This is a four year training programme for palliative medicine, provided in a variety of settings including:
- - In-patient Specialist Palliative Care units / hospices (NHS and independent)
- - Day Hospice
- - District General Hospitals
- - Regional Cancer Centre and teaching hospitals
- - Community-based services.
There are opportunities to experience out-patient work, both new and follow up, and for exposure to oncology, chronic pain services, interventional pain management and related medical specialities required by the curriculum.
Trainees rotate every 12 months to benefit from the experience offered by the different training posts. Currently the changeover takes place in August.
The wide geographical spread of the East of England offers a variety of urban, suburban and rural settings.
The on-call commitment is non-resident throughout the rotation and there is no acute-medicine cover. Trainees are required to work a minimum of 20 full weekends on-call during their training period, in units that accept out-of-hours admissions and that give telephone advice to non-specialist colleagues. The frequency of on-call varies from post to post but will be no more than one in five weekends. Some posts require that you cross-cover another hospice nearby when on-call. There may be posts with no on-call commitment.
There are currently separate posts at the following locations:Between them these posts offer a varied experience of Palliative Medicine.
This post provides an exciting opportunity to work in a busy teaching hospital whilst being supported to complete the PGCE at UEA and develop a teaching portfolio.
The post was developed in 2006 to encourage trainees in their 3rd or 4th years to enhance their teaching skills and develop an interest in education. The post will consist of 75% clinical commitment and 25% education time. The trainee is strongly supported to complete a one year certificate in education theory and practice at the University of East Anglia and will be released from clinical commitments half day a week to complete this course.(MClin Ed).This course starts in September and completes the following July. The EOE LETB will usually support the applicant in funding the cost of the course although entry to the course is competitive.
There are strong links with the School of Medicine, Health Policy and Practice at the University of East Anglia and there are opportunities to lead undergraduate lectures, seminars and communication skills workshops as well as formal and informal teaching for postgraduates.
Palliative Medicine at NNUH is part of the Oncology and Palliative Care Directorate and is extremely well integrated.
The Specialist Palliative Care Team within Norfolk and Norwich University NHS Trust currently work Monday-Friday 9-5 but the Trust are committed to expanding the specialist palliative care service in 2017 to provide 7 day 9-5 service, rapid response service to front door, increased outpatient clinics and ward based education and the STR will be integral to this service provision.
There is strong consultant leadership and we are committed to full implementation of the NICE guidance. To this end we have developed Trust guidance on EOLC and developed an integrated end of life care plan, which is currently being implemented.
The Specialist Palliative Care Team assess and support approximately 1750 inpatient referrals / year and have implemented IPOS outcome measures since 2015. There is an extremely busy outpatient service and we currently run 5 clinics / week including twice weekly teaching clinics and a multidisciplinary breathlessness service.
The team hold a weekly inpatient and outpatient MDT, monthly business meeting and daily triage round. We have a target to respond to referrals within 48 hours and the team’s response rate for 2015 was 94%. There are two consultants, a full time SpR (EOE rotation) and 0.6 WTE GPST as well as full time experienced Trust doctor who support the inpatient and outpatient service. The consultants/ STR attend the oncology, haematology, lung and gynaecology MDTs but have also committed to providing palliative care input to cancer of unknown primary, upper GI, colorectal, brain, pancreatic and NET MDTs with the expansion to the service. It is also anticipated that MDTs will be established within renal, neurology, respiratory and cardiology to address the needs of patients with non-malignant diseases.
We work very closely with the acute oncology service as 50% of the patients attending have palliative care needs and we are working towards expanding this 24-hour a day service to facilitate hospital admission avoidance and early discharge.
A palliative care educator post (band 7) is due to be recruited to support the education needed to ensure competencies in End of Life Care are achieved for all staff and to support Advance Care Planning.
Palliative care discharges / transfers are supported by a dedicated social worker and Palliative Care Discharge coordinator who liaises with community partner organizations to ensure that patients wishes are achieved where possible, fast track funding applications are completed and prompt discharge is facilitated. The palliative care social worker attends the Specialist Palliative Care Team weekly MDT and will also support patients with other social /financial issues.
Members of the Chaplaincy team also attend the weekly MDT and are available 24/7 to provide spiritual and religious support to patients and their relatives.
This year the CQUIN for end of life care is focused around ensuring patients are asked about their preferred place of death and that attempts are made to achieve this where possible. It is anticipated that this CQUIN will be expanded next year and may inform the enhanced supportive care CQUIN.
The Specialist Palliative Care Team holds monthly clinical governance meetings and is active in audit and research. The entire team participates in national and local audits and quality improvement projects and strive to ensure patient safety / service improvement. The clinical lead attends the monthly Caring and Patient Experience Group to represent palliative and end of life care in the Trust.
There is an established End of Life and Bereavement Steering Group which meets bi-monthly and an active Ethics Group.
The STR participates in a 1 in 5 first on call for Priscilla Bacon Lodge ( 16 bed specialist inpatient unit) and there is a 24/7 telephone on call rota, which is shared between the consultants at PBL, NNUH and West Norfolk. This on call telephone advice service is provided to palliative care patients in NNUH, Central Norfolk Community, Priscilla Bacon Lodge inpatient unit and Queen Elizabeth Hospital, Kings Lynn.
The Hospital Palliative Care Team work closely with community specialist palliative care services based at Priscilla Bacon Lodge to provide seamless services to our shared patients.
Norfolk and Norwich University Hospitals NHS Trust Colney Lane Norwich NR4 7UY Tel: 01603 286286
I have been asked to write a brief summary of the training post at the Norfolk and Norwich University Hospital for this website in order to highlight the many opportunities that the job offers registrars training in palliative medicine. As part of the year in Norwich trainees are offered the prospect of enrolling in the University of East Anglia’s postgraduate course in Clinical Education culminating in a Postgraduate Certificate in Clinical Education and fellowship of the Higher Education Academy. This part time course at the University campus (a ten minute walk from the hospital across the University’s playing fields) is fully funded by Health Education England, working across the East of England and comprises three modules taught in a multidisciplinary environment across the entire 12 month posting.
On its own the part-time postgraduate certificate course from the UEA might be reason enough to consider applying for the post in Norwich but it is also worth considering the merits of the remainder of the registrar’s week. The Norfolk and Norwich is a large acute modern hospital with a busy workload for the palliative team. This offers many opportunities both for learning and for teaching that may not be presented at other trusts. The senior palliative staff have worked hard to maintain good professional relationships with the other specialities; consequently referrals can come from all areas of the hospital. The palliative team maintain a regular presence on the oncology and haematology wards and are frequently involved in many aspects of patient care and advance care planning. The team consists of two consultants, a registrar, an experienced staff grade and a part time FY2 doctor, complimented by a vibrant team of specialist nurses. The working relationship between the doctors and nurses within the team form one of its great strengths. On calls for the registrar are as part of a rota held at the local inpatient unit, the Priscilla Bacon Centre, and are non-resident, busy but well supported by the 2nd on call tier when necessary.
The postgraduate certificate from the UEA is taught by an experienced faculty from across the disciplines allied to medicine as well as occasionally by doctors from both the community and hospital settings. The emphasis throughout the course is on learning as an adult and the onus is very much on the student to read and research the required areas rather than be spoon fed and lectured at didactically. The modules are assessed in a variety of ways and learning about the appropriate assessment methods forms part of the course itself. This “learning about learning” and indeed “teaching about teaching” is a recurring theme throughout each of the modules and the resulting reflective nature of the whole process forms a central skill evolving out of the course.
The first module concentrates on continuing professional and personal development. Students develop an understanding of the principles of learning and teaching, specifically within an adult environment, through the use of a reflective diary and a variety of continuing professional development tools. This module highlights the way the course is both structured and run, and in particular introduces students to their respective supervisors who are available for individual support throughout the entire course. It is assessed through the production of a reflective account of the students learning, allowing for a fair amount of flexibility in the manner of the submitted work and hence a great degree of freedom to reflect and learn in a manner most suitable to the individual student.
The second module incorporates a work-based project, again giving the individual student plenty of scope to choose the nature of their particular project. The choices made are representative of the various multidisciplinary backgrounds of the students involved. Students are supported by learning about the various teaching methods and styles, culminating in a videoed session of each student teaching their classmates. Assessment for this module is split between the teaching session’s feedback and an account of the work-based project itself.
The final module for the postgraduate certificate builds on some of the progress made in the second module and asks students to develop a further work-based project, again of the individual student’s design. This project is deliberately open ended with no set time frame involved in its assessment which encourages students to develop real and meaningful pieces of work that might conceivably continue even after the module is deemed complete. Assessment is through a submitted portfolio of evidence that reflects much of the learning throughout the three modules, tying together many of its principles and reinforcing much of the student’s learning.
Overall the placement at the Norfolk and Norwich Hospital represents outstanding value for a training registrar. The hospital team actively support the registrar’s commitment at the university and protected time is offered to allow for self-directed study. The mix of clinical work and study allow for a significant degree of progress to be made as a palliative doctor, not least through the reflective and personal journey resulting from the time at the University. All registrars passing through specialist training are to be the educators of the future, both on a formal basis for their trainees and patients and an informal one as mentors and supervisors throughout their clinical working life. This course provides a sound basis upon which to explore the concepts within medical education that are relevant to our own personal careers. It introduces much of the continual learning and reflective practice necessary for success, all the while exposing the training registrar to a varied and challenging clinical workload that makes this placement a highlight within the palliative medicine rotations offered in Health Education England, working across the East of England
Training Opportunities: Addenbrooke’s Hospital Palliative medicine
Addenbrooke’s Hospital has a 7 day specialist palliative and end of life care multi-professional service including nurses, clinical psychology, AHPs, doctors and an administrative team. The team works across the entire trust seeing patients in outpatients, ED, wards and intensive care services. The team is busy and no two days the same.
- work as part of the hospital advisory support team in a University Teaching Hospital together with on call at local hospice with indirect consultant supervision
- learn about the work of the Breathlessness Intervention Service, Feeding Issues MDT and Enhanced Supportive Care Clinics
- weekly consultant ward round and opportunities for team working
- see patients in ED, care of elderly, surgery, acute medicine and all specialities
- see patients in regional services such as transplant, vascular surgery, neurosurgery, oncology and bone marrow transplant/haematology etc
- attendance at regional teaching organised by the EOE palliative medicine trainees is strongly encouraged and CUH is centrally placed in EOE
- there is regular local Palliative Care Team Teaching with opportunity to attend and participate
- Trust wide education and Grand Rounds, lots of speciality teaching to attend
- lots of opportunities for formal and experiential teaching with Medical Students, Foundation Years, CMT/IM, Registrars and consultants
- run a teaching program and organise regional trainees’ study day
- present in the Grand Round is expected
- opportunities for teaching nurses and AHPs etc and in community
Leadership, governance and management experience;
- rota/take part in and chair departmental meetings (clinical and non-clinical)
- co-ordination of a multidisciplinary team
- running, chairing and organising a monthly doctors’ meeting
- work with consultants to organise clinical administration and correspondence
- opportunity to attend trust meetings on End of Life Care, cancer and non-cancer. Governance M&M, learning from deaths and research
- audit and service development is strongly encouraged with opportunities to participate and supervise audits, local and often national
The trainee will take part in the non-resident on call rota at Arthur Rank House and is expected to be within 45 minutes travel time of the hospice when on call.
Educational Supervisor: Dr Yvonne Cartwright
Address: Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge. CB2 0QQ
Telephone: 01223 274404
St Helena Hospice (independent) and Colchester General Hospital (part of East Suffolk and North Essex NHS Foundation Trust – ESNEFT). Colchester is a historic town, easily reachable from London, Chelmsford and Ipswich by train or road and set within beautiful countryside.
This is an excellent post for a new trainee (a ‘first’ hospice post) but also can offer all the opportunities needed for the later years of training where the focus is more on leadership and management. The post is mainly hospice based, with many opportunities to work in the community setting. There is weekly specialist palliative care MDT which the trainee is encouraged to attend, and as experience grows to lead.
St Helena has 22 inpatient beds and day centres in Colchester and Clacton. It was rated ‘outstanding’ by the CQC in 2017. There is a 24 hour advice and rapid response service (SinglePoint), and many opportunities for teaching and supervision of junior staff, as well as other leadership and management experience. The hospice has a well-established education department with links to Essex University.
You will join a friendly and supportive medical team consisting of a lead consultant, 3 other consultants, 1 associate specialist, a nurse consultant, 2 senior speciality doctors, 2 ANPs, a GP trainee, 1 FY1 and 1 FY2, and most importantly an excellent secretary keeping us all organised.
We have excellent links with the hospital teams, particularly with oncology and inpatient dementia care. We have set up a joint heart failure MDT with cardiology and there are opportunities to attend MDTs in oncology and MND. St Helena has a Macmillan outreach CNS who works with hard to reach groups in the area, particularly working with the homeless.
The registrar takes part in the on call rota which is compliant with the new contract. This is non-resident and there is an expectation of being within 1 hour’s travel time of the hospice when on call.
Lead Consultant: Dr Emma Tempest (St Helena Hospice)
Educational supervisor: Dr Katherine Oakley (Consultant, St Helena Hospice, Training Programme Director)
Consultants/clinical supervisors: Dr Emma Tempest
Dr Hattie Roebuck (St Helena Hospice and ESNEFT)
Dr Julia Thompson, Trust Lead for End of Life Care,
Clinical Strategy Lead for Palliative Care (ESNEFT and St Helena Hospice)
Employment contract held by: East Suffolk and North Essex NHS Foundation Trust
Colchester General Hospital
Colchester CO4 5JL
Address: St Helena Hospice
Colchester CO4 9JU
Sue Ryder Thorpe Hall Hospice (and Peterborough City Hospital)
Educational supervisor: Dr Richard Partridge
Sue Ryder Thorpe Hall Hospice, run by the national charity Sue Ryder, provides specialist palliative care services to a wide local area including the people of North Cambridgeshire, South Lincolnshire, Rutland and East Northamptonshire. In July 2015 a brand new purpose-built inpatient unit was opened. It has 20 single rooms all with en-suite bathrooms. It forms part of the Sue Ryder Services on site which includes the old mansion house (the site of the previous inpatient unit) and the 'West wing' which has been redeveloped for day therapy services. This is all set within several acres of grounds including landscaped gardens, yet in the heart of the city of Peterborough. Sue Ryder, formerly Sue Ryder Care, was founded over fifty years ago as the Sue Ryder Foundation, and has major experience as a provider of care to adults with complex needs. Currently with six specialist palliative care centres, Sue Ryder is one of the largest independent providers of specialist palliative care in the UK.
The Specialty registrar works within a team including 2 consultants, specialty doctors, GP trainees and an F1 doctor.
First on-call out-of-hours cover for the hospice is provided by a combination of the specialty doctors, specialty registrar and GP trainees. Since September 2015 there is a middle grade doctor on site Mon-Fri 09.00-19.00.
The registrar works as part of a full multi-professional team at the hospice including nurses, nursing assistants, clinical psychologist, Family support and bereavement team, occupational therapist and physiotherapist, complementary therapy team, spiritual care team, discharge co-ordinator.
Sue Ryder has a nurse-led day centre at Thorpe Hall for adult patients with chronic progressive neurological conditions, such as multiple sclerosis, Parkinson’s disease and MND. The team also support the once weekly Synergy Café where people with dementia and their carers can relax, chat or participate in enjoyable activities as well as spending dedicated time with our facilitators who can help with information, advice and practical support. Thorpe Hall also has a Hospice at Home service to Peterborough and the surrounding area. This provides crisis intervention to patients and their families at home via hands on nursing support and advice.
Thorpe Hall is situated just a few minutes’ drive from Peterborough City Hospital which is part of the North West Anglia NHS Foundation Trust (NWAFT). This was built as a state-of-the-art unified hospital in 2010. There are around 650 beds. There is an oncology centre with 4 linear accelerators and a team of oncologists and an inpatient haematology/oncology ward. There is a well-established hospital specialist palliative care team including a palliative medicine consultant, hospital Specialist Palliative Care nurses and clinical psychologist. There is a palliative medicine clinic on a Monday and Friday morning at PCH which the registrar can attend this if this is part of their PDP. NWAFT also manages the well-established community specialist palliative care team covering Peterborough, North Cambridgeshire and the Fens, currently based at the Robert Horrell Macmillan Centre in the grounds of Peterborough City Hospital. It now operates, in conjunction with the Hospital Specialist Palliative Care Service 7 days a week 09.00-17.00.
There are very close links with the Chronic Pain Team at Peterborough City Hospital. There is a monthly joint meeting between the Chronic Pain Team and the Palliative Medicine Consultants to discuss complex cases. They provide a variety of interventional techniques and nerve block procedures. The registrar is encouraged to attend this meeting and also can arrange to spend time with the pain team observing interventional procedures and pain clinics.
Other Training Opportunities during this post may include
- Opportunity to undertake domiciliary visits as they arise.
- Opportunity to spend time with Hospice at Home service.
- Clinical governance – Attend monthly Medical governance meeting (patient safety, audit, risk management, and quality improvement).
- Teaching experience – there are regular opportunities to teach to nursing staff, medical students and other staff.
- Management – opportunity to attend senior management team meetings, involvement in recruitment, contribute to handling of critical incident. Opportunity to attend twice yearly medical team business meetings including strategy review.
- Regional teaching – attendance at monthly regional registrar study days
- Weekly CPD meeting – journal club. The trainee will be expected to take part in and attend the weekly journal club when articles or presentations relevant to palliative medicine are discussed.
- Opportunity to supervise and be involved in induction of more junior medical colleagues
- Opportunity to spend time with local chronic pain team including outpatient clinics and interventional nerve block lists. There is also the opportunity to attend the monthly combined palliative medicine/chronic pain team meeting where complex cases are discussed and imaging reviewed
- Opportunity to attend the local MND MDT.
- Optional attendance at the hospice children’s bereavement group ‘Charlie Chimp Club’
Sue Ryder Thorpe Hall
Employment contract held by:
North West Anglia NHS Foundation Trust
Peterborough City Hospital
The Priscilla Bacon Centre for Specialist Palliative Care Services incorporates an NHS 16 bedded inpatient unit, a day therapy unit and a busy community specialist palliative care team. As part of Norfolk Community Health and Care NHS Trust, the services also link closely with those provided by the Norfolk and Norwich University (NNUH) Foundation Trust. There are three Consultants working within the service as well as a cohort of experienced SSAS doctors. The unit also has a CMT and GP training post and is actively involved with medical student training.
As a Specialty Registrar working with the team here, there is the opportunity to work on the inpatient unit, day unit or in the community team depending on your training requirements and experience.
The inpatient unit offers specialist care for complex symptom control and end of life care in a range of malignant and non malignant disease and care is coordinated closely with hospital specialist teams where appropriate.
The day unit is led by a Nurse Consultant. Treatment is multi-professional and goal focused. Medical interventions include blood transfusions, bisphosphonate and other infusions and paracentesis.
The specialist community team is evolving and the medical team now provide a rapid response service which allows complex patients to remain at home. It has strong links with primary care services and works closely with both the NNUH and the Priscilla Bacon Lodge inpatient unit. It offers a great breadth of exposure to challenging management of malignant and non malignant disease. There are close links with local prisons offering the opportunity to undertake assessments in this setting too.
Working at the Priscilla Bacon Centre offers numerous opportunities to develop skills in management, teaching, quality improvement and service development. It has a true multidisciplinary team approach and is a supportive and collaborative learning and working environment.
Dr Katie Soden, Lead Consultant
Priscilla Bacon Lodge, Colman Hospital, Unthank Road, Norwich, Norfolk, NR2 2PJ
The post is based at Farleigh hospice in Broomfield, Chelmsford. Farleigh hospice is on site at Broomfield Hospital. Broomfield Hospital has recently merged with Southend and Basildon Hospitals to form the Mid and South Essex NHS Foundation Trust.
Farleigh has ten specialist inpatient beds. There are currently four consultants working across the community, hospital and inpatient settings. The post is primarily based on the inpatient unit. In addition to learning to manage complex inpatients there are excellent opportunities to develop leadership skills when working with more junior medical staff. The rest of the ward medical team currently consists of one FY2, two part time GP trainees and one speciality doctor. The registrar provides day to day clinical leadership on the inpatient unit with support from consultants and regular consultant ward rounds.
Depending on grade and training needs the post may also involve work in the community including home visits, outpatients and supporting clinical nurse specialist colleagues and other members of the specialist team in the community.
There is a 1 in 5 weekend and occasional weekday on call commitment. When on call the registrar covers the inpatient unit and depending on experience may also give telephone advice for community and hospital patients (with consultant support as needed). This can develop useful skills in prioritisation, time management and clinical judgement. The trainee needs to be within 1 hour’s travelling time of the hospice when on call.
There are teaching opportunities within the medical team, wider hospice clinical team and for visiting medical students. There are opportunities to attend management meetings to gain an understanding of life as a consultant. Farleigh Hospice is part of the Hospice UK Project ECHO network and so there may be opportunities to be part of this innovative education programme.
With connections to neighbouring Broomfield hospital you can gain experience working with our colleagues in the pain team and the adult psychiatrists at the Crystal Centre.
It is a supportive post that would be suitable for a trainee of any level.
- Dr Zoe Helman.
North Court Road
Essex CM1 7FH
Employment contract held by:
Mid and South Essex NHS Foundation Trust
Essex CM1 7ET
Arthur Rank House (NHS Hospice) and Papworth Hospital (NHS tertiary referral)
A full-time trainee will spend three days each week at Arthur Rank Hospice and 2 days each week at Papworth hospital.
Arthur Rank hospice has 12 specialist palliative care beds and up to 9 ‘nurse-led’ end of life care beds. The inpatient unit is staffed by two part-time experienced staff-grade doctors, a full-time internal medicine trainee and a GP trainee. The specialist beds are usually full and are occupied by patients with a variety of malignant and non-malignant conditions, often with highly complex care needs.
The hospice also has a community specialist nursing team which is made up of clinical nurse specialists and a hospice at home team. The hospice at home team currently provides ‘hands-on’ overnight care from a team of experienced healthcare assistants and registered nurses. The specialist nursing team provide support to patients based in the community, seeing patients at clinics in the hospice or in their own home. The Addenbrookes Motor Neurone Disease clinic is now based in the hospice outpatient department.
There are three palliative care consultants who oversee the inpatient unit and community teams. Dr Richella Ryan has chief responsibility for the inpatient unit, Dr Lorraine Petersen is Medical Director and works in the community and at Addenbrookes hospital and Dr Sarah Grove covers the community and Papworth hospital. We also run a twice monthly Pain Management Group which comprises a palliative medicine consultant, a chronic pain consultant and a psychologist, and reviews patients with difficult pain.
Depending on their level of experience and training needs, a trainee can either work on the inpatient unit or use the opportunity to gain community experience by seeing patients in outpatient clinic or on home visits, either alone or jointly with the community specialist nurses. The trainee can also expect to attend and/or provide consultant cover for the Pain Management group and should take the opportunity to visit MND clinic and other specialist clinics.
Papworth hospital is a specialist cardio-thoracic hospital, based in the Addenbrookes Biomedical campus. The trainee works as part of the hospital Supportive and Palliative Care team, along with a part-time consultant (0.3 WTE), two Clinical Nurse Specialists (1.5 WTE) and an administrator. The team supports patients with a wide range of (usually non-malignant) cardiothoracic diseases and the trainee should particularly expect to gain experience in the management of breathlessness and in the management of patients on the intensive care unit. The trainee will join Dr Grove at Papworth on Tuesdays and Thursdays.
There are many opportunities to gain teaching and management experience across both sites eg
- teaching medical students, qualified healthcare professionals
- attending clinical governance, information governance and trustee meetings
- chairing multidisciplinary team meetings
- writing or reviewing policies and procedures
- being involved in complaint investigations
- attending and presenting at journal club
- participate in and supervising quality improvement project
The trainee is expected to contribute to the non-resident first on call rota and senior trainees have the opportunity to take part in the consultant on call rota (with supervision). The trainee is expected to be within 45 minutes travel time of the hospice when on call.
- Dr Lorraine Petersen
Arthur Rank Hospice Charity
Cherry Hinton Road
CambridgeTel: 01223 675777
Employment contract held by:Papworth Hospital NHS Foundation Trust Papworth Everard Cambridge CB23 3RE Tel: 01480 830541
Sue Ryder Care St John's Hospice (independent) and Bedford General Hospital (DGH).
Split post between 15 bedded in-patient unit, with two consultants and FY2 doctor, and the nearby DGH as part of the advisory team. Thee are also opportunities for Outpatients and Community visits.
- Dr Penny McNamara
Address:St. John's Hospice St John's Road Moggerhanger Bedford MK44 3RJ
Employment contract held by:Bedford Hospital NHS Trust Kempston Road Bedford MK42 9DJ
These posts offer trainees experience in a NHS setting both in a Specialist Palliative Care in-patient Unit and Hospital Support Team in a tertiary referral Cancer Centre.
The post can be adapted to prioritize the learning needs of the individual trainee and there are numerous educational opportunities. There are 3 Palliative Care Consultants who have extensive experience in supervising and training Junior Doctors, are accredited Educational Supervisors and are all involved in teaching.
- In-patient care, management of referrals and bed state
- Assessment of new admissions
- Weekly bed meeting, inpatient MDT
- Twice weekly Consultant ward round on inpatient unit
- Advisory service to Cancer Centre in-patients and out-patients
- Attend oncology and supportive care OPC’s
- Participate in Day Centre MDT
- Palliative care review of patients attending daycentre as outpatients
- Attend pain clinic lists
- Quarterly clinical governance meetings and audit/QI
- Opportunity to supervise a GP VTS trainee and FY1
- Providing OOH care to in-patients which includes covering a neighbouring independent hospice
- support to a 24hr advice line
- Opportunities to attend management meetings
Specific Educational events:-
- Weekly journal club attended by local community Palliative Medicine Consultants
- Weekly palliative care teaching in seminar format
- Opportunity to teach multi-professional team and medical students
- Large in house Education programme
- Trainees are offered monthly clinical supervision
- Opportunity to attend Schwartz rounds
Dr Jas Gill
East and North Hertfordshire NHS Trust
Michael Sobell House | Mount Vernon Hospital | Rickmansworth Road | Northwood |
Middx | HA6 2RN | www.enherts-tr.nhs.uk
Speciality Registrar in Palliative Medicine, Basildon University Hospital
Basildon University Hospital is a large University Teaching Hospital with a busy Accident & Emergency Department, Medical Assessment Unit and Acute and Chronic Dialysis Units. It is close to London lying just outside the M25 with major road and rail links to London and the Channel crossings.
The hospital has an active Postgraduate Medical Education Centre with comprehensive library facilities and a well-established teaching programme.
The speciality registrar (StR) in palliative medicine has two main clinical roles:
- To provide day to day clinical management of patients under the care of the consultant in palliative medicine on the 23-bedded cancer medicine ward (on average around 10-12 patients). The majority of patients have an underlying diagnosis of cancer but the ward also has the remit to care for patients with non-malignant life-limiting illness whose palliative needs cannot be met elsewhere in the hospital. The SpR is supported in this role by an FY1 Doctor and an ST1/2 doctor on the general practitioner speciality training scheme.
- To provide (along with the consultant in palliative medicine) medical input to the Macmillan Hospital Palliative Care Team. The team also comprises a team leader, 5 WTE Macmillan clinical nurse specialists, 2 WTE counsellors, 1 HCA and secretarial support. The team has an average of 500 referrals each year.
The StR also participates in one hospital out-patient clinic in palliative medicine each week and attends the weekly locality specialist palliative care multi-disciplinary meeting. There are also opportunities to attend cancer site specific multi-disciplinary meetings, the monthly motor neurone disease clinic, and the paediatric palliative care multi-disciplinary meeting. Many StRs also elect to spend some clinical time with the community paediatric Macmillan clinical nurse specialist.
There is close collaborative working with oncologists who, although based at Southend University Hospital (a Cancer Centre), do regular out-patient clinics at Basildon and haematologists (based at Basildon University Hospital). The opportunity to attend oncology and/or haematology clinics is available. The Palliative Care CNS team also support the acute oncology service.
There will also be opportunities to observe interventional pain relief procedures and to attend network and service development groups.
Participation in audit is strongly encouraged and palliative medicine contributes to the regular audit programme in medicine. The StR in palliative medicine often organises the weekly teaching programme for junior ward staff on the cancer medicine ward and can gain management experience by co-ordinating ward medical staff leave. They are encouraged to attend the weekly medical X-ray meeting and medical Grand Round.
For further information or discussion please contact Dr Catherine O’Doherty, Consultant in Palliative Medicine, Basildon University Hospital 01268 524900 (main switchboard) ext. 4740 or 01268 394740 (secretary).
Garden House Hospice Care (GHHC), is an independent hospice, serving a population of 360,000 people and is the hospice for North Hertfordshire, including Stevenage, Royston, Letchworth, Baldock, Hitchin and surrounding villages. The hospice itself is in Letchworth.
Garden House Hospice Care has a very friendly and supportive working environment, offering a range of exciting opportunities for both in-patient and community clinical settings.
Clinical care provided by GHHC includes:
- a 10 bedded In-Patient Unit primarily providing symptom control and last days of life admissions
- the Hawthorne Centre providing a wide range of day services on and off site
- a 24/7 Hospice at Home and Continuing Health Care team providing nursing care to patients in their own homes
- Family Support Services, providing pre and post bereavement for adults and children
- Compassionate Neighbours Scheme supporting those at risk of loneliness and social isolation
- Medical supervision provided to the Herts Community Trust Specialist Palliative Care CNS Team by the GHHC Medical Director.
In addition to these direct clinical services, GHHC has a growing education department, which is part of the Hertfordshire Hospice Education Consortium, promoting collaborative working across the region, to provide training to hospice and non-hospice healthcare workers across the local region.
The medical team at GHHC includes two Consultants (including the Medical Director), one Specialty and Associate Specialist (SAS) doctor, two full time GP trainees and two one day per week GP trainees.
Trainees are based at the 10 bedded in-patient unit for up to 60% of the job with the remainder of the job being a community role, comprising medical reviews for patients attending the Hawthorne Centre Day Hospice and attendance at the Hawthorne Centre MDT, outpatient clinic, domiciliary visits, attendance at Gold Standards Framework (GSF) meetings in GP practices and work with the Herts Community Trust Specialist Palliative Care CNS Team, including attendance at the weekly Medical Meeting.
Trainees are largely based at the 12 bedded in-patient unit and have the opportunity to gain experience of day care by weekly attendance at the Hawthorne Centre to review day patients and see outpatients.
Other training opportunities at GHHC include but are not limited to:
- attendance at the weekly inpatient unit MDT
- attendance at the weekly GHHC In-House Education events, covering a wide range of topics relevant to hospice work, including regular journal club
- increase learning about heart failure by attending the Lister Heart Failure Clinic with one of the GHHC consultants
- increase understanding of the enablement and rehabilitative approach to palliative care, for example by spending time attending sessions at the Hawthorne Centre
- teaching in a range of situations and to different professional audiences
- involvement in audit personally and in a supervisory role and other quality improvement work
- experience of clinical governance by attending the Clinical Team Leaders and Hospice Care and Clinical Governance Trustee meetings
- support to increase management skills, for example by chairing MDT meetings, involvement in recruitment, attending full board trustee meetings and supervising of GP trainees
- positive support to be involved in research projects
On call is non-residential 1 in 5 weekends and 2 weeknights over 5 weeks, covering GHHC and St John’s Hospice in Moggerhanger. Trainees able to attend the hospice within an hour during the out of hours period will be able to undertake this on call from home.
- Dr Sarah Bell, Medical Director
Garden House Hospice Care
Letchworth Garden City
01462 679 540
Employment contract held by:
E & N Herts NHS Trust
Coreys Mill Lane
St Elizabeth Hospice is a charitable hospice in Ipswich, supporting the population of East Suffolk. There is an 18 bedded inpatient unit; an active day services area which includes outpatient clinics and offers interventions including bisphosphonates, blood transfusions and paracentesis; and a large community team which provides both planned and reactive visits. There is a 24 hour specialist advice line and close working relationships with the neighbouring Ipswich Hospital which is a cancer centre. Experience gained may include MND services and Young Adult/transitional care.
The Palliative Medicine registrar post is mainly based on the inpatient unit, but there is the opportunity to work in outpatients and community according to training needs and level of experience. There is opportunity for teaching experience as well as audit/governance projects and aspects of working outside the NHS.
You will join a friendly and approachable team, which includes 4 Medical Consultants, 2 Nurse Consultants, 5 part time speciality doctors and a GP registrar. The team is supported by a full multidisciplinary team including nursing, physio, OT, emotional wellbeing (including art and music therapy) spiritual care and complementary therapy.
The trainee is expected to be within 45 minutes travel time of the hospice when on call.
Educational Supervisor: Alison Blaken
Other Consultants: Sam King, Charlotte Williams, Cecily Wright, John Zeppetella
Address: St Elizabeth Hospice, 565 Foxhall Road, Ipswich IP3 8LX
Tel: 01473 727776
Employment contract held by: Ipswich Hospital (East Suffolk & North Essex Foundation Trust), Heath Road, Ipswich IP4 5PD
Tel: 01473 712233
St Clare Hospice has an 8 bedded in-patient unit with 10 places a day each Day Hospice. It also works in conjunction with Community and Hospital Palliative care teams. It provides specialist Palliative care service to a population of 400,000 inhabitants residing in West Essex and East Hertfordshire area. Apart from medically led clinical service, it also runs an active Equipment loan service, Bereavement Counselling service and Research and Education activities.
The post will be based at hospice with primary duties at In-patient unit. There are two hospice based consultants in Palliative Medicine, one hospital based consultant in Palliative Medicine with honorary contract and one Consultant Psychiatrist with honorary contract with St Clare Hospice. Two consultants work across the community, hospital and inpatient settings. In addition to learning to manage complex inpatients there are excellent opportunities to develop leadership skills when working with more junior medical staff. The rest of the ward medical team currently consists of one full time Senior Specialty doctor, two part time specialty doctors, one full time GP trainee, one part time GP trainee and two part time FY2 doctors. The registrar provides day to day contribution to the inpatient unit with support from consultants and regular consultant ward rounds.
Depending on grade and training needs the post may also involve work in the community and hospital including face to face visits, outpatients and supporting clinical nurse specialist colleagues.
There is a 1 in 5 weekend on call commitment. When on call the registrar covers the inpatient unit and depending on experience may also give telephone advice for community and hospital patients (with consultant support as needed). This can develop useful skills in prioritisation, time management and clinical judgement. The registrar is expected to be within 1 hour’s travel time of the hospice when on call.
There are teaching opportunities within the medical team, wider hospice clinical team and for visiting medical students. There are opportunities to attend management meetings to gain an understanding of life as a consultant. Hospice runs regular teaching days on Introduction to Palliative care and conferences on specialist topics. It also receives medical and Physician associate students from Universities of Cambridge, Barts and Anglia Ruskin and therefore there is opportunity for undergraduate teaching.
With an honorary consultant in Psychiatry, there is opportunity to learn relevant clinical skills applicable to Palliative care.
It is a supportive post that would be suitable for a trainee of any level.
- Dr Syed Qamar Abbas
- Dr Jonathan Riordan
St Clare Hospice
Essex CM17 9JX
Employment contract held by:
St Clare Hospice
Palliative Medicine training in West Suffolk
A palliative medicine placement in West Suffolk provides trainees with a breadth of experiences, all in one site, based in the geographical centre of the East of England region. Placements can be adapted to suit the needs of the trainee, to allow experience in the hospice’s inpatient unit and community team, and hospital palliative medicine.
St Nicholas Hospice Care and West Suffolk Hospital are unusually well connected, both in terms of geography, and continuity between clinical teams. In addition to this, there is a high level of integration between inpatient, day and community services across the hospice – all team members work across all areas; many nurses work in both teams. All this adds up to a high level of continuity for patient care, and the opportunity to follow patients across multiple settings across the year
St Nicholas Hospice Care:
- Predominantly funded by an independent charity
- Main hospice building set in grounds of West Suffolk Hospital (five minute walk between sites), comprises the below
- Inpatient specialist palliative care unit typically staffed for 8 inpatients (though registered for up to 12)
- Two consultants (both working across hospice and hospital), senior staff grade doctors, a GPVTS and FY2 doctor
- Community nursing services run 7 days a week (daytime only) – clinical nurse specialists, registered nurses, health care assistants – registrar would have the opportunity to run caseload meetings, provide home visits and outpatient clinics
- Day hospice services operating two days per week, nurse and therapist-led model
- Independent living team (physio, OT, music therapy, complimentary therapy)
- Family support team (psychological support workers) and chaplaincy services
West Suffolk Hospital:
- Acute NHS Foundation Trust Hospital with 430 inpatient beds
- In addition to the usual adult medical and surgical wards, has Emergency Department, inpatient oncology ward and outpatient chemotherapy facilities, critical care unit
- Palliative care team run a six day per week service, with five clinical nurse specialists, three of which are prescribers
- Set in parkland in Bury St Edmunds
- Bury St Edmunds is a vibrant and pretty town in West Suffolk
- West Suffolk and Thetford (South Norfolk) have a population of around 280,000
- This is in the geographic centre of the East of England region, easily commutable from Cambridge, Ipswich, Colchester or Norwich areas
- The hospice has two consultant ward rounds each week
- The hospice and hospital each run an MDT each week
- There are several cancer site-specific MDTs each week which trainees can attend
- SPA/non-clinical time would be timetabled each week at the proportion recommended by the SAC
- The trainee would be supported to attend the regional training days
- There is a busy pain team WSH with which the palliative services works closely
- Opportunity to get involved in a variety of managerial and senior opportunities, such as:
- clinical governance
- project roles
- joining any research projects the hospice is currently taking part in
- clinical supervision of trainees
- multiple opportunities to provide education
- There is a child bereavement programme, which the trainee can get involved with, offering an unusual opportunity to support bereaved children, under close supervision
- On call is non-resident and it is expected that the doctor will be within one hour maximum travel time of the hospice
- The frequency of on call is at a rate of no more than 1 in 4 weekends/week nights; currently 1 in 6 but may change from year to year
- The service covered while on call is usually limited to the inpatient unit, though during the day on Sat/Sun, the community CNS may discuss community patients with the doctor on site
- There is a Suffolk on call palliative medicine consultant rota providing telephone support at all times
- A driver’s licence is preferred, but would be possible for non-drivers, providing the doctor was able to commute to work, and stay on site during on calls (there is hospital accommodation available)
- If the doctor has a licence but no access to a car, they would be able to drive the hospice’s pool cars for home visits to community patients.
St Nicholas Hospice Care
Bury St Edmunds
Employment contract held by:
West Suffolk NHSFT
Dr Sarah Mollart, email@example.com
At Southend University Hospital we have a SpR in Palliative Medicine post. It is within the Acute Trust.
We have inpatient specialist palliative care beds and supervise both GP trainees and FY1s in caring for these patients.
We also run an advisory support team for the rest of the hospital.
As an SpR in Palliative Medicine you would be given the opportunity to care for inpatients in specialist palliative care beds, do daily ward rounds with consultant support, attend both palliative care and cancer site specific MDTs. We have an out-patient clinic on Wednesday afternoon where you will see patients both jointly and on your own.
Since we are a cancer centre we have the opportunity to be able to allow you time to spend in oncology clinics and oncology ward rounds and in radiotherapy planning.
We have close links with the chronic pain team who provide our intervention pain control and previous registrars have enjoyed spending time with the team and watching interventions.
We have a local children’s hospice and a paediatric consultant who specialises in palliative care and registrars are encouraged to spend time both with her in the Acute Trust and also over at the children’s hospice.
We are fortunate enough to have three part-time consultants in palliative care which means that there is clinical supervision daily by a variety of different consultants.
We have close links with our community team and indeed provide consultant community sessions and previous registrars have also enjoyed time out in the community.
We enjoy having our registrars and aim to make their time with us specific to meet their learning needs.
We ask our registrars to do a one in five Saturday on-call 9am to 5pm with the nursing team in the Acute Trust seeing the palliative care patients that the team know and new referrals.
Place of work and contract held by:
Southend University Hospital NHS Foundation Trust,