SUSSEX COAST JOINT TRAINING PROGRAMME IN INFECTIOUS DISEASES-MEDICAL

MICROBIOLOGY AND VIROLOGY

2016Academic Clinical Fellowship, ST3 level

PROSPECTUS

Brighton and Sussex Medical School (BSMS) in collaboration with Brighton and Sussex University Hospitals NHS Trust (BSUH) and the Brighton PHE collaborating centre are pleased to the availability of an Academic Clinical Fellowship (ACF) in Infectious Diseases and Microbiology sponsored by the National Institute of Health Research. The academic component of the fellowship will be primarily focussed on the development of WGS methods for Neisseria gonorrhoeae and their integration into workflows for clinical management and public health. The post attracts funding from the NIHR to fund a Masters level qualification with additional funds for courses and meetings. Successful applicants will be encouraged to enrol on the BSMS/Brighton University Masters of Research (MRes) degree course which is the vehicle for delivering the taught component of the ACF. The Fellowship is a three-year post, 75% clinical and 25% academic with block release for research, and will attract a run-through training number.

The regional infectious diseases unit at Brighton is the centre of an established joint training programme in clinical microbiology and infectious diseases. The scheme accommodates seven trainees who rotate between BSUH, other NHS sites in Sussex and Surrey and spend a year in one of the London centres. All our posts have GMC approval for Core Infection Training. On call banding is funded locally for our training posts.

BSMS has a strong track record delivering successful ACL/ACF posts in infection. Currently two ACFs and one ACL are in post. Previous ACFs have gone on to secure research funding, undertaken and completed doctorates, published in high impact journals and achieved substantive appointments. A vacant NTN is available from 2016.

Our success in this area has been built on the close working relationship between Dr Martin Llewelyn (Reader in infectious diseases at BSMS, Lead consultant, Department of Microbiology and Infection at BSUH) and Dr John Paul (PHE, Consultant Microbiologist BSUH). Brighton is one of four sites working in collaboration with PHE as part of the Modernising Medical Microbiology (MMM) consortium led from Oxford [http://modmedmicro.nsms.ox.ac.uk/] and funded by UKCRC (£5.5m) and HICF (£2.7m). JP is a co-applicant to grants that support MMM and is co-leader with Dr Xavier Didelot for the theme: Methods for integrated genetic and epidemiological analysis, within the NIHR HPRU grant: Development of Modelling Methodology(Imperial College London). ML is an MMM collaborator and chairs a genome wide association study group on behalf of MMM. He leads on a work package and also of a sub-study for the Antibiotic Reduction and Konservation (ARK) consortium working in association with MMM in Brighton and Oxford. He is a co-investigator on clinical trials through the UK Clinical Infection Research Group and runs a wet-laboratory programme studying host immunological responses to infection.

Brighton BSUH also provides access to a highly evolved research environment for the study of HIV, and sexually transmitted infections. As the base of the only medical school in Kent Surrey and Sussex it is also the hub of the Comprehensive Local Research Network and delivers the bulk of CLRN adopted research in the region through is Clinical Investigation Unit. Dr Llewelyn and Dr Amanda Clarke (HIV medicine) are the joint leads for infection research in the region. This ACF proposal builds on ongoing studies in Brighton to investigate antimicrobial resistance in Neisseria gonorrhoeae, using WGS and conventional microbiological and epidemiological methods to track transmission and develop methods for predicting resistance using WGS. An ACF engaged in the proposed project would benefit from progress already accomplished through a collaborative PHE/MMM pilot study. This includes development of bioinformatic tools applicable to N. gonorrhoeae (Dilrini Da Silva, Oxford), sequencing of a back catalogue of 900 isolates, ethical approval for collecting enhanced epidemiological data prospectively, building collaborative relationships with the reference laboratory at Colindale (Michelle Cole, Stephanie Chisholm), with Imperial College (Xavier Didelot; mathematical modelling) and CDC Atlanta (Gail Bolan, David Trees; sharing of resistant strains etc.). The pilot study was formatted around an out of programme experience for a PHE ID/microbiology trainee (Joanna Peters) and in addition attracted the award of a BASHH fellowship for a GUM trainee (Fiona Cresswell). Abstracts and papers relating to this pilot phase are in preparation.

Unanswered questions remain about the contribution made by different genes to resistance and part of the proposed project would involve collaborative working with MMM and the reference laboratory to refine methods for genetic prediction of resistance. There is also a need to explore how a WGS method could be integrated with conventional workflows to enhance surveillance. This issue would form acore part of the ACF research project.

BSMS hosts a range of other infection research groups (http://www.bsms.ac.uk/research/our-research/infection-immunology/) including Prof Kern (CMV and TB immunology) Dr Waddell (Innate immune responses to mycobacteria) and Dr Sacre (innate immune cell signalling), Prof Newport heads one of five new Wellcome Trust Centres for Global Health Research that support researchers in public health and tropical medicine [http://www.wellcome.ac.uk/News/2013/News/WTP051591.htm]. An ACF would have additional opportunities to form collaborative relationships with staff involved in projects investigating antimicrobial resistance in samples collected at units in Zambia, Ethiopia and Sudan.

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Outline of the programmeThe objective of the post is to produce specialists with adequate training and experience to be awarded a Certificate of Completion of Training (CCT) in Medical Microbiology and Infectious Diseases. It also aims to focus training on research and health protection and is formally linked to the HPA. Training will be in accordance with the requirements laid down by the PMETB approved RCP/RCPath programme on combined training in Medical Microbiology and Infectious Diseases, August 2010.

This is up to a 6-year programme, which will be adjusted flexibly to meet the needs of individuals depending on previous experience and will comply with the Joint Training Programme of the JCHMT.

The joint training offered in Medical Microbiology/Infectious Diseases is based in the integrated Microbiology and Infection Service at BSUH and rotates through BSUH and hospitals within the South Coast region. The training programme is overseen by KSS Deanery.

Research and the Academic Clinical fellowshipInfectious diseases is a major academic theme at Brighton and Sussex Medical School. The academic training posts in infectious diseases have historically been very successful and previous post holders have achieved success with published and presented research, going on to secure funding for further academic training to PhD. 

The successful applicant will be paired with a member of faculty to develop a research project in line with the trainee’s interests and academic background.  Projects may be patient focused or lab-based (microbiology, immunology or genetics).  Major areas of research at the moment are as follows: Dr Llewelyn works on clinical and immunological assessment of patients with healthcare-associated infections such as Staphylococcus aureus and Clostridium difficile. He is working with the modernising medical microbiology consortium (http://modmedmicro.nsms.ox.ac.uk ) (www.modmedmicro.ac.uk) to use microbial whole genome sequencing to study transmission and pathogenicity of these organisms and with the UK Clinical Infection Research Group to undertake a multicenter Randomised Controlled Trial of rifampicin in the management of S. aureus bacteraemia (www.ukcirg.co.uk). With Prof Florian Kern at BSMS he is developing the measurement of host immune responses as tools for risk stratifying patients who are exposed to healthcare associated infections. Prof Newport is Professor of Infectious Diseases and Global health and works on genetic regulation of immune responses and susceptibility to infectious diseases such as tuberculosis. Dr Agranoff is consultant in infectious diseases and acute medicine. He is currently PI at BSUH for the ProMISe trial (protocolised management in sepsisDexEnceph Trial) and has additional research interests in proteomics and metal ion transport in intracellular pathogens.

The Academic Clinical Fellowship provides for 25% protected research time per year for up to 3 years. The particular configuration of clinical and research time will be tailored to individual candidates’ needs, balanced against service and clinical training requirements. The programme is designed to be flexible and every effort will be made to accommodate individual training needs. The trainee will be assigned an academic educational supervisor and will have opportunities to follow research interests in Brighton or elsewhere.

Where a candidate does not already have a higher degree (most cases), the focus during the protected research time will be on generating preliminary data to support

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an application for a clinical research fellowship from one of the major funding bodies e.g. Wellcome Trust/MRC to pursue a higher degree. If the candidate is unsuccessful in securing funding during the first 3 years of the programme, training will continue on the existing joint clinical training programme.

The successful appointee should contact Dr Llewelyn to discuss the post as soon as possible after appointment.

Supervisory Arrangements

Academic Lead for IAT Programme:Name: Timothy ChevassutPosition: Senior Lecturer and Honorary Consultant in HaematologyInstitution: Brighton and Sussex Medical School /

Brighton & Sussex University Hospitals NHS TrustAddress: Medical Research Building

University of SussexFalmer

Town: BrightonPostcode: BN1 9PSTelephone: 01273 873232Email: t.chevassut@bsms.ac.uk

Academic Supervisor:Name: Dr Martin LlewelynPosition: Chair Geriatrics and Stroke MedicineReader in Infectious diseases and therapeuticsInstitution: Brighton & Sussex Medical School /

Brighton & Sussex University Hospitals NHS TrustAddress: Audrey Emerton Building Royal Sussex County Hospital Eastern RoadTown: BrightonMedical Research Building University of Sussex FalmerPostcode: BN1 9PS2 5BETelephone: 01273 523361876671Fax: 01273 877889523366Email: m.j.llewelyn@bsms.ac.uk

Partnership Details

Dean of Medical School:Name: Professor Malcolm ReedPosition: Dean Brighton & Sussex Medical SchoolInstitution: Brighton & Sussex Medical SchoolAddress: BSMS Teaching Building

University of SussexFalmer

Town: BrightonPostcode: BN1 9PXTelephone: 01273 877577Email: m.reed@bsms.ac.uk

Postgraduate Dean:

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Name: Professor Graeme Dewhurst Position: DeanInstitution: Kent Surrey & Sussex Postgraduate DeaneryAddress: 7 Bermondsey StTown: LondonPostcode: SE1 2DDTelephone: 020 7415 3402Email: GDewhurst@kssdeanery.ac.uk

Trust Chief Executive:Name: Matthew KershawGillian FairfieldPosition: Chief ExecutiveInstitution: Brighton & Sussex University Hospitals NHS TrustAddress: Chief Executive's Office

Sussex House1 Abbey Road

Town: BrightonPostcode: BN2 1ESTelephone: 01273 696955Email: matthew.kershaw@bsuh.nhs.uk

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1.0 Sussex Coast Training Programme - overview

Training programme director Dr Dan Agranoff (daniel.agranoff@bsuh.nhs.uk)

BSUH Consultants in Microbiology /Infectious Diseases

Microbiology and virology:Dr M Cubbon, Dr M Ibrahim, Dr J. PaulInfectious diseases:Dr D Agranoff, Dr M Llewelyn, Prof M Newport, Dr Sharma. Dr Sargent

Consultants in Microbiology at other training programme sites in Sussex

Chichester:Dr M Greig, Dr S Jerwood;Crawley (and Redhill, Surrey):Dr K Knox, Dr D Lyon, Dr B Stewart;Worthing:Dr J Bates, Dr J Child, Dr J Legg, Dr R SierraFrimley Pk Hospital:Dr D. Garner

HPA regional microbiologist

Dr J Paul (Brighton)

Programme director Dr Dan Agranoff (Consultant in Infectious Diseases, RSCH)

Educational supervisors: Prof. Melanie Newport , Dr Martin Llewelyn , Dr Eli AlexanderMarc Cubbon, Dr Dan Agranoff

The Department of Microbiology and Infection at BSUH NHS Trust is the hub for the South Coast Training Programme in Infectious Diseases and Microbiology and offers joint Infectious Diseases/Medical Microbiology training with trainees rotating through neighbouring laboratories in Chichester, Worthing, Crawley/Redhill and Frimley Pk/Guildford. There are currently 7 specialist training posts in the programme (2 Medical Microbiology/Virology and 5 Joint Medical Microbiology/Virology - Infectious Diseases posts). The trainee will follow the Royal College of Pathologists Curriculum for Specialist Training in Medical Microbiology and Virology (2010), and the Joint Royal Colleges of Physicians Specialty Training Curriculum for Infectious Diseases (2010).

In the joint programme:1. At least two years will be spent acquiring training in laboratory based infections

and health protection (as agreed with the HPA). 2. At least two years of direct patient care on the infectious diseases unit(s) and in related clinical

disciplines.There will be opportunities (depending on interest and availability) to spend additional time in research and to explore aspects of clinical microbiology, virology, public health microbiology and infectious diseases in greater depth (see below under elective options)

Training is organised in two parts:

1. Medical Microbiology at BSUH/rotation to Microbiology services at Chichester or Crawley, Worthing or Frimley Pk/Guildford plus experience at HPA sites

2. Infectious Diseases at BSUH/London

The programme incorporates the following training sites:

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ii. The Royal Sussex County Hospital, Brightoniii. Worthing hospitaliv. St Richard’s Hospital, Chichesterv. East Surrey Hospital, Redhill / Crawley Hospitalvi. Frimley Park Hospital / Royal Surrey Hospital, Guildfordvii. A London-based placement in Infectious Diseases

1.1 Indicative programme outline

Year 1: Medical Microbiology* (complete Part 1 FRCPath at the end of year)

Year 2: Clinical Infectious Diseases in Brighton (+3 months protected research time)

Year 3: Medical Microbiology* (complete Part 2 FRCPath at the end of year) (+ 3 months protected research time)

Year 4: Clinical Infectious Diseases in Brighton/London

Year 5: Infectious Diseases/ Microbiology Clinical Research – as OOPR

Year 6: Flexible year depending on training needs (usually 6 months ID/ 6 months Micro)

* I year of Medical Microbiology training will take place in Brighton and the other year will be at one of the District General Hospitals on the rotation i.e. St Richard’s Hospital (Chichester), Worthing Hospital, Crawley/East Surrey Hospitals (Redhill) or Frimley Pk/Royal Surrey Hospital (Guildford).

During the Microbiology training there may be an opportunity to enrol on the 2 year Medical Microbiology MSc course in London (1 day per week – Tues for pt1, Thurs for pt2)

1.2 Elective options:

Elective rotations may be available by negotiation. Options include: -

Infection Prevention and Control Genito-urinary Medicine Attachment to an established Infectious Disease/Virology unit abroad. Attachment to an HIV unit in Brighton.

1.3 Appraisals, Assessments and Examinations

Progress through the programme will follow the appropriate appraisals, assessments and examinations organised by the RCP, RCPath and Deanery as agreed with PMETB.

1.4 Enrolment with collegeSpecialist trainees are expected to enrol with the RCP at the commencement of joint training. A portfolio and a record of training will be maintained in accordance with the requirements for joint trains as required by the RCPath and RCP.

2.0 Infectious Diseases and Microbiology at Brighton and Sussex University Hospitals NHS Trust (BSUH) – The Royal Sussex County Hospital, Brighton.

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2.1 What we do at BSUH

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. It is the hub of the KSS training programme in ID-MMV. 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 half a million 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.The Department of Infection and Microbiology is based at the Royal Sussex County Hospital, Brighton and provides services across the Trust which comprises the Royal Sussex County Hospital in Brighton and the Princess Royal hospital in Haywards Heath.

2.2 Our Partner Medical School

The school's first 128 students started their five-year course in October 2003 and it has proved an outstanding success, typically receiving more than 15 applications per place and consistently among the most competitive medical schools in the country. Students spend the first two years based mainly at the University campuses at Falmer, but with significant clinical exposure throughout the period, particularly in primary care. During year 3 the main focus is hospital based specialties at the RSCH, while years 4 and 5 are spent obtaining further basic science training and gaining experience in other medical disciplines. Year 5 is mainly based around regional attachments and will provide experience in shadowing house officers. The School aims to teach a research-rich curriculum in which basic and clinical science are prominent. In addition, we have developed an imaginative teaching programme that incorporates new technology (such as the innovative PDA project, MoMED) and the use of imaging alongside anatomy teaching, which has been a particular success. Feedback from the National Student Survey has demonstrated an exceptionally high level of student satisfaction. Close links have been developed with many NHS consultant colleagues and honorary academic titles are conferred for those who have a particular engagement with the School. BSMS is also closely involved with postgraduate education. 

BSMS has produced a new 5 year strategic plan (2009 – 14) that places growing its research capacity as the number one priority. We have made significant investments in research infrastructure, including a world-class Clinical Imaging Sciences Centre (CISC) and a Clinical Investigation & Research Unit (CIRU) dedicated to patient orientated research and early clinical trials. There has been a rapid increase in postgraduate research students and research income has more than doubled over the last five years.

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The research programme of the School is growing rapidly. It is focused around major themes that include neuroscience, oncology, and infection and inflammation. Within these we have particular strengths in elderly care medicine, primary care and epidemiology and in imaging. There is a joint Research Office that handles NHS R&D contracts and strong links between BSMS research faculty and NHS colleagues.

2.3 The Infectious Diseases UnitThe infectious diseases clinical team runs Grant ward, an 11-bedded infectious diseases isolation and cohorting ward andand is directly responsible for inpatient care of between 6-1212-15 patients at any one time. In-patient work comprises a mixture of healthcare associated infection, community acquired and imported infection. In addition the infectious diseases team receives an average of 30 consultation requests per month from other teams. The consultant on duty runs a weekly routine out-patient clinic with the ward specialist registrar and twice weekly Rapid Access clinics for more urgent referrals. The team also delivers an out-patient parenteral antibiotic service (OPAT) to between 25-30 patients at any one time. . A new twice weekly Rapid Access Infectious Diseases clinic has recently been set up, and takes place on Wednesday afternoons and - in parallel with the routine ID clinic - on Friday afternoons.

The Microbiology and Infectious diseases consultants work closely together to provide an integrated Clinical Microbiology and Infection Service, to support teaching of medical students from the Brighton and Sussex Medical School and to support a training programme for joint trainees in Microbiology and Infectious Diseases. We currently have seven trainees rotating through a scheme involving Worthing, Chichester and Surrey and Sussex Hospitals.

New initiatives include plans to develop a Travel Medicine Clinic and an integrated OPAT service.

There are also close links with a busy HIV/GUM service and with the Health Protection Unit based in LewesPublic Health England including a weekly joint clinical meeting.

2.3.1 Consultant infectious diseases staff

Prof Jon Cohen Honorary consultant in Infectious diseases (Dean of BSMS)

Dr Dan Agranoff Consultant in Infectious Diseases and Acute Medicine

Dr Martin Llewelyn Honorary consultant in Infectious diseases (Senior lecturer)

Prof Melanie Newport Honorary consultant in infectious diseases

Dr Catherine Sargent Consultant in Infectious Diseases and Acute Medicine

Dr Sunil Sharma Consultant in Infectious Diseases and Microbiology

2.4 The Microbiology laboratory The laboratory in Brighton is a former Public Health Laboratory which transferred to the NHS in 2003, although it remains a Health Protection Agency (HPA) collaborating laboratory. There is a service level agreement between the Trust and the HPA. The Food, Water and Environmental (FWE) Microbiology services are now under Trust management. The budget holder is the Head BMS for microbiology and the budget manager is the Pathology Services Manager. The overall budget is £6.7 million; income £1.5 million, pay £2.5 million, non-pay £2.7 million. CPA status is conditional accreditation. The laboratory is accredited under the IBMS as a training laboratory for Bacteriology and Virology. The laboratory participates in a comprehensive range of quality control schemes (UKNEQAS). The department provides routine bacteriology and mycology services to Brighton and Sussex University Hospitals (BSUH) NHS Trust and general practices in the Brighton and Hove PCT and the Mid-Sussex PCT catchment areas. In addition virology and food/water/environmental work is undertaken for East and West Sussex, together with the southern part of Surrey. Virology and serology work is undertaken at the Brighton site. The laboratory serves a population of 460,000. Approximately 35% samples come from general practice. The laboratory provides specialist services for neurosciences, paediatrics, cardiac surgery, cancer, renal and HIV medicine. BSUH provides regional services for molecular virology and serology. Other laboratories served with

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specialist tests include Maidstone and Tunbridge Wells, Eastbourne and Hastings, Crawley and Redhill, Worthing, Ashford (Kent), Chichester, East Grinstead and Nuffield Hospitals.

With the future development of managed pathology networks, there may be opportunities to work in other laboratories across Sussex.

Current annual workload figures are as follows:

Bacteriology 250,000Virology/Molecular/Serology 160,000Food/water/environmental 18,000

The laboratory includes a recently commissioned and fully equipped molecular suite. This has allowed the phasing out of tissue culture methods and their replacement by PCR-based tests (e.g. for Herpes simplex) and the introduction of PCR-based tests for other agents such as influenza and cytomegalovirus. A Consultant Virologist has recently been appointed. This is a new post working alongside other clinical members of the service. Equipment includes: Abbott Architect, Diasorin Liaison, Rotagene 3,000, Roche Light-cycler 2.0 and 480, Magnapure Classic and Compact, Abbott M2000 and M2000 RT, BD Viper, Biomerieux BacTalert, BacTalert 3D,Vitek and Menarini Sedimax. Future developments include Abbott HIV protease sequencing, BD Bactec FX, Midgit and Phoenix plus BD Epicentre. The laboratory information management system is Clinisys for Clinical Microbiology and GP Order Comms (Anglia Ice) is being rolled out. There is electronic reporting to wards and general practice. Future links to other Trusts are possible. For food and environmental work we use QSYS LIMS with web-based reporting of results. Kiestra automation is being procured for automation and regionalisation of bacteriology work.

2.4.1 Consultant Medical Microbiology staffDr Marc Cubbon Lead consultant in Microbiology and infection control doctor

Dr Eliza AlexanderDr Sally Curtis Consultant microbiologist and lead for antimicrobial governance

Dr Stephen MephamSunil Sharma Consultant in Microbiology and Infectious Diseases, Lead for the OPAT service

Dr Mohammed Hassan-Ibrahim Consultant virologist

Dr Stephen Mepham Consultant in Microbiology and Infectious Diseases

Dr John Paul Honorary Consultant Microbiologist

2.5 Junior medical staffThe number of posts is as follows:

NTNs 2 Infectious Diseases, 2 MicrobiologyAcademic F2 10.6 WTE (rotating post) - IDF1 trainee 1 - ID

2.6 Infection ControlThe Director of Infection Prevention and Control is Mr Des Holden who is also a consultant obstetrician and Medical DirectorDr Stephen Holmberg, medical director and consultant cardiologist. He is supported by Dr Marc Cubbon, consultant microbiologist and infection control doctor, and Yvette PickfordSuzanne Morris, nurse consultant in infection control. The rest of the infection control team consists of

Senior Infection Control Nurses  2.0 WTEInfection Control Nurses 2.0 WTESurveillance and Audit Nurse 0.9 WTEPersonal Assistant 1.8 WTE

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There are service level agreements to provide support to the infection control teams at several neighbouring non-acute trusts (Southdowns, East Sussex Downs and Weald PCT, Mid Sussex PCT, Brighton and Hove PCT) and there are close links with the local Health Protection Unit in Lewes.  There is wider communication with infection control staff and environmental health officers via the East Sussex, Brighton and Hove Community Health Protection Committee.

2.7 Clinical Service Routine:

The trainee is expected to take part in all aspects of the work of the department.

A timetable of responsibilities will be drawn up to allow for the training requirements of the appointee. Sufficient time will be allocated for personal study and scientific research. Where necessary, the timetable will allow for training at other sites in order that the appointee is able to fulfil College training requirements.

An appropriate timetable of service duties will be drawn up ensuring a balanced exposure to the full range of diagnostic reporting, clinical ward rounds, and Infection Control and Management activities. Fixed timetabling is not in line with current work patterns and does not take into account the flexibility required of a reactive speciality.

2.7.1 Outline work plan (ID):

AM 12pm 1pm PMMonday Microbiology

weekend handoverClinical referrals

Ward/ clinical referrals

Tuesday Consultant ID ward round

C. diff. mtng Teaching medical students

Wednesday

SpR TeachingClinical referrals

Infection radiology meeting

Grand round

Rapid Access ID clinic

Thursday Ward roundFriday Clinical

infection meetingConsultant ward round

ID outpatients clinicRapid Access ID clinic

Saturday Lab/Clinical 1:5

Sunday Lab/Clinical 1:5

2.7.2 Outline work plan (Microbiology)

AM 11am 1pm PMMonday Microbiology

weekend handoverClinical referrals

Haem-Onc MDT

TB MDT (11.45)

Bench roundITU round

Tuesday Renal round ITU round (11.30)

Teaching medical students

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Wednesday

SpR Teaching ITU round (11.30)Infection radiology (12)

Grand round

Bench round

Thursday HIV MDT (9.30)ITU round (11.30)

Paeds MDT (12)

TMBU round

Friday Clinical infection meeting

Renal roundITU round

Bench round

Saturday Lab/Clinical 1:5

Sunday Lab/Clinical 1:5

2.7.3. Clinical on-call commitments:

Once appropriately trained in microbiology, the SpR will be first on call on average 1:5 over the year’s appointment. Calls will be received directly from clinicians or BMS staff. The SpR will be expected to work on-site on weekend daytime when on-call. Consultant cover will be provided.

The work intensity has been calculated at Band 1A, but will be confirmed by diary card within 6 weeks of commencing the post.

2.8 Research

The trainee will have opportunities to follow research interests in Brighton or elsewhere. Current departmental research interests in Brighton include involvement in multicentre studies on Staphylococcus aureus and Clostridium difficile.

2.9 Audit

Specialist trainees are required as part of their training to be able to perform audit projects. A list of audit projects is available for specialist trainees or they may elect to look at a subject of their own choice if approved by their educational supervisor. A monthly research and audit meeting is jheld on the last Wednesday of the month.

2.10 Useful websites BSUHT - http://www.bsuh.nhs.ukUniversity of Brighton - http://www.brighton.ac.ukUniversity of Sussex - http://www.sussex.ac.ukBSMS - http://www.bsms.ac.ukFor further informationabout the City of Brightonand Hove and surroundingarea - http://www.thisisbrighton.co.uk

3. Medical Microbiology at Surrey & Sussex Healthcare NHS Trust (SaSH)East Surrey Hospital, Redhill and Crawley Hospital

3.1 Educational Supervisor:Dr Karen Knox

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01293 600300 x3109 (secretary)Direct line 01293 600300 x3028karen.knox@sash.nhs.uk

The trainee will spend their time divided between laboratory based training at Crawley Hospital and the acute clinical site at East Surrey Hospital in Redhill.

Laboratory base at Crawley HospitalThe Department of Medical Microbiology is sited at Crawley Hospital and is 10-15 minutes walk to the centre of Crawley and rail links. It is approximately 10 miles from East Surrey Hospital in Redhill, the acute hospital site (see below). Crawley Hospital is a community hospital under the domain of West Sussex PCT. The laboratory and its staff remain under SaSH.

Acute Trust Hospital: East Surrey Hospital, RedhillEast Surrey Hospital is sited a short distance south of Redhill town centre and approximately 10 miles from the Crawley hospital laboratory base.

Population, number of beds and specialties:East Surrey Hospital is a 400-bedded acute general hospital and designated trauma centre serving a catchment area of around 400,000 population. It is a very busy hospital with expanding departments in Emergency Medicine, Trauma & Orthopaedics, Cardiology, Paediatrics and Maternity. It has a 10-bedded ICU, 6-bedded HDU, 8-bedded CCU with angiography suite, and a level 2 Neonatal Unit.

East Surrey Hospital provides a wealth of interesting cases for training, including infectious diseases, some of which are admitted by virtue of the hospital’s proximity to Gatwick Airport.

3.2 Induction:The educational supervisor will be responsible for initial induction of the trainee, introducing him/her to departmental arrangements and staff.

The StR is expected to attend the Trust’s Induction programme which consists of a whole day.

Departmental induction will include a session with the OMM or Chief BMS and covers Laboratory orientation and health & safety.

3.3 University links:

East Surrey Hospital is recognised for undergraduate teaching by the new medical school at the University of Brighton.

3.5 Pathology departments:

The Medical Microbiology laboratory was refurbished in 2005 as part of the reconfiguration of acute services within SaSH NHS Trust. It remains the single Pathology discipline sited off the acute East Surrey hospital site at Crawley Hospital. There is StR office space at both the Crawley and East Surrey Hospital sites.

Accreditation status:The Microbiology department currently holds conditional CPA(UK) Accreditation.

3.5.1 PERSONNELThe Department has a very friendly atmosphere and encourages team-working.

Senior Medical Staff:

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Dr Bruce Stewart, Consultant Medical Microbiologist (CMM), Clinical Support Services Director and Laboratory LeadDr Donald Lyon, CMM and Antibiotic LeadDr Karen Knox, CMM and Lead Infection Control Doctor

Infection Prevention and Control and Antibiotic Stewardship Team (IPCAS team - based at East Surrey Hospital):

Ashley Flores, Lead Infection Prevention and Control Nurse (IPCN) and Deputy DIPCRuth Bradburn, Senior IPCNSuzanne Rapley, IPCNJill Clarke, Infection Control Practice Development and IV line NurseColin Pink, Infection Control Programme ManagerAmy Lee, Antibiotic Pharmacist

Senior Laboratory Staff:Mr Michael Rayment, Pathology Services Manager (PSM)Mr Peter Webber, Operational Manager for Microbiology (OMM)Mrs Rosalind Phipps, Lead Biomedical Scientist (BMS)

The laboratory staff further consists of 5 Senior BMS, 15 BMS, 1 trainee BMS, 10 MLAs, 1 A&C.

Administrative Staff:2 WTE senior medical secretaries (Mrs Janis Trim and Ms Lucy Gritton)

3.6 Departmental workload:The Microbiology Laboratory is fully computerised (Isoft APEX Laboratory Information Management System) and provides a comprehensive service covering all aspects of general microbiology to the acute Trust Hospital and community hospitals and GPs in the east Surrey and northern patch of West Sussex.

The Department processes approximately 200,000 samples per annum, split roughly 50:50 between the Trust and direct access (GP work).

The work of the laboratory comprises a full range of general microbiology including mycology, mycobacterial detection, parasitology and basic serology. A programme of introduction of technology and automation has continued since 2004 which has seen the establishment of BD ProbeTec for Chlamydia PCR, Bactec MGIT for liquid TB culture, Norovirus molecular detection platform and IL-Sprint for automated urine microscopy. The serology platform has recently been replaced with a random access system (Abbott Architect). Further planned developments include the introduction of automated organism ID/susceptibility testing (e.g. Vitek, Phoenix).

The Infection Control service encompasses Surrey and West Sussex PCT but the community premises (GP practices, nursing homes and community hospitals) are primarily covered by the local PCT employed IPCNs the hospital IPCAS team have good communication.

3.7 Meetings:Senior Management Meeting (monthly): OMM, CMMs and PSMSenior BMS Meeting (monthly): OMM and senior BMS staffLaboratory Staff meetings (monthly): OMM, CMMs and all laboratory staffLaboratory educational meetings – as announcedIPCAS team meeting (bimonthly)Infection Control Taskforce meetings biweeklyMedical Grand Round at PGMEC East Surrey Hospital weekly

3.8 Liaison with major clinical units: ITU MDT meetings (ESH) on Monday and Thursday mornings. Daily telephonic communication is

expected as a minimum outside of this. Attendance on wards Monday and Thursday afternoons as clinically indicated by significant cultures or

as part of a consult service. Paediatric Grand Round Tuesday afternoon – opportunity to attend. Close working relationship with all clinical specialties is expected. Close working relationship with CCDC and Community Infection Control teams.

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There are opportunities to develop enhanced links with other departments e.g. GUM, Orthopaedics, SCBU.

3.9 Accommodation:At Crawley Hospital the trainee has a dedicated office with a PC, desk, filing cabinet and telephone. This is situated adjacent to the laboratory. At East Surrey Hospital the trainee has a desk space with PC access telephone within the shared clinical office.Laboratory facilities can be allocated as required for project or other work (examination preparation).

3.10 Educational arrangements

3.10.1Training agreement:The Educational Supervisor will discuss and agree a training programme with the StR within the first week of commencing the appointment. The training agreement and objectives will be reviewed and revised.

3.10.2 Appraisals:Protected time will be set aside on a 3 monthly basis for formal documented appraisal of the StR by the Educational Supervisor. There is ample opportunity for non-formal discussion outside of these times.

3.10.3 Postgraduate educational facilities:

The post-holder will have access to the Trust’s Post-graduate Medical Centre, with a lecture theatre and modern audiovisual equipment at East Surrey Hospital. A Medical Grand Round is held on Thursday lunchtimes.

Library facilities:There is a library on each of the hospital sites, which host a range of English, European and American postgraduate journals and textbooks. The post-holder will have their own office at Crawley Hospital and a shared office at East Surrey Hospital with access to a computer and the Internet.

IT Facilities:The trainee has access to a PC at both sites (dedicated PC at Crawley site; shared PC at East Surrey site). All PCs are connected to the hospital mainframe and provide full email facilities, access to the Trust intranet and to the internet (www) and library search facilities. They are also linked to the laboratory reporting system, hospital PAS (Cerner) and radiology system.

3.10.4 Timetable of Educational events:The StR may, if appropriate to level of training, attend an MSc course on a protected day release basis at the Royal London hospital depending upon level of training.The StR is encouraged to attend the Medical Grand Round at East Surrey Hospital on Thursday lunchtime.There is opportunity for the StR to attend the Friday morning ID/Micro clinical meeting at the Royal Sussex Hospital (Brighton).

3.11 Principal service responsibilitiesClinical Service Routine:

The trainee is expected to take part in all aspects of the work of the department appropriate to their level of training and experience.

Depending on experience previously gained, the post-holder will undertake dedicated time on a bench rotation before participating fully, as directed by the CMMs, in all aspects of diagnostic and clinical microbiology. This includes responsibilities in: laboratory supervision; the verification, interpretation and

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authorisation of microbiology results; the clinical management of patients with infectious diseases including telephone advice, ward review of patients and participation in multi-disciplinary team meetings; and infection prevention and control work. These services support the acute clinical services based at East Surrey Hospital as well as being provided to the community hospitals and GPs (some 50 practices) of West Sussex and Surrey PCTs.

The post-holder will be expected to carry out these clinical duties as part of a team with the three Consultant Medical Microbiologists who work a one-week-in-three clinical duty roster. The post-holder will also be expected to participate in audit, governance, educational and research activities as a key member of the department. In addition, the post-holder will be expected to maintain a log book of cases in which s/he has been directly involved.

Clinical on-call commitmentsCurrently, once appropriately trained, the post-holder will undertake non-residential out-of-hours on-call duties on a rotational basis, including weekend working (average 1:7). There is always an on-call Consultant timetabled to provide support. The on-call service is to provide clinical microbiology and infection control advice to the on-call teams within the Trust (and very occasionally to the community services). There is always an on-call BMS to provide the technical service. The work intensity has been calculated at Band 1B which will require diary card confirmation during the year.

Teaching responsibilities:Where the opportunity arises, the post holder will be encouraged to participate in undergraduate teaching and the training of nurses, BMS and junior medical staff as appropriate.

3.12 Research possibilities:StRs will be encouraged to pursue research into areas of interest and will be supported in work required for an MSc, MRCPath or MD if appropriate. If the necessary facilities or specialist support and supervision is not available on site, time will be allocated to enable this to be sought elsewhere.

3.13 Clinical audit:The Trust has an active audit department available to help in design and analysis of individual audits. The StR will participate in local and regional audits and is encouraged to design and run audits projects according to his/her own interest.There is a regular programme of antibiotic audits supported by an antibiotic pharmacist.

3.14 Management training:According to stage of training, the StR will be exposed to laboratory management through discussion and tutorials with the CMMs and is encouraged to attend laboratory and other appropriate Trust meetings.

4. Medical Microbiology at St Richard’s Hospital, Chichester

4.1 Educational Supervisor:Dr Susan Jerwood01243 831631 or ext 3547Susie.Jerwood@wsht.nhs.uk

4.2 SettingSt Richard’s Hospital is a busy DGH where trainees will get a good grounding in practical microbiology. All trainees will spend time on the benches, the length of time depends on previous experience. There are daily ward rounds in ITU, for bacteraemias and hot cases. There is a weekly medical grand round which trainees are encouraged to attend, and can present if they wish. Day to day activities will be tailored to the stage of training, for example prior to exams more time can be spent in the laboratory or towards the end of training more time can be spent on managerial tasks. All trainees will be actively encouraged to take part in departmental audits and time off clinical work is set aside for these and other training activities.

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4.3 StaffingAt consultant level there are 2 microbiologists at St Richard’s (Dr Jerwood and Dr Greig).  The trainee usually works a standard 9am-5pm working day.

4.4 EducationTrainees participate in a programme of training days currently organised by the London deanery.  Tutorials and seminars are arranged on a regular basis at the different centres and trainees are also welcome to attend the Friday meetings in Brighton when not on clinical cover.  Most MMV trainees have undertaken an MSc in Microbiology and trainees are encouraged to submit abstracts and attend MMV/ID meetings such as the Federation of Infection Societies annual meeting.

4.5 On-callSpRs contribute to a microbiology on call rota on a 1:5 basis with consultant cover. On-call is off site, though the on-call person needs to go into the laboratory on Saturdays and bank holidays (approximately 10am-4pm) to deal with authorising, new blood culture results and any other matters that cannot wait.5. Medical Microbiology at Worthing Hospital

5.1 Educational Supervisor:Dr Jo Legg01903 285088Joanne.Legg2@wsht.nhs.uk

5.2 SettingWorthing Hospital is a large district general hospital covering a population of approx. 250,000. The hospital provides a range of core services with a renal dialysis unit, large interventional Cardiology unit, a 6 bed ITU / 6 bed HDU, and a 30 bed Medical admissions ward. It is a busy hospital with a high proportion of elderly patients. Worthing and St Richard’s Hospitals (Chichester) have recently merged as a Trust (Western Sussex Hospitals NHS Trust) and services are currently undergoing reconfiguration across the 2 sites. The hospital is a recognised undergraduate teaching site for Brighton Medical School and Guys/Kings/Thomas’s Medical School.

5.3 StaffingThere are 3 Consultant Microbiologists at Worthing: Dr’s Legg, Bates and Child, and one Specialist Trainee. The Infection control team comprises 1 Nurse Consultant and 3 Infection Control Nurses. The department is also supported by a full time Antimicrobial Pharmacist.

5.4 Microbiology LaboratoryWorthing Hospital has a large modern Microbiology Laboratory which has full CPA accreditation. It is provides a comprehensive service to the hospital and GP’s in the Worthing area. The work of the department comprises a full range of general microbiology, including mycology, parasitology, and basic viral serology. A fuller virology service is purchased from Brighton, and TB work provided by St Richard’s Hospital.

5.5 Clinical Microbiology ServiceThe Microbiology team provide a very clinically focussed service to the hospital and to the local community. There is a daily laboratory bench round followed by a clinical ward round to review patients on ITU and any patient with a bacteraemia or other significant infection. In addition, a member of the team undertakes regular orthopaedic ward rounds and attends a weekly Diabetic foot MDT.

5.6 Microbiology TrainingThis depends on the previous experience of the trainee. For new trainees a period of 2-3 months is spent in the laboratory, followed by training in the clinical authorisation of results. The trainee then takes part in clinical ward rounds, and provides clinical microbiology advice to the hospital and GP’s with consultant supervision. For those trainees in later stages of training, in addition to clinical consults, experience in

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management roles are organised including infection control and outbreak management, antimicrobial stewardship, and laboratory management.Trainees are expected to participate in audit projects and are given protected time to complete these, and other research projects if appropriate.

5.7 EducationTrainees participate in a programme of training days currently organised by the London deanery.  Most trainees attend the 2 year MSc in Medical Microbiology in London (1 day/ week day release) and also attend the Friday morning Clinical Infection meetings in Brighton. Trainees are also encouraged to attend and or present at national meetings such Federation of Infection Societies and British Infection Association.

5.8 On-callTrainees take part in a 1 in 5 on call rota with consultant cover. Weekend cover includes on site authorisation and clinical ward round on a Saturday.

6. Medical Microbiology at Frimley Park Hospital and The Royal Surrey County Hospital

6.1 Educational Supervisor:Dr David Garner01276 423501david.garner@fph-tr.nhs.uk

6.2 SettingFrimley Park Hospital NHS Foundation Trust is a major general hospital located in Surrey, close to the Hampshire and east Berkshire borders. It provides a full range of district general hospital services for the population of north east Hampshire, west Surrey and east Berkshire with a catchment population of approximately 400,000. The Royal Surrey County Hospital NHS Foundation Trust NHS Foundation Trust is a leading modern general hospital and specialist centre for cancer services and treatment, based in Guildford. The RSCH serves a population of 320,000 for emergency and general hospital services, mainly from West Surrey, East Hampshire and North Sussex and 1.2 million people for cancer services.

6.3 StaffingThere are 3.6 Consultant Microbiologists at Frimley Park Hospital and 2 Consultant Microbiologists at the Royal Surrey County Hospital, who form part of a single department serving both acute Trusts. The two Trusts have their own Infection Control Teams and Antimicrobial Pharmacists.

6.4 Microbiology LaboratoryFrimley Park Hospital has a cutting edge, modern Microbiology Laboratory including Kiestra, MaldiTOF and automated urinalysis. It has full CPA accreditation. It is provides a comprehensive service to both Frimley Park and Royal Surrey County hospitals and GP’s in the Surrey, Hampshire and East Berkshire areas. The work of the department comprises a full range of general microbiology, mycology and parasitology, as well as a specialist virology service. The current laboratory workload is in excess of 600,000 specimens per annum.

6.5 Clinical Microbiology ServiceThe Microbiology team provide a clinically focussed service to the both hospitals and to the local community. There is a daily laboratory bench round followed by a clinical ward round to review patients on ITU and any patient with a bacteraemia or other significant infection. In addition, a member of the team undertakes regular orthopaedic ward rounds and attends a weekly Haematology MDT.

6.6 Microbiology Training

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This would depend on the previous experience of the trainee. For new trainees a period of 3 months is spent in the laboratory. The trainee would then be expected to participate in the provision of the clinical microbiology service to both hospitals and GPs including oncall, whilst under the supervision of one of the Consultant Microbiologists. In addition the trainee will be given experience in management roles such as network laboratory management, infection control and antimicrobial stewardship. Trainees will also be expected to participate in clinical audit and teaching of junior medical staff and laboratory staff.

6.7 EducationTrainees participate in a programme of training days currently organised by the London deanery.  Most trainees attend the 2 year MSc in Medical Microbiology in London (1 day/ week day release). Trainees are also encouraged to attend and or present at national meetings such Federation of Infection Societies and British Infection Association.

6.8 On-callTrainees take part in a 1 in 5 on call rota with consultant cover. Weekend cover includes on site authorisation on Saturday with the potential for off site authorisation on Sunday.

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