SPECIALTY TRAINING PROGRAMME IN [SPECIALTY] PROGRAMME IN
This is a 7 month LAT in Cardiology at ST3 aimed at doctors who can
demonstrate the essential competencies to enter this level of training.
The programme is based in hospitals in the Wessex Deanery including:
North Hampshire Hospital Basingstoke
The Royal Bournemouth Hospital Bournemouth
St Richards Hospital Chichester
Dorset County Hospital Dorset
St Mary’s Hospital Isle of Wight
Jersey General Hospital St Helier, Jersey
Poole Hospital Poole
Queen Alexandra Hospital Portsmouth
St Mary’s Hospital Portsmouth
Salisbury District Hospital Salisbury
Southampton General Hospital Southampton
Royal Hampshire County Hospital Winchester
Wessex Deanery is a relatively small deanery with a defined geographical area
which does lead to there being a single unit of application. In the majority of
cases successful candidates will be asked to preference their choice of location
for either one or two years. Some specialties will require successful candidates to
preference both commencing location and specialty. Future placements will be
based, as normal, on individual training and educational needs. Please note that
applications are to the Wessex Deanery as a whole. This may mean that you
may be allocated to any geographic location within the Wessex Deanery
depending on training needs.
The Wessex Deanery covers a geographical area from Basingstoke in North
Hampshire to Dorchester in West Dorset and the Isle of Wight to the South; in
addition some programmes rotate to Jersey and Chichester in West Sussex. This
is a spread of approximately 65 miles North to South and 76 miles East to West.
The Wessex Deanery serves a population of around 2.8 million people.
The Wessex Deanery is part of NHS Education South Central within South
Central Strategic Health Authority which covers Berkshire, Buckinghamshire,
Oxfordshire in the north (under Oxford Deanery) and Hampshire and Isle of
Wight. In addition, Wessex Deanery provides training programmes within Dorset
and South Wiltshire under a formal agreement with the South West Strategic
Health Authority. The Wessex Deanery is responsible for the training of some
Study and Training
The primary aim of all posts is the training programme developed and there is a
region wide syllabus and minimum standards of education agreed by all Trusts
within the rotation. Training will be given in all aspects of non-invasive cardiac
testing available on site.
The Deanery is committed to developing postgraduate training programmes as
laid down by PMETB, Colleges and Faculties and by COPMED - the
Postgraduate Deans Network. At local level college/specialty tutors work with the
Programme Director and Directors of Medical Education in supervising these
programmes. Trainees will be expected to take part in these programmes
(including audit) and to attend meetings with their nominated educational
All posts within the training programme are recognised for postgraduate training
by the Postgraduate Medical Education Training Board (PMETB) in accordance
with their standards for training.
Study leave is granted in accordance with Deanery/Trust policy and are subject
to the maintenance of the service.
All posts have a service element and the following covers the majority of duties.
There will be minor variations in different hospitals but the list is aimed at
covering the majority of duties:
1. Supervise, monitor and assist the House Officer (F1) in the day-to-day
management of in-patients in posts with an attached F1.
2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior
3. Attend and participate in ward rounds as timetabled
4. Attend outpatient clinics.
5. Take part in rostered emergency work.
6. Dictate discharge summaries.
7. Study for higher examination and maintain continued professional
8. Attend weekly educational and multidisciplinary sessions.
9. Undertake audit at various times throughout the rotations.
10. Teach medical students as directed.
11. Co-operate with members of the personnel department when monitoring
hours of work and other personnel issues.
12. Attend induction in each hospital or new department
13. Comply with all local policies including dress code, annual and study leave
Trust Generic/Specialty Information – please insert relevant information
Isle of Wight Healthcare NHS Trust
The Cardiology Departments at Portsmouth and the Isle of Wight have
developed formal links. This supports the development of a single department
spanning different sites working to agreed protocols and standards across all
areas including inpatient care. By the end of 2005 virtually all cardiac services
except surgery should be provided for Island patients in either Newport or
Portsmouth. Both sites will be integrated into the Central South Coast Cardiac
Network, which includes Southampton. Once the current expansion in
Southampton is complete, this centre will provide cardiac surgical services to
patients within the Network.
A full non-invasive diagnostic service is run in Newport. Patients requiring
coronary angiography have this performed in a new Catheter Laboratory at
Queen Alexandra Hospital, Portsmouth. Percutaneous coronary intervention
should be established in Portsmouth during 2005. Permanent pacing is currently
undertaken at Southampton, although planning is underway to repatriate this
service to the Isle of Wight.
The Island based service has recently been improved through the development
of one-stop clinics; rapid access chest pain clinics and the establishment of
Patients requiring cardiac surgery are currently referred to the Royal Sussex
County Hospital in Brighton. There are further close links with cardiac surgeons
at Southampton and the Royal Brompton.
3 Consultant Cardiologists
1 Staff Grade for Cardiology
1 Specialist Registrar Cardiology and GIM
Cardiology is one of 8 sub-specialties within the Care Group.
A new Cardiac Centre is currently being built on site and is due to open in early
2005. The CCU in the new building will be ‘state-of-the-art’ with an adjacent
pacing room and step-down ward.
The Cardiology Department has an establishment of:
1.00 MTO5 (currently as job share) Cardiac Technician
2.54 MTO 3/2 Cardiac Technicians
0.95 Grade A Health Care Assistant
The new department has been designed to allow integration of senior doctors’
office space with the secretariat, consulting rooms, and the clinical areas. The
Coronary Care Unit and step-down ward is adjacent.
The Specialist Registrar will attend a mix of general medicine and cardiology
clinics weekly and also the chest pain clinic weekly. In the main out-patient clinics
there will be an opportunity to see a mix of new and follow-up patients. In the
chest pain clinic the post-holder will see and assess new patients with recent
onset chest pain.
The Specialist Registrar will be responsible for the day to day running of general
medical and cardiology in-patients under the supervision of the Consultant
Cardiologists. The Specialist Registrar will take a lead role in the management of
patients on the CCU. The post-holder will be expected to advise medical Senior
House Officers and House Officers, and to provide an acute medical opinion for
other specialties on request. During on-call periods the Specialist Registrar will
be in charge of the resident on-call medical team. When “on take” adult patients
of all ages will be accepted for admission.
Training will be given in all aspects of non-invasive cardiac testing available on
site. Training will be given in various invasive procedures such as
pericardiocentesis and temporary pacing. There will be some exposure to cardiac
catheterisation, and permanent pacemaker implantation.
The post-holder will be responsible for reporting of a proportion of non-invasive
tests, and for dictation of departmental discharge summaries. The Specialist
Registrar will participate in clinical audit. The post-holder will also participate in
the teaching of medical and nursing staff and arrange clinical meetings and
clinical ward rounds for medical staff and students. Opportunities are available
for research, which is encouraged by the senior medical staff.
Monday CCU/step-down round Gen Med/Cardiac Clinic
Tuesday Echo/cardiac caths Research
Wednesday Academic session Admin
Thursday Ward work Chest Pain clinic
Friday CCU/step-down round TOE/Echo/admin
Study and Research
The medical unit academic activities are well supported by junior doctors as well
as consultants. Wednesday morning each week is a full academic session. The
successful candidate will be expected to play his/her part in the postgraduate
activities, teaching and clinical audit. Undergraduate teaching is provided for fifth
(final) year students from the Southampton Medical School. Regular weekly
tutorials are presented by the SHOs with SpR and consultant support. The
medical unit is a Membership Examination Centre and three of the consultants
locally are examiners. There is a very high pass rate for MRCP by senior house
There is an office for the Specialist Registrars in medicine with computer access.
Candidates are welcome to contact Dr M Connaughton or Dr D Price on 01983
North Hampshire Hospitals NHS Trust
2 Respiratory Diseases
2 Care of the Elderly
1 Stroke Physician
Other Medical Staff
3 Cardiology SpRs
2 Respiratory SpRs
1 Endocrinology SpR
1 Gastroenterology SpR
1 GIM & Rheumatology SpR
2 Acute Medicine SpRs
9 Senior House Officers
Directorate Accommodation and Facilities
The Directorate occupies two floors of the main North Hampshire Hospital
building. There are four acute medical wards, two wards for care of the elderly
and a nine-bedded CCU. There are also self-contained units for stroke
rehabilitation, day assessment and medical admission assessment. Heart and
lung function testing is also located within these floors and there is a seminar
room for staff education and training. There is a dedicated catheter laboratory
where primary and elective angioplasty, day case catheterisation and pacemaker
insertion takes place on a daily basis. In addition to General Medicine, there are
Consultants in Dermatology, Clinical Haematology, Genito-Urinary Medicine and
visiting Consultants in Oncology, Neurology and Nephrology.
This post is approved by the Wessex Cardiology ASEC and the Postgraduate
Dean. It forms part of the Wessex Cardiology training rotation. The post is
recognised for Specialist Registrar training in Cardiology and General Internal
Medicine. The post-holder will divide their time between general medicine and
specialist cardiology duties. The successful applicant will be appointed to a
training programme within the regional training scheme or to a locum with
accreditation for training post.
Specialist Registrars will receive training in cardiac catheterisation and
permanent pacing. There will also be the opportunity to insert intra-aortic balloon
pumps and perform preicardiocentesis.
Training will also be given in all aspects of non-invasive cardiology available on-
site. This includes both transthoracic and transoesophageal echocardiography.
There are close cardiac surgical links with the Royal Brompton Hospital and the
SpRs will benefit from exposure to the joint clinics run on a monthly basis.
The Specialist Registrar will attend two general medicine/cardiology clinics
weekly and also a chest pain clinic weekly. In the main out-patient clinic there will
be an opportunity to see a mix of new and follow-up patients. In the chest pain
clinic the post-holder will see and assess new patients with recent onset chest
pain. There will also be the opportunity to attend the specialist hypertension and
heart failure clinics as well as to gain experience at the nationally renowned
cardiac rehabilitation centre at Alton.
The Specialist Registrar will be responsible for the day to day running of general
medical and cardiology in-patients under the supervision of the Consultant
Cardiologists. The Specialist Registrar will take a lead role in the management of
patients on the CCU and will act as the co-ordinator to referrals for invasive
cardiac investigations and treatment. The post-holder will be expected to
supervise the work of the Senior House Officers and House Officers, and to
provide an acute medical opinion for other Directorates. During on-call periods
the Specialist Registrar will be in charge of the integrated on-call medical team.
The Cardiology Team
3 Specialist Registrars
2 Senior House Officers
Visits to the Department are welcomed and can be arranged by contacting
♦ The Postgraduate & Medical Personnel Manager
Tel: 01256 314792
♦ Dr A Bishop
Tel: 01256 313633 or
♦ Dr C Brookes
Tel: 01256 314713
Poole Hospital NHS Trust
The Work of the Department
There are approximately 120 beds including those for infectious diseases,
coronary care and intensive care. There are eight physicians, each of whom has
a different special interest. All junior staff attend the diabetic clinics and
retinopathy clinic providing experience in the management of both in and
outpatient diabetes. There are facilities for exercise testing,
echocardiocardiography and isotope studies. The Specialist Registrar is thus
trained in all aspects of the non-invasive assessment of cardiac patients. Each
firm also deals with general medical patients taking acute medical emergencies.
1 Specialist Registrar
7 House Officers
General management of the inpatients under the guidance of the Consultant.
Outpatient duties 2 sessions per week.
8.30 am daily – Coronary Care Ward Round
Monday Ward round Myoview meeting
Tuesday Clinic Ward/Admin
Wednesday CCU WIR DLB Echo List
Cardiac Catheter List
Thursday Pacing (Bournemouth) Meeting
Friday - Ward/Admin
On top of this basic programme time has to be found for:
(a) Dictation of discharge summaries – 3 to 4 hours weekly
(b) Preparation of clinical meetings (approximately 1 week in 7)
(c) Preparation for and giving tutorials to House Physicians and nurses
(d) Research projects and writing papers
Teaching of junior staff and occasional lectures to nurses. Regular teaching
rounds in rotation.
(a) Training in permanent cardiac pacing and cardiac catheterisation
(b) Supervision of exercise myoview scans
(c) Supervision of cardiac rehabilitation (maximum 1 hour per week).
In case of prolonged absence, external or internal ‘locum’ cover will be
contracted where possible.
Cardiac Unit and Facilities
An 8-bedded and monitors Coronary Care Unit (CCU) consists of 4 acute beds
and 4 progressive care beds (new unit opening shortly). It is closely linked (in
staffing and geographically) to the 6-bedded Intensive Care Unit. Between the
two units is a large pacing/procedures room, fully monitored and radiologically
protected. Typical procedures performed here include temporary transvenous
pacing (single and dual chamber), elective cardioversion, pericardial aspiration
and right heart catheterisation, including Swan-Ganz catheter placement, where
it is preferred not to undertake this at the bedside.
The CCU receives > 1300 patients per year. Audit in 1995 revealed a 33% acute
myocardial infarct rate. There is no age-related admission policy. Audit of case
workload in 1995 revealed diagnoses of acute myocardial infarction, unstable
angina, undiagnosed chest pain, acute cardiovascular failure, tricyclic drug
overdose, massive pulmonary embolism, cardiac arrhythmias including heart
block, cardiac tamponade, infective endocarditis and acute aortic dissection.
Junior staff are encouraged to use this unit as a “cardiac care unit” and not just a
coronary care unit. The Cardiac Department itself has recently moved into the
Philip Arnold Unit and comprises an exercise bicycle/treadmill suite, ECG, 24-
hour ECG analysis room, respiratory function laboratory and echocardiograph
laboratory. Outpatient facilities include an ECG and spirometry investigation
The department performs 11,000 ECGs a year (plus approximately 2,000 a year
performed on CCU by nursing staff), 2,500 exercise tests, 3,600
echocardiograms, 3,600 24-hour electrocardiograms. In conjunction with the
Medical Physics Department 190 tetrofosmin exercise and adenosine stress
SPECT scans are performed.
One HP Sonas 2500 machine
One Accuson Cypress machine
4 trained echo technicians
Junior medical staff who specifically wish to train in cardiology attend the Hewlett
Packard echo course. If study leave awards are not made then cardiac
endowment funds are used to fund the courses necessary.
Routine testing is performed on a Marquette Case 2 treadmill and computer-
augmented cardiograph. A Bosch isokinetic bicycle is also available for pre and
post cardiac rehabilitation assessments.
24-hour ECG Analysis
The Department has 12 Reynolds Tracker recorders and a Reynolds 700
analysis system. Three cardiomemo recorders are also used for recording
inpatients with very intermittent symptoms.
Myoview Single Photon Emission Computed Tomography (SPECT)
The Department generally performs four of these per week using a Mitsubishi
computer controlled gamma camera in the Medical Physics Department. Images
are interpreted jointly by the Consultant Cardiologists and Radiologist, and
Other Specialist Equipment
1. Oesophageal recording, pacing and electrophysiological assessment is
performed using the Arzco oesophageal pill electrode system and dedicated
pacemaker. The technique has proved useful in the analysis of complex
arrhythmias and the termination of supraventricular arrhythmias without drug
2. Dual chamber temporary cardiac pacing. Standard temporary ventricular and
temporary arterial J pacing electrodes are connected to an APC Micropace
generator. This is used for patients in AV block with poor haemodynamics.
3. Hewlett Packard Merlin Monitors. These are the standard monitors in ICU and
there is a mobile Merlin for CCU. This multi-modular system allows cardiac
output studies, two invasive and one non-invasive pressures, two
temperatures, expired CO2 analysis, and pulse oximetry and is invaluable in
patients requiring intensive haemodynamic monitoring.
4. New x-ray intensifier awaited.
A more detailed audit of coronary care activity is planned. A computer and
database software package has been purchased for this. The Hospital has a
dedicated resuscitation training officer. Resuscitation policy, equipment and
training is the remit of the resuscitation committee, comprising: Consultant
Cardiologist, Consultant Anaesthetist, RTO Ward Sister, CCU Sister/Charge
Nurse, Pharmacist, Medical Electronics Department Chief and Chief Cardiac
Technician. A charity has provided a Laedal arrhythmia simulator and
resuscitation monitor to supplement the basic Resusci-Annie monitor.
Teaching and Postgraduate Facilities
Senior and junior staff with MRCP/FRCP undertake teaching sessions which are
timetabled around the sittings of MRCP. Formal courses are run three times a
year in Wessex, one of which is at Bournemouth and Poole. Southampton
medical students rotate through the district and there is a foreign medical student
elective programme. On four mornings per week there is a 30-minute CCU
teaching session run by the Consultant.
Portsmouth Hospitals NHS Trust
Duties of the Post
This appointment provides the opportunity to work in close contact with 8
consultants, each with complementary experience and interests that cover all
aspects of clinical cardiology. There is ample opportunity to perform regular
transthoracic and transoesophageal echocardiography, permanent pacemaker
implantation and diagnostic angiography. Further experience in electrophysiology
and interventional angiography will be available (off site at present but later this
year on site).
There are 3 other Registrars in cardiology.
The applicant will be required to contribute to a structured teaching program for
final year medical students and SHOs, as well as regular departmental and
hospital educational meetings. Informal teaching of juniors will be provided by
registrars during their normal working practice. Within the department, one
afternoon a week is dedicated to continued education with a formal presentation,
as well as exchange of experiences and lessons from the week. Continued
education with departmental audit and research is encouraged, with funding
available for further relevant examinations (such as British Society of
The medical registrar will only cover the MAU and A&E. There is a post take
During this time the medical registrar will cover the wards and assist in MAU.
Occasional weekend cover of the wards at St Mary’s Hospital
Every 4 weeks, each registrar will spend a week at QAH.
Typical timetable during stay at QAH
Monday CCU/Ward Round Ward Referral
Tuesday Pacing/TOE for In-Patients Departmental Educational
Wednesday CCU/Ward Round IP Echo
Thursday CCU/Ward Round Ward Referral
Friday CCU/Ward Out Patient Clinic
The effort is made to make sure that all the registrars will get experience in
different aspects of invasive and non-invasive cardiac investigations, out patient
clinics and Rapid Access Chest Pain Clinic. You will also have at least 3 half-day
study leave per month
Royal Bournemouth and Christchurch Hospitals NHS Trust
The trainees will participate in the acute medical take, share in the inpatient
work, have regular training sessions in cardiac procedures, and support the
working of the Chest Pain Unit. The trainees will work closely with the
Cardiologists, an existing Associate Specialist in Cardiology and with the
Consultant Physicians attached to the cardiac wards. The Chest Pain Unit run
by an Associate Specialist in Cardiologyworks very closely with the AAU,
facilitating early diagnosis and triage of a significant proportion of the medical
admissions in the AAU. Close working and a flexible approach to between the
two Units is encouraged. Currently both Units form part of the Medical
The acute general medical take averages 46 patients per day. The on take
medical team covers all acute medical beds including GUM patients but excluding
haematology. Each team has 8 junior doctors of which 6 are on take during the
day. In addition there are 4 Trust Grade SHOs allocated to Cardiology, Thoracic,
Rehab and AAU respectively. Night cover at SHO level includes a shift system.
Consultant led post take ward rounds are mandatory. There is a 42 bedded Acute
Admissions Unit and about 85% of medical emergencies come through the unit,
the exceptions being those requiring direct access to urgent specialist care
including CCU, ITU, HDU and the GI bleeder unit. Patients that the on call team
deem likely to be discharged within 72 hours are taken over by the AAU
Consultant; approximately 48% are discharged within this period. There are a
large number of planned medical admissions including day cases in part
generated by the open access endoscopy, ECG and Chest XRay services. There
are also a large number of routine cardiac admissions per week (pacemaker,
angiography, PCI, electrophysiology and cardioversion patients). There are beds
available for HIV/AIDS patients. The Medical Directorate currently operates a
ward based consultant teams system. Each specialty is allocated a specific
number of beds/wards and is also linked to non-medical wards in order to provide
care for outlying medical patients.
Dorset Heart Centre
In recognition of the range of cardiac services offered the service has been
renamed the Dorset Heart Centre and has been officially opened by HRH the
Princess Royal. The Dorset and Somerset Health Authority has a major
commitment to the development of cardiac services in Dorset with the more
specialised cardiology and cardiovascular interventional radiology for the County
of Dorset based at the Royal Bournemouth Hospital. The Sub-Regional Dorset
Pacing and Diagnostic Cardiac Catheter Services were established here in 1989
and 1994 respectively and since the devolution of these services to West Dorset
in 2004 continue to serve the catchment of East Dorset and surrounding areas.
The pacing service is one of the largest in the UK.
The new purpose-built Cardiac Intervention Unit (CIU) opened in April 2005 and
is for the provision of Percutaneous Coronary Intervention (PCI) and
Electrophysiology for a large area. The Electrophysiology Service covers the
whole of Dorset (biventricular pacing, ICDs and ablation therapy) and for PCI
covers most of Dorset and parts of Hampshire and Wiltshire. To go with these
developments three new specialist cardiologists were appointed bringing the
consultants based here to six.
There are four radiologists performing interventional vascular procedures and
four vascular surgeons. There is extensive experience of endovascular aortic
stenting within the cardiovascular team. All four acute hospital units in Dorset
(Bournemouth, Poole, Dorset County and Yeovil) provide standard non-invasive
cardiac investigations including treadmill exercise testing, 24 hour ECG
ambulatory monitoring and echocardiography. There are cardiac nuclear
medicine facilities at Bournemouth and Poole. Yeovil has a separate pacing
service. West Dorset started a pacing and diagnostic cardiac catheter service
based in Dorchester in 2004.
The Centre is at the Royal Bournemouth Hospital with an ECG outstation at
Christchurch Hospital. The Centre is on one level with the Cardiac Department,
pacing theatre, twelve - bedded Cardiac Care Unit (CCU), two cardiac/general
medical wards (50 beds), CIU and the Medical Investigations Unit (MIU)
adjacent. The seven bedded ITU and eight-bedded HDU are alongside the CCU.
Elective cardioversion and pacemaker patients are mainly kept on the MIU. The
Chest Pain Unit is next to the Acute Admissions Unit. The Nuclear Medicine
department is within Radiology.
The new Cardiac Intervention Unit has been designed to enable a flow of
patients through two routes, elective and emergency. On entering the CIU there
is a fast track corridor direct to the catheter lab area. The elective route is via a
separate entrance to the CIU starting with reception, pre-clerking and then the
admission area before moving to the labs. There are three new single flat-plane
Siemens labs adjacent to each other. Two are primarily for diagnostic
catheterisation and PCI. The third lab is for electrophysiology. Adjacent to these
labs is a monitored 24-trolley area for patients about to undergo or following an
intervention. This area is closed overnight. Patients requiring overnight stay
return to CCU. Within the CIU is a large administrative area for housing the
consultants, secretaries and other administrative support as well as the nurse
practitioners and others nurses.
6 Consultants based at RBH
7 Consultants with sessions at RBH
1 Associate Specialist
3 Registrars (Wessex Regional Specialist Training programme)
6 Senior House Officers
3 Junior House Officers
7 Clinical Assistants/Hospital Practitioners
(pacing, cardiac rehabilitation, echocardiography, tilt testing and heart failure)
Most of the equipment is modern. All the routine 12 lead ECGs are performed on
Hewlett Packard/Philips Pagewriters, some with screens. There are several types
of patient activated ECG recorders and receiving devices including Novacor,
Cardiocall and Lifecard. Twenty-four hour ambulatory ECGs are analysed with
Reynolds equipment (Pathfinder 700 and Pathfinder 600) using analogue and
digital recorders. For exercise testing there are two Marquette Centras, one of
which has an additional facility for signal averaging and analysis of digital ECG
recordings. There is a bicycle ergometer. There are three 2D Hewlett Packard
echo machines with doppler (two HP Sonos 5500 and one 4500) and an Esoate
Portable “My Lab 30” together with trans –oesophageal probes. The ambulatory
blood pressure machines are SpaceLabs Medical.
New pacing equipment for monitoring during implantation and follow up is in
place. There is a full range of programmers, ECG machines and portable ECG
scopes with a print out facility. For Tilt testing there is motorised tilt table and a
CNS systems Track Force Haemodynamic system. The dedicated pacing theatre
is part of the CCU, and has haemodynamic and ECG monitoring, a Philips digital
C–arm with image storage and full pacing implant equipment.
The department is computerised (Tomcat and Medcon). The ITU, HDU and CCU
are fully equipped with Philips Merlin monitors and central stations. Digital ECG
telemetry is monitored from the CCU and extends to four adjacent wards
including both cardiac wards and AAU. There is continuous ST ECG segment
monitoring in the CCU, AAU and cardiac wards (Philips MIDA system). There is
monitoring for all the recovery bays in the CIU. In Nuclear Medicine there are two
Siemens E-Cam gamma cameras, one double-headed and with the potential
capability for PET.
The three new digital flat plate Siemens catheter labs are sited adjacent to each
other with the build and space for future lab expansion. The labs are fully
equipped for PCI including pressure flow wires, IVUS and rotablation. There are
three balloon pumps and equipment for emergency transfers. The EP lab has a
Bard EP Labsystem and an EnSite 3000 Mapping and Navigation system with
the facility for a full range of diagnostic and therapeutic procedures including
pulmonary vein isolation / left atrial ablation. There is a common archiving and
data management system and the ability to view images across the hospital
(Medcon and Tomcat). There is a dedicated viewing and post-processing room.
The figures for the financial year 05/06 are as follows.
ECGs (excluding ITU/CCU) 35,819
Ambulatory 24 hour recorders 2,348
Other ambulatory ECG 953
Exercise/stress tests 2,474
Ambulatory blood pressure 346
New pacemaker 526
Pacemaker revisions inc. box 306
Pacemaker checks 5,107
Tilt tests (excluding those in 127
Diagnostic cardiac catheters 2,816
Nuclear scans (patients) 181
New referrals (excl GIM) 6,000
1. Coronary Prevention - There is a district wide strategy for cardiovascular
health and this covers primary prevention. The aim is for each of the major
acute units to act as a focus of such activities. There are Lipid Clinics based
at the Royal Bournemouth Hospital and run by a Consultant Endocrinologist
in conjunction with a Consultant Biochemist.
2. Pre-hospital Cardiac Care - All the front-line ambulances in Dorset have at
least one trained paramedic. Ambulance crew members regularly train at the
hospital and are skilled in recognition of arrhythmias and selected emergency
conditions, cannulation, intubation, ventilation, defibrillation, cardiac massage
and drug administration. The service has 12 lead ECG machines with
telemetry. This has enabled early alert of the receiving hospital and pre-
hospital thrombolysis to be initiated by the Dorset Ambulance Service. The
Service has the third highest number of patients that have received pre-
hospital thrombolysis in the UK.
3. Coronary Thrombolysis and Primary PCI - General Practitioners have
been encouraged to use the 999 facility for all suspected infarcts and to
cooperate with the paramedics. There is a fast track admission policy to keep
the door to needle time to a minimum. 12 lead ECGs of patients with
suspected STEMI are transmitted from the ambulance to the CCU. Pre-
hospital thrombolysis and thrombolysis in A&E is encouraged. Between 9 to 5
weekdays a Primary PCI service has been available since the beginning of
4. Coronary Care Unit - Suspected myocardial infarct patients are admitted to
the CCU. There are standard guidelines for major cardiac emergencies for
the junior medical and nursing staff. During the week there are daily
consultant led ward rounds run by the cardiac team and juniors. A&E staff
and paramedics are encouraged to attend. Some junior nursing staff rotate
between CCU and the Cardiac Wards.
5. Cardiac Rehabilitation - This programme was started in 1989 and is one of
the largest in the country. All eligible patients who have a myocardial infarct,
PCI or cardiac surgery are invited to attend. Last year over 800 new patients
and 500 partners participated in Phase III. The programme includes regular
exercise, advice on healthy living and stress management and leads on to a
self help period under the auspices of the Bournemouth Heart Club, a
registered charity run by ex-patients. There is a supervisory team of cardiac
nurses, physiotherapists and a clinical assistant. Phase I of the Bournemouth
Heart Club building opened on the Royal Bournemouth Hospital site in 1996
and Phase II, incorporating a second gym and other facilities, opened in
2000. A walking group is being established.
6. Echocardiography - There is a once weekly routine session of
transoesphageal echocardiography .
7. Nuclear Cardiology - This is mainly perfusion imaging. There are fortnightly
joint reporting sessions run by a Consultant and the staff of Nuclear Medicine.
8. Cardiac Catheterisation/PCI - Routine diagnostic cardiac catheterisation of
all Dorset adult patients started at the Royal Bournemouth Hospital in 1994.
The West Dorset diagnostic catheter activity devolved to the Dorset County
Hospital in 2004. Patients from East Dorset and Salisbury requiring PCI are
treated in house. There were 996 PCI procedures in 05/06. Patients requiring
surgery are referred to Southampton and London. The visiting and resident
cardiologists are responsible for the training of the cardiac registrars that
attend the catheter lab sessions.
9. Electrophysiology - Biventricular pacing is performed on site and this activity
is due to expand shortly. Electrophysiology (EP studies, ICDs and ablation
therapy) started within the CIU at the same time as PCI. For 2005/06 the
Dorset contract was for 72 ICDs and 161 EP/ablation procedures. Patients
with GUCH are referred to Southampton.
10. Cardiac Pacing - Permanent pacing was devolved from Southampton
starting here in 1989 with new patients and later included all previously paced
Dorset patients followed up there. It is now one of the largest pacing services
in the UK. 60% of the new implants are dual chamber systems. Apart from
some Poole patients follow up is mainly at the Royal Bournemouth. The
procedures are largely performed by trained clinical assistants and the
cardiac registrars under the supervision of the consultants. The visiting and
resident cardiologists are responsible for the training of the cardiac registrars
that attend the pacing sessions.
11. Research - This is encouraged. There are ongoing evaluations of pacing
leads and generator programs. There are two part-time research nurses
looking at adjunctive treatment post infarction, heart failure and angina.
Research/Clinical Fellows in PCI and EP (one each) are due to be appointed
12. GP Open Access Services - Patients can be sent up to one of the twice-
weekly ECG clinics with the result sent by return of post. Appropriate action is
taken by the on-take medical team if necessary. Some practitioners Fax
ECGs for reporting. Overall 2,300 GP initiated ECGs were reported last year.
The Chest Pain Service originally established in 1992 is now subsumed into
the Rapid Access Chest Pain Service and currently run by an Associate
Specialist. There is no open access echo service. GP open access to
ambulatory ECG and BP monitoring has been established for the
Bournemouth PCT. There is also an ambulatory ECG service for one of the
Ringwood and Westbourne Practices. The Heart Failure Service to the
Bournemouth PCT started in 2003 and is run by a Clinical Assistant and
nurse practitioners under the auspices of the cardiologists. The service has
recently expanded to cover the whole of the population of East Dorset.
13. Staff Developments - As part of the drive to reduce junior doctors’ onerous
duties there has been considerable movement within the Trust to recruit and
train Nurse Practitioners to take over some of the roles previously performed
by junior doctors. For Cardiology this has taken the form of exercise test
supervision, tilt testing, routine pre-clerking of catheter patients, assistance
with cardioversions and caring of heart failure patients by cardiac-trained
nurses. There are also three cardiac arrhythmia nurses dealing with pre-
admission assessments, assisting with device implants and follow up. There
is a further nurse and clerical assistant to coordinate cardiac referrals to and
from tertiary centres.
14. Teaching - There is a once weekly lunchtime cardiac case presentation and
radiology review meeting. Quarterly morbidity and mortality meetings are
planned. The cardiac registrars participate in the Wessex Region Teaching
Programme and have their own Research Forum.
15. Audit - Door to needle times and pacemaker procedures are audited on a
regular basis. Other audits have been carried out, mainly to do with patients’
views on the various services provided, on the cardiac rehabilitation service, as
well as the clinical performance of the pacing and heart failure services. The
National Service Framework has resulted in more comprehensive audit
throughout cardiology. With the advent of the PCI and EP Services Audit
meetings have been extended.
The role of the appointee
The candidate will train in all three specialist cardiac techniques
(echocardiography, pacing and diagnostic cardiac catheterisation), will be on the
acute medical take rota and deal with cardiac inpatient and outpatient work.
Training and supervision as appropriate will be provided. The candidate will work
closely with the Cardiologists and also the Associate Specialist in Cardiology.
Main duties and responsibilities
♦ Ward work for the cardiology teams
♦ Assist in the running of the Rapid Access Chest Pain Clinic (RACPC) -
approximately 1 session/wk
♦ Teaching of junior medical staff, nurses and allied health professionals
♦ Provision of medical support/back-up to the nurse practitioners and specialist
♦ General cardiology outpatient clinics
♦ Specialist Cardiac Technique(s) (echocardiography, pacing and diagnostic
The Specialist Registrar will be responsible for supervising the intake and for
first-line management of medical emergencies, under supervision of the
Consultant on-call. All patients are reviewed by the Consultant the following
morning on the post-take ward round. The on-take medical team covers all acute
medical beds including GUM patients but excluding haematology. The inpatient
load averages 25 patients for each Cardiac Firm. In addition to the general
medical component of the post, there are a large number of non-urgent cardiac
admissions per week (procedures and clinic admissions). There are regular
twice-weekly Consultant ward rounds when teaching is provided, and in between,
the Specialist Registrar is expected to maintain close contact with the
The Specialist Registrar is expected to supervise the Senior House Officers and
House Officers, and the Coronary Care Senior House Officer, and share the
organisation of the junior staff rota for the three firms.
There are early morning coronary care ward rounds with the Consultant
Cardiologist of the week. The junior cardiac medical staff are expected to attend.
There are twice weekly outpatient sessions in general medicine and cardiology.
The Specialist Registrar will see new outpatient referrals under supervision of the
Consultant, and follow-up cases from hospital admissions. The Specialist Registrar
will often receive referrals from junior staff for general medical or cardiac opinions
on both in and outpatients, and these are subsequently reviewed with the
The results of exercise tests, ambulatory monitoring, and other non-invasive
investigations are all reported formally by the Specialist Registrar or Consultants.
The Specialist Registrar’s reports can be discussed with the respective Consultant.
The Specialist Registrar will be expected to attend specialist practical training in
cardiac catheterisation (one to two sessions), permanent pacing (one session),
surface echocardiography (one session) and transoesophageal echocardiography
(only once trained in transthoracic echocardiography).
The Specialist Registrar will occasionally perform some clinical teaching of medical
students and nursing staff.
The Specialist Registrar will work predominantly for one Cardiac Firm, rotating at
four monthly intervals. The three registrars in cardiology will share the organisation
of the pacemaker bookings.
To summarise the sessions will be much the same for each registrar but the time-
tabling will vary with each of the three firms. Depending on the experience of the
registrar the sessions may be adjusted to assist with training:
1 Permanent Pacing
1 Diagnostic Cardiac Catheterisation
1 Chest Pain Clinic
1 On Call
2 Cardiac Outpatients
2 Ward Work
1 Administration / Cardiac Reporting
The Specialist Registrar will work under the joint supervision of the Service
Leads, and for the individual Cardiologists through whom the registrar will rotate
on a 4 monthly basis so that each registrar will work for all the cardiologists over
the year in post. There are 3 firms; each cardiac firm has two or three
The Royal West Sussex NHS Trust
Department of Medicine
There are 13 admitting Consultants with specialist interests as follows:
2 Diabetes and Endocrinology
2 Respiratory Medicine
4 Medicine for the Elderly
In addition there are
3 Consultant Haematologists
2 Consultant Dermatologists
1 Consultant Neurologist
1 Consultant in Rehabilitation Medicine
6 Specialist Registrars (including this post)
3 Staff Grades
13 Senior House Officers
3 Trust Doctors (SHO level)
9 Pre-Registration House Physicians
Since 1992 there has been complete integration of medicine and elderly
medicine. An Admission ward was opened in July 1994. There are fixed on take
days with no conflicting commitments for senior or junior staff. There are
Consultant-led post-take ward rounds on the morning following the on-call day.
Department of Cardiology
1 Specialist Registrar
1 Staff Grade
2 Senior House Officers
1 Pre-Registration House Physician
2 Hospital Practitioners
1 Senior Chief (MTO5)
3 Chiefs (MTO4) (full-time plus 1 vacant post)
3 Senior grades (MTO3)
1 Cardiographer (senior)
1 British Heart Foundation Cardiac Liaison Nurse
2 Physiotherapists part-time
1 Staff Nurse part-time
With the opening of the new development in January 1997 there is now a six
bedded Coronary Care Unit with an adjoining eighteen bedded cardiac ward. The
Cardiac Department is currently located near the out-patient clinics on the first
floor and has recently been refurbished and enlarged. There is a rapid access
chest pain clinic close to the Coronary Care Unit.
In the existing cardiac department there are three Hewlett Packard ECG
machines, two Hewlett Packard Sonos 5500 echocardiography machines with
colour flow doppler, a Case 15 treadmill exercise system, an Oxford Medilog 24
hour halter ECG analysis system and Reynolds and Novocor Event Recorders.
Three pacing clinics are held weekly in the department and there is a full range of
programmers for analysis.
Number of procedures undertaken per year
1,800 Treadmill Exercise Tests
1,200 24 Hour EGGs
120 Event Recorders
122 Pacemaker Implants
1,200 Pacemaker Checks
220 Cardiac Catheterisation (King Edward VII Hospital, Midhurst)
♦ Coronary Care Unit
The new 6 bedded CCU opened in January 1997. A daily ward round is
carried out by the Consultant Cardiologist with the junior staff of the
admitting medical teams.
♦ Cardiac Rehabilitation
A programme of cardiac rehabilitation commenced in 1990 supported by the
CHSA/BHF. This programme is now funded by the Health Authority. There
are in-patient sessions followed by education out-patient sessions and
exercise classes for patients post myocardial infarction and following
cardiac surgery. These are run by physiotherapists and a cardiac nurse in
conjunction with the cardiac medical team and are held at St Richard’s
Hospital, Chichester and at Bognor War Memorial Hospital, Bognor Regis.
♦ Pacemaker Implantation
A programme for pacing at Chichester was started in 1989. 122 new
implants were undertaken in 1998/1999. Pacemaker implants have been
undertaken by the Consultant Cardiologist together with the Specialist
Registrar and trained pacing nurses and cardiac technicians in a theatre in
the Day Surgery Unit.
♦ Cardiac Catheterisation
A programme of district cardiac catheterisation was introduced at King
Edward VII Hospital, Midhurst, in 1989. There has been a steady increase in
the numbers of patients investigated from 45 (1989) to 220 (2000/2001). All
cardiac catheterisation has been undertaken by the Consultant Cardiologist
and training is provided for the Specialist Registrar.
♦ Tranoesphageal Echocardiography (TOE)
TOE has recently started in Chichester and is undertaken in a weekly
session in the Day Surgical Unit.
♦ Cardiac Meeting
There is a weekly lunchtime meeting on Fridays where cases of cardiac
interest are presented by medical teams on a rota basis. These
presentations are interspersed by tutorials and lectures by the Consultant
Cardiologist and visiting speakers.
Experience and Training
The routine intake of patients averages at 20-25 admissions. The average
total number of patients on the cardiac firm is 30-40 patients. There are two
Consultant ward rounds weekly. There are two weekly medical / cardiac out-
patient sessions. The Specialist Registrar will see new and follow-up
patients and will be directly supervised by the Consultant. There is a weekly
medical clinical meeting attended by Consultant Physicians and their junior
The two Consultants undertake daily teaching ward rounds on the Coronary
Care Unit. The Specialist Registrar will be expected to provide a cardiology
consultation service throughout the hospital under the supervision of the
Consultant Cardiologist. The Specialist Registrar will be trained in
techniques / 2D echocardiography with doppler, assessment of results of
treadmill exercise testing, halter 24 hour ECG analysis, etc. Pacemaker
implantation and cardiac catheterisation will be supervised directly by the
Consultant Cardiologist at King Edward VII Hospital, Midhurst. This training
meets the requirements for General Cardiology Training and Basic Sub-
speciality Training in Cardiology as set out in the guidelines for specialist
training in cardiology published in the British Heart Journal in April 1995.
Recognition and Training
The post is recognised for Consultant training by the Royal College of
Physicians. Teaching is more than adequate, with individual consultants
arranging teaching sessions whenever required. Teaching is an integral part of
this post with protected teaching sessions from 1.30 pm to 5.00 pm on
Wednesday afternoon. There are also regular lunchtime departmental meetings
including the Department of Medicine for the Elderly and Cardiology.
Specialist Registrar Timetable at St Richard’s Hospital, Chichester
Monday CCU Ward Round Echo List (Formal session)
Consultant Ward Round CCU Ward Round
Tuesday CCU Ward Round Cardiology Out-Patient Clinic
Pacing List CCU Ward Round
Wednesday Angiography Midhurst Medical Teaching Round
(alternate weeks) Echo List - informal session
CCU Ward Round
Thursday CCU Ward Round Lunch: Multidisciplinary Social
Consultant Ward Round Meeting
Study / Research / Audit
CCU Ward Round
Friday CCU Ward Round Lunch: Cardiology Meeting
Procedures (TOEs +/- Cardiology Out-Patient Clinic
Pacing) CCU Ward Round
Arrangements for visiting the hospital and meeting members of staff may be
♦ Dr Reid’s secretary
Tel: 01243 831591 or
♦ Dr Murphy’s secretary
Tel: 01243 788122 ext 2734
Salisbury Health Care NHS Trust
This post is part of a six year unified training grade (Specialist Registrar)
appointment with recognised training in Cardiology and General Medicine. There
are two cardiology SPR posts in Salisbury.
Responsibilities of the post
The major responsibilities of this post in outline are to:
♦ Supervise the admission of unselected general medical emergency patients.
♦ See ward and A & E referrals when on take
♦ Supervise the management of cardiology and general medical inpatients.
♦ Perform outpatient duties in Cardiology and General Medicine.
♦ Teach SHO, PRHO, Medical Students and Nursing staff.
♦ Undertake training and research.
♦ Perform duties in occasional emergencies and unforeseen circumstances at
the request of the appropriate Consultants where practical.
Monday CCU ward round Cardiology Outpatient clinic
Echocardiography list (New patients)
Tuesday CCU ward round/cardiac General training (CPD,
catheterisation management, finance and
Cardiology/Medicine ward personnel)
Wednesday CCU ward round Pacemaker implantation/TOE
Thursday CCU ward round CPD and clinical governance
Ischaemic Heart Disease
Friday CCU ward round Research
The Department of General Medicine
There are 90 medical beds shared between the Consultant Physicians. There is
a CCU with five beds and eight adjacent beds monitored by telemetry. There are
four ITU beds and four HDU beds.
The Consultant Physicians are
3 Cardiology and General Medicine
3 Elderly Care and General Medicine
2 Respiratory and General Medicine
3 Gastroenterology and General Medicine
2 Diabetes, Endocrinology and General Medicine
There are additional Consultant Staff in:
Rheumatology and Rehabilitation (2)
Clinical Haematology (3)
Clinical Oncology (2)
There are visiting consultants in Neurology and Renal Medicine.
SpRs in Respiratory Medicine, Gastroenterology, Diabetes, Elderly Care
4 SHOs in Adult Medicine
1 SHO in Oncology and Haematology and one in ITU
6 SHOs in Elderly Care and covering Palliative Care
The full range of District General Hospital facilities are provided with excellent
pathology and radiology services (including 24 hour CT scanning and on site MRI
scanning), upper and lower gastrointestinal endoscopy and ERCP, respiratory
function testing and bronchoscopy, EEG and Neurophysiology. Many elective
procedures are performed in the purpose built Day Diagnostic Unit. Outpatient
facilities are new and purpose built.
Responsibilities in General Medicine
General Medical duties of the post will include responsibility for medical
emergency admissions and referrals from other wards. General Practitioner
emergency referrals will be seen on the Medical Admissions ward. Management
of General Medical inpatients, and outpatients in a consultant supervised clinic.
The post offers wide and excellent experience in General Medicine.
Weekly hospital Grand Round, weekly joint medical Xray/histology meeting,
weekly CPD and Clinical Governance session
Department of Cardiology
There is a full range of non-invasive investigations provided on site in Salisbury.
Transoesophageal echocardiography lists take place each week. The cardiac
catheter laboratory opened in October 2004. Temporary pacemakers are
implanted on the Coronary Care Unit. Permanent pacemakers are implanted in
the cardiac catheter laboratory. Pacemaker follow up clinic takes place in the
cardiac department at Salisbury. A full cardiac rehabilitation service is provided.
A nurse-led heart failure service is established and a thrombolysis nurse
oversees the thrombolysis service.
Responsibilities in Cardiology
The holder will gain experience in general cardiology in accordance with the
guidelines for specialist training in cardiology approved by the British Cardiac
Society and the Specialist Advisory Committee in Cardiovascular Medicine of the
Royal College of Physicians. There is an average of 20 medical admissions on
each take day. The Cardiology firm sees 1,750 new outpatients and 2,000 follow
up patients are seen by the Medical/Cardiology firm. These new and follow up
patients are seen in three clinics each week. Cardiac catheterisation training
presently takes place in the fixed laboratory. The full range of non-invasive
techniques are available in Salisbury and the Registrar will be expected to gain
experience in all techniques. Pacemaker implant lists take place each week. The
registrar will gain experience in temporary and permanent pacemaking. A full
cardiac rehabilitation service is provided. There will be specific training in basic
and advanced life support technique by the Resuscitation Training Officer. There
is the opportunity to attend the hyperlipidaemia clinic and to attend clinics of
other medical specialties at the request of the trainee. The trainee will be
involved in the Open Access Echocardiography clinic, Rapid Access IHD clinic,
Cardiac Rehabilitation and Obstetric Cardiology.
The trainee will be required to undergo some training in management. A formal
syllabus, to include continuing professional development, general management,
finance and personnel management is under development.
The trainee will be actively involved in audit throughout the period of the post in
There are facilities for clinical research. Trainees with an interest in molecular
medicine may benefit from the Regional Genetics Unit in Salisbury .
Southampton University Hospitals NHS Trust
Wessex Cardiothoracic Unit
The Wessex Cardiothoracic Centre serves a regional population of approximately
2.5 million in Hampshire, Dorset, Wiltshire and the Isle of Wight. Government
figures project a continuing increase in population of the region in the next
decade. Many patients are referred from outside Wessex, particularly from
Cornwall, Devon, Somerset, West Sussex, Wales and the Channel Islands.
Occasionally patients with special problems are referred from even further afield.
The Unit is situated on Levels D and E, East and North Wings at the
Southampton University Hospital (General Hospital site) and comprises:
110 Adult Cardiology/Cardiac Surgical
5 Day ward (for adult cardiac catheterisation or pacemaker patients)
6 Rapid Transfer Unit for regional referrals
14 Coronary care unit beds
5 Adult Cardiology High Care
16 Paediatric Cardiology/Paediatric Cardiac Surgical
10 Dedicated adult cardiothoracic intensive care (separate general and
paediatric intensive care units)
8 Adult ‘fast track’ cardiac surgical
Four cardiac catheter laboratories are sited in the department, all adjacent to the
operating theatres . Two rooms have biplane digital angiography equipment, and
are used for paediatric cases and a range of adult procedures including coronary
intervention and electrophysiology. The other two rooms have single plane
cineangiography and are used for electrophysiological (diagnostic, ablation,
implantable defibrillators, resynchronisation therapy), pacing, invasive and
interventional procedures. Each room has on-line computer backed physiological
Outpatients and Non-Invasive Cardiology
There is a dedicated cardiothoracic outpatients department, including a rapid
access service for patients with chest pain (1705 seen in 2003). Facilities for
echocardiography (including doppler, colour flow mapping and TOE) and
exercise testing, 24-hour ambulatory ECG monitoring and tilt table testing exist
on the ward level. The Department of Nuclear Medicine undertakes nuclear
cardiology and lies adjacent to the intensive care unit. Two CT scanners and an
MRI Scanner are in use on the site. A £45 million cardiac expansion plan is
currently underway to provide a major extension to the department. Building is
completed and scheduled for opening in October 2006.
Activity of the Unit
The Unit undertakes all forms of open heart surgery, both for adult acquired
(1200) and for congenital (270) heart disease, and the full range of interventional
procedures including coronary intervention of all sorts (1304 procedures in 2003),
balloon valvuloplasty, embolisation, ASD closure etc. The Unit also has an active
electrophysiology programme including AV node, accessory pathway, AF and VT
ablation, AICD implantation etc. (487) and insertion of permanent pacemakers
(593). The results of cardiac surgery undertaken in the unit over the last 22 years
are held on a database, as are all the results of coronary intervention and
electrophysiology. Non-invasive cardiological investigation plays a large part in
the activities of the unit and includes trans-thoracic and transoesophageal
echocardiograms, ambulatory ECGs, exercise ECGs, ambulatory BP recordings
and Tilt Tests.
5 Consultant Cardiologists / Intervention
3 Consultant Cardiologists / Electrophysiology
1 Consultant Cardiologist / Heart Failure
5 Consultant Paediatric Cardiologists
1 Consultant Paediatric Cardiologist / Adult Congenital Heart Disease
5 Consultant Cardiac Surgeons
1 Consultant Thoracic Surgeon
2 Consultant Cardiothoracic Surgeons
3 Consultant Radiologists
1 Specialist Registrars in Adult Cardiology (NTN)
0 Senior House Officers in Adult Cardiology
1 Specialist Registrars in Paediatric Cardiology (NTN)
0 Specialist Registrar in Adult Congenital Heart Disease (NTN)
3 Trust Fellow in Paediatric Cardiology
1 Senior House Officers in Paediatric Cardiology
Duties of the Post
Clinical responsibilities include the care of adult inpatients undergoing cardiac
investigation, management of patients on the coronary care unit, the medical
aspects of some patients returning from open heart surgery, and outpatient
clinics. The appointee will also undertake cardiac catheterisation, pacemaker
procedures, echocardiography, stress testing, ambulatory ECG monitoring.
There are also responsibilities for administrative work generated by clinical
activities and the teaching of medical, nursing and technical staff, and medical
students. Full training in all aspects of cardiological practice will be offered as
outlined in the current “Guidelines for Specialist Training in Cardiology” published
by the Royal College of Physicians.
For more information or to arrange visits to the Unit candidates should contact
the Cardiology Office (telephone 02380 794703).
West Dorset General Hospitals NHS Trust
The Department of Cardiology
The West Dorset Cardiology Department is located at Dorset County Hospital.
The dept provides full non-invasive investigations including treadmill exercise
testing, transthoracic and transoesophageal echocardiography, 24 hour Holter
and patient activated arrhythmia monitoring. The West Dorset Cardiac Catheter
Lab opened in Oct 2004 and provides diagnostic angiography for outpatient day
cases and urgent inpatients with plans for a local PCI service from April 2007.
Pacing implant and follow up is provided at Dorset County for approx 150 new
implants per annum, including biventricular devices and implantable loop
recorders. ICD implants are performed by the West Dorset team at the Royal
Bournemouth hospital with plans for local implant and follow up service from April
2007. A full cardiac rehabilitation service, a nurse led heart failure clinic, an open
access echo and a rapid access chest pain service are also provided.
2 Consultant Cardiologists
1 Clinical Assistant – 2 sessions
1 Senior Chief (MTO5)
1 Part Time Senior Chief
3.5 Chiefs (MTO4)
1 Senior (MTO3)
2 Students (MTO1) (Degree Course)
3 Full Time Cardiographers
Monday CCU round and ward work Cath lab – angio
Echocardiography Admin, audit, research
Tuesday CCU and Consultant round Cath Cath lab – pacing
lab Rapid access chest pain clinic
Wednesday CCU round Postgraduate Teaching
Outpatient clinic Dorchester Audit, Research
Thursday CCU round and PTWR Outpatient clinic Weymouth
Friday CCU round and ward work Rapid access chest pain clinic
Cath lab Admin, Audit, Research
Clinical - General Medicine
The SpRs currently work a partial shift system on call. The on call Specialist
Registrar will be responsible for supervising the medical intake and for first-line
management of medical emergencies, under supervision of the Consultant on-
call. The SpR on call during the day will attend the post take ward round the
following morning. The SpRs are expected to attend 2 outpatient clinics per
week. The outpatient workload is mostly cardiac but any general medical patients
will be seen in the cardiology clinic. The General medical education program
occurs every Wednesday afternoon with further tutorials and grand round cases
Clinical – Cardiology
The SpRs will be responsible for the day to day management of the patients on
CCU and the cardiology ward. This will include the assessment, investigation and
management of all cardiology emergencies and the management of routine
cardiac admissions. A nurse specialist will be responsible for the routine
preclerking of cardiac catheter and pacing patients. The trainee will provide a
cardiology consultant service for the whole hospital under the supervision of the
Consultant Cardiologists and be expected to provide cardiological advice at the
request of surgeons and anaesthetists as well as medical colleagues, again
under the direction of the Consultant Cardiologists. The SpR will be trained in
Swan-Ganz Catheterisation, temporary pacing, cardioversion and pericardial
There will be specific training in basic and advanced life support techniques via
the Resuscitation Training Department. The SpR will be expected to attend 2
cardiology outpatient clinics (Dorchester and Weymouth) and will see new
patients under supervision as well as follow ups. The SpR will also be
responsible for one rapid access chest pain assessment clinic per week. Training
will be provided in Transthoracic echocardiography (and TOE if/when trained in
TTE). Each SpR will have the opportunity to attend one or two angiography
sessions per week and at least one pacing session alternate weeks. Weekly
cardiology meetings provide further education in echocardiography and pacing
and review of interesting/complex angios
The SpR will be responsible for the supervision and training of the junior staff as
well as presenting cardiology cases and teaching as part of the medical
directorate education program
The trainee will be required to undergo training in management. This will take the
form of day-to-day involvement in administration of the unit and the Medical
The trainee will be encouraged to be involved in departmental audit throughout
the post and responsible for the audit of pacing and angiography which will be
reviewed six monthly.
There are facilities for clinical research. The trainee will be encouraged to be
involved in research throughout the period. This research is likely to continue
throughout the whole trainee period of six years but there will be protected time
built into the Trainee’s programme at all stages. There is co-ordination of
research by Cardiac Specialist Registrars/Trainees in Wessex supported by the
Specialist Training Committee (STC) in Cardiovascular Medicine.
The trainee will be encouraged to attend at least one relevant international or
national meeting each year and encouragement will be given to the Trainee to
submit and to present research at these meetings. The trainee will attend at least
one course each year of special interest as deemed appropriate by trainee and
Winchester and Eastleigh Healthcare NHS Trust
The Specialist Registrar in Cardiology, is one of eleven registrars in the Medical
Unit of the RHCH. There are 9 other registrars, and one other Flexi registrar. In
addition, there are 15 SHO’s in the department, and one additional SHO in the
elderly care ward call the Mount at RHCH. There are 10 house officers.
Duties of the Post
The Medical Registrar is responsible on a day-to-day basis for the clinical care of
the patients under the two consultant cardiologists and other consultant
physicians with specialist interests. There are 6 consultant ward rounds each
week, although the team often splits for these. Care of acute general medicine in-
patients is an essential part of this post. Attendance at one cardiology clinic and
one Post-MI Clinic a week. Performance of DCC sessions (alternating with the
Acute Medicine SpR). On-Call duties in the general medical acute unselected
take to EMAU as below. Seeing cardiology in-patient referrals.
The Team comprises two consultant cardiologists with one Consultant Care of
the Elderly Physician; two SpR (this post, and an Acute Medicine SpR); two SHO
and two PRHO.
Coronary Care Unit. This is a 6 bedded unit on Clarke ward with the usual
monitoring facilities. In addition there are 8 channels of telemetry on the cardiac
ward. The two cardiologists take a morning CCU ward round in rotation by week,
and on occasion of absence this is taken by the Cardiology SpR.
There are 3-4 outpatient clinics per week including 2 rapid access chest pain
clinics and a cardiac rehabilitation exercise class on Wednesday evenings. The
Cardiac SpR together with the SpR in Acute Medicine on the team run a weekly
DCC session, and a weekly Post-MI Clinic. Of the other consultant OPD’s, the
cardiac SpR attends 1 per week, seeing some new and follow-up patients of the
2 Consultant Cardiologists
2 Consultant Physicians, Diabetes/Endocrinology
3 Consultant Physicians, Gastroenterology
2 Consultant Physicians, Respiratory Medicine
1 Consultant Physician, Elderly Care and Rehabilitation
4 Consultant Physicians, Elderly care
2 Consultant Dermatologists
2 Consultant Rheumatologists
1 Consultant Neurologist (2 sessions per week)
11Specialist Registrars (including this post)
12Senior House Officers
2 GPVTs SHOs
7 House Officers
1 Staff Grade (based in A & E)
Department of Cardiology
The department is situated in a modern part of the RHCH adjacent to the
cardiology ward. It comprises an office, a large exercise treadmill room,
echocardiography room and another large room used for ECG recording and
rhythm analysis. Another room for respiratory function is within the same area
and the respiratory technician is shared with cardiology. There are currently 1 full
time MTO, two part time MTO, and 1 part time temporary MTO performing the
duties of cardiac physiology. There is a team of Senior ATO technicians who
record the ECG’s, and also fit and remove the ambulatory devices. The
cardiology department has both invasive and non-Invasive facilities as follows:-
Permanent pacemaker implantations are carried out by the two consultant
cardiologists at RHCH, average number two per week. Diagnostic
angiography is carried out on Winchester patients at North Hampshire
Hospital Basingstoke, and at Southampton General. The SpR in Cardiology
will arrange honorary contracts at these sites to allow training in angiography.
The department at RHCH is well equipped with two echo machines, the GE
Vivid-7 and the HP Sonos 5500. Transoesphageal echos are also performed.
There is a Cambridge treadmill machine, and Reynolds 24-hour tape, event
recording and ambulatory BP equipment. All this equipment is less than 3
years old with the exception of the HP.
Rapid Access Chest Pain Clinic
This clinic is held twice weekly with a capacity of 10 patients weekly. It is
multidisciplinary and computerised. There is a GP clinical assistant who assists
with this clinic.
Post Myocardial Infarction Clinic
This is held weekly and run by the SpR. It is a vital clinic for the correct follow-up
of these patients and assists with the essential audit database work.
There is opportunity for the SpR to receive training in the above invasive and
non-invasive techniques. There is emphasis on bedside clinical teaching on the
ward rounds and also in outpatients. There is a general X-ray meeting on
Wednesday lunchtimes and a Unit Medical meeting on Thursday lunchtimes. The
Registrar will also help with teaching both medical students on rotation from
Southampton University Hospitals and in the training of SMHOs who are
planning to sit the MRCP Diploma Examination.
Shortlisted candidates may visit the hospital by prior arrangement with:
Dr B C Thwaites Dr Peter Golledge
Consultant Cardiologist Consultant Cardiologist
01962 863535 ext 5791 01962 824594
Junior Doctors hours are constantly under review throughout all hospitals in
Wessex; on call / shift commitments are therefore subject to change. Banding
arrangements may differ as individual Trusts determine rotas at local level. Full
details of banding are available from the Medical Personnel Department of the
The Specialist Registrar/trainee 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.
Main Conditions of Service
The posts are whole-time and the appointments are subject to:
1. The Terms and Conditions of Service (TCS) for Hospital Medical and
Dental Staff (England and Wales)
2. Satisfactory registration with the General Medical Council
3. Medical Fitness – You may be required to undergo a medical examination
and chest x-ray. Potential applicants should be aware of the Department
of Health and GMC/GDC requirements with regards to HIV/AIDS and
Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be
required to provide, in advance of appointment, evidence of immunity or
have a local blood test (as deemed necessary by the Occupational Health
4. Right to work in the UK
5. Criminal Records Check/POCA check carried out by the Trust Medical HR
6. Pre-employment checks carried out by the Trust Medical HR department.
Your duty hours will be between 40 and 56 hours per week (part-time staff pro
rata) depending upon the pattern of work offered by the employer, which should
be in accordance with paragraph 20 of the TCS. This may include work in the
evenings, at night and weekends. The TCS may be viewed at [insert Deanery
link and/or] http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm
All posts on the rotation are working towards compliance with the European
Working Time Directive regulations.
You should be paid monthly at the rates set out in the national terms and
conditions of service for hospital medical and dental staff and doctors in public
health medicine and the community health service (England and Wales), “the
TCS”, as amended from time to time. The payscales are reviewed annually.
Current rates of pay may be viewed at [insert Deanery link and/or]
posts will be paid pro-rata.
Depending upon the working pattern and hours of duty you are contracted to
undertake by the employer you should be paid a monthly additional pay
supplement at the rates set out in paragraph 22 of the TCS. The current
payscales may be viewed at http://www.nhsemployers.org/pay-conditions/pay-
conditions-2339.cfm The pay supplement is not reckonable for NHS pension
purposes. The pay supplement will be determined by the employer and should
be made clear in their offer of employment and subject to monitoring.
You will be entitled to join or continue as a member of the NHS Pension Scheme,
subject to its terms and rules, which may be amended from time to time. Further
information can be viewed at http://www.nhspa.gov.uk/nhspa_site/index.htm
Your entitlement to annual leave will be five or six weeks per annum depending
upon your previous service/incremental point, as set out in paragraphs 205 – 206
of the TCS.
The TCS may be viewed at http://www.nhsemployers.org/pay-conditions/pay-
Entitlements are outlined in paragraphs 255-240 of the TCS.
You will be required to give your employer and entitled to receive from them
notice in accordance with paragraphs 195 – 196 of the TCS.
The employer is expected to offer study leave in accordance with paragraphs
250 – 254 of the TCS. Local policy and procedure will be explained at your
The employer is expected to offer travel expenses in accordance with
paragraphs 277 – 308 of the TCS for journeys incurred in performing your duties.
Local policy and procedure will be explained at induction.
The employer is expected to offer subsistence expenses in accordance with
paragraph 311 of the TCS. Local policy and procedure will be explained at
The employer will have a local policy for relocation expenses based on
paragraphs 314 – 315 of the TCS and national guidance at
http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm. You are
advised to check eligibility and confirm any entitlement with the employer before
incurring any expenditure. In addition to local policy there is Deanery guidance
which can be viewed on www.nesc.nhs.uk
All NHS employers are required to undertake pre-employment checks. The
employer will confirm their local arrangements expected to be in line with national
guidance at http://www.nhsemployers.org/primary/primary-3524.cfm
It will be a requirement of employment that you have professional registration
with the GMC for the duration of your employment.
Health and safety
All employers have a duty to protect their workers from harm. You will be advised
by the employer of local policies and procedures intended to protect your health
and safety and to comply with these.
Disciplinary and grievance procedures
The employer will have local policies and procedures for dealing with any
disciplinary concerns or grievances you may have. They will advise you how to
access these, not later than eight weeks after commencement of employment.
The employer will confirm your supervisor on commencement.
The Deanery’s management of Specialty Training programmes, including issues
such as taking time out of programme and dealing with concerns or complaints,
is available at www.nesc.nhs.uk and in the national ‘Gold guide’ to Specialty
Training at http://www.mmc.nhs.uk/