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  2. 2. Background Academic Health Sciences Centre As part of his report, “Healthcare for London – a Framework for Action”, Lord Darzi proposed the creation of “new breed” Academic Health Science Centres, which will be world class centres of acute care excellence, able to compete both nationally and internationally for major research programmes, the best clinicians and academics. King’s College Hospital NHS Foundation Trust will play a key role in this as a founding partner of London’s most comprehensive Academic Health Sciences Centre (AHSC), along with King’s College London and Guys and St Thomas’ and the South London and Maudsley NHS Foundation Trusts. The partnership is based on the tripartite mission of excellence in research, teaching and clinical practice and will focus on translating research more speedily into better outcomes for patients across our hospitals. This is a very exciting prospect enabling us to compete globally for research opportunities and ensuring our ability to deliver world-class clinical services. All AHSCs are different, depending on where they their build strengths across the tripartite mission of service, teaching and research. Our partnership has a common vision to provide services which are built around the needs of the patient, driven by research and led by clinicians, contributing to the improved health and wellbeing of Londoners. Doing things differently – outside traditional boundaries, through different roles and with other partners, in a wider range of settings, involving patients, their carers and the citizens of London in developing new models of care – is at the heart of the innovation our AHSC looks to offer. The organisation to support this vision is for closer and integrated working between the partners rather than of a merger between institutions. King’s College Hospital King’s College Hospital is one of the largest and busiest in London, with a well- established national and international reputation for clinical excellence, innovation and achievement. Two thirds of the clinical activities of the hospital are in support of the socially and economically diverse communities of the boroughs of Southwark and Lambeth. As both a healthcare provider and a major employer with over 5,500 staff, King’s plays an important part in helping reduce local social and health inequalities. The hospital provides a broad range of secondary services, including specialist emergency medicine (e.g. trauma, cardiac and stroke). It also provides a number of leading edge tertiary services, such as liver transplantation, neurosciences, blood cancers treatments, foetal medicine, cardiology and cardiac surgery, on a regional and national basis. King’s College Hospital has an enviable track record in research and development and service innovation, and there has been considerable investment linked to the national Best Research for Best Health strategy. In partnership with King’s College London the Trust has recently been awarded a National Research Centre in Patient Safety and Service Quality. It is also a partner in two National Institute for Health Research biomedical research centres. The first is a Comprehensive centre with King’s College London and Guy’s and St Thomas’ NHS Foundation Trust and the second is a Specialist centre with the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry. King’s College Hospital has also recently strengthened its research and development infrastructure in order better to support clinical researchers across the organisation.
  3. 3. The hospital is principally located on a single site, with 950 beds, but has a number of important outlying satellite services including dialysis, foetal medicine, cardiac diagnostics, and outpatient outreach clinics in other locations. It works in close collaboration with other health providers in South East London, including Primary Care Trusts, to ensure the sustainability and excellence of services across the area. In recent years, there has been substantial investment in both the facilities and resources of the hospital, which has transformed the quality of care that it now delivers. King’s is undertaking a programme of transformational change, in the context of a broad review of the operational aspects of the Trust’s service development strategy, under the banner of ‘First Choice’. The programme reflects the growing demand from patients for more choice in the delivery of their care, together with the need for the continuous review of efficiency to ensure maximum allocation of resources to direct patient care. In its first full year as a Foundation Trust, the hospital delivered a surplus of £12.5m, and projects a continuing surplus throughout the lifetime of its current financial plan. The Trust has an annual income in excess of £470m, the majority of which is derived from Primary Care Trust commissions. However, education and research are also important sources of income, currently contributing around 12% of the total. The Trust is embarking on a strategy to achieve greater diversification of its income, with growth anticipated in tertiary referrals, research and commercial services activities. There is also a developing fund raising partnership with the King’s College Hospital Charity. Further information about King’s can be found on its website, and on the development of our AHSC at
  4. 4. DEPARTMENT DESCRIPTION 1. INTRODUCTION THE DEPARTMENT OF RADIOLOGY Main Department Neuroimaging Nuclear Medicine The activities and development of the Imaging Services reflect those of the Hospital as a whole with integration of both undergraduate and postgraduate training with the service commitments to the institution. Recent redevelopment of the Main Department on the Denmark Hill site encompasses enhanced diagnostic facilities with 2 CT Scanning units including 2 MDCT scanners; 3 Interventional Suites with an adjacent 10 bedded Recovery and Day Case unit run by Radiology Staff; General Inpatient, Outpatient and IVU Rooms; and 2 Digital Screening Rooms. There is a dedicated Emergency Department Radiology facility placed immediately adjacent to the Emergency Department. This also serves some of the outpatient departments. Recently Kings has been designated as one of the 4 London Major Trauma Centres and a large ED rebuild and expansion will encompass this Radiology Department. An ED CT scanner and increase in plain radiography facilities are planned for 2010. The Ultrasound section has 5 Scanning Rooms and its own Reception and Waiting areas. The MR unit houses a 1.5T MRI scanner and a Business Case for a 2nd scanner on this site is being progressed. There is an Academic and Administrative floor with conference, film museum, library and teaching facilities. A fully integrated PACS, RIS and Voice Recognition system has been operational since December 2005. The main radiology staff complement includes 72 radiographers, 15 nurses and 22 administration and support staff, including 4 consultant secretaries/PAs. All Consultants have offices in the academic/administrative area within the department, Ultrasound and Breast Units. There are 17 Consultant staff and 30 Radiology trainees on rotation between Kings and its allied training hospitals. The Radiology Department is part of the Clinical, Scientific and Diagnostic Services Division (CSDS), one of the six divisions within King’s. Within the institution the Department has a high profile, with well-established Clinico–Radiological interaction, multidisciplinary meetings and a significant research output. The Imaging department is part of the Imaging Clinical Academic Group within the AHSC of King’s Health partners. This brings the Imaging Sciences Division of KCL, and the Imaging Clinical Services of King’s College hospital and Guy’s and St.
  5. 5. Thomas’ NHS Trust into a structure which will deliver a single research, education and service strategy across the multidisciplinary groups. There is a dedicated Neuro-Imaging Department as part of the NeuroSciences Care Group, that provides specialist diagnostic and interventional radiology for the Region. There are MDCT, Angiography, MRI scanning suites and general radiology facilities. Additional facilities including MR and MDCT are present on the Denmark Hill site at The Maudsley. Within Clinical Neurosciences, there is a major collaboration for Imaging research within the Academic Department of Neurosciences and the world renowned Institute of Psychiatry. There are currently 7 full time Neuroradiology Consultants. There is a dedicated Nuclear Medicine Department that provides specialist diagnostic and therapeutic services for the hospital and GKT Cancer Centre. There are currently 3 Consultant Nuclear Medicine Physicians with expertise in all aspects of diagnostic and therapeutic radionuclide medicine. 2. SPECIFIC AREAS GENERAL RADIOLOGY The General Radiology Department has a high volume of work. The ED Radiology Department completes over 60,000 examinations per year. The Golden Jubilee Wing PFI Build completed in 2003, contains a six room general radiology development. As part of the Major Trauma Centre designation, King’s is investing in expansion of the ED facilities including placement of an ED MDCT and increase in general radiology capacity within this site. ULTRASOUND General Ultrasound workload is 22,000 examinations per year. All ultrasound machines have colour Doppler facilities. King’s is one of the leading international centres for ultrasound contrast media research with numerous peer-reviewed publications. The Academic Department of Obstetrics and the Harris Birthright Unit at King’s have international standing as a referral centre for ante–natal diagnosis and intervention. There are links exist between these units and the Department of Radiology. AXIAL IMAGING A Siemens Sensation 16 Slice MDCT was commissioned in 2004, and a second GE 64 slice MDCT was sited in 2007. Major cancer services for hepatobiliary, pancreatic, haemato-oncology, lung, breast, colorectal and neurological malignancy are based in Kings serving both the local SE London as part of the Guys, King’s and St. Thomas’ Cancer service, Kent and other local and national networks. The axial imaging reflects these specialist services which also include the NSCAG funded services of adult and paediatric liver transplantation. A Siemens 1.5 Tesla unit is housed in a new MR suite for body and musculoskeletal imaging. The Business Case for a second MR scanner within this unit is being prepared. This bid is partly based on potential for collaborative cardiac research within the KHP Imaging CAG.
  6. 6. ANGIOGRAPHY AND INTERVENTIONAL All interventional procedures are performed within the 3 dedicated interventional suites within the main department. The 10 bedded recovery and day case facility is directly adjacent to the 2 interventional suites. All interventional techniques are established including angioplasty, an EVAR programme and all non-vascular interventional techniques. Cardiac and neurovascular intervention are undertaken within dedicated specialist units within Kings as the regional centre for Neurosciences and the recent designation as hyperacute stroke centre by Healthcare for London HEPATOBILIARY AND TRANSPLANT SERVICES King’s College Hospital provides one of the largest comprehensive adult and paediatric hepatobiliary and pancreatic services in Europe. The adult and paediatric liver transplantation, hepatology and hepatobiliary surgery programmes have a national and international referral base. King’s is also designated as a national centre for islet cell and paediatric small bowel transplantation. There is a strong research base and developing clinical profile for hepatocyte transplantation. Imaging and intervention are recognised as key components of this service and research profile. As part of the GKT joint Cancer Centre, KCH delivers hepatobiliary and pancreatic cancer services to south London and the Kent Cancer networks but attracts referrals nationally. All interventional HPB techniques are conducted including TIPSS, embolisation and tumour ablation with King’s designated as a European training site. EMERGENCY DEPARTMENT RADIOLOGY This area is designated to serve ED outpatients and community referrals. Following the recent review of trauma services in London, King’s has been designated as the Level 1 Trauma Centre for South East London with it’s network partners including Guy’s and St. Thomas’ NHSFT, Lewisham and the combined South East London Trust based at Bromley, Sidcup and Woolwich. This strategic development for trauma services will commence in April 2010 and there are advanced plans for the infrastructure changes necessary to deliver a comprehensive trauma service on this site. The ED Imaging Department is to be redeveloped to facilitate siting of a fourth MDCT. As part of this service development there will be enhanced consultant input into ED services. This will include both neuro, non-neuro trauma and vascular intervention. Currently, there are on-call rotas for interventional, non-interventional and neuroradiology consultants delivered on a 1:7 basis. It is envisaged that ultimately there will be three consultants with an interest in trauma radiology. BREAST RADIOLOGY Breast Radiology is an integral part of the department of Radiology and provides a breast imaging, assessment and diagnostic service for both the King’s symptomatic breast clinic and the South East London Breast Screening Programme (SEL BSP). It also receives referrals from other centres for diagnostic work up and image guided biopsy procedures.
  7. 7. The target population for SEL BSP is just over 140,000 women aged 50-70 years and the programme is now fully expanded to provide two views at every screen and to invite women up to the age of 70 years. At King’s, all screen film reading and assessment are carried out for women screened in LSL and Bromley. Assessment for women resident in Greenwich and Bexley is carried out at Queen Mary’s Hospital, Sidcup. PAEDIATRICS Paediatric services are centred within the Variety Club Childrens’ Hospital and incorporate both general and specialised paediatrics. Areas of specialisation include the supraregional liver, regional neonatal, neurosurgical and regional respiratory disease. There are close links with the Harris Birthright Unit for prenatal diagnosis and intervention. There is a dedicated neonatal and childrens’ intensive care unit. A major component of the paediatric services are those serving a local population. Close clinico-radiological links are established between the specialist services and the Radiology Department with multidisciplinary meetings forming a key part of patient management. CLINICAL ORGANISATION The King’s Radiology Department has followed a policy of organ specialisation in preference to procedure based specialisation. This compliments the close clinico- radiological partnership which exists within the Trust. The Department is under the CSDS Directorate within King’s and is part of the KHP Imaging CAG. Each clinical subspecialty has at least two consultant radiologists with a subspecialty interest and who are available to cover all imaging and, where appropriate, interventional requirements of that subspecialty. The clinico-radiological management of patients is addressed with formal clinico-radiological meetings, multidisciplinary meetings encompassing colleagues from the clinical discipline, histology, radiotherapy and oncology. There are established clinical and radiology links with GSTT in several specialities including neurosciences, hepatobiliary, breast, urology surgery and trauma. Within King’s the Emergency Consultant led on-call service is provided on a 24/7 basis. At any one time there are three Consultants on-call, covering interventional, non-interventional and neuroradiology specialities. TEACHING AND TRAINING MEDICAL STUDENT TEACHING King’s College Hospital NHS Foundation Trust, as a major teaching hospital, works in partnership with King’s College London to provide the highest possible quality of medical education. The quality of King’s graduates supports the performance of the Trust. The mutual interest of the Trust and School in quality medical education is supported by the SIFT contract. Consistent with the educational aims of the Trust and the School, and the SIFT contract, the Trust requires, and the School expects, all clinical Consultant staff to
  8. 8. devote on average the equivalent of one Programmed Activity each week (4 hours) to undergraduate teaching activities for whole-time staff. These activities would include the planning and review of teaching, and the assessment of students which could, where properly structured, be undertaken simultaneously with service delivery commitments, including ward rounds and outpatient clinics. Of necessity the requirements of the medical curriculum change over time and it is not always possible to identify specific teaching commitments in job plans – when this is the case the general requirement for teaching time should be made clear. The need for sensible flexibility is acknowledged by the Trust and, for example, within a service department it can be sensible for the overall teaching commitment to be unevenly allocated between staff to achieve optimal teaching and service quality. The Trust is clear that the teaching and training of junior medical staff is a separate responsibility from undergraduate education. The appointed physician will participate in teaching medical students, post-graduate doctors and other groups at King's College Hospital and King’s College London (KCL) School of Medicine. POST GRADUATE TRAINING The Trust has over 300 posts funded by the Deanery for postgraduate training with virtually all specialties having trainees. RADIOLOGY TRAINING A dedicated Specialty Registrar area has been established within the Radiology Academic and Administrative floor within the department at King’s College Hospital. This includes an x–ray museum containing 20,000 films, PACS links, an x–ray library with appropriate radiology journals on-line, computer and secretarial support. There are excellent Library facilities at the Weston Education Centre on the King’s College Hospital site. TRAINING STRUCTURE – StR and Fellowships STR POSTS The Kings Radiology department has a large StR training scheme mainly based at King’s College Hospital, which allows opportunity to gain the FRCR and a UK CCT in Radiology. The other hospitals involved in the scheme include The Mayday, The Royal Sussex County, Tunbridge Wells and Maidstone. All aspects of the Royal College of Radiologists’ Core Curriculum of Training are covered and there are opportunities for Subspecialty Training during year 4 & 5. This scheme is administered through the London Deanery in conjunction with the local Training Committee and all posts have London Deanery National Training Numbers. At present there are 30 StRs on the King’s rotation with variable numbers of flexible trainees. PROGRAMME ORGANISATION The Training Programme is organised by the Head of Training (Dr Maria Sellars), the Educational Supervisors, Dr David Elias (years 1 and 2), Dr Steve Connor (years 5
  9. 9. and 6) and Dr Rema Wasan, (years 3 and 4 and College Tutor). Bi-annual meetings of the Training Committee are held and are attended by representatives from junior and senior firms where training issues are debated and managed. There is regular communication between the consultants and trainees regarding training issues. Opportunities for research are available at all stages of trainee development. All trainees are expected to contribute to the departmental research programme by involvement in projects, presentation at international meetings and paper writing. POSTGRADUATE ACTIVITIES AND RESOURCES Study leave is granted according to national guidelines with appropriate funding available. This is supervised by Dr Jason Wilkins. The postgraduate facilities are excellent with a monthly timetable of meetings, seminars and workshops covering management, clinical governance, interview technique and other related issues. There are daily tutorials which are lead by the Consultants in the Department. TERMS AND CONDITIONS OF SERVICE 1. The post is covered by current terms and conditions of service. 2. The salary is Specialty Registrar grade with London Weighting allowance 3. The on call commitment and number of hours worked daily will allow fulfilment of a 1b Band category (1c in the first year) and are compliant with current EWTD. 4. Appointments are conditional upon a satisfactory medical examination. Annual leave, including bank holidays must be taken before the end of the appointment. RESEARCH AND DEVELOPMENT To consolidate and advance the Trust’s role as a major academic medical centre, involvement in high quality R&D is strongly encouraged. Current arrangements for funding R&D within the NHS make it essential that: · all R&D is recorded and co-ordinated by the Trust’s R&D office · before starting projects, appropriate steps are taken to ensure that they meet prevailing standards of research quality and have ethical approval Most of the Trust’s allocation of NHS service support funding (the R&D Levy) must be used in connection with externally grant-supported studies. The Trust’s portfolio of Levy-supported R&D also includes pilot studies to generate data in support of the development of grant proposals, and small-scale clinical studies at the border of research and audit. An important component of the Trust’s R&D strategy is to strengthen the support facilities available to Researchers. This includes assistance with research design, statistics and access to grant opportunities. Multi-disciplinary involvement in the research process is seen by the NHS(E) as key to increasing the relevance of projects funded by the NHS, and ensuring the eventual uptake of validated research evidence. The Academic Health Sciences Centre will provide the opportunity for basic and translational research activity as part of the Imaging Clinical Academic Group. The
  10. 10. Imaging Sciences at KCL has an international profile for all areas of imaging research activity and the closer liaison that will develop between the NHS Trusts of KCH, GSTT and KCL will provide the opportunities for the appointee to develop a research activity linked to their clinical specialist interests. 3. DEPARTMENTAL STAFFING [AND SPECIFIC EQUIPMENT OR RESOURCES] DEPARTMENT OF RADIOLOGY Dr. John Karani, BSc, MB BS, FRCR–Hepatobiliary and Gastrointestinal (Clinical Director) 10PA Dr. Michael Michell, MA MB BChir (Cantab), DMRD, FRCR, - Breast 10PA (Clinical Director South East London Breast Screening Programme) Dr. Pauline Kane,MB BS,MRCP, FRCR–Hepatobiliary, Endocrine 10PA Dr. Paul Sidhu, BSc(hons), MBBS, MRCP, FRCR, DTM&H –USS and Vascular 11PA Dr. Sujal Desai, MD, FRCP, FRCR – Thoracic and Haemato-Oncology 10PA Dr. Suzanne Ryan, MBBCh, BAO, MRCPI, FRCR–Gastrointestinal and USS 10PA Dr. David Elias, MSc, MRCP, FRCR–Trauma, Musculoskeletal and Orthopaedics (Clinical Tutor) 10PA Dr. Maria Sellars, MB BS, FRCR-Paediatrics and Ultrasound (Head of Training) 9PA Dr. Jason Wilkins, MB, ChB, MRCP, FRCR-Interventional and Musculoskeletal 10PA Dr. David Evans, FRCS, FRCR – Interventional and Breast 10PA Dr. Rema Wasan, MB BS, MRCP, FRCR - Breast and General (Clinical Tutor) 7PA Dr. Claire Peacock, MB BS, MRCP, FRCR – Breast and General 5PA Dr. Pamela Allen, MBBS, BSc, MRCP (Paeds), FRCR - Paediatrics and Ultrasound 8PA Dr. Praveen Peddu, MBBS, MRCS, FRCR – Hepatobiliary and Gastrointestinal 10PA Dr. Nicola Mulholland, MBBS, MSc, MRCP, FRCR – Thoracic, Haemato-oncology and Nuclear Medicine 6PA Dr. Dean Huang, MBBS, MRCP, FRCR – Renal and Vascular 10PA DEPARTMENT OF NEURORADIOLOGY Dr. Josef Jarosz, MA MB, BChir, MRCP, FRCR (Lead Clinician) 11 PA Dr. Neil Deasy, BSc, MRCP, FRCR 11PA Dr. Stephen Connor, MRCP, FRCR 11PA Dr. Timothy Hampton, MRCP, FRCR 11PA Dr. Naomi Sibtain MB BS, MRCP, FRCR 11PA Dr. Ata Siddiqui, MB BS. FRCR 11PA New appointee to start last quarter 2009. DEPARTMENT OF NUCLEAR MEDICINE Dr. Muriel Buxton-Thomas, MB BS, MSc, FRCP (Lead Clinician) 12PA Dr. Mazin Al-Janabi, MBChB, PhD, MD, MiMgt 6 sessions Dr. Nicola Mulholland, MBBS, MSc, MRCP, FRCR – Thoracic, Haemato-oncology and Nuclear Medicine 4PA