Renal Medicine at Royal Sussex County Hospital
BSUH is the regional teaching hospital working across two sites: the Royal Sussex County Hospital in Brighton and the Princess Royal Hospital in Haywards Heath. The Brighton campus includes the Royal Alexandra Children’s Hospital and the Sussex Eye Hospital, and the Haywards Heath campus includes the Hurstwood Park Regional Centre for Neurosciences.
We provide general acute services to our local populations in and around the City of Brighton and Hove, Mid Sussex and the western part of East Sussex and more specialised and tertiary services for patients across Sussex and the south east of England.
Both hospitals provide many of the same acute services for their local populations. In addition, the Princess Royal is our centre for elective surgery and the Royal Sussex County Hospital is our centre for emergency and critical care. Our specialised and tertiary services include neurosciences, paediatrics, cardiac, cancer, renal, infectious diseases and HIV medicine. We are currently developing our capability as the designated major trauma centre for the region.
We treat over 800,000 patients each year. Working as one hospital across two sites, and playing to the strengths of both, gives the flexibility to develop services which meet the needs of our patients at different stages of their treatment and care.
Central to our ambition is our role as developing academic health sciences centre, a provider of high quality teaching, and a host hospital for cutting edge research and innovation; and on this we work with our partner, Brighton and Sussex Medical School (BSMS), the Kent, Surrey and Sussex Postgraduate Deanery and our local Universities.
We also work in close partnership with our local GPs and commissioners to ensure that local health services are provided and improved in ways which best meet the needs of our patients and their families.
There are many priorities and improvements that we wish to make but of these there are three that will define our development over the coming years:
• being research active with our partner Medical School, niche and deep rather than widely spread, in the areas of oncology, neurosciences, infectious diseases, ageing and paediatrics;
• leading on postgraduate multi-disciplinary education for the region; and
• being the major trauma centre for the south east.
Each of these raises the bar and radiates benefit and expectation more widely.
OUR VISION AND STRATEGIC GOALS
Our vision is to be locally and nationally renowned for delivering safe, high quality and compassionate care and to be the regional centre of clinical and academic excellence.
We are progressing plans to develop the Royal Sussex County Hospital as the regional centre for Teaching, Trauma and Tertiary Care (our 3Ts programme).
The KSS managed programme appointed its first trainees in 2010. The program is developing by the movement of existing training posts largely on the South Coast from London Deanery to KSS Deanery. Validation of the Programme by the London and KSS Deaneries and relevant SACs took place in 2009.
Renal training is centred at the Sussex Kidney Unit (SKU), Royal Sussex County Hospital Brighton. This is a large tertiary centre providing the full range of renal services with the exception of the acute phase of transplantation (but including donor and recipient work up and post transplant care after 1-3 months).
Transplantation takes place at St George’s & Guy’s Hospitals and the program includes a rotation to the St George’s unit for acute transplantation experience.
SKU provides renal care to a population of approximately 1.2 million in East and West Sussex. It is based in Brighton with satellite units in 3 other hospitals, outreach clinics in 5 other hospitals and close links with Worthing hospital. SKU is housed in a purpose built centre including a 26 bedded ward with separate procedure rooms (one with image intensification), main and home heamodialysis areas, PD area, clinic suites and accommodation for specialist nursing staff, dieticians, pharmacists, counsellor etc
Medical staff include currently 7 substantive and 1 locum consultants. There are 7 numbered registrars (ST3+/SpR) and non-training grade registrar level posts are being created. There are 6 doctors at SHO / F1 level or equivalent
Numbers of patients treated include (2009 snapshot data)
New patients starting dialysis: 119
HD prevalent patients: 328
PD prevalent patients: 84
Transplant f/u: 294
Clinics held in Brighton include general nephrology, hypertension, low clearance, transplant f/u, urgent referral/ ward discharges, live donor assessment, PD, HD, vasculitis. There are also outreach clinics for HD and/or general nephrology in Bexhill/ Hastings, Crawley, East Grinstead, Eastbourne, and Haywards Heath.
General medicine training is provided at Worthing and in the future RSCH including an attachment to ICU/HDU. The RSCH based general medicine training is scheduled to start in 2013 (at ST6 level) and although it will be EWTD compliant and provide adequate training for curricular requirements further details are not yet available
Shift Practice and Rota
Changes are taking place both in service delivery and in training which will affect timetables. Regarding service these include anticipated increase in our reach clinics, with new acute medical model potentially greater in-patient referral/ outlier work, earlier repatriation of transplant patients (more transplant clinics). Regarding training: new curriculum, effect of EWTD on learning methods and work time, KSS based programme and consequent need for most of the curriculum to be delivered by SKU (supported by St George’s Hospital attachment).
The following general points apply:
Posts are EWTD compliant; this is achieved partly by programmed weeks of compensatory leave in addition to the usual Annual and Study Leave entitlements
Trainees move through a series of attachments. The ward attachment is for 2 weeks, other attachments are for longer to achieve continuity of care and education/ experience. These currently comprise: Heamodialysis, Peritoneal dialysis & outliers, Clinic, Outreach & satellite, Floater. The balance of work between these attachments is reviewed and adjusted to reflect trainees views. All attachments (not just the “clinic” attachment) involve some OP work with the exception of the ward post. A scheme showing the different attachments over the year as for 2009-10 is appended but as indicated will be subject to review reflecting service and training changes and trainee feedback as are details of work within attachment (eg balance of clinics).
The normal working day is from 0830 to 1730. The on-call registrar works until 2130 M-F. At weekends the registrar works 0900-2100. There are no on-call duties overnight. The ward registrar usually is on call for one of the week-ends during their fortnight ward attachment.
The F1 –ST2 doctors are all based on the ward supporting the ward consultant and registrar. One of them starts at 0730 and another works from 1100 to midnight so that there is always a junior doctor supporting the registrar. A consultant (usually the ward consultant) is always on call. Clinics are directly supervised by consultants. Procedures are supervised to a level appropriate to the trainee and a consultant is always available even if the registrar has achieved competence in that procedure
Education and Study Schedule
Main unit handover meeting:
This meeting starts the week every Monday morning at 08.30 to 09.30 in the renal seminar room. All consultants and junior doctors on duty, together with a nursing representative of every clinical area, the renal dieticians and pharmacists meet to go through the previous week’s discharges and deaths, the current inpatients, and planning the theatre lists for the following 2 to 3 weeks.
Renal radiology meeting:
Held weekly on Friday mornings 08.30 to 09.30 in the renal seminar room. There is a strong educational component to this meeting.
Renal biopsy meeting:
Held every Friday lunchtime, 13.00 to 14.00 in the department of histopathology. This is again an educational opportunity.
Renal clinical governance/academic meetings:
These take place every Wednesday. The unit’s clinical governance meetings are from 14.30 to 17.00 once per month and all medical staff are expected to attend. The meeting incorporates audit against Renal Association/ Registry guidelines/ data and trainees are encouraged to actively participate in this (preparing components of this with audit nurse). The other weeks there is a departmental academic meeting 17.30 to 18.30.
Held every Thursday morning, 08.30 to 19.15 in the Audrey Emerton Education Centre and is run by Dr S Holt. Interesting or instructive acute medicine cases are presented by junior doctors on a rolling basis, and discussed by the group of juniors and consultants from a range of medical specialities.
Hospital staff round: held 1300-1400 during university terms. Departments within medical specialities lead for the meeting on a rotational basis
Renal journal club/ learning circle: Thursdays 1300-1400 for renal consultants and higher specialist trainees only. The journal club alternates with the learning circle; the latter is intended to give a topic based coverage of neprhology based on facilitated peer learning.
S Thames organises a program of 6 renal training days per year, one hosted by each of the 6 main renal units annually. Attendance at these is expected. GIM training days are also organised via S Thames. The Pan Thames audit days take place 2-3 times per year.
Active participation in audit, case report writing, clinical research project etc is encouraged.
Anticipated duration of programme and start date
- 5 years to include higher specialist training in Renal Medicine and GIM and not counting OOP time
- Annual recruitment (Nationally coordinated) to start first week of October
- Expected outcome, i.e. completion of Core or CCT
- CCT in Renal Medicine
- CCT in GIM
- MSc in nephrology as part of programme
- OOP opportunities leading to higher degree/ other qualification to fit individual needs/ desires
Basic Pay referring to national salary scales
Travel and relocation expenses policy
Dr A MacDiarmaid-Gordon
Dr C Kingswood
Dr S Lawman
Training Programme Director, KSS Renal Programme - Adam MacDiarmaid-Gordon
Dr E Kingdon