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					                                                              Page No.

Introduction

Barking Havering & Redbridge Hospitals NHS Trust -                3
King George and Queen‟s Hospitals

Barnet General Hospital                                           5

Barts and the London NHS Trust                                    6

Basildon & Thurrock University Hospitals NHS Trust                9

Chase Farm Hospitals NHS Trust                                    11

Essex Rivers Healthcare Trust – Colchester General Hospital       13

Homerton University Hospital NHS Foundation Trust                 15

Mid Essex Hospital NHS Trust (Broomfield Hospital)                17

Newham Healthcare NHS Trust                                       18

North Middlesex University Hospital                               20

Princess Alexandra Hospital NHS Trust                             22

Royal Free Hampstead NHS Trust                                    23

Southend Hospital NHS Trust                                       25

UCL Hospitals Trust                                               27

Whipps Cross Hospital                                             29

The Whittington Hospital Trust                                    30

Committee Members                                                 32

Useful Contact Numbers                                            33




                                        1
                                INTRODUCTION

The rotation involves eight, 5 year rotations with opportunities for Research, academic
medicine and flexible (part-time) training. The first three years of the scheme are
relatively fixed and the latter two years allocated according to educational need by the
Training Committee. Three of the five years involve acute general medicine in hospitals on
a rota of 1:7 or more frequently. The details of the on-call rotas and training offered
vary from one Trust to another. An outline for each Trust is given in the attached
prospectus.

Candidates who wish to undertake a career in Academic medicine may also be catered for
but the number of posts available for training and at consultant level is small. Those
desiring to follow such a path should indicate this clearly early in the recruitment process
as the requirements for the Appointments Committee may be slightly different. Trainees
may enter research, but only with the agreement of the Training Committee. Anyone
planning to undertake a research project should not accept a post except on a provisional
basis without the Committee‟s agreement. Normally, out of programme experience such
as this will be for a maximum of three years unless there us good reason to extend it. A
useful guide on research posts is produced by the Royal College of Physicians on behalf of
the Academic Medicine Group (entitled Guidelines for Clinicians Entering Research).

ASSESSMENTS

There are regular assessment and appraisal sessions held between trainees and trainers
and the Training Committee holds annual RITA panels to review progress. Trainees should
be clear that their annual RITA panel will cover both gastroenterology and GIM training,
and all the relevant pages in the training folder relating to these two aspects must be
completed.

TEACHING PROGRAMME

The Training Committee has set up a Teaching Sub-Committee to co-ordinate the teaching
programme across the Region. Day release sessions are organized once a month with the
aim of completing a review of the curriculum over a 2 ½ year period. This means that
every SpR has at least two chances of attending every session during their training. The
sessions take place in various hospitals around the Region on different days of the week.
Attendance at these is compulsory for all SpRs unless prevented by an on-call commitment
for emergencies.




                                             2
          Barking Havering & Redbridge Hospitals NHS Trust
                  King George and Queen’s Hospitals
BHR Trust covers a population of over 700 000 people with 2 acute hospital admission
sites (both with A&E) and supporting rehabilitation units. The combined hospitals have
over 1000 beds and serve a catchment population of widely diverse social and cultural
backgrounds. There is therefore a wide range of gastrointestinal disease providing full
experience and training in gastroenterology. The Trust is an Associate University
Teaching hospital.

Senior Medical Staff

                       Subspecialty interests                     Base hospital
Dr W Ashraf            ERCP/Therapeutic endoscopy                 King George

Dr GE Bettany          Nutrition/ERCP/Therapeutic endoscopy       King George

Dr WR Burnham          Nutrition, IBD                             Queen’s

Dr W Fickling          Therapeutic endoscopy, endoscopic U/S,     Queen’s
                        ERCP
Dr S Grainger          Inflammatory bowel disease                 King George

Dr D Hollanders        Viral liver disease                        Queen’s

Dr P Premchand         Therapeutic endoscopy, ERCP                 Queen’s

Dr M Smith             GI physiology, IBD                         Queen’s
Mr Kumar                 Associate Specialist in Endoscopy        KGH/Q‟s
There are also specialist nurses with interests in endoscopy, inflammatory bowel disease,
viral liver disease, nutrition and colorectal disease.

 Gastroenterology Services
All consultants are involved in the provision of general gastroenterology services with
further individual practice in GI sub-specialities. There are also close links with surgical
GI services with both outpatient and endoscopy clinics running concurrently or shared.
BHRT is an accredited upper GI and colorectal cancer centre. There are active nutrition,
radiology and oncology services covering all sites, and radiotherapy at Queen‟s hospital,
as part of the joint centre with Barts and the London hospitals Trust.




                                              3
Endoscopy Services
BHR is accredited by JAG for training in all aspects of diagnostic and therapeutic
endoscopy, including ERCP and EUS. Endoscopy services are based in the Day Surgery unit
at King George hospital (2 rooms) and the Clinical Diagnostic Unit at Queen‟s hospital
(currently 3 rooms). Across both units more than 9000 endoscopies, including >3000
colonoscopies and >300 ERCPs, are performed annually. Training in all forms of diagnostic
and therapeutic endoscopy including ERCP, stenting, endoscopic ultrasound and wireless
capsule endoscopy are available to trainees according to requirements. There is also a
consultant led emergency GI bleeding service on both sites.

General Medicine
All posts provide training in general medicine. The average take ranges from 25-60 acute
admissions on each A&E site. There are acute admissions units at both A&E sites.
Currently registrars work a full shift. Each registrar works in a consultant team with
supporting SHOs and HOs.

Postgraduate meetings
There are weekly gastroenterology clinicopathological meetings on each site and a
combined upper GI cancer meeting across Queen‟s and King George hospital sites. There is
also a monthly SpR journal club. An active interest in audit and research is encouraged
with papers presented regularly at major meetings. In addition there are busy
postgraduate centres on both sites with weekly medical grand rounds and other specialty
meetings. SpRs are encouraged to lead teaching of postgraduates and undergraduates.

SpR posts
Across the Trust there are 6 full time SpR posts. Depending on training needs, SpRs may
have the opportunity to gain experience at more than one site. In addition, there are two
joint lecturer posts (between Queen‟s and the Royal London hospital). All posts provide
training in acute general medicine and in gastroenterology and are timetabled with the
needs of the individual SpR in mind. The clinical lecturers are expected to participate in a
joint research programme with the St Bartholomew's & the Royal London School of
Medicine and Dentistry.

Further information:
Dr Stephen Grainger 020 970 8053(KGH)( stephen.grainger@bhrhospitals.nhs.uk)
Dr Magda Smith 01708 435000 ext 2095 (Queen‟s ) (magda.smith@bhrhospitals.nhs.uk)




                                             4
             Barnet General Hospital – Teaching Prospectus.

Staffing.

Consultants.
There are two full-time gastroenterologists, Dr S Mann and Dr K Tang. Dr. Patrick
Harbinson is the Consultant for the Care of the Elderly on the „jumbo‟ medical firm. The
gastroenterologists have 1 SpR, 2 SHOs. and one pre-registration HO. On the Care of the
Elderly side of the firm, with whom there is some cross-cover after hours and for annual
leave, there is a separate SpR, SHO and PRHO.

Education Experience and Services Provided.
The post is a busy job combining general medical and gastroenterology in-patients,
gastroenterology outpatients (including a clinic at Edgware Community Hospital) and
endoscopy.   A wide range of training opportunities in diagnostic and therapeutic
endoscopy, including colonoscopy and ERCP is available in a new endoscopy unit. The
hospital has been completely re-built with the medical GI wards adjacent to surgery.
With the recent appointment of a third gastroenterologist it is anticipated that more
specialised clinics, in particular for liver disease (including viral hepatitis) and
inflammatory bowel disease, will be running. There are also training opportunities in
nutrition.

The gastroenterologists work closely with the GI surgeons and oncologists and there are
weekly multidisciplinary meetings for review of cancer patients, GI radiology and
alternate week histology.

In addition there are many opportunities for general medical education with daily
coronary care and stroke unit ward rounds and weekly grand rounds, journal club, „chest
meetings‟ and „morning report‟.

An electronic patient record is now operating and has many advantages to medical staff, in
particular relating to ordering and reviewing test results, obtaining clinical summaries and
keeping patient/diagnosis lists.

On Call.
The firm is on call 1:5 for 24 hours for unselected general medical cases. There is a CDU
and a ward-based specialty admission policy. There is an age-related policy, whereby all
patients over 75 are admitted under the Care of the Elderly firm which works alongside
the general medical team. In addition there are some short-stay multi-specialist areas.



Further Information.
Contact Dr S Mann - 020 8216 4990 or Dr K Tang – 020 8216 4986.




                                             5
                      Barts and the London NHS Trust
Barts and the London NHS Trust incorporates The Royal London (Whitechapel) where the
SpRs are based, St Bartholomew’s (Smithfield), The London Chest (Bethnal Green) and Mile
End Hospitals. Gastroenterology services are primarily based at the Royal London, with some
out-patient and ward consultation work at Barts, and some emergency endoscopy at the
London Chest Hospital and at St Bartholomew’s.
The Digestive Disorders Clinical Group integrates luminal and pancreaticobiliary
gastroenterology, hepatology and nutrition in three firms as detailed below. All staff are actively
involved in the teaching of both under- and post-graduates and ongoing research, audit and
Clinical Governance.

Senior Staff
Prof. Q Aziz           ( Academic: GI motility )
Dr. C. Ainley         (GM/Gastro: Pancreato-biliary medicine)
Dr. E. M. Alstead     (Academic: Hepatology – NHS post at Whipps Cross )
Dr N. Beejay          ( Capsule endoscopy – NHS post at Newham General )
Dr P.D. Fairclough (Gastro/Endoscopy: Lead for endoscopy )
Prof G. R. Foster     (Academic: Hepatology)
Dr M. J. Glynn        (GM/Gastro/Hepatology: Clinical Director for Medicine)
Dr M.P. Kelly         (Gastro/Academic: Gastrointestinal infection)
Prof PJ Kumar         (Gastro/Academic: Coeliac disease, education)
Dr. G. Libby          (Psychiatry; Functional bowel disease)
Dr James Lindsay      (GM, Gastro, IBD, Endoscopy – Training Lead)
Dr. R. Marley         (Hepatology and General Medicine; Lead clinician)
Prof. J. Powell-Tuck (Gastro/Academic: Clinical Nutrition)
Prof. R Playford      ( Academic: Vice Warden )
Prof. D. S. Rampton (Gastro/Academic: IBD / luminal gastroenterology)
Prof. I. R. Sanderson (Head of Academic Department)
Prof. D. Van Heel    ( Academic; genetics of IBD/Coeliac )

Team structures
1      Hepatology & GM                               Prof. G. Foster, Drs R. Marley
                                                     & M. Glynn

2      Clinical Nutrition                            Prof. J. Powell Tuck

3      Inflammatory Bowel Disease,                   Dr C Ainley, Dr J Lindsay &
       Pancreaticobiliary and GM                     Prof. D Rampton (not GM)

Teams 1 and 3 also care for general medical admissions. There are 3 SHOs and 4 Pre-
registration House Officers ( F1 grade ), as well as 2 specialist nurses in nutrition, 2 in
Gastroenterology and Hepatology and a Nurse Endoscopist.
Six Specialist Registrars are attached to the unit. Two senior posts provide opportunities for
specialist interest training and also spend some time at Barts. 3 junior posts rotate every 4
months between the 3 teams. The sixth post is a sixth year post exclusively in Hepatology, and
rotates between two London Hepatology Units during the year.




                                                6
General Internal Medicine
All the SpRs (except the Hepatologist) take part in the medical „take‟ rota (currently 1:8,
either day or night, however this is subject to change). Admissions average 25 per 24
hour period (range 15-35). There is a ward-based system of triage to specialties the day
after admission.
With the introduction of MMC in August 2007 the firm structure and general medical
provision will change. The exact format is being finalised, but it is likely that the SpR
equivalents will spend a short period of time attached exclusively to an „ acute medical
care firm „, with the majority of the year being spent exclusively in gastroenterology.

Gastroenterology
An integrated multi-disciplinary service is run within the department and in conjunction with
other clinical groups, most importantly surgery, pathology and radiology. There is a high volume
of clinical activity within the unit, seeing 8000 out-patients ( 2500 new ), performs ~7000
endoscopic procedures and admits ~500 patients annually. The Department offers a wide
range of training opportunities with special interests in:

         Clinical Nutrition covers inpatient parenteral and enteral nutrition, and has the
          third largest UK home parenteral nutrition service.
         Diagnostic and Therapeutic Endoscopy: ERCP, sphincter of Oddi Manometry,
          colonoscopy, endoscopic mucosal resection, APC, stenting, endoscopic ultrasound,
          and wireless capsule endoscopy. PDT and Nd-YAG laser work should come on-
          stream this year.
         Gastrointestinal cancer – upper & Lower GI and Pancreatico-biliary.
         Inflammatory bowel disease
         Non transplant hepatology
         Physiology: GI motility, 24 hour pH studies, ano-rectal physiology
         Psycho/Neurogastroenterology and functional bowel disorders

Endoscopy training is provided within a modern 5-roomed unit with integrated screening
which takes part in the National Endoscopy Programme. We expect to start screening
patients in the National Bowel Cancer Screening Programme in early 2007. There is also a
GI investigation/physiology laboratory in the Endoscopy Unit.

Hepatology
The hepatology department specializes in the management of viral hepatitis and general
hepatology. It includes one of the largest hepatitis B and C treatment units in the country.
Specialist joint clinics exist with renal medicine, a local specialist addiction unit, the
department of HIV medicine and paediatrics. Regular academic meetings are held and trainees
are encouraged to participate in research projects. Close links exist with the Royal Free
transplant unit, as well as local referring hospitals.


Clinical Governance
There is a monthly Clinical Governance meeting (afternoon of the first Thursday of each
month). SpRs are expected to take a full part, and will be expected to complete and
present at least one audit to the meeting during their tenure.



                                               7
Weekly programme
The weekly sessions which have a teaching component are:

Tues  08.00   Morning Report G(I)M
      08.15   Upper GI MDT
      10.00   IBD teaching ward round
      10.45   IBD Histology meeting
      11.30   IBD Xray meeting
      12.30   Grand Round G(I)M
Wed 08.00     Hepatobiliary/Pancreatic cancer MDT
      13.00   Hepatology – cases and journal club – fortnightly
Thurs 12.30   Acute Medicine teaching (SpR‟s and SHO‟s) G(I)M
      13.00   Gastro - cases and journal club
      16.45   Gastro/Hepatology Research meeting
Fri   13.00   IBD - cases and Journal club

Academic gastroenterology
The „Centre for Gastroenterology‟ – our academic partner - is housed in the recently
refurbished Wingate Institute (GI Physiology) and in the new Medical School buildings
adjacent to the hospital on Turner Street. There are strong links between the clinical
and academic units with weekly joint meetings. There are opportunities for research
within the department, with up to four clinical research fellows at any one time. The
department runs an M.Sc. course in Gastroenterology.

Further Information

For further information, please contact Dr Michael Glynn (0207 377 7486) , Prof David
Rampton (0207 377 7442), Dr James Lindsay ( 0207 377 7443 ) or Dr Peter Fairclough
(020 7601 8516).




                                            8
        Basildon and Thurrock University Hospitals NHS Trust


Introduction
Basildon University Hospital is an acute DGH with about 450 beds, including 150 general
medical beds. There are 14 monitored beds on the CCU and a seven bedded ITU. There
is an on-site Haemodialysis Unit, a specialist Haematology Day Unit and a three-room
dedicated Endoscopy Unit with seventeen available bed spaces. Most diagnostic facilities-
including spiral CT and MRI - are available within the hospital. A new Cardiothoracic
Centre for South Essex is currently being built on the site. The local catchment
population is about 320,000.

Firm Structure
There are three Consultant Gastroenterologists - Dr C P Willoughby, Dr D J Gertner and
Dr J Subhani . A fourth locum consultant is in post, with plans in train for a substantive
appointment, with a special interest in Endoscopic Ultrasound.

The firm has one SpR in general medicine and gastroenterology from the London rotation. A
second SpR in gastroenterology and G.I.M. has been appointed on the Eastern Deanery
rotation. There is a Staff Grade in Gastro/GIM, an FY2 and three FY1s. The firm also includes a
Nurse Consultant in Gastro and several nurse specialists who help to run the MDT, IBD service
and the Nutrition Team.

General Medicine
The firm is on-call for emergency takes on a 1:5 rota, with prospective cover for predicted
absences. A shift pattern of working is in place so that the junior jobs are compliant with the
EWTD. An age-related admission policy applies to the take days, with patients over the age of
78 being admitted by the COTE team and managed on their wards unless bed constraints
mean that the patients end up on Edith Cavell ward, when our team remains in charge of them.
On an average take day, 15-20 patients will be admitted under the firm. The SpR will be
responsible for patients admitted on take days to the CCU and ITU, the latter in co-operation
with the ITU medical staff. Post-take ward rounds are routinely undertaken and are Consultant-
led. General medical patients requiring later out-patient follow-up are seen by either
consultants or the SpR in the medical clinics. The firm’s inpatients are largely centralised on
Edith Cavell Ward. Patients admitted on take days but triaged to other wards are transferred to
the care of the firms based on these wards (the same applies in reverse to patients admitted
under other firms but then sent to Edith Cavell Ward).

On average, the SpR will expect to be in charge of 20-30 in-patients at a time. He or she
will usually attend two clinics a week with a consultant, at each of which 6-10 new patients
and 15-25 follow-up patients will be booked.

It may be of interest to SpRs that the South Essex Medical Trust supports research projects,
often run by current or previous registrars working for the Trust. This may be useful in funding
research time.

Gastroenterology experience
New clinic patients tend to be referred by specialty, so a large proportion of these are
likely to have gastro-intestinal problems. About 30-40% of the in-patient load tends to
be gastroenterological. The GI consultants have a special interest in inflammatory bowel

                                               9
disease and clinical nutrition as well as in endoscopy. Dr Subhani has a special interest in
liver disease and runs a Liver Clinic on Monday afternoons.

The Endoscopy Unit services the Respiratory Physicians, Urologists and Colo-rectal
Surgeons as well as the medical Gastroenterologists.
Currently over 3,000 upper GI examinations and procedures are carried out annually, as
well as about 1500 colonoscopies and 300 ERCP‟s. The SpR will have the opportunity to
experience “hands on” a wide range of endoscopic investigations and therapeutic
activities. Upper GI interventions performed routinely include sclerotherapy and banding
of varices, the insertion of oesophageal metal stents, injection therapy for bleeding
ulcers and insertion of endoscopic gastrostomies. Colonoscopic polypectomy including
endoscopic mucosal resection is performed by both the Physicians and Surgeons. Two
ERCP lists a week are undertaken with at least 85% of these procedures having a
therapeutic component such as gallstone removal or biliary stenting. An argon plasma
coagulator is available for treating bleeding lesions and de-bulking tumours. A wireless
capsule endoscopy service was started in 2006. Expansion of the Endoscopy Unit facilities
is being planned at present. An endoscopy simulator is available in the Clinical Skills
Centre.

Dr David Gertner runs the hospital‟s Clinical Nutrition Team and special experience is
available in this field. The SpR will receive training in the insertion of central and
peripheral feeding lines.

A joint meeting with the Surgeons, Pathologists, Oncologists and Radiologists is held
weekly to discuss colo-rectal cancer or upper GI cancer management. There is also a
weekly GI meeting. There is a weekly x-ray review meeting on Tuesday lunchtimes and
the GI unit participates in the hospital ground round or audit meeting every Friday.

Further Information:    For further information please contact Dr P Willoughby on
01268 598559 or fax 01268 598685.




                                            10
                     Chase Farm Hospitals NHS Trust

Introduction
Chase Farm is one half of the Barnet & Chase Farm Hospitals NHS Trust. The
catchment area for Chase Farm patients is Enfield, Cheshunt and Waltham Cross,
(population 250,000).

SpR post in Gastroenterology and General Medicine
There are three consultant gastroenterologists (Drs van Someren, Besherdas and
D‟Souza). There are two SpR posts, which offer a wide range of experience in
core gastroenterology, based at Chase Farm Hospital. The specialist interests of
the consultant staff are therapeutic endoscopy, dyspepsia and hepatology. Each
SpR is able to tailor the gastroenterology aspect of the post to training
requirements. There is a fully equipped endoscopy room with daily lists and a
nurse practitioner specialising in dyspepsia. There are three ERCP lists weekly,
with half being out of district referrals. Liver disease is treated on site, except
for viral hepatitis (Dr Tang, Barnet General Hospital).

There are two general medical firms for the three consultants each with three SHO‟s   and
one HO divided between the two teams. Admitting teams have responsibility             for
unselected acute general medical admissions and the coronary care unit. The posts     are
EWTD compliant with a full shift system now in place with ten SpRs contributing to    the
rota.


There are CT and MRI scanners on site, as well as the usual range of other medical
and surgical specialities with the exception of nephrology.

Education and Research
It is expected that the SpR attends all the regional training days and cancels
their duties at Chase Farm on those days. Study leave is provided for attendance
at National and International meetings, which the SpR should attend as well as
other meetings of interest. The SpR is expected to attend a weekly GI x-ray
meeting, upper and lower GI cancer MDT in addition to journal clubs, grand rounds
and other Trust meetings of interest. There are weekly on site meetings (grand
rounds, postgraduate meetings) and attendance at other hospital meetings (e.g.
The Royal Free) is encouraged. The SpR should produce at least one abstract and
one paper during the year.

Barnet Hospital
Three are two consultant gastroenterologists and one SpR at Barnet. The
consultants work closely together. SpRs remain attached to one site but the work
of the department is under review and this may alter in the future.



                                          11
Other Hospitals
Three is a close collaboration with the departments of hepatology and surgery at The
Royal Free Hospital, Hampstead. Neurosurgical and nephrology cases are referred to The
Royal Free. Cardiac catheterisation and radioisotope work are undertaken at the North
Middlesex Hospital, Edmonton.



Further Information
Contact Dr N van Someren (020 8375 1529), Dr K Besherdas (020 8375 1540) or
Dr D‟Souza (020 8375 2192).




                                         12
     Essex Rivers Healthcare Trust - Colchester General Hospital
Introduction
There are two SpR posts in gastroenterology in this Trust and they are located at
Colchester General Hospital. The Trust serves a population of approximately 340,000.
Colchester General Hospital provides all acute medical and surgical services. There are
160 acute medical (including 30 medical assessment beds and 30 chest disease beds), and
120 acute geriatric beds. On the same hospital site there are the A & E Department,
Emergency Assessment Unit, Critical Care, including HDU and ITU, Radiology and
Haematology Departments, Day Unit (medical, surgical and endoscopy) the MRI Unit and
the Postgraduate Medical Centre. Gainsborough Wing which opened in 2000, houses
Rheumatology, Neurology, Rehabilitation and Care of the Elderly.

Consultant Staff
Dr R E Cowan, Dr D O‟Riordan and Dr S Nugent, Consultant Gastroenterologists and Dr T
Rudra, Consultant Geriatrician with an interest in gastroenterology, Professor R W
Motson, Mr R Austin and Mr T Arulampalam, Consultant Colorectal Surgeons and Mr D
Menzies, Consultant Upper GI Surgeon and Mr M Tutton, Consultant in GI Surgery.

Gastroenterology Experience
It is believed that during the year in Colchester, the post holder will acquire a broad
knowledge of gastroenterology and hepatology and will become proficient and confident in
most forms of GI endoscopy, especially upper GI and colonoscopy.

Each SpR attends two out patient clinics per week; three are held at Colchester General
Hospital and one at Clacton Hospital. Typically a total of 3-4 new patients (all GI disease)
and 10-12 follow-up patients (including some GIM) are seen in each clinic.

GI Endoscopy
There are six supervised GI endoscopy sessions per week that the SpRs can attend, with
opportunities to perform one of these, mostly upper gastrointestinal endoscopies,
unsupervised once or twice per month according to experience. These lists comprise a
mixture of upper GI, ERCP and colonoscopy/flexible sigmoidoscopy examinations,
diagnostic and therapeutic. Typical numbers with which each SpR will be directly involved
are as follows: Diagnostic OGD 12-14 per week, Diagnostic colonoscopy 4-6 per week,
Therapeutic OGD - variceal treatment 1-2 per month, oesophageal dilatations 1-2 per
week, stent or tube insertions 1-2 per month, upper GI bleeds 6-8 per month, PEG
insertions 2-3 per month; Therapeutic Colonoscopy - polypectomy 1-2 per week, ERCP
(Diagnostic 2-3 per month, Stenting 2-3 per month, Sphincterotomy 2-3 per month).
Argon plasma coagulation therapy is also performed in the Endoscopy Unit.




                                             13
In-Patient Experience
There are two timetables for the SpRs and they alternate three months on each. Both
timetables give the SpR responsibility for covering half the main ward work, with the help
of two SHOs and two PRHOs. Colchester General operates a ward-based system with the
gastroenterologists responsible for a ward of 30 beds. At any one time there will be 8-12
in-patients with gastroenterological problems under the care of three
gastroenterologists. For 3 months one SpR will cover the ward patients of Dr O‟Riordan
and the other those of Dr Nugent, and vice versa.

One of the SpRs has responsibility for the care of outliers on two designated surgical
wards and on the EAU, while both deal with the in-patient gastroenterology referrals
under the supervision of Dr Cowan, who covers for the other two Consultants when they
are away. There is a small difference in endoscopy opportunities between the two
timetables to reflect the different intensity of ward work.

Special Training Opportunities
In addition to general gastroenterology, special experience and training is offered in the
following areas: Inflammatory bowel disease, upper GI cancer, chronic viral hepatitis,
especially hepatitis C, day case liver biopsy and ERCP. There is an x-ray meeting,
reviewing mostly gastrointestinal studies, alternating each week with a gastrointestinal
histopathology meeting. GI Cancer multidisciplinary teams meet twice per week and
attendance is encouraged. There is a quarterly meeting with Dr A Gimson, Consultant
Hepatologist and Dr Sue Davies, Consultant Histopathologist, both from Addenbrooke‟s
Hospital, when difficult liver cases are discussed. In addition, with one of the timetables
there is time allowed for a day-release spent on the Liver Unit at Addenbrooke‟s Hospital
approximately two Fridays per month, according to availability.

General Medicine
The post-holders participate in a 1/12 on call rota. The SpRs head an on-call team of 8
junior doctors in medicine and COTE. Typically there are 35-50 emergency admissions of
all age groups in 24 hours. The SpR is expected to supervise the SHOs and PRHOs. The
SpR participates in the teaching of 3rd year medical students rotating from Royal London
& Barts Hospitals. There is active postgraduate medical training and the SpR also
participates in the gastroenterological teaching of the SHOs studying for MRCP. The
weekly programme includes a journal club, a medical meeting and a monthly grand round.
Audit meetings are held monthly and the SpRs are encouraged to conduct individual
specialty-based audits.

Further information
Contact Dr Cowan on 01206 742382, Dr O‟Riordan on 01206 742085 or Dr Nugent on
01206 744233.




                                            14
         Homerton University Hospital NHS Foundation Trust

Introduction
Homerton University Hospital serves a multi ethnic population of 250,000. It was opened in
1986 when it was linked to St. Bartholomew’s Hospital. In 1990, it became a single Trust and
in 2001 it was granted full university hospital status. There are a total of 518 beds on site,
including a 9-bedded ITU, 56-bedded acute care unit, a stroke unit and an elderly rehabilitation
unit.    The regional neurological rehabilitation unit is also on site. The medical
gastroenterologists work closely with their surgical colleagues in a combined medical and
surgical department, and joint clinics, academic and clinical meetings are held. There is
excellent support from diagnostic imaging, including spiral CT, MRI and MRCP. Histopathology
and oncology services are closely linked to services at St. Bartholomew’s and the Royal
London with oncology clinics on site.
Senior Staff in Gastroenterology
Medical: Prof. Parveen Kumar, Dr Anne Ballinger, Dr Christine Blanshard, Dr Ray
Shidrawi, Dr Annette Fritscher-Ravens.
Surgical: Lower GI: Mr Peter Lunnis, Miss Helen Pardoe, Mr Charles Knowles;
Upper GI: Mr Kay Mannur and Mr Andrew Jenkinson; General GI: Mr Femi
Olagbaiye.
Clinical Services
There are eight medical gastroenterology clinics per week, including specialist liver and
IBD clinics. There are nurse-led clinics in IBD, dyspepsia and hepatitis, and patients with
hepatitis B and C are treated on site. There is a combined medical and surgical X-ray
meeting weekly and histopathology can be reviewed at a weekly meeting. Gastroenterology
Audit and Clinical Governance Meetings are held bi-monthly. Training is offered in all
aspects of clinical gastroenterology and hepatology, excluding liver transplantation. The
Homerton is accredited as a colorectal cancer unit and have recently been successful in
their application with Barts and the Royal London NHS Trust to be a first-wave colorectal
cancer screening unit. Surgical treatment of oesophagogastric cancer is carried out by our
upper GI surgeons at the Royal London Hospital, with whom we are a joint centre.
Multidisciplinary upper and lower GI cancer meetings are held weekly

Endoscopy services
A 2 room endoscopy unit with X-ray facilities is available. There are daily upper and lower
GI endoscopy lists, ERCP, endoscopic ultrasound and capsule endoscopy. Training is
offered in all aspects of diagnostic and therapeutic endoscopy including endoscopic
management for acute upper GI bleeding, stenting, PEGS, etc.


General Medicine
Homerton Hospital provides an acute medical service to the population in Hackney and
East London. There is an average acute medical take of between approximately 20-25
patients.




                                              15
The specialist registrar is one of 12 covering the acute take on a full shift basis working
56 hours per week. Other acute sub-specialties provided within the Trust include chest
medicine, diabetes and endocrinology, clinical pharmacology, cardiology, rheumatology,
neurology, haematology and care of the elderly.

Postgraduate Meetings
There is a postgraduate meeting every Monday and a Medical Unit meeting on a
Tuesday. There is a departmental journal club on Friday mornings and a full
programme of audit, clinical governance and other educational meetings.

Further information: Contact Prof. Kumar, Dr Ballinger, Dr Blanshard or Dr
Shidrawi on 020 8510 7435.




                                            16
         Mid Essex Hospital NHS Trust (Broomfield Hospital)

Introduction
Broomfield Hospital is a large District General Hospital with a catchment area of
350,000. The Department of Gastroenterology is part of the division of medicine and
provides a comprehensive service in diseases affecting the digestive tract, liver, biliary
tract and pancreas. We liaise closely with other groups, in particular general surgery,
diagnostic radiology, histopathology and cancer services.

Senior Staff
Dr S H Saverymuttu (Consultant Gastroenterologist), Dr C C Khin (Consultant
Gastroenterologist ), Dr R Radzioch ( Locum Consultant Gastroenterologist ), Dr G Pratt
(Gastrointestinal Radiologist). .


Clinical Gastroenterology
In-patient work is confined to the Broomfield Hospital site. There is a modern twin-room
Endoscopy Unit. Two Nurse Endoscopists help with the endoscopy workload. Out-patient
clinics are held at Broomfield Hospital, St. Michael‟s Hospital, Braintree, and St. Peter‟s
Hospital, Maldon. There is a large volume of clinical activity (over 3,000 out-patient
attendances and 4,000 endoscopies). There is a weekly MDT meeting for upper GI and
lower GI tract cancers with the general surgeons, oncologists, radiologists and
histopathologists. The Firm has a 26 bedded ward for in-patient gastroenterology and
general medicine. Two ERCP lists per week are held in the Xray department and one EUS
list per week in endoscopy.


General Medicine
SpRs have a general medical commitment with a 1:8 on-take rota. The Firm has two FY1,
one FY2 and an SHO to support the general medicine.

Further information
Please contact Dr Saverymuttu on 01245 514097 or Dr Khin on 01245 514620.




                                            17
                     Newham Healthcare NHS Trust


Introduction
Newham University Hospital NHS Trust (NUHT) is the secondary referral care centre
for one of the most deprived inner city populations in London of approximately 250,000.
Over 50 languages are spoken within Newham and the cultural and ethnic diversity of this
borough brings with it a wide range of health problems and pathology, making it an
excellent training ground for all levels of medical training. Newham has the highest rate
of tuberculosis and HIV related childbirths in the country.

NUHT is an associated teaching hospital for students of the Queen Mary Westfield
University. Acute medical services are provided from the newly refurbished A& E
department and we have been successful meeting most targets for A&E waiting times.
NUHT has successfully completed a PFI build and considerable improvements have been
made on site with new facilities.
Newham is now well on its way to an integrated EPR system with most investigations being
requested online. A choose and book system for OP appointments is being implemented in
a phased manner.

General Medical Services
The acute medical services are provided through three mega firms each comprising a
speciality and care of the elderly physician/s and their junior medical staff. The rota has
been changed to meet the EWTD and as a result the SpRs are on a 1 in 14 rota of 12 hours
duration and usually on take with their mega firm team of doctors (Senior and junior). All
the SHOs are on the BLT rotation and work on a partial shift system. Approximately 25
patients are on admitted on call and in patient workload amounts to about 20 pts at any
given time per consultant firm.

Medical Staff in Gastroenterology
Consultants: Drs.Vasu Kulhalli, Nigel Beejay and Matthew Guinane (Gastroenterologists)
and a fourth Consultant post is allocated and will be appointed in due course. In addition
there are three Specialist Registrars in gastroenterology, two SHOs ( ST2 ) for medicine
and gastroenterology, and a further SHO ( ST2 ) in haematology and an ST1 post who do
their general medicine on our firm and two PRHOs ( FY1 posts ). In addition we have a
Research fellow based jointly between Newham and the Wingate Institute at the BLT.



Gastroenterology Services
Approximately 2500 new patients are seen every year and about 4500 endoscopy
procedures including 900 colonoscopies are performed every year. The Endoscopy Unit is
a purpose built three room endoscopy suite in the newly built Ambulatory Care and
Diagnostic Centre (ACAD) to enable improved service delivery. In addition NUHT has
completed a pilot project as part of the National Endoscopy Booking Programme. Close
links with the BLT allow easy access for GI physiology studies as well as EUS. Dr. Beejay


                                            18
runs the Capsule Endoscopy Service at BLT and NUHT has close links with the Liver Units
at the BLT, Kings College Hospital and Royal Free Hospital NHS Trust.

Meetings
There are regular weekly departmental meetings with the surgeons and radiologists as
well as fortnightly meetings with the pathologists. There is a weekly MDT meeting for
Upper GI Cancer and Lower GI Cancer and NUHT actively participates in the weekly
Hepato-biliary MDT meetings at the BLT. NUHT runs a monthly endoscopy governance
meeting. In addition there are weekly grand rounds in general medicine in the Academic
Centre at NUHT, weekly Gastroenterology Grand Rounds at the BLT where we present on
Thursday lunch times, as well as the weekly academic meetings at the Wingate Institute.

Research
The clinical material in Newham lends itself to multiple opportunities for research. Dr.
Beejay has a special interest in Capsule endoscopy and is actively involved in research in
this area. There are close links with the Wingate Institute as well as the BLT which have
excellent facilities for GI motility, laboratory research and information technology.

Specialist Registrars
There are currently three specialist registrars in post. The 2 year 1/2 posts offer
training in general gastroenterology and diagnostic upper GI endoscopy and flexible
sigmoidoscopy as well as general medicine. The year 4/5 post offers experience in ERCP
and therapeutic upper and lower GI endoscopy, research or special interest opportunities
at the Wingate Institute as well as general medicine with opportunities in general hospital
management.

We believe that Newham with its population demographics and a young dynamic
gastroenterology department offers an exciting opportunity for training in all aspects of
Gastroenterology.
For further information please contact:

                                   Dr. V Kulhalli     02073638084
                                   Dr. Nigel Beejay   02073638080
                                   Dr. Matthew Guinane02073638084




                                            19
                     North Middlesex University Hospital
Introduction
The North Middlesex Hospital serves a large area of North London with a population of
300,000. The catchment area has a diverse social ethnic mix with a large proportion of
the population coming from an ethnic minority background. There is thus a very wide
range of interesting Gastroenterology, Hepatology and General Medicine and, in particular,
the opportunity to train in the management of diseases less common in more affluent
areas.

Senior Staff
Dr Andrew Millar             Consultant Physician and Gastroenterologist
Dr Paul Maxwell              Consultant Physician and Gastroenterologist
Dr Janine Wright              Consultant Physician and Gastroenterologist
SR Caroline Philippou        GI Specialist Nurse

SpR Job Plans
The two SpRs rotate on a monthly basis as „Ward-based‟ and „Endoscopy-based‟; this is of
particular help in allowing greater intensive training in Endoscopic skills.

Out-Patient Sessions
Each clinic comprises a mixed new-old patient list of 8-10 patients maximum. Trainees are
encouraged to always discuss any problems with the Consultant.                     A further
discussion/training period is usually held at the end of each clinic. In addition the SpR will
be given the exiting opportunity to learn voice recognition dictation directly to the
computer screen.

In-Patient Care
The joint gastroenterology firm manages an average of 35 in-patients. The ward SpR
maintains daily review of particularly Gastroenterology and critically ill patients, and
supervises 2 FY1s and 3 FY2s/SHOs and a Physician‟s Assistant (PA). The SpR reviews 3-5
in-patient referrals per week mostly prior to attending with the Consultant. All discharge
summaries are created electronically from a database maintained by the junior staff and
the PA, which also provides the patient lists and „TTA‟ forms. These are reviewed at the
weekly death and discharge meeting and countersigned by the Consultant. The ward SpR
has responsibility for ensuring that discharge summaries are completed.

Endoscopy Sessions and GI physiology
The Endoscopy SpR attends 3 Consultant-led and attended endoscopy sessions per week.
Training is provided in approximately 20 diagnostic upper GI endoscopies, 5 therapeutic
endoscopies including oesophageal dilatation/stenting, 6 colonoscopies per week and 3-4
ERCPs if appropriate to the training needs of the SpR. The SpR may soon also have the
opportunity to learn Oesophageal pH and Manometry . The department carries out most
advanced endoscopy, excluding laser therapy and ultrasound. We have an interest in
endoscopic antireflux procedures.


                                             20
General medicine
The SpR takes part in a 1:10 12-hour partial shift rota with day off before and after a
night shift. Each „take‟ is followed by consultant-led post-take ward round. Appropriate
general medical patients are followed up by the SpR in the out-patient department.

Nutrition
The Gastroenterology Department works integrally with the multidisciplinary Nutrition
team, which is led by Dr Maxwell. Each of the two SpRs will rotate internally and will
spend 6 months working with the Nutrition Team, including the weekly Nutrition Ward
Round.

Academic Meetings
The SpR attends and presents at the GI Multi-disciplinary Cancer meeting, a separate
Gastroenterology Clinical Radiological Histology and Surgical Meeting for Benign Disease
and the weekly Medical Grand Round. The North Middlesex Hospital has two GI
oncologists and a large GI cancer workload. Protected time is given for SpR training days.
Each SpR will be expected to complete at least one Audit Project and 1-2 Case Reports
for publication. In addition, the SpR will be invited to take part in the on-going Clinical
Research activity of the Department.

Further information:        Dr Andrew Millar 020 8887 2251, Dr Paul Maxwell 020 8887 2683
                            Dr Janine Wright 020 8887 2683




                                            21
                  Princess Alexandra Hospital NHS Trust

Introduction
Princess Alexandra Hospital is a busy district general hospital serving a population of
280,000 along the M11 corridor. The Department of Gastroenterology is part of the
medical division and provides a comprehensive service for diseases of the gastrointestinal
tract. There is close liaison with surgical, oncology and pathology services.

Senior Staff in Gastroenterology
Physician: Dr D M Preston, Dr E A Stoner, Dr R A Phillips (part time)
Surgeons: Mr S Vivekanandan, Mr O. Lalude
Other senior staff: Dr Redla (GI Radiologist), Dr Ali (Staff Grade), Dr Yousef (Staff
Grade) Dr H Taylor, Dr K Menon, Dr J Riches, Dr M Khalil (Hospital Practitioners
endoscopy), two nurse specialists in colorectal disease and nutrition.

Gastroenterology Training and Experience
As well as providing a wide experience in core Gastroenterology, training in diagnostic and
therapeutic endoscopy including ERCP can be provided. There is an active nutrition
support team and the SpR will contribute to this. Training is also available in oesophageal
pH and Manometry recording. The endoscopy unit carries out more than 3500 upper GI
endoscopies, 900 colonoscopies and 150 ERCPs each year.

General Medical Experience
The SpR will take part in a new partial shift rota that complies with new deal
arrangements. The Gastroenterology firm contributes to an unselected general medical
take one night in six. There is no shift longer than 13 hours. Supervision is provided by
the „Physician of the day‟ who carries out twice daily ward rounds on all newly admitted
patients. There is a daily consultant coronary care unit round.

Other information
We pride ourselves on running a very informal and friendly unit. There is close consultant
supervision for all endoscopy training and we have a Gastroenterology ward where the
consultants and secretaries have their offices, so that the SpR feels part of a cohesive
team. Our Trust has a number of teaching links particularly with the Royal Free Hospitals
and University College Hospital, London. Medical students from The Royal London
Hospital attend for teaching. There are also links with Addenbrooks Hospital, Cambridge.

Further information
Contact Dr D M Preston 01279 827424 or Dr E A Stoner 01279 827821




                                            22
                      Royal Free Hampstead NHS Trust

Introduction
The hospital has 930 beds and provides services in nearly all major branches of medicine,
surgery, maternity and psychiatry.       There are specialist units in liver medicine,
hepatobiliary surgery and transplantation, renal services, hematology, plastic surgery,
oncology, neurosciences, paediatric gastroenterology, infectious diseases/HIV/AIDS.

Consultant Staff in Gastroenterology/Hepatology
Prof. H Hodgson, Prof. G Dusheiko, Prof A K Burroughs, Prof O Epstein, Prof K P Moore,
Dr M Morgan, Dr J S Dooley, Dr M Caplin, Dr M I Hamilton, Dr D Patch,

There are 3 Year 3 posts, 3 Year 4/5 posts as well as a Specialist Registrar in Hepatology
post. One Lecturer post – which is outside the rotation – may be re-introduced.

Gastroenterology
The Department provides training in core gastroenterology and includes special expertise
in IBD, oesophageal and gastric disorders, IBS, neuroendocrine tumours. Nutrition
experience is offered by the integrated clinical nutrition team. The unit has a number of
GI nurse specialists and offers the opportunity to experience a modern clinical unit.
There is a large and interesting outpatient service with specialist clinics including rapid
access dyspepsia clinic, coeliac clinic and IBD clinics. The on-call rota includes hepatology
experience, providing a well rounded experience for GI trainees.

Endoscopy
Training is available in diagnostic and therapeutic upper and lower GI endoscopy. This
includes oesophageal dilatation, variceal injection and banding and therapeutic lower GI
procedures. Oesophageal stenting is currently carried out the Radiology Department.

Training is also available for one SpR in ERCP with focused involvement in patient
assessment, follow up and training in ERCP.

An OPD “onestop” flexi sigmoidoscopy clinic offers additional lower bowel endoscopic
experience. A new endoscopy unit opened in September 2005 and has been equipped with
a full range of modern endoscopes, and now also houses the paediatric gastoenterology
unit. There is a Symbionix upper and lower GI simulator for training and there is potential
to gain experience in reading capsule endoscopy which has recently been added to the
imaging modalities available to patients. The unit has a special interest in the
developments occurring in virtual colonoscopy.

GI Physiology
The Louise Ryan Physiology unit performs >1000 investigations annually including, upper and
lower GI manometry, 24 hour pH studies, electrogastrography, breath testing (HP and
hydrogen), transit studies and bilitec measurement. There is opportunity for trainees to learn
some of these techniques.




                                             23
Neuroendocrine Tumour Unit
The unit is internationally recognised as a leader in the treatment of patients with
neuroendocrine tumours. It comprises a multidisciplinary team including gastroenterologists,
hepatologists, endocrinologists, oncologists, pathologists, radiologists, nuclear medicine
physicians and surgeons. There are two special nurses. There are weekly multidisciplinary
tumour meetings, clinics as well as nurse clinics. There is an active scientific and clinical
research programme and the unit is at the forefront for the advance of new therapies. There is
an opportunity for trainees to gain experience in the care of these complex patients.

Hepatology
The In-patient hepatology and transplant service provides for a wide experience in the
management of acute and chronic liver disease, the preparation of patients for liver
transplantation and the post-operative management of all the complications of organ
transplantation. The Unit acts as a referral centre for liver failure, patients with
neoplastic liver disease, and complications of chronic liver disease. There is a wide and
active interest in the management of chronic viral liver disease.

Management of the complications of bleeding oesophageal varices includes significant
exposure to the emergency management of bleeding oesophageal varices including
injection sclerotherapy, banding and management of Sengstaken Blakemore tubes, and the
department provides an emergency TIPS service. There is an active clinical and research
base in portal hypertension including the measurement of hepatic wedge pressures to
guide therapy.

General Medicine
Acute general medical experience backed up by continued in-patient and out-patient
follow-up is provided for four of the SpR posts. Takes are split into day and night rotas
with a „Hospital at Night‟ team undergoing development.

Additional information
The Department and the hospital provide extensive postgraduate training as documented
below:
 Twice weekly morning report meetings to discuss general medicine.
 Postgraduate seminars in liver disease and hepatology on a weekly basis.
 Weekly research meetings in gastroenterology and hepatology and weekly x-ray
   meetings.
 Weekly meetings in histology
 Weekly medical Grand rounds.

Further Information: Please contact Dr D Patch 0207 794 0500 ext 8097




                                             24
                    Gastroenterology at Southend Hospital

Introduction
There has been a centralised gastrointestinal service at Southend since 1995 and a new
endoscopy unit with three rooms opened in November 2005. This includes screening
facilities and the department of gastroenterology. A third consultant, Dr Mary McStay,
has recently been appointed to complement the opening of the new unit. The department
has extensive technical expertise, a high throughput and excellent equipment. It liaises
closely with surgeons, radiologists, pathologists and oncologists within the Trust which is a
designated Cancer Centre. All staff are actively involved in teaching at post and
undergraduate levels. Southend has been awarded Associated University status in
recognition of its increasing role in teaching doctors at all levels. It has also received full
King's Fund accreditation.


Senior Staff
Dr J D O‟Brien, Consultant Physician/Gastroenterologist,
Dr G P Bray, Consultant Physician/Gastroenterologist.
Dr M McStay, Consultant Physician/Gastroenterologist.
Mr AA Brown, Consultant Colorectal & General Surgeon
Mr MJ Dworkin, Consultant Colorectal & General Surgeon

Gastroenterology
In the new Endoscopy Unit there are three procedure rooms, one with lead screening for
ERCP and steenting. Between 7-8,000 procedures per year are performed in the
department including upper GI, lower GI, biliary and other procedures. There is an open
access endoscopy service and 50-60% of all new patients are initially directed for
endoscopy. There is a particular interest in management of gastrointestinal cancer and
close links with GI Oncologists, GI Surgeons, Radiologists, Nutrition staff, Palliative Care
Team and the Gastroenterologists. There are regular histology meetings. We have an
Endoscopy Nurse Practitioner with an additional role in running Inflammatory Bowel
Disease clinics as well as a second nurse specialist working with IBD and liver patients as
well as helping with ERCP. There is a full range of therapeutic endoscopy including
insertion of oesophageal, biliary and enteral metal stents, biliary lithotripsy, argon beamer
therapy and endoscopic haemostasis for upper GI bleeding. Capsule endoscopy is also
performed and it is hoped to develop endoscopic ultrasound. Research interests are
primarily clinical involving colorectal, pancreatic cancer and coeliac disease.


Teaching Opportunities
There is close consultant supervision in endoscopy training. There is also excellent
general medical experience and the SpR is an integral member of the post-take ward
rounds. He/she is also expected to supervise the SHOs and House Physician in
collaboration with the Consultants.
Time for endoscopy and GI training, however, is protected. A trainee is actively
encouraged to attend all the gastrointestinal training days and any GI commitments are
excused to facilitate attendance.

                                              25
There are two GI SpR posts. The unit is very busy with plenty of opportunity for the
trainee to obtain hands-on experience in all aspects of gastroenterology.

Further Information
Contact Dr Joe O‟Brien on 01702 221156 or Dr Gary Bray on 01702 221158 or Dr Mary
McStay.




                                        26
                              UCL Hospitals Trust
Introduction
UCL Hospitals Trust provides a wide range of gastroenterology services with the GI Unit
and dedicated beds at the new University College Hospital. A 595 bed hospital opened in
2005 with a second phase due to open in 2008.

Staffing of GI Unit

Medical Consultants and main interests:
Dr S Bloom/Dr S McCartney         Lower GI & general medicine, IBD.
Prof. S G Bown/Dr L Lovat         Upper GI Medicine, Laser endoscopy,
Dr L Langmead                     Acute medicine, luminal GI
Dr A R W Hatfield/Dr G Webster Pancreatico-Biliary Medicine, ERCP, EUS
Prof. R Williams/Dr R Jalan/ Dr N Naoumov/Dr S P Pereira     Hepatology
Prof. A Forbes                    Nutrition
Dr A. Emmanuel                    GI Motility

Surgical Consultants
Prof P Boulos/Mr A Obichere       }Colorectal surgery/anorectal physiology & motility
R CRG Cohen/Mr A Windsor          }
Mr A Shankar/ Mr T Kurzawinski    Pancreatico and Hepatobiliary surgery
Prof. I Taylor                    Hepatic surgery

Clinical Training Offered
A comprehensive training in Gastroenterology/Hepatology is provided by the Unit, which
has particular expertise in hepato-biliary endoscopy and endoscopic ultrasound, laser
treatment of tumours of the upper and lower GI tract, and the management of
inflammatory bowel disease, adolescent gastroenterology, portal hypertension and acute
liver failure.

Teaching and Educational Supervision
There are seven SpRs attached to the Department. Three are in Year 2 or 3 posts and
four are in Year 4 or 5. Since 2000, SpR training has been provided in six-monthly
modules: Upper and lower GI Medicine (2 senior posts), Pancreatico-Biliary and Lower
GI/General Medicine (2 junior posts) although the senior pancreaticobiliary and both of
the liver posts are currently for a full year.          The educational supervisor for
gastroenterology is Dr McCartney. All SpRs will normally have two out-patient clinics (one
general GI and one specialist), two endoscopy lists, two-three consultant ward rounds, at
least one academic session and an optional session for additional clinical training or
research.

General Medicine & Gastroenterology
Drs Bloom and McCartney provide the acute medical services and receive a mixture of
acute GI and general patients via daily triage. The three junior SpRs take part in the
Acute Admissions unit rota and spend 4 months of the year covering the acute medicine
service. The remaining SpRs ( if sufficiently experienced ) take part in the
gastroenterology on call rota
                                           27
The General Gastroenterology outpatient service is provided by Drs Bloom, McCartney,
Webster and Lovat.



Specialty Options and Research Opportunities
One session is set aside each week for the trainee to pursue personal interests, which
may be either clinical or laboratory based. Current research areas of interest include
inflammatory bowel disease, advanced therapeutic endoscopy, oncology/palliative care,
hepatology and basic research in association with other departments at University College
London. The Department has a first class research record.

Further information:
Dr S Bloom 020 7380 9126, Dr S McCartney 020 7380 9126 or Dr Pereira 020 7380 9011




                                           28
                         Whipps Cross Hospital


Whipps Cross is a busy District General Hospital with Associate Teaching
Hospital status.    The department of gastroenterology provides a fully
comprehensive gastroenterology and endoscopy service for the Trust and the
gastroenterologists work closely with gastrointestinal surgeons and radiologists.
There are six consultant gastroenterologists, Dr. Elspeth Alstead, Dr. Af
Sawyerr, Dr. Ralph Greaves, Dr. Liz Carty, Dr Richard Makins, and Dr Ed
Seward. There are currently two SpR posts in gastroenterology and general
medicine and the rest of the team is composed of two SHOs/FY2 and three
house officers/FY1. There are a wide variety of training opportunities available
and it is possible to try to cater for different training needs of individual
trainees. The department of gastroenterology has recently won the Hospital
Doctor Team of the Year award for gastroenterology 2006. A new purpose-built
endoscopy unit was opened on February 2006.

General Medicine
All the general medical SpRs are currently on a full shift and do stand-alone
night shifts with days off before and after. When on call for general medicine
the SpR is supported by one SHO/FY2 and two house officers, working as a
team. All medical patients are admitted to a new emergency medical center
where, in addition there is an EMC acute medical team, and then triaged to
specialty as appropriate. The post will provide adequate opportunity for the
acute management and follow up of general medical patients.

Gastroenterology
Out-patient and in-patient work covers all areas of general gastroenterology
(especially inflammatory bowel disease, functional bowel disorders and general
hepatology). There are excellent endoscopic imaging and medical day care
facilities and opportunities for supervised training in advanced therapeutic
upper GI endoscopy, colonoscopy, ERCP and Capsule Endoscopy. It is also
possible for training in ultrasound to be arranged if required. The SpRs are
encouraged to participate in the multidisciplinary nutrition team, GI cancer
meetings, weekly gastroenterology team meetings including audit and pathology
and a weekly joint x-ray meeting with the GI surgeons. The department has
close links with gastrointestinal surgery and interventional radiology and also
links with psychological medicine and palliative medicine. Whipps Cross provides
opportunities for clinical research, audit training in medical education and
participation in management at a departmental level. Close links with Barts and
The Royal London also provide potential research opportunities.

Further     information:         Dr.    E    Alstead        020    8535     6706



                                       29
             The Whittington Hospital Trust

Consultants
Dr V S Wong and Dr D Suri


Work of the Department
The Department is extremely busy seeing approximately 2,500 new outpatients
per year. There is a full range of upper GI endoscopy and colonoscopy services.
There are two specialist GI nurses who have a range of duties including fibre
sigmoidoscopy.

Inpatients
There are 20 in-patient gastroenterology and general medical beds on Reckitt
Ward.

Endoscopy Unit
A new purpose built two room Endoscopy Unit was opened in 1996. This Unit is
situated next to the GI ward and is staffed by 4 endoscopy nurses. Ward staff
nurses are trained in the Unit and the ward has a rotating night cover so that at
any time of the day or night there are experienced nurses available to assist
with endoscopy of bleeding patients. The Unit is fully equipped with up to date
endoscopy and colonoscopy equipment.

Special expertise of the Department
1.     GI Bleeding. Over the last 15 years the department has audited its GI
       bleeding figures and has regularly had one of the lowest mortality levels
       of any Unit in the UK.
2.     Colonoscopy. There are four weekly lists with polypectomy.
3.     ERCP Dr Wong has a weekly ERCP list at which a full range of
       therapeutic techniques occur.
4.     Therapeutic Upper GI Endoscopy. There is a weekly list at which
       oesophageal stents, oesophageal dilations, variceal sclerotherapy
       (injection/banding) PEGs etc. are placed.
5.     IBD There is a busy IBD clinic with management of complex patients.
6.     Liver disease Dr Wong and Dr Suri have special interest and training in
       hepatitis C.
7.     Management techniques. Both consultants have considerable
       experience and training in management and have regular weekly session
       with each member of junior staff in which trainees have both
       gastroenterology and management tutorials.

General Medicine
Trainees do 1:10 general medical takes with 15-30 admissions per 24
hours.


                                       30
Research
There are a number of clinical projects that are on-going. Registrars are
encouraged to participate in these.

Further information
Please contact Dr Voi Shim Wong on 0207 272 3070




                                       31
Committee Members (as from January 2007)

Dr P Willoughby – Chairman                        (Basildon & Thurrock
                                                    University Hospital)
Mr S Miles    - Associate Dean

Dr E Alstead                                     (Whipps Cross Hospital)
Dr C Blanshard                                       (Homerton Hospital)
Dr S Bloom                                          (Middlesex Hospital)
Dr R Cowan                                 (Colchester General Hospital)
Pro. G Foster                (St. Bartholomew‟s /Royal London Hospitals)
Dr M Glynn                                        (Barts and The London)
Dr D Patch                                         (Royal Free Hospital)
Dr. Magda Smith                                    (Queen‟s Hospital)
Dr K Besherdas                                 ( Chase Farm Hospital)



A Teaching Sub-Committee organises a monthly training day at various
locations around the region. On occasions eminent speakers are invited to
address the given topic. The teaching curriculum is covered over 2½
years in order to allow for each SpR to attend the entire course during
their five years of clinical training.



The majority of SpRs spend up to three years in academic research. In
order to enhance the research training provided, an Academic Sub-
Committee has been formed in order to oversee this important aspect of
the registrar‟s education.




                                   32
               Useful Contact Numbers
S.T.C.DirectLine 01268 593049 E-mail: charles.Willoughby@btuh.nhs.uk

Jacinta Kpodo Medical Workforce Officer, Deanery      020 769 23361
jkpodo@londondeanery.ac.uk

Kimberley Archer JCHMT Specialty Co-ordinator for Gastroenterology
020 7935 1174 x474    (Contact re research).

Emma Spurgeon JCHMT Information & Support Services Manager
020 7935 1174 x442 (Contact re enrollment).

Diane Mathias Co-ordinator, N.E. Thames Training Program
020 8876 6317                    mathiasd@globalnet.co.uk

Dr Magda Smith Chairman, Gastroenterology SpR Teaching Committee –
N.E. Thames Direct Line 01708 708224

Professor Graham Foster    Academic Representative / Assessor of
Research Proposals 020 7882 7242    g.r.foster@qmul.ac.uk

Dr Paul Kooner SpR Representative paulkooner@hotmail.com
Mobile 07767685453

Matthew Skinner Medical Recruitment Officer Hammersmith Hospital
020 8383 3403




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