethnic minorities;
Insulin Resistance; Vitamin D metabolism
General Diabetes, General Endocrinology
Thyroid disease and Antenatal diabetes
General Endocrinology, pituitary disease,
Neuroendocrine Tumours, Andrology,
Gender Dysphoria, Diabetic Foot Care
Training Programme Director D+E
Diabetes
Endocrinology
Medicine, Renovascular
Paediatric Diabetes, Metabolic disorders
Paediatric Endocrinology, Endocrine Late
effects of Paediatric Cancer and its
treatment
Thyroid, parathyroid, adrenal and breast
surgery
13

Associate Consultant Staff
Professor Shirley Hodgson
Mr Alberic Fiennes
Mr Henry Marsh
Mr Andrew Martin
Dr Paul Collinson
Dr Frances Boa
Dr Catherine Egan
Mr Jimmy Uddin
Professor Michael Brada
Thomas Addison Unit Staff Members
Diabetic Specialist
Nurse
Research Nurses
Endocrine Nurses
Dietician
Podiatrist
Retinal Screeners
4
3
4
2
3
2
2
Clinical Genetics
Bariatric Surgery
Pituitary Surgery
Pituitary Surgery
Chemical Pathology
Chemical Pathology
Consultant Opthalmologist (Diabetes)
Consultant Opthalmologist (Thyroid eye
disease)
Radiotherapy (Royal Marsden)
SpR
SHO
PRHO
The department of endocrinology and diabetes is a dedicated unit, The
Thomas Addison Unit. It consists of 12 outpatient rooms, a 3 bedded
podiatry unit, the endocrine investigation unit and offices. All aspects
of diabetic care including diabetic nurse specialists, dieticians,
podiatry and endocrine nurse specialists are accommodated within
the department.
Diabetes Services
The Thomas Addison Unit currently has around 5,000 active cases on
its lists. In common with all Hospital
Diabetes Service, the majority of its
work is outpatient activity, although
the team also has access to general
medical beds for management of
diabetic complications, particularly
acute diabetic foot management,
provides a referral service for
inpatient care of patients with
diabetes admitted under other
specialties. In addition to new
patient, follow-up, nurse screening
and annual review clinics, the Department also provides joint diabetes
5
2
3
14

antenatal service, joint diabetes complication clinics for nephropathy,
neuropathy and retinopathy, paediatric and adolescent diabetic
clinics, a patient education programme.
Intensive management of type 1 patients is based around the DAFNE
programme (Dose Adjustment for Normal Eating) which provides
structured education for patients in the form of a one week intensive
course which is run at 4 times a year.
The Diabetic Foot Clinic provides a comprehensive service for the
management of the diabetic foot and has a very large caseload of
complex patients with neuropathic and ischaemic ulceration and
Charcot arthropathy. There is a rolling audit programme including
management of diabetic emergencies and diabetic pregnancy in which
SpRs are encouraged to participate.
Endocrinology Services
The Department of Endocrinology provides a local and tertiary referral
service for all aspects of Endocrinology, with particular strengths in
pituitary disorders, thyroid disorders and specialist clinics for genetic
endocrine disorders and Obesity.
There is a busy programmed Endocrine Investigation Unit staffed by a
full time endocrine specialist nurse and this provides excellent
opportunities for training in Endocrine investigations.
Pituitary Disorders: St George’s is a regional neurosurgical centre
and is now amongst the busiest centres for pituitary surgery in the
UK. Close collaboration exists between the endocrine and
neurosurgical departments, with monthly joint meetings. Both pre-
and post-operative assessment of patients with pituitary disease is coordinated
through the Endocrine Investigation Unit.
Thyroid disorders and thyroid cancer: The department hosts weekly
thyroid clinics for management of general thyroid disorders. In
addition, thyroid cancer management is currently undertaken in the
setting of a joint multidisciplinary meeting in conjunction with
consultant endocrine and ENT surgeons.
Obesity: St George’s is an important referral centre for obesity
surgery, and the endocrine department provides medical input to the
preoperative evaluation and management of patients, working closely
with the surgical and psychiatric teams.
Genetic Endocrine disorders: A large cohort of patients is followed in
clinics designated for rare patients with genetic conditions including
von Hippel-Lindau, Multiple Endocrine Neoplasia and monogeneic
forms of diabetes.
15

Andrology: There is a weekly Andrology clinic seeing patients with
erectile dysfunction male infertility and hypogonadism. There are
close links with the department of urology where psychosexual
counselling is offered.
Gender Identity Disorder. There is a weekly clinic at the Nation
gender identity clinic at Charing Cross hospital run by Dr Leighton
Seal. This clinic sees 90% of the country’s transsexual population
(2000 patients)and is a unique learning opportunity both from a
diagnostic view point seeing many intersex cases and the long term
management of cross gender hormone replacement.
Joint Ophthalmic meetings: These are a particular strength with the
siting of Moorfields Eye Hospital within the St George’s site. Regular
weekly retinal meetings are held with Dr Catherine Egan and
fortnightly thyroid eye disease clinics with Mr Jimmy Uddin.
General Medicine Duties
St George’s hospital is a busy acute trust and benefits fro offering the
support of a large teaching hospital to
provide excellent services to our
population. At present the acute take rota
is recognised for low intensity GiM and
consists of 2 on calls per month plus a
further 2 ward cover slots, this currently
under site-wide review. There is a
dedicated diabetes /endocrine ward with
nursing expertise in the management of
diabetes and its complications. There are
approximately 14 beds.
Approximate number of emergency admissions per 24 hours 30 with
the daily oncall being split into 2. The current composition of the in
taking team: SpR 1 (second SpR for ward cover 5pm-10pm) 2 SHOs, 1
HP.
CLINICS PER WEEK Total clinic sessions (half-days) per week
See Time Tables Below
Specialist Clinics Available for training
Joint Paediatric Endocrine:
Joint Paediatric Diabetes:
Joint Genetic Endocrine Clinic (MEN or
VHL):
Joint Genetic/Young Adult Diabetes
Clinic:
Infertility (with Dr Gerard Conway,
UCLH):
Late Effects of Paediatric
Cancer
Incidentaloma:
Obesity:
Andrology
Antenatal
Gender Identity
16

Endocrine Experience:
The main emphasis for these SpR posts is Specialist Endocrinology in
an extremely active endocrine unit. The Endocrine Investigation Unit
(with two Specialist Endocrine Nurses) performs a full range of
endocrine dynamic testing with weekly endocrine results review. The
SpRs are involved in the day to day running of the Unit.
All imaging modalities are available including CT, MR and Nuclear
Medicine. There are specialist surgeons for pituitary, thyroid and
adrenal disease in addition to bariatric surgery for morbid obesity. Joint
neuroradiology meetings are held monthly.
There is close collaboration with Ophthalmic colleagues from Moorfields
which has a branch on the St George’s site. This includes integrated
visual field testing and retinal review (see below) together with
collaboration with Mr J Uddin for thyroid eye disease. There are regular
multidisciplinary team meetings with the Head & Neck team and the
Endocrine surgical team.
DIABETES EXPERIENCE:
This is a busy and well staffed unit, including 4 Specialist Nurses, 3
Podiatrists, 2 Dieticians and a full complement of support staff in a
dedicated unit.
Professor Nussey has established a programme of retinal photography
for eye screening and there is a weekly joint meeting with the
ophthalmologists for case reviews and education. An education and
quality control programme is being set up with colleagues from
Moorfields (Dr Catherine Egan) to ensure training in retinopathy
grading.
There is a busy antenatal diabetes service run by Dr Panahloo. There is
a joint weekly clinic with Mr Manyonda, and the registrar is involved
with various ongoing audit projects in the clinic. The clinic also offers a
preconception service. The registrar is involved with antenatal ward
referrals.
In foot care there is a monthly joint foot health clinic with the vascular
surgeons providing a multidisciplinary approach to foot health
Internal Education Programme:
This includes weekly seminars and Grand Rounds in addition to postclinic
meetings and the joint meetings detailed above. There is also a
weekly General Medicine teaching session. SpRs are expected to
participate actively in audit and governance projects and to produce a
poster for a National Endocrine meeting annually.
17

Research Opportunities
There is an active programme of research at the Tomas Addison unit.
Currently there are projects in
diabetes control, polycystic
ovarian disease and renovascular
disease ongoing in the
department.
Collaborations with scientists in
the Medical School (including
Professors Alan Johnstone, Guy
Whitley, Saffron Whitehead, Juan-
Carlos Kaski and Dr Helen Mason) mean that a number of projects for
SpRs interested in laboratory research have been available subject to
the usual funding constraints.
There are also links to the department of endocrinology at Imperial
college investigating the endocrinology of gender dysphoria. Clinical
research projects are also available and currently involve retinal imaging
and PCO.
Teaching Opportunities
We have a strong medical school and close links with Kingston
University. St George’s has been at the forefront of medical education
developing the four year post graduate entry programme which
pioneered the use of problem based learning approach for medical
education.
In the department we have both 5 year and 4 year course students
attached to the clinical firms and there is ample opportunity for
teaching. The department of endocrinology organise the weekly
Student Grand Rounds encouraging clinical presentations by the
students in a format designed to improve presentation skills.
Specific Attractions of The Posts
These posts offer the exciting opportunity to be closely involved in a
number of aspects of Specialist Endocrinology while undertaking lowintensity
General Medicine in a Teaching Hospital environment.
18

Timetables:
SpRs to Professor Stephen Nussey/Dr Gul Bano (2 Posts)
Tim
e
Mon Tues Wed Thurs Fri
0800 Retinal meeting
(2nd Obesity MDT
in month) (2nd, 3rd and 4th in month) or
Neuroradiology/
surgery meeting
(1st Head & Neck
meeting (4
in month)
th in
month)
0830 Retinal
meeting (1st Thyroid Eye
disease Clinic
(1
in
month)
st and 3rd) 0900 Paed Diabetes
Medical Obesity
(Dr Bain)
Clinic (2nd Diabetes/Rena
in
l Diabetes (1st
month)
in month)
Genetic
Diabetes (3rd
in month)
Clinic
1230 Student Grand Academic Grand Round Endocrine
Round
Meeting
1330 Retinal Investigation
Or Thyroid MDT
review meeting Meeting
1330 Late Effects (1st and 3rd) or
Incidentaloma
Clinic (2nd and
4th) General
Endocrine/Gyna
e (1st and 4th)/ Adolescent (3rd in month) or
Joint Surgical
Clinic (2nd Infertility (Dr Endocrine Clinic
Conway)
MEN or VHL
monthly
Clinic (2
in
month)
nd Paed
Endocrine (Dr
in Albanese)
month
bimonthly)
1700 Postclinic
Postclinic
meeting
meeting
SpR to Dr Panahloo
am Antenatal
DM clinic
Monday Tuesday Wednesday Thursday Friday
pm Ward Round
Retinopathy
Meetingx2/month
Ward Work
Student Grand
Round
Or Thyroid MDT
Post Take Round
Neuroradiology/su
rgery meeting (1 st
in month)
Ward Round
On call alternate week
Journal Club
On call alternate
week
Research/Audit
Endocrine Clinic
and General
internal Medicine
Clinic
Post Clinic Meeting
Foot Health Clinic
X1 / month
Diabetic Clinic
Grand Round
X Ray Meeting
Ward Work
Data
Interpretation
Ward Work
Medical
Student
Teaching
19

SpR to Dr Seal
am Research
/Audit
pm
Monday Tuesday Wednesday Thursday Friday
Gender
Identity Clinic
Charing Cross
SpR to Dr Earle
Retinopathy
Meetingx2/month
Ward Work
Foot health clinic
liaison (1 hour)
Student Grand
Round
Or Thyroid MDT
On call alternate week
GiM
multidisciplinary
meeting
On call alternate
week
Teaching Medical
Students
Post Take Round
Monthly
Neuroradiology/s
urgery meeting
(1 st in month)
Ward Round
Journal Club
Joint Vascular
Foot Health Clinic
X1 / month
Diabetic Clinic
Grand Round
Endocrine Clinic X and Ray Meeting
General internal
Medicine Clinic
Andrology Clinic
Post Clinic
Meeting
Diabetes &
Renovascular
Endocrine Clinic
Post Clinic
Meeting
Ward Round
Data
Interpretatio
n
Ward Work
Tim
e
Mon Tues Wed Thurs Fri
0800 Retinal meeting
(2nd Post-Take
in month) Round
0900 Ward Round On-Call
Type 1 Diabetes Ward Round
Clinic (monthly)
Diabetes
Ward Work
Clinic
1230 Student Grand
Round
or Thyroid MDT
1330 General Internal
Medicine/Endocri
ne
Joint
Diabetes/Renal
Clinic (alt weeks)
1700 Postclinic
meeting
Medical
Student
Teaching
Cardiovascular
Research Group
or Journal Club
Research/Audit
Grand Round or
Retinal Review
meeting
(monthly)
Results Review
(alt weeks)
Community
Teaching
(optional)
Endocrine
Investigation
Meeting
Medical
Student
Bedside
Teaching
and/or PBL
with Case
Portfolios
20

Contact Numbers:
Consultant Professor Stephen Nussey (Sec 0208 725 1027)
Current post holders Dr Osman Sharfi (Bleep No. 6237)
Dr Sunil Simjee (Bleep No. 6680)
Dr Henrietta Brain (Flexible trainee)
Consultant Dr Arshia Panahloo (Sec 0208 725 3902)
Current Post Holder Dr Geeta Nargarajan (Bleep No 6636)
Consultant Dr Leighton Seal ( 0208 725 1027)
Current Post Holder Dr Yashica Nathan (Bleep No 7508)
Consultant Dr Kenneth Earle ( 0208 725 34990918)
Current Post Holder Dr Tabinda Dugul (Bleep No 6957)
Medical Staffing Department: 0208 725 2209
21

How to Find Us
The Thomas Addison Unit
Lanesborough Wing
St George’s Hospital
Tooting
SW17 ONN
Telephone 0208725142
fax 0208 725 3572
Underground
Tooting Broadway underground station on the Northern Line is ten
minutes walk from the main pedestrian entrance on Effort Street.
Bus
TAU
864 Calling at: Putney Bridge Station, Putney Station, Wandsworth,
Earlsfield, Bruntewood Lane, St George's Hospital, Colliers Wood,
Merton Abbey, South Wimbledon Station
Alight at St George's Hospital, Blackshaw Road
870 Putney Bridge Station, Putney Station, Southfields, Wimbledon
Park, St George's Hospital, Tooting Broadway, Tooting Station,
Mitcham, Beddington, Waddon, Croydon
Alight at St George's Hospital, Garratt Lane
919 St Helier Station, Morden, Mitcham, Colliers Wood, Tooting
Broadway, Tooting Bec, Wandsworth Common, Burntwood Lane,
Earlsfield, Wandsworth
Alight at Tooting Broadway
22

Brighton and Sussex University Hospitals NHS
Trust
Princess Royal Hospital
Consultants Dr Trevor Wheatley
Dr Andy Smith
Telephone 01444 441881
Background Information
Brighton and Sussex University Hospitals NHS Trust
Brighton and Sussex University Hospitals NHS Trust was established
on the 1st April 2002 from the integration of Brighton Health Care
NHS Trust and the acute services of Mid Sussex NHS Trust. Brighton
and Sussex University Hospitals NHS Trust provides hospital services
to the local
population of some 500,000. It also provides a range of specialist
services including cancer services, neurosciences, cardiac surgery,
renal services, HIV medicine and interventional cardiology and
Intensive Care for adults, children and new-born babies, to a
population of approximately 1 million.
The Trust manages around 1,140 beds and provides the majority of its
services from two main sites:
• The Royal Sussex County Hospital campus (including the
Sussex Eye Hospital) in Brighton,
• The Princess Royal Hospital campus (including the Hurstwood
Park Neurological Centre) in Haywards Heath.
The Princess Royal Hospital
The Princess Royal Hospital (PRH) is a modern 368 bed hospital built
on the outskirts of Haywards Heath. It opened in 1991 and provides
acute services to a local population of around 150,000. The site
includes a fully equipped ITU, and coronary care unit.
23

Hurstwood Park Neurological Centre is a secondary and tertiary
referral centre for both neurosurgery and neurology including a
purpose built ITU/HDU.
The Radiology department offers a full range of services including CT,
MRI nuclear medicine and bone densitrometry. Limited interventional
radiology such as inferior petrosal sinus sampling is available through
the neuroimaging department.
Chemical pathology, haematology and microbiology are available on
site.
A new state of the art Post Graduate Medical Centre (PGMC) has
recently opened offering facilities for multimedia presentation. The
PGMC includes a library which can be accessed 24 hours a day.
Electronic access is available for many journals not held in the library.
Recreational facilities include a social club and 18 metre indoor
heated swimming pool.
Parking facilities at the PRH are excellent and a shuttle bus runs
between PRH and the Royal Sussex County Hospital (RSCH) sites
hourly.
General Medicine
There are 130 medical beds including a 6 bedded CCU, a high
dependency respiratory bay offering non-invasive ventilation and a 24
bedded stroke unit. A fully equipped six bedded ITU/HDU is run by
intensivists with input from the admitting medical teams.
The medical team is divided into 4 firms. Each firm comprises 2
consultants, 2 specialist registrars (full shift pattern), an SHO (full
shift pattern) and a pre-registration HO (no overnight duties since
inception of hospital at night scheme).
Endocrinology and Diabetes
Endocrinology and diabetes services are provided by Dr Trevor
Wheatley and Dr Andy Smith in conjunction with the 2 specialist
registrars (see timetables below). In addition to timetabled general
diabetes and endocrine clinics SpRs are encouraged to attend
specialty clinics which include, joint pituitary, metabolic bone disease,
diabetes foot, medical obstetric, young adult and insulin pump clinics.
There are close liaisons with the neurosurgical team at the adjacent
Hurstwood Park Hospital. Patients undergoing hypophysectomy (30-
40 per annum) or other neurosurgical procedures likely to interfere
24

with pituitary function are seen by the endocrine team whilst in
hospital and subsequently in the combined pituitary clinic.
Ultrasound guided fine needle aspiration cytology (FNAC) of the
thyroid is carried out by the radiology department and
cytopathologists.
Specialist registrars are encouraged to attend monthly joint (PRH and
RSCH) endocrine meetings for case discussion/ journal club.
Thyroid and parathyroid surgery (including intraoperative PTH assay)
are performed on site by the University Hospital Trust’s consultant
endocrine surgeon. Additionally there is opportunity to attend the
interdisciplinary thyroid cancer clinic, held at the RSCH.
The diabetes service is supported by Diabetes Specialist Nurses (2.5
whole time equivalents), a Diabetes Dietician (0.4 wte) and Podiatrists
(0.2 wte). We offer an intensive insulin course based loosely on the
DAFNE program and are seeking funding to implement DESMOND
locally.
Given the rural nature of our catchment area we have fostered close
ties with primary care. This includes running a “Diabetes in Primary
Care” education course, consultant outreach clinics and managing a
network of Community Diabetes Specialist Nurses (2.5 wte).
Teaching
The first cohort of Brighton and Sussex medical students entered their
3 rd year in Oct 2005. Roughly one third of the year are allocated to the
PRH on clinical attachments. The Registrar will have opportunity to
participate in the clinical teaching of these students.
Postgraduate Study and Research
Regular events include a weekly Medical Meeting for hospital staff and
GP’s (Monday lunchtime), X-ray meeting for surgical and medical staff
(Wednesday lunchtime), and Medical Division Meeting (Wednesday
afternoon). A multidisciplinary grand round is held monthly.
Registrars are encouraged to undertake research. Clinical research
would be undertaken at the PRH however there are opportunities for
basic science research at Brighton or Sussex Universities. Dr
Wheatley is an Honorary Fellow in the faculty of health, Brighton
University and is honorary Lecturer in the Department of Life
Sciences, University of Sussex.
25

Dr Smith has research interest in arterial compliance and
haemodynamics in type 2 diabetes. Professor C Rajkumar (stroke and
elderly care) has a laboratory equipped to measure arterial compliance
by a variety of methods. This offers the opportunity for collaborative
work in this growing field.
Timetables
Specialist Registrar 1
Monday Tuesday Wednesday Thursday Friday
am Ward Round
(Joint pituitary
clinic monthly)
pm
Educational
Meeting
Medical
obstetric clinic
Specialist Registrar 2
Diabetes/ GIM
Clinic
(metabolic
bone clinic
monthly)
Diabetes
Clinic
X-Ray
Meeting
Medical
Education
Meeting
Endocrine
Meeting
(monthly)
Ward
Round
Grand
Round
(monthly)
Endocrine
Clinic
Monday Tuesday Wednesday Thursday Friday
am Ward Round
(Joint pituitary
clinic monthly)
pm
Educational
Meeting
Diabetes Clinic/
Medical
Obstetric Clinic
Alternate Weeks
Diabetes
Clinic
(young adult
every 2/12.
CSII every
6/12)
X-Ray
Meeting
Medical
Education
Meeting
Endocrine
Meeting
(monthly)
Ward
Round
Grand
Round
(monthly)
Endocrine/
GIM Clinic
26

How to Find Us
The Princess Royal Hospital
Lewes Road,
Haywards Heath,
RH16 4EX
Tel: (01444) 441 881
Fax: (01444) 414174
By Bus
RDH Bus 33 and Compass Bus 40 stop outside the hospital.
For more information about travelling to the hospital please visit East
Sussex County Council website and West Sussex County Council
Website link to Road And Transport and www.westsussex.gov.uk
By Train
Haywards Heath is served by Southern Railway and Thameslink
Trains.
27

KINGSTON HOSPITAL
Galsworthy Road, Kingston Upon-Thames, Surrey
Consultants:
Dr Mark Spring Consultant and Undergraduate Subdean
Dr Matthew Oldfield Consultant and Clinical lead Medical Assessment
Unit
Telephone: 0208 546 7711 ext 2745/2115
The Trust
Kingston hospital NHS trust provides elective and emergency hospital services for
the populations of Kingston, Richmond and Putney as well as parts of
Twickenham and South Wandsworth. It has an enviable location in leafy Surrey
and enjoys close clinical and academic links with St George’s hospital. The
hospital has a dynamic and innovative outlook with a major redesign of the site
ongoing to provide new ward blocks and postgraduate facilities; an application for
foundation status is at an advanced stage. Kingston hospital has approximately
600 beds of which 200 of these are medical. The firms’ ward base is currently
very manageable with an average of 20 beds. Kingston values its junior staff,
recently supporting a mutually beneficent redesign of the on call rota and this
has been reflected in the feedback from junior medical staff.
General Medicine:
This is a busy acute hospital with a full
range of specialties provided by the 16
medical consultants. Medical admissions
vary between 10-40 in each 24hour
period and give excellent exposure to the
full range of medical emergencies. The
Accident and emergency department has
recently been redeveloped and is
modern, efficient-consistently achieving
28

4 hour targets, and pleasant to work in. A new acute medical assessment unit
(MAC) has been introduced to streamline medical admissions and is additionally
staffed by an on call consultant of the day as well as by permanent admissions
unit staff grades aiding the take. Full radiological, endoscopic, ITU and HDU
support is available. Specialist skills provision occurs in the Coronary care and
stroke units with respiratory expertise for BIPAP. An outreach team from ITU
provides additional expert assistance and advice for medically sick patients.
Diabetes and Endocrinology
The full range of Diabetes and Endocrine specialty services are provided. The
main base for the post is at Kingston Hospital, but one diabetes clinic is based at
the newly built Queen Mary’s hospital in Roehampton, a pleasant 10 minutes
away across Richmond Park.
A full range of diabetes clinics run and include
specialist adolescent, eye, antenatal and renal
clinics as well as multidisciplinary clinics for the
diabetic foot which has established orthotic links
with the Douglas Bader unit. There is senior
experienced diabetes nurse support from a team
that includes one of the first Diabetic nurse
consultants as well as psychology and dietetic
expertise. A number of patients in clinic are now
managed with pump therapy and a continuous
glucose monitor has been purchased and is
available for clinical and study use.
The diabetes renal clinic is run jointly with a
consultant nephrologist from St Georges and
offers opportunities for research with projects
currently running in renal anaemia and vascular
stiffness.
The consultants at Kingston have research interests in the pathogenesis of renal
complications, renal anaemia, diabetes and pregnancy and the investigation of
endocrine disease.
Endocrine clinics are unselected with registrars involved recently in the
investigation and diagnosis of acromegaly, Sheehans’ syndrome,
hypoparathyroidism and an insulinoma.
Close endocrine surgical links exist with St George’s hospital and Queens Square
as well as with the Hammersmith hospital providing endocrine and neurosurgical
management for the patients.
Monthly endocrine meetings occur with biochemistry and neuroradiology allowing
discussion of ongoing and interesting cases.
29

Current Registrar Timetable:
On call duties are full shift comprising: 1:11 first oncall day (9am to
9pm)
1:11 second on call (9am to 5pm)
Monday Tuesday Wednesday Thursday Friday
am Consultant
W/round
Registrar
W/Round /
Medical
Antenatal joint*
Study /
Research
Diabetic foot
Consultant
W/round-
Lipid clinic*
Endocrine L
Hospital, general
lunc meeting and practitioner
h Medical unit
grand round
grand round
pm Specialty Endocrine clinic Diabetes Clinic Endocrine
clinics:
Diabetes
renal
Adolescent
Diabetic eye
clinic
1:11 week of nights (split as a 3 and 4 day block)
Registrar
W/Roun
d
*The two consultants alternate ward coverage, currently on a monthly basis, and
consequently the days of their ward rounds maintaining access to speciality
clinics on these days.
30

How To Find us
From M25 (London orbital motorway)
Exit the motorway at junction 10, (signed London (SW), Kingston, Guildford &
A3), and take the A3 towards Kingston. Exit the A3 at the Coombe Lane
Interchange.
Join the A238 (Coombe Lane). Continue down Coombe Lane and turn right at
the junction with Galsworthy Road.
From M3
Exit the motorway at junction 1 (signed Sunbury, Kingston & A308).
Join the A308 (following signs for Kingston). Continue on the A308 to
Kingston and after crossing the River Thames, follow the one way system
rejoining the A308 (London Road).
Turn right onto the A238 (Coombe Road and turn left at the junction with
Galsworthy Road.
By Train
Norbiton Station is served by South West Trains and receives services from
London Waterloo.
For further information about train times and fares, please telephone National
Rail Enquiries on 08457 48 49 50, or visit www.railtrack.co.uk for the
railtrack website.
By Bus
From Kingston Hospital forecourt Bus routes 514 and K2
From Galsworthy Road Bus routes 57, 213, K3, N213
From Coombe Road (A238) Bus routes 514, K2, K3 and K5
From Kingston Hill (A308) Bus routes 57, 85, 213 and N213
31

ASHFORD AND ST PETER’S NHS TRUST
Consultants: Dr Mike Baxter
Dr Safdar Naqvi
Dr Helen Ward
Background Information
Contact Number: 01932-722-306
Ashford and St Peter’s provides acute hospital services to a large and
diverse population, with a catchment of around 450,000 stretching from
West Hounslow to Woking.
Although north west Surrey is a relatively affluent part of the country there
are, nonetheless, pockets of deprivation with higher health and social needs
within the Trust’s catchment area. The catchment population also has a
higher proportion of older people with increased health needs, longer
average stays in hospital and a greater need for social and community care.
General Internal Medicine
Ashford and St Peter’s is a busy district general hospital with support from
a full range of specialities. The Medical Assessment Unit is consultant led
and is currently expanding from 20 beds. On a day to day basis the
medical take is supported by the MAU consultants, on-call general medical
and cardiology consultants. The acute medical activity all occurs at the St
Peter’s site.
In addition to the MAU and general/specialty medical wards St Peter’s has a
5 bed medical high dependency unit, 7 bed coronary care unit with step
down facilities. There is an 8 bed, anaesthetist led intensive care unit plus
a critical care outreach team that provides support for acutely ill ward
patients. Non-invasive ventilation is used on the respiratory ward in
addition to HDU and there is a specialist led stroke unit. The medical unit
is extremely well supported by excellent radiological, pathological and
endoscopic services.
32

Ashford hospital provides rehabilitation services, out-patients, “cold”
surgery and planned investigations. Some services for the local population
are also provided at community hospitals in Woking, Weybridge and
Walton.
Endocrinology and Diabetes
A full range of services diabetes and endocrinology services are provided.
Diabetes and endocrinology out-patient clinics are held at both sites. The
registrar clinics are predominantly at St Peter’s with an alternate week
clinic at Ashford Hospital.
The department is well supported by both in-patient and out-patient
diabetes specialist nurses and diabetes dietician. There is availability for
continuous glucose monitoring at both sites.
There is a dedicated diabetes podiatrist and excellent liaison with the
vascular surgeons. There are specific clinics for young adults with diabetes,
joint renal-diabetic clinic run with Dr Marsh (consultant nephrologist),
endocrine/diabetes ante-natal clinic run jointly with Dr Newbold,
(consultant obstetrician) and a transition clinic for adolescents run jointly
with Dr Bahl (consultant paediatrician).
Also within the trust there are paediatric clinics for diabetes and
endocrinology and retinopathy clinics and the consultants are happy for the
endocrinology SpR to attend for training purposes.
There are weekly general endocrine clinics with an after clinic discussion
meeting and dedicated weekly thyroid/parathyroid clinics with monthly
joint medical-surgical clinic with Mr Thomas, endocrine surgeon. Excellent
radiology support is provided with on site MRI, ultrasound guided fineneedle
aspirations and nuclear medicine scanning.
Post graduate study
There are weekly grand round and hot topic meetings in the post graduate
education centre plus monthly educational half days.
The post graduate education centre library provides a comprehensive range
of both print and electronic knowledge and learning resources, excellent IT
facilities, and a comfortable and well equipped learning environment which
is accessible 24 hours a day.
A range of alerting services and fast and efficient document supply
complements the inquiry and information service. There is time for an
academic half day and the time of this is arranged to suit the needs of
individual registrars.
33

SpR Timetable
AM
PM
Monday Tuesday Wednesday Thursday Friday
Endocrine
Clinic at
Ashford
Hosp* with
after clinic
discussion
meeting
Alternate
weeks
SpR ward
round
Consultant
Ward Round
followed by
multidisciplinary
meeting
Complex
Diabetes clinic
which includes
monthly young
adult, joint renal
clinics and
quarterly
transition clinic
Thyroid
Clinic**
General
Diabetes
Clinic
Alternate
weeks
OR
Consultant
Ward Round
Consultant
Ward Round
Alternate
weeks
SpR ward
round
*All SpR activities take place at St Peter’s hospital except an alternate week endocrine
clinic. There is a shuttle bus that runs between the 2 sites on a frequent basis. A 15
minute drive separates the two sites.
**Over the next year the department is looking to alter the thyroid clinic organisation and
aim to change the SpR timetable to have an alternate week thyroid clinic and a weekly
endocrine clinic.
The general medical teams are “ward-based” and on average have 15-20 in patients. Dr
Ward and Dr Naqvi alternate the ward cover on a four monthly basis but this does not alter
the registrar timetable. The on call rota is currently 1 in 10 with the nights in blocks of 3
and 4.
34

Getting here
Travel information for St Peter’s hospital, Guildford Road, Chertsey, KT16
0PZ can be found on at
http://www.ashfordstpeters.nhs.uk/intranet/Ashford---
/Travelling/St_Peters_hosp_leaflet_v4.pdf
Ashford Hospital is on the A30 close to junction 13 of the M25 and
Heathrow Airport. There are excellent rail links ton central London. St
Peter’s hospital is near Junction 11 of the M25 and it is 10
35

MAYDAY UNIVERSITY HOSPITALS NHS TRUST
Consultants: Dr. Malcolm Prentice (0208 401 3034)
Dr. Richard Savine (0208 401 3037)
About the Trust
Mayday Healthcare NHS Trust was formed in 1993 and provides acute
health services for the people of Croydon and its neighbouring areas.
Croydon is London's largest borough (of around 370,000) and has a
transient, relatively young population with a high level of ethnic diversity. In
2005/06 the Trust had a turnover of £161million, over 3,000 employees,
and a strong local identity with the population of Croydon.
Croydon is a multi-cultural borough with approaching 20% of its population
categorised as being from black and ethnic minority backgrounds and the
Trust more than reflects this diversity in its workforce. At the last count
our staff included 39% black and ethnic minority staff.
In July 2005 the Trust was awarded the highest rating of three stars in the
Healthcare Commission’s annual performance ratings. We also won the
Health Services Journal “Acute Healthcare Organisation of the Year” and
the “Employer of the Year” in the Best of Business Awards.
Post-holders are involved with the provision of care of two sites:
Mayday University Hospital is a District General Hospital (with 45 day
case beds) and a 24 hour Accident & Emergency Department. The hospital
is based on a 19 acre site in Thornton Heath and the earliest buildings date
from 1885. The most recent large building project was the new Jubilee
Wing, opened in December 2004. There is a well equipped Post-Graduate
Centre, with a library and IT access on-site.
The Trust also provides services from Purley War Memorial Hospital
(constructed in 1918 with later additions). Purley Hospital currently
36

provides outpatient services and we have planning permission to rebuild the
hospital to provide a first rate diagnostic and outpatient facility in the South
of the borough.
Department of Diabetes/Endocrinology
The department currently consists of two consultants (Drs Prentice and
Savine), two SPRs, a Staff Grade doctor, four clinical assistants and 1.5
WTE Diabetes Specialist Nurses, with access to a further 4 WTE DSNs
employed by the local PCT. It provides a wide range of secondary care
services in the field, and developments in early 2007 are likely to broaden
the experience available here still further.
Diabetes
Croydon has led the way in establishing an Integrated Care Service in
Diabetes, and there are close links with the Croydon GPSI service, and
Community Specialist Nursing Team. The publication in 2006 of the
Croydon Joint Diabetes Care Guidelines, together with the establishment of
a graded locally enhanced service to allow management if insulin treated
type II patients in primary care, has changed the profile of Diabetes Service
provision at Mayday, allowing for the forthcoming developments in
specialist diabetes services, and for a new patient wait time of only 1-2
weeks.
At present, as well as clinics in General Diabetes, there is a weekly Joint
Diabetes/Antenatal Clinic held in Maternity Services with a dedicated
Consultant obstetrician, Mr. Greg Ward. There is also a weekly joint
Diabetes/Renal Clinic held with Dr. Vip De Silva our Renal Physician. A
monthly Young Persons clinic is held for patients in the age range 15-25
years, and there is a quarterly handover clinic starting in January 2007
with Dr. Susanna, our Lead Consultant for Paediatric Diabetes.
In addition to these clinics, monthly joint clinics in Diabetic Vascular
Medicine, and in Insulin Pump Therapy are to commence by second quarter
2007, as is the provision of the DAPHNE education programme for type I
patients.
SPRs will also be offered the chance to attend Diabetic Retinal Clinics, (with
additional specialist teaching on retinal photographic examination and
grading from Mr. Dilo De Alwis, our Consultant Ophthalmologist), and Lipid
Clinics with our Consultant Chemical Pathologist, Dr. Anne Tarn.
In addition to our out-patient services, the department also provides a
strong commitment to the provision of diabetes care for our ward based
patients, particularly in our busy vascular, cardiology and renal dialysis
units.
37

Endocrinology
The department provides not only broad experience in General
Endocrinology, but also offers specialist clinics in Pituitary Endocrinology,
and a Joint Paediatric Endocrinology with Prof. Peter Hindmarsh from GOS
Hospital, London. In addition, there is a weekly Thyroid Nodule “One-Stop-
Shop” clinic run by Dr. Prentice, where patients undergo thyroid ultrasound
and fine needle aspiration biopsy. SPRs are encouraged to attend to learn
the rudiments of these procedures. In addition, the department organises a
quarterly study day, accredited by the Royal Colleges of Medicine and
Radiology, and SPRs are encouraged to attend this in addition to their
practical sessions.
In addition to out-patient clinics, there is a dedicated weekly session for
dynamic endocrine testing, (usually supervised and organised by the SPRs),
a quarterly Joint Thyroid Pathology Results meeting, and a weekly Joint
Biochemistry/Endocrine meeting with Dr. Tarn to review all endocrine test
results.
General Internal Medicine
The department participates in a busy on-take rota for General Internal
Medicine, with each consultant being on-call on an approximately 1 in 10
basis. Takes last a full 24 hours, and are currently supported by two
consultant physicians in our Emergency Assessment Unit during working
hours.
There are currently 12 Registrar Grade doctors working on the medical rota,
and a system of internal cover operates for both annual and study leave.
This is a shift system, whereby the day shift (8am until 9 pm) is worked
with one of the consultants within the department, and a separate registrar
covers the night shift (8pm until 9 am). Day shifts are worked singly, while
the night shift rota is split so that one registrar works Monday through
Thursday nights (with Friday as a day off), and a second registrar working
Friday through Sunday nights, with the Monday as a day off. Clinics are
generally cancelled during an SPRs night shift weeks.
In-patients are distributed by a “Zoning” system, based on team “home
wards”, and this usually ensures that the inpatient load for each SPR is no
more than 15-20 patients at any one time. Current “base” wards are
Ashburton 1 (male) and Ashburton 2 (female).
SPR Posts
Currently the two SPR posts are arranged such that one post is assigned to
each consultant, with rotation six months into the job. Clinics are
distributed such that each SPR can undertake at least one Diabetes and
one Endocrinology clinic each week in each half of the job, with some
flexibility to allow attendance at specialist clinics as needed.The two SPRs
38

work as a team, to allow cover for both in-patients, and out-patient clinics,
when one is away on leave. Occasionally the need arises for both SPRs to be
absent at one time, but this is discouraged and should only be in
exceptional circumstances.
Research and audit projects are actively encouraged by the department, and
protected time can be given for such projects.
Most SPRs find their time at Mayday useful and enjoyable – although the
general medical side of the firm is busy, outside of take days the duties are
not too onerous. There is generally sufficient time to gain a good grounding
in most aspects of general diabetes and endocrinology, together with
sufficient patient mass in several aspects of specialist care to provide a
rewarding experience during the year spent here. The firm has one SHO and
two HOs (one per consultant).
39

Specimen Timetables
Service commitment clinics are in bold, while educational clinics are in
italics.
SPR One (Dr. Prentice)
Monday Tuesday Wednesday Thursday Friday
Am Thyroid
Nodule
Clinic
Pm General
Diabetes
clinic (Dr.
Savine) –
rotational
basis with
Young
Persons
Diabetes,
Vascular
and Pump
clinics
SPR Two (Dr. Savine)
Lipid clinic
(Dr. Tarn)
Consultant
WR
Post-take
WR (alt
weeks)
General
Diabetes
Clinic (Dr.
Prentice)
(alt weeks)
1-2 Medical
Grand
Round
Retinal
clinic/teaching
(Mr. De Alwis)
General
Endocrinology
Clinic (Dr.
Prentice) –
rotational basis
with Paediatric
and Pituitary
Clinics,
including
Endocrine
Pregnancy Slots
in all clinics
Consultant
WR
12.30-2
Joint
Endocrine
Results
meeting
Monday Tuesday Wednesday Thursday Friday
Am Consultant
WR
Pm General
Endocrine
clinic
(Purley – Dr.
Prentice)
Lipid clinic
(Dr. Tarn)
General
Diabetes
Clinic
(Purley –
Dr.
Savine)
Post-take
WR (alt
weeks)
Joint Renal
Clinic (alt
weeks)
1-2 –
Medical
Grand
Round
Joint Diabetes
Antenatal Clinic
Retinal
clinic/teaching
(Mr. De Alwis)
Consultant
WR
General
Endocrine
clinic (Dr.
Savine)
12.30-2 -
Joint
Endocrine
Results
meeting
40

How to find us
Mayday University Hospital
530 London Road
Croydon
CR7 7YE
Telephone: 020 8401 3000
Purley War Memorial Hospital
856 Brighton Road, Purley
Surrey
CR8 2YL
Telephone: 020 8401 3000
41

EPSOM and ST HELIER UNIVERSITY HOSPITALS
NHS TRUST
Consultants Dr Andrew Rodin (STC Chairman)
Dr Stephen Hyer
Background
Tel: 020 8296 2580/2114
Fax: 020 8644 4377
Epsom and St Helier University Hospitals NHS Trust is a large acute Trust
serving South West London and Surrey. The Trust's two District General
Hospitals, Epsom General Hospital and St Helier Hospital, both offer an
extensive range of acute services, including 24-hour A&E. The Trust
provides services to local communities including the whole of the London
Borough of Sutton and part of the London Borough of Merton; the Surrey
Boroughs of Epsom and Ewell, Reigate and Banstead and Elmbridge, plus
part of the District Council of Mole Valley.
42

Within this main area, the Trust serves approximately 650,000 people. It
also provides medical care for a wider population, particularly for certain
specialist services.
The busy Accident and Emergency department deals with 80,000
attendances per annum. The South West Thames Renal Medicine and
Transplantation Service is based at St Helier Hospital and, together with its
satellite services, it provides a full nephrology service including
transplantation for a renal population of 2 million in London, Surrey and
Sussex Borders. St Helier Hospital has a full range of outpatient facilities
and a comprehensive range of diagnostic facilities (including MRI and CT
scanning, nuclear medicine, ultrasound and vascular diagnostic services).
St Helier Hospital is an Associated Teaching Hospital and the main partner
Teaching Hospital to St George’s University of London. Medical students on
the 5 year MB BS course and the 4 year Graduate Entry Programme are
taught here throughout the year. There is an Undergraduate Centre with
an Undergraduate Sub-Dean, Clinical Teaching Fellows and Undergraduate
Administrator and a purpose-built Multi-Professional Teaching Centre for
clinical teaching including communication skills. The hospital has a wellequipped
Post-graduate Medical Centre with audio-visual links to the
Postgraduate Centre at Epsom Hospital. There is a full programme of
postgraduate activities including weekly Grand Rounds, lunchtime lectures
and specialist/departmental meetings and there are educational
programmes for doctors in training.
General Medicine
The Trust has approximately 250 beds for Medicine and Elderly. There is an
HDU, ITU and CCU at St Helier Hospital. HDU and ITU are run by Intensive
Care physicians with input from the patient’s admitting medical team and
there are daily ward rounds which are led by the ITU team. Patients in CCU
remain under the care of their admitting medical teams but there are also
daily cardiologist-led ward rounds. There is also a Consultant-led Stroke
Unit, which has its own permanent staff. There is excellent out-of-hours
laboratory support and 24 hour availability of emergency radiology. There is
also an emergency endoscopy service for acute GI bleeding.
Physicians are grouped into 4 medical teams for acute medical takes.
Specialist Registrars work a full-shift system and are on-call on a 1 in 9 basis.
Day shifts are from 9.00 am to 9.00 pm and night shifts from 9.00 pm to 9.00
am. Weeks of night duty are split into blocks of 4 and 3 nights.
There are both medical and surgical assessment units (MAU and SAU). The
MAU is run by a full-time Consultant in Acute Medicine and his team with
whom the admitting medical team work closely. There are post-take ward
rounds at the end of each 12-hour period and these are led by the on-call
Consultant of the day. If patients are admitted they are transferred from the
MAU to the short-stay medical ward and if they require more than 48 hours
in hospital they are then moved to the appropriate Team’s beds. There are
usually 15-20 admissions in 24 hours.
43

Diabetes and Endocrinology
The Diabetes service is based in the Doreen Kouba Diabetes Centre which
was opened in 1989 and provides a base for our Specialist Team. As well as
providing consulting rooms, the Centre has a Seminar Room, Dietitians’
Room, Eye Room, Podiatry Room, Demonstration kitchen, and office
accommodation for secretarial and clerical staff.
Members of our Medical Team
Dr Andrew Rodin, Consultant Physician
Dr Stephen Hyer, Consultant Physician
1 Specialist Registrar in Diabetes and Endocrinology and General Medicine
1 Senior House Officer in Medicine
1 FY1 House Officer
44

Other Clinical Staff in Diabetes
Dr Judy Tyrrell, Associate Specialist in Diabetes (part-time)
Dr Jo Dearnaley, Diabetes Psychiatrist (part-time)
Dr Paula McInnes, Clinical Assistant in Diabetes
Dr David Jones, Clinical Assistant in Diabetes
Linda Troy, Diabetes Specialist Optometrist
Pauline Strugnell, Diabetes Specialist Nurse
Margaret Booth, Diabetes Specialist Nurse
Deborah Simmonds, Diabetes Specialist Nurse
Orleas Mullings, Diabetes Specialist Nurse
Caroline Morgan, Diabetes Specialist Nurse
Debra Hutchings, Diabetes Specialist Nurse
Sarah Harrison, Diabetes Specialist Dietitian
Emma Hammond, Diabetes Specialist Dietitian
Elizabeth Scrivens, Diabetes Podiatrist
Claudine Cleaver, Diabetes Podiatrist
Associated Clinical Staff
Mr Paul Thomas, Consultant Surgeon (Joint Diabetes-Vascular Clinic)
Mr Hasan Shehata, Consultant Obstetrician (Joint Diabetes-Ante-natal
Clinic)
Dr Michael Bending, Consultant Nephrologist (Joint Diabetes-Renal Clinic)
Mr Peter Fison, Consultant Ophthalmic Surgeon (Retinal Clinic)
Dr Atunu Dutta, Consultant Paediatrician (Paediatric Diabetes)
Teresa Hatcher, Paediatric Diabetes Specialist Nurse
We provide a full range of clinical services in Diabetes and Endocrinology and
the Specialist Registrar is provided with opportunities to gain specialist
experience in a number of multi-disciplinary clinics.
Excellent training is provided in all aspects of diabetes management. The
specialist Diabetes service provides weekly Rapid Access clinics for prompt
assessment of new complications or management problems. For complex
patients and those requiring multi-disciplinary management we have weekly
Intensive Management clinics and we also provide a weekly multidisciplinary
Diabetic Foot Clinic.
There is a very busy weekly multidisciplinary Diabetes Pregnancy clinic and a
multidisciplinary Insulin Pump Therapy clinic. We have close links with the
St Helier Renal Unit and have a monthly joint Diabetes Renal clinic. Our
other specialist clinics include twice monthly Diabetes Clinics for Young
Adults, a weekly Retinal Assessment Clinic, and Diabetes Psychiatry clinics (3
per week).
Our team of Diabetes Specialist Nurses and Specialist Dietitians provide
clinics every day and run our well-established structured Group Education
programmes for type 1 diabetes (ALFFI) and type 2 diabetes.
45

The Specialist Registrar also has the opportunity to gain experience in a
digital photographic diabetic retinopathy screening programme, the use of our
District Diabetes Register and in aspects of Diabetes service management
through our Diabetes Team Meetings and Away-Days.
There are a number of endocrinology clinics and the Specialist Registrar
attends a weekly General Endocrine clinic. This clinic provides broad
experience in pituitary, thyroid, parathyroid, adrenal and reproductive
endocrinology. Each clinic is followed by a case review meeting. In addition,
a weekly joint specialty Thyroid clinic at Royal Marsden Hospital, Sutton,
offers the Specialist Registrar particular experience in the use of radioiodine
and in the management of thyroid cancer
All endocrine investigations are carried out at our Medical Investigation Unit
and a full range of endocrine imaging techniques is available. The Specialist
Registrar is involved in planning and reviewing the results of endocrine
investigations.
Timetable for the Specialist Registrar
Monday Tuesday Wednesday Thursday Friday
Morning Consultant
Ward Round
and
Multidisciplinary
team meeting
Lunchtime Joint
Endocrinology/
Chemical
Pathology
meeting
(monthly) or
Clinical
Governance
meeting
(monthly)
Afternoon Diabetes Clinic/
Diabetic Foot
Clinic
Diabetic
Pregnancy
clinic
Post-take
ward round
Joint
specialty
Thyroid Clinic
or Diabetes-
Renal Clinic
Diabetes
Team meeting
(monthly)
Ward work Specialist
Registrar
Ward Round
Grand
Round
Consultant
Ward
Round
Postgradua
te Lecture
Endocrine
Clinic
Post-clinic
Case
Review
Diabetes
Journal
Club
(monthly)
or Clinical
Cases
meeting
(monthly)
Diabetes
Clinic
Medical
student
teaching
46

Departmental and Hospital Meetings
• There is an excellent Postgraduate Medical Centre with an active
programme of educational activities, including weekly Grand Rounds,
weekly postgraduate lectures, and clinical audit half-days.
• Regular Departmental meetings include a monthly Diabetes Journal
Club, monthly Diabetes clinical cases meeting (multi-professional),
weekly Endocrinology post-clinic case discussion, monthly Diabetes
Clinical Governance meeting, and a monthly joint meeting of
Endocrinology, Paediatric Endocrinology and Chemical Pathology
departments.
Research and Clinical Audit
• We have an active programme of clinical audit and the Specialist
Registrar is expected to complete at least one clinical audit during this
post.
• Involvement in ongoing research activities is encouraged and it is
possible for the Specialist Registrar to undertake small clinical research
projects during this post.
• There are also opportunities to participate in clinical trials through our
Clinical Trials Unit.
• The Specialist Registrar is encouraged to present original work at local,
regional and national professional meetings
Specific attractions of this post
• Extensive clinical experience in both diabetes and endocrinology in a
large District General Hospital and Associated Teaching Hospital.
• Wide range of opportunities for specialist training, including joint
clinics at Royal Marsden Hospital and at the South-west Thames
Regional Renal Unit, St Helier Hospital, which provides unrivalled
training opportunities in diabetes-related renal disease.
• Excellent clinical facilities, including a purpose-built Diabetes Centre
and a Medical Investigation Unit (for all endocrine investigations).
• Excellent teaching experience – medical students from St George’s
Hospital (5 year course and Graduate Entry Programme), postgraduates
and other professional groups – and excellent teaching facilities in our
multi-professional teaching centre.
• Active departmental and hospital education programmes
Who to contact for further information
Dr Andrew Rodin
Dr Steve Hyer
Tel: 020 8296 2580/2114
Tel: 020 8296 2580/2114
Fax: 020 8644 4377
Fax: 020 8644 4377
Email: Andrew.Rodin@epsom-sthelier.nhs.uk Email: Steve.Hyer@epsom-sthelier.nhs.uk
47

How to Find Us
Diabetes and Endocrinology
St Helier Hospital
Wrythe Lane,
Carshalton,
Surrey
SM5 1AA
48

WORTHING AND SOUTHLANDS HOSPITALS
WORTHING
Consultants: Dr Gordon Caldwell
Dr Ute Weis
Telephone: 01903 205111 x 5543
Worthing Hospital
Worthing is on the south coast about 10 miles west of the city of Brighton
and Hove. Worthing is the largest town in West Sussex, and the hospital
serves a population of over 300,000. The surrounding areas are surprisingly
beautiful and rural, offering opportunities for mountain biking, horse riding
and many sea sports. London is just over an hour away by train, with the
railway station within walking distance of the hospital.
Acute Medicine
The hospital offers all major acute services apart
from cardiothoracic surgery, based in Brighton,
and neurosurgery in Haywards Heath. We have
one of the busiest ITUs on the South Coast. There
are about 25 acute medical admissions a day, and
a further 10 to 15 admissions to medicine for the
elderly. There are 9 full time equivalent physicians
on the acute take rota, supported by 12 SPRs in
Medicine, 10 Foundation Year one doctors and 14
in the intermediate grades. We usually attract very
good junior staff. The rotas are subject to
49

evolution in relation to EWTD and Hospital at Night and we like to engage
SPRs in discussions about changes. Our “take team” consists of 2
Consultants, the SPR (ST4?), 2 intermediate doctors and 2 F1s. We are on
take 2 days in 9 on a rolling rota, and thus offer a wealth of general medical
experience.
Diabetes and Endocrinology
We run a very general service for Diabetes and
Endocrinology from our Diabetes Centre. The
experience serves as an excellent introduction to
Diabetes and Endocrinology for a year one SPR
(ST4?).
We have a strong team of nurses led by a Consultant
Nurse. We work closely with local GPs. We run
specialist clinics for children run by Dr Sue Coldwell,
adolescents, pregnancy, renal disease, and a foot
clinic. This gives and excellent experience in both
specialist and general diabetes care.
We run a general endocrine clinic once a week, and we have strong links
with the acaedemic unit at Brighton University Hospital.
SpR Timetable
Monday Tuesday Wednesday Thursday Friday
Am Consultant
W/round
Lunch
Pm New
Patient
Clinic
Learning Opportunities
Endocrine
clinic *
Diabetes
Review
Clinic
Type 2
Education
Session
(Alt Week)
Foot Clinic
(Alt week)*
Consultant
W/round-
Diabetes
review *
Ante
Natal
Clinic
(Alt
week)
We expect out SPR to show drive and initiative and to be a self motivated
learner, and of course offer a great deal of support. The SPR attends
regional training days, as well as all the Department of Medicine teaching
sessions. We expect the SPR to be actively involved in teaching, training and
assessment of junior staff. We encourage involvement in audit.
50

Other information
Our SPRs have all enjoyed working in our team, and have valued time spent
with us. Their experience here gives a strong broad foundation for building
further expertise in Diabetes and Endocrinology. Please come to visit us to
see what we have to offer –
contact Sandra E Smith on 01903 205111 x 5543 or email
Gordon.caldwell@wash.nhs.uk or ute.weis@wash.nhs.uk
How to Find Us
Worthing Hospital
Lyndhurst Road
Worthing
West Sussex
BN11 2DH
Southlands Hospital
Upper Shoreham Road
Shoreham-by-Sea
West Sussex
BN43 6TQ
Brighton and Eastbourne in the east Haywards Heath, Gatwick Airport and
London Victoria to the northLocal trains run approximately every 20
minutes. Most train services to and from Worthing are provided by
Southern and South West Trains
Worthing Hospital
Southland Hospital
Further details can be found on the hospital web site at
http://www.worthinghospital.nhs.uk/Finding_us/
51

THE ROYAL WEST SUSSEX NHS TRUST
ST RICHARDS HOSPITAL
Consultants Dr Ken Laji
Dr Deborah Bosman:
Telephone Secretary. (01243) 788122 ext 2725
The Trust
St Richard’s Hospital is a 500-bed provider of acute hospital services
serving a population of approximately 212,000 in South West Sussex and
East Hampshire covering over 450 square miles.
The hospital provides a range of core services including accident and
emergency, acute medicine, general surgery, urology, orthopaedics,
obstetrics, gynaecology, paediatrics (including SCBU), rehabilitation and
cancer services. In addition, the hospital provides special expertise in the
following areas: maxillofacial surgery, diabetes and endocrinology, vascular
surgery, chronic pain relief, aortic aneurysm and colorectal screening,
minimally invasive surgery, special back clinic, cardiac catheterisation and
pacemaker implantation, and services for the younger physically disabled.
There is a 24 hour Accident and Emergency Department, a dedicated
Medical Admissions Unit, and supporting diagnostic, physiotherapy and
occupational therapy facilities. A fully equipped radiology department with
CT, MRI and Nuclear Medicine facilities, with instant access to studies
through PACS system.
Hospital has an purpose-built Treatment Centre comprising operating
theatres, an endoscopy suite, cardiac catheterisation lab and associated
recovery and patient care facilities. The Chichester Suite is a 12 bedded
Private Patients Unit which opened in July 1997 and in October 1998
expanded to 16 beds. The suite is an integrated part of St Richard’s
Hospital (work in this area may be included within this post).
52

The department of Diabetes and Endocrinolgy is a stand alone building
where outpatient facility for specialist clinics is managed by dedicated
admin staff.
The hospital has computer terminals in all inpatient and outpatient
locations enabling real-time electronic results reporting, internet access,
and access to the Diabetes Information System. All wards have wireless LAN
access points, with further development plans for roaming access to results
and future EPR applications as part of National Programme for IT
implementation.
The number of patients cared for each year is 125,000 out-patients, 26,500
in-patients, 45,000 A & E attendances, 13,000 day surgery procedures and
1,900 births.
The Trust has been awarded a whole hospital Charter Mark for the third
consecutive 3 year period and is also holds the Investors in People award.
The Locality
The hospital is situated in a very pleasant part of the country, just south of
the Downs and about six miles from the Channel coast. As the county town
of West Sussex, Chichester is an important administrative, industrial and
business centre. This Cathedral city is a local centre of culture as well as a
popular tourist venue. The Chichester Festival Theatre, which is within
walking distance of the hospital, is an internationally famous tourist
attraction. Chichester Harbour and the coastal resorts offer excellent
facilities for sailing and other water sports. The well-known racecourses of
Goodwood and Fontwell are nearby, as are facilities for a wide variety of
sporting and other recreational activities including a local tennis and
squash club.
The main industries of the district are farming and horticulture, with
extensive glasshouse facilities in the coastal area. In addition, service and
light manufacturing industries are now assuming increasing prominence.
The extraction of natural resources, particularly from the greensand beds to
the north of the Downs and the gravel pits centred on Chichester, is
currently much in demand, with exploration for oil as a more recent
development.
Both road and rail communications are good with a direct link to London
Victoria in under two hours, and to Gatwick Airport (30-40 minutes). There
is also a rail service along the south coast to Brighton in the east and to
Portsmouth in the west.
53

The Firm
This appointment is that of Specialist Registrar to Dr K Laji (Lead Clinician)
and Dr D Bosman, Consultant Physicians with a special interest in
Diabetes and Endocrinology. The medical team consists of two
Consultants, one Specialist Registrar, one Senior House Officer and one
Pre-Registration House Officer (F1 Trainee). Diabetes multidisciplinary
team consists of a nurse consultant, four specialist nurses, two dieticians,
three podiatrists and other support staff. There are usually one or two
medical students attached to the firm.
Duties of the post
The post offers excellent opportunities for gaining experience in all aspects
of diabetes and endocrinology. Particular areas
where you could plan your training programme are
adolescent and antenatal diabetes, diabetic renal
disease, foot, ophthalmology along with
opportunity to gain hands on experience in
endocrine dynamic function testing.
General Medicine: Duties are at St Richard’s
Hospital and include management of acute
medical admissions, the day-to-day care of the
general medical and diabetic patients on the
wards. The acute medical, medicine for the elderly
and rheumatology services are fully integrated,
with all specialties taking part in the acute general
medical rota. The on-call commitment is one in
eight, with an internal cover system for both annual and study leave. The
registrar is expected to supervise both the senior and pre-registration house
officers.
In addition the new post holder will be expected to share equally in the
hospital medical rota.
Diabetes and Endocrinology: Three
fixed out-patient clinics per week -
general medicine, diabetes and
endocrinology (see timetable below).
At each of these sessions, the
appointee will manage own list of
unselected new and follow up
patients, and will work under
supervision of the consultant
physicians. Liaison with the
multidisciplinary team at the
Diabetes Centre is part of daily
working pattern.
54

The trainee is expected to plan his or her specific specialist training needs
in advance of commencing the post. Currently these include
paediatric/adolescent diabetes, Joint diabetes antenatal clinics, diabetes
podiatry service, dedicated lipid clinic and endocrine dynamic investigations
service. A diabetic renal clinic is planned, which the registrar is expected to
attend. Furthermore, retinal screening service offers additional experience
and the trainee will have opportunity to gain experience in this area.
Academic activities: St Richards has an active postgraduate department
with weekly meetings at which the trainee is expected to participate and
contribute regularly. There is ample opportunity to get involved in teaching
and audit. The trainee will attend the regional specialty teaching sessions
regularly and clinical commitments will be cancelled to enable this.
Depending on the trainee’s needs and the stage of training, dedicated
research/academic session can be built in to the job plan.
Timetable
Monday
AM PM
Consultant Ward Round
or Specialty Clinic (TBA)
Tuesday Registrar Wardround Renal Clinic
EndocrineOut-patient Clinic
Wednesday Diabetic Clinic Educational Meeting
Thursday
On call day/Consultant
Ward Round
Friday Consultant post-take
Ward Round or Antenatal
Clinic
Recognition And Training
Medical Clinic/Adolescent
Diabetic Clinic and Foot
Clinic
Free session for audit,
research, Administration, etc
The post is recognised for higher training by the Royal College of Physicians.
Teaching is an integral part of this post with protected teaching sessions
from 1.00 pm to 5.00 pm on Wednesday afternoon. There are also regular
lunchtime departmental meetings including those in the diabetes centre.
There is a regular monthly regional specialist registrar training programme,
which the appointee will be expected to attend.Facilities are given for study
leave in accordance with the regulations.
55

There is an active Medical Education Centre. A wide variety of courses,
tutorials and seminars with local and visiting speakers are held under the
auspices of the Postgraduate Clinical Tutor, Dr A G Dewhurst, for clinical
staff of all disciplines, including general practitioners. Library support for
clinical activity, research and education is provided by Chichester Health
Libraries, one of the largest non-university health libraries on the south
coast. Facilities include 200 journals, multimedia viewing, networked
Medline and other databases and internet access. In addition, the medical
education centre offers free wireless internet access.
All categories of medical staff are able to meet in the doctors’ dining room
and newly built hospital restaurant. The large lecture theatre has the latest
computerised presentation technology.
Office and computing
There is dedicated office space with computer terminals located in the
diabetes centre. Onsite accommodation is available on request.
Terms and Conditions of Service
There are local policies for grievance/disciplinary procedures and removal
expenses. The terms and conditions of service otherwise offered are set out
in the Terms and Conditions of Service of Hospital Medical and Dental Staff
and General Whitley Council Conditions of Service as amended from time to
time.
The salary is on the scale determined within the guidelines of the New Deal,
and no peripheral allowance is payable. The Trust is actively working
towards compliance with the European Working Time Directive, and this
will mean changes in working patterns that involve groups of doctors in
training working full shifts or being non resident on call.
The successful candidate will be expected to pass a medical examination.
The Specialist Registrar in Diabetes and Endocrinology accepts that he/she
will also perform duties in occasional emergencies and unforeseen
circumstances at the request of the appropriate Consultant in consultation
where practicable with his/her colleagues, both senior and junior. It has
been agreed between the professions and the Department that while juniors
accept that they will perform such duties, the Secretary of State stresses
that additional commitments arising under this sub-section are exceptional
and in particular that juniors should not be required to undertake work of
this kind for prolonged periods or on a regular basis.
St Richard's Hospital operates a No Smoking Policy, to which all staff must
adhere.
56

The Trust is committed to providing safe and effective care for patients. To
ensure this there is an agreed procedure for medical staff that enables them
to report, quickly and confidentially, concerns about conduct, performance
or health of medical colleagues (Chief Medical Officer, December 1996). All
medical staff, practising in the Trust, should ensure that they are familiar
with the procedure and apply it.
Accommodation
Accommodation, both married and single, may be available, although its
availability to any particular doctor must depend on the position at the date
he/she takes up the appointment. Junior medical staff wishing to be nonresident
may be allowed to do so, but must always occupy a room in the
hospital when on-call.
Further Information
Further information is available from the department’s website
(www.chichesterdiabetes.org.uk) or by emailing Dr Laji:ken.laji@rwstr.nhs.uk
or Dr Bosman: deborah.bosman@rws-tr.nhs.uk.
Arrangements for visiting the hospital and meeting members of staff may be
made with the departmental secretary. (01243) 788122 ext 2725
How to find Us
Royal West Sussex NHS Trust
St Richard's Hospital
Spitalfield Lane
Chichester
West Sussex
PO19 6SE
57

http://www.frimleypark.nhs.uk/
Consultants
FRIMLEY PARK HOSPITAL
NHS FOUNDATION TRUST
Dr Emma Bingham emma.bingham@fph-tr.nhs.uk 01276604009
Dr Jennifer Tringham jennifer.tringham@fph-tr.nhs.uk 01276604010
General information about the Trust
Frimley Park Hospital is a district general hospital, which serves mainly the
people of West Surrey and North East Hampshire. It is located close to the
borders of the counties of Surrey, Hampshire and Berkshire and this is
reflected in our patient catchment area. Neighbouring hospitals include
Royal Surrey County Hospital, Guildford; St Peter’s, Chertsey; and Ashford
Hospital, Middlesex.
The primary catchment area for Frimley Park Hospital, includes the towns
of Camberley, Farnborough, Aldershot, Fleet and Farnham. The population
served is currently 370,000+ and this has been increasing at approximately
2% per annum over the past decade. It is divided almost equally between
Surrey and Hampshire. Situated by junction 4 of the M3, M4 and M25
motorways are easily accessible, as are Heathrow and Gatwick airports. The
district is a little over 11 miles from North to South and only 13 miles wide.
It includes some major urban centres, areas of London commuter belt and
also a number of quieter rural communities.
58

Opened in 1974 it is now the third largest hospital in the old South West
Thames Region, and is proud of its reputation as a friendly hospital with
excellent relationships between all
grades of staff. The Hospital became
a second-wave NHS Trust on 1 April
1992. It is a 'Best Buy' Hospital and
was originally designed to serve the
needs of a population of 170,000.
This number has since more than
doubled. In February 1996 Frimley
Park opened a Ministry of Defence
Hospital Unit integrating services
previously provided by the
Cambridge Military Hospital in
Aldershot. In the last few years the
Hospital’s workload has increased every year to 56,500 finished consultant
episodes and 215,000 OPD attendances. Major additions to the original
hospital have recently been added in the last three years including a
dedicated Medical Assessment Unit, a new Endoscopy Unit, new day case
facilities and a Treatment Centre (mainly ophthalmology). A Cardiac Catheter
laboratory opened in 2006. The radiology department has adopted the PACS
system for immediate digital imaging.
Our 'three star' hospital is the proud possessor of a Charter Mark for
excellence in public service, originally awarded in December 1997 and reawarded
in 2000 and 2004. It also has an Investors in People award, and has
achieved CNST level 3 for acute and maternity services. Foundation status
was granted in April 2005. The hospital is the first in England to gain top
marks (Level 3) in the tough new risk management standards (NHSLA).
General Medicine
FPH is a very busy acute DGH. There is a large Accident & Emergency
department with 4 Consultants. The Hospital is a designated Major
Accident receiving hospital and is a Category 2 trauma centre. Attendances
stand at 90,000+ p.a.
The medical directorate (medicine and elderly care) has a total of 275 beds.
This includes a 30 bedded Medical Assessment Unit, an 8 bedded CCU and
a newly opened 8 bedded Adult High Dependency Unit offering non-invasive
ventilation, and particularly focuses on respiratory patient care. Daily
admissions of 25-45 patients with the take split into the day (8am-6pm) and
night (6pm-8am). The medical team is divided into 4 megafirms with 3-4
consultants, 3 registrars (single 13 hour shift), 4 SHOs (full shift week of
nights) and 3 F1s per megafirm.
There are monthly audit and educational half days, weekly radiology and
journal clubs and grand round alternate weeks.
59

Endocrinology and Diabetes
The service is lead by Dr Emma Bingham and Dr Jennifer Tringham with
the support of one SPR (second post being applied for), one SHO and one
F1. We run a 13 bedded ward (which is being developed into a
diabetic/endocrine ward) and usually have a total of around 20 general
medical inpatients.
We run general diabetes and endocrine clinics, but there is also opportunity
to attend a busy joint medical/obstetric, thyroid cancer, diabetic foot, lipid,
transition/teenage diabetic and ophthalmic clinics on an occasional basis.
We admit endocrine patients for investigation and there is opportunity to
attend the clinical investigation unit at RSCH.
There are weekly endocrine clinic meetings and joint biochemistry
endocrine meetings every 3 months to discuss complex patients. We
encourage attendance at regional endocrine meetings run at Kings and St
Thomas’ every 3 months. Weekly diabetes team meetings include education
and audit projects.
There are 2 WTE hospital based DSNs and 1.4 WTE community based. The
DSNs are piloting an education programme for Type 1 patients based on
DAFNE and the community team are in the process of setting up XPERT
education programme for those with Type 2 diabetes. We have a dynamic
dietetic and podiatry service.
Teaching
We have close links with Southampton medical school and the Endocrine
firm have a final year student attached with occasional St Georges students.
The SPR and SHO take part in teaching and assessing the students and our
students will also shadow our F1.
Postgraduate facilities
We are fortunate to have a
modern, state of the art
postgraduate centre with good IT
resources. There is a doctor only
dining room incorporated which
provides a friendly and sociable
environment. Frimley is well
known as a busy, but very
pleasant place to work and many
of our juniors re-apply for further
posts here.
60

Summary
FPH is a great post for a year 1 or 2 SPR because it provides busy acute
medical training plus the opportunity of attending some specialist clinics in
a friendly and supportive environment situated close to London.
Timetable
am 09.00
MDM
9.30
Reg WR
Monday Tuesday Wednesday Thursday Friday
9.15
Consultant
WR
Lunch Team
meeting
pm 13.45
Antenatal
clinic
13.45
Diabetic
clinic
9.00
Clinic CMH
09.00
Foot WR
9.30
Consultant
WR
Xray
meeting
Grand
Round
Ward work 13.45
Endocrine
clinic
9.00
Reg WR
Admin/research
teaching
61

Finding Us
Frimley Park Hospital
NHS Foundation Trust
Portsmouth Road,
Frimley
Surrey GU16 7UJ
Tel:01276 604604
By Train
Southwest Trains services from Waterloo to Guildford via Ascot serve
Frimley Stn. From there you can take the short walk to the Hospital or use
bus routes 2 and 71.
By Car
The hospital is best approached via the M3. Exit at Junction 4, and then
follow the signs for Frimley/Camberley. At the exit roundabout take the
second exit, then filter to the left following signs for Frimley (written in
road). Join the Frimley by-pass taking the middle lane. At the roundabout
go straight across and the hospital is the first exit on your left at the next
roundabout.
62

Consultants:-
SURREY AND SUSSEX NHS TRUST
EAST SURREY HOSPITAL
Dr. Kenneth Foster
Dr. Adrian Gossage
Telephone: 01737 768511 ext 1743 or direct line 01737 231743
The Trust
The Surrey and Sussex NHS Trust covers the area surrounding Gatwick
Airport and provides all acute medical services to a population of
approximately 450,000 in a number of towns, including Horsham, Crawley,
Dorking, Redhill/Reigate and surrounding villages, surrounding through to
the outer suburbs of London. All acute services for the Trust were located
on the East Surrey site in 2004, extension and refurbishment of facilities on
the site are on-going and expected to be completed by 2008. Currently
there are approximately 250 medical beds at East Surrey. General Medical
facilities include an attractive cardiac unit, which includes an Angiography
suite, and large and well equipped ITU and HDU facilities. The medical
admission unit is about to be refurbished and extended. The site is
compact and there are excellent support facilities, including CT and MR and
support from visiting Nephrologists, Oncologists etc.
General Medicine
The Endocrine Registrar will take part in the medical on-call rota on a 1 in
10 basis. Day-time on-call shifts are worked from9am to 9pm and the
Registrar’s nights are split between a 3 day weekend and 4 days of week
nights, worked in a separate week. Medical admissions average between 40
and 50 per 24-hours and give excellent exposure to a wide variety of
medical problems. The consultant input is active and friendly. There is a
full range of support services, including radiological, endoscopic and ITU
63

outreach. When on-call the Registrar will supervise the work of at least 4
other junior doctors.
The MAU is staffed in the daytime by its own team of 2 Consultants and
junior staff who work flexibly with the “on take” team.
Diabetes and Endocrinology
The full range of diabetes and endocrine services are provided from the base
at East Surrey Hospital. Clinics are held in the community, including
Crawley where there is a significant ethnic population. Joint clinics are
held with the high risk obstetric team for antenatal medical problems, with
the Consultant Endocrine Surgeon and with Consultant Vascular Surgeons
in our joint diabetic foot clinic.
There is an active Podiatry Service, for patients with diabetic foot problems
and the Registrar would be expected to be involved with the consultants in
this aspect of care. There are four experienced diabetes nurse specialists
working in the Trust, who will normally liaise closely with the Registrars as
well as the Consultants.
The unit has considerable experience in Continuous Subcutaneous Insulin
Infusion and aims to be innovative in its approach to the care of patients
with diabetes. The district already runs DESMOND courses for Type II
patients and has introduced a modified DAFNE training. We have also
recently developed a MSc training module for primary care under the
auspices of Brighton University and the participation of the Registrar in
these training programmes will be encouraged.
Training and Education
The hospital is proud of its Post Graduate Education Centre, which includes
130 seat lecture theatre and video conferencing facilities. There is a clinical
skills room for tuition of junior staff, in addition to a range of programmes
held by the department of medicine generally. The Registrar will be
expected to attend monthly diabetes/endocrine units departmental
meetings, endocrine x-ray meetings and neuro-radiology meetings, the latter
reviewing Pituitary MRI and CT scans. This is a busy endocrine unit with a
lot of material for audit and research will be encouraged.
Fifth year students from Brighton and Sussex University’s Medical School,
will be based at East Surrey Hospital on a regular basis from 2007. We
already have a small number of 5 th year students from St. George’s Hospital
Medical School and Imperial College London. The Registrar will be
encouraged to involve himself in the training of these students.
64

Registrar Time-Table
The two Consultants currently divide their workload on the basis of the
County of Residents of patients admitted, so as to facilitate out-patient
follow-up.
Monday Tuesday Wednesday Thursday Friday
Am Training
Day/Academic
day/ MSc
(By
Arrangement
with
Consultant)
On Call or
Retinopathy
Clinic*
Post Take
Ward
Round
Lunch Visiting
Lecturer
Pm Training On Call or Diabetes
Day/Academic Antenatal clinic
day/ MSc Clinic * Including
Foot Clinic
(East
Surrey)
Ward
Work -
Grand
Round
Consultant
W/round
Dr Foster
Endocrine
Clinic
(Monthly
joint
Sugical
Clinic)
Diabetes
clinic
(Dr
Gossage
Crawley)
* When not on take the Registrar is encouraged to attend the Diabetic
Retinopathy Clinic, (Mr. L Herbert) and the antenatal medical clinic:- Dr.
Foster and Mr. Penny.
65

Finding Us
The East Surrey Hospital is well sign posted just to the east of the A23
about 1 mile south of Redhill town centre.
Trains to Redhill run from London Bridge and Victoria.
East Surrey Hospital
Canada Avenue
REDHILL
Surrey
RH1 5RH
T: 01737 768511
66