OXFORD DEANERY SPECIALTY TRAINING PROGRAMME

IN CHEMICAL PATHOLOGY

About Oxford Deanery

The Oxford Deanery covers the counties of Oxfordshire, Berkshire and

Buckinghamshire, with Banbury and Milton Keynes in the North, to Reading and
Slough in Berkshire and High Wycombe and Aylesbury in the West.

The Oxford Deanery is part of NHS South of England which comprises South
Central, South West and South East Coast Strategic Health Authorities. The Oxford
Deanery is responsible for the training of some 1500 trainees.

The Oxford Deanery is a relatively small deanery with a defined geographical area
which serves as a single unit of application.

The Chemical Pathology Training Programme

The Chemical Pathology training programme is a 5-year programme, starting at St1.

During this time, the trainee's work will be monitored for satisfactory progress and
subject to annual reviews in the form of ARCPs. Progression on the programme will
be dependent upon these reviews.

The posts on this rotation have been approved for Specialist Training by the Royal
College of Pathologists. The posts attract National Training Numbers and provide
training towards a Certificate of Completion of Training (CCT).

The Postgraduate Dean has confirmed that this post has the necessary educational
and staffing approvals.

The programme is based in the Oxford University Hospitals Trust, and will include
clinical duties in any of the four hospitals in this Trust (the John Radcliffe Hospital,
the Churchill Hospital, the Nuffield Orthopaedic Centre, and the Horton General
Hospital in Banbury. In general, trainees will be based in the Department of Clinical
Biochemistry in the John Radcliffe Hospital, but may be asked to attend
Trust Information

The Department provides an analytical and consultative service to clinicians in

general practice, hospitals and specialist units within Oxfordshire, and specialist
services over a wider area. The catchment population is approximately 800,000.
The throughput (patients per bed per year) of the hospitals in Oxfordshire is amongst
the highest in the country. Because teaching and general hospitals are combined a
very wide range of medical problems is covered. The group has many specialist
departments, many of world-wide reputation.

The main group of teaching hospitals is based in Oxford. These hospitals are: the
John Radcliffe (JR, 643 beds), the Churchill Hospital (383 beds), the Nuffield
Orthopaedic Centre (NOC, 196 beds), the Littlemore Hospital (371 beds), the
Warneford Hospital (104 beds). The JR, Churchill and NOC are part of the Oxford
University Hospitals Trust, and the Littlemore and Warneford Hospitals are part of the
Oxfordshire Mental Health NHS Trust. Horton General Hospital in Banbury is part of
the Oxford University Hospitals Trust and is a District General Hospital with 220
beds.

The JR is the main acute hospital in Oxford, and has general medicine and surgery,
maternity, paediatrics (in the Childrens Hospital), and specialties such as
ophthalmology, neurology and neurosurgery (in the West Wing), whilst the Churchill
Hospital has many specialist units such as oncology, clinical haematology, chest
medicine, haemophilia, dermatology, and endocrinology and diabetes. The
Littlemore and Warneford Hospitals form the main centres of the psychiatric service.
There are also eleven major country towns with Community Hospitals. Many of the
Regional Specialties are provided within the Oxford hospitals.

The Clinical Biochemistry Department has laboratories on three sites (JR, Churchill,
Horton Hospital), receives approximately 7,000,000 requests per year and performs
approximately 6 million tests per year. It offers a regional service for endocrinology,
for antenatal screening for neural tube defects and Down syndrome, and for
neonatal screening for PKU, congenital hypothyroidism and MCADD.

The laboratory at the John Radcliffe Hospital provides routine and emergency
services together with the postgraduate teaching and research laboratories of the
Department. Dr Brian Shine and Professor Jonathan Kay, Consultant Chemical
Pathologists are based here. The Biochemistry Laboratory suite occupies 1,110
square metres. A new laboratory combining Haematology and Biochemistry operates
from 8:30 to 18:00 on weekdays at the Churchill Hospital. The laboratory at the
Horton Hospital provides routine and emergency services.

NHS staffing consists of two whole time equivalent Consultant Chemical

Pathologists, 3 Specialist Trainees, 1 Academic Clinical Lecturer, 1 Foundation Year
2 doctor, one Consultant Scientist, one Biochemist, one Principal BMS, four Chief
BMSs, seven senior BMSs, 27 BMSs, Junior BMSs, and administration, clerical and
secretarial staff.
The JR laboratory is currently divided into four analytical sections, each under the
day-to-day control of a head of section; two other heads of section are responsible
for training and information management.

Analytical equipment includes a Siemens track system with 3 Centaurs and 3 Advia
2400 instruments at the JR, 1 Advia 2400 at the Churchill, and 2 Advia 2400s and 1
Centaur at the Horton Hospital, 1 DPC Immulite 2000, and an AutoDelfia
immunoassay system. Other equipment includes a Konelab 30, 2 Waters HPLC
systems, and three Tandem Mass Spectrometry systems.

Analytical techniques currently available include electrophoresis, spectrophotometry,

ELISA, thin layer chromatography, HPLC, and mass spectrometry.

The Laboratory is CPA accredited. The laboratory at the JR is open 24 hours a day.
It is staffed by a medical graduate or scientist from 0830h to 2100h during the
working week and 0830h to 1300h on Saturday. The laboratory at the Horton
Hospital is open 24 hours a day. The Churchill laboratory is open from 0830h to
1900h on weekdays.

The laboratory data-handling is fully computerised, except for the neonatal screening
laboratory. The system is written in M and operates on a Hewlett-Packard
minicomputer. Other computing facilities include many networked microcomputers
used for analyser control, and personal computers for data analysis, word
processing, statistics and graphics.

Scientific meetings within the department include a Journal Club, a clinical meeting,
and an analytical and quality assurance review (all weekly). medical staff also runs a
series of case presentations for all laboratory staff. Many departments of the
hospitals run scientific meetings, which our staff may attend. There is a weekly
Grand Round during term time.

Formal clinicopathological conferences are held to review hepatology, endocrinology,

paediatric neurology, paediatric endocrinology, and general paediatrics. The medical
staff in Clinical Biochemistry is responsible for preparing cases for these conferences
in addition to the staff rounds that all clinical departments hold.

The department is recognised by the Royal College of Pathologists for higher

specialist training in Chemical Pathology and Metabolic Medicine with Chemical
Pathology.

The department provides a programme for the training of Medical Laboratory

Scientific Officers and graduate and scientific staff.

Recent R & D interests include:

Point of Care Testing and data networking.
Effects of external pressure on skin metabolism. Biochemical markers of viability in
isolated perfused xenotransplants.

Biochemical assessment of liver viability during experimental liver transplantation.

Improved methods for evaluating early deterioration of renal function in patients with
diabetes mellitus

Biochemical aspects of chronic wound healing with particular focus on oxidative

stress in chronic venous ulceration

Modelling of decision analysis for diagnostic tests

Defining reference ranges using mathematical models

Comparison of plasma and urine metanephrine levels in patients with suspected

phaeochromocytoma

Comparison of plasma and urine 5-HIAA levels in patients with suspected and known
carcinoid tumours

University Department: Nuffield Department of Clinical Laboratory Sciences.

Research:
The Nuffield Department of Clinical Laboratory Sciences brings together all of the
clinical laboratory based disciplines within the Oxford Medical School (Microbiology,
Genetics, Cellular Pathology, Haematology and Clinical Biochemistry). The Nuffield
Departments date from Lord Nuffield's original benefaction to the Oxford Medical
School in 1938. The Head of Department is Professor Kevin Gatter.

As well as the teaching of Undergraduate and Clinical Medical Student courses, the
Department has an active research programme, holding more than 2.2m per
annum (11m in total) of research grants from Research Councils and charities. It
was rated 5 in the most recent HEFCE research assessment.

Currently there are active research teams in areas including the resistance of
tumours to chemotherapy, the genetic basis of mental retardation, gene therapy for
cystic fibrosis, microbial genetics, genetics of skull and limb malformations, the
biology of stem cells, myelodysplasia and myeloid leukaemia, tumour angiogenesis,
immunodiagnostics and malaria.

Research groups

Blood Research Group

Principal Investigator: Prof. D. Roberts

Cerebral Malaria Research

Principal Investigator: Dr. Isabelle M. Medana

Clinical Genetics Group

Principal Investigator: Prof. Andrew O.M. Wilkie

CRUK Tumour Pathology Group

Principal Investigators: Prof. Kevin C. Gatter, Dr. Francesco Pezzella and Dr.
Stephen B. Fox

Gene Medicine Research Group

Co-Directors: Dr. Deborah R. Gill and Dr. Stephen Hyde

LRF Molecular Haematology Unit

Directors: Prof. Jim Wainscoat and Dr. Jackie Boultwood

Molecular Genetics Research Group

Principal Investigator: Dr. Richard J Gibbons

Oxford Multidrug Resistance Group

Principal Investigator: Dr. Richard Callaghan

Staphylococcal Resistance group

Principal Investigators: Dr. Derrick W.M. Crook and Dr. Nicola Jones

Stem Cell Research Group

Principal Investigator: Dr. S. Watt

Ultrastructural Morphology Group

Principal Investigator: Prof. David J.P. Ferguson

The Oxford Medical Informatics group is based in the NHS Department of Clinical
Biochemistry and is involved in a number of research projects including: decision
support, communications, data management, electronic data exchange and
messaging.

Research opportunities exist within other research groups, including that run by
Professor R.V. Thakker in the Nuffield Department of Medicine. This group carries
out research into the molecular basis of endocrine and metabolic conditions, such as
parathyroid disorders affecting calcium metabolism.

There are also links with the Institute of Molecular Medicine, Oxford Centre for
Diabetes, Endocrinology and Metabolism, and the Botnar Research Centre, Oxford
University Institute of Musculoskeletal Sciences. There is, therefore, an active
programme of seminars and research visitors.

For further details about ongoing research:

http://www.ndcls.ox.ac.uk/research.php

Duties of Post

a) Laboratory Responsibilities:
Duties as appropriate to the grade of the post under the direction of the consultants
responsible including:

Supervision of the clinical biochemistry service. Duty Chemical Pathologist

approximately 4-5 sessions per week*, including evenings until 2100h.

Supervision of and participation in biochemical analysis of specimens and

interpretation of results for the Oxford and Banbury Hospitals and surrounding
general practitioners. Provision of services in endocrinology and trace metals,
paediatric investigations and less common determinations for other hospital
laboratories in the Region.

Attendance at the Departmental Clinical Meeting on Wednesday mornings.

Attendance by agreement at the Departmental Quality Assurance Meeting on

Thursdays.

Attendance on a rota basis of one Specialist Trainee at the Departmental Business

Meeting on Thursdays.

Other commitments, by arrangement tailored to an individuals training requirements,

to make up the 40 core hours

Training in analytical sections. Routine analytical work.

Secondment possibilities include: District General Hospitals (including Horton

General Hospital); Postgraduate Teaching Hospitals, if possible, for training in
specialist aspects of Chemical Pathology particularly Paediatric Chemical Pathology
and possibly Toxicology; Department of Immunology in Oxford.

Attendance at relevant Scientific and Medical meetings inside and outside the
Hospital including the possibility of structured courses, such as day release MSc
courses where relevant as can be arranged to fit in with training and service needs.

Writing of reports and letters as appropriate.

On-call shift

The Laboratory is open 24 hours a day. A shift system of Medical Laboratory

Scientific Officers carries out the major part of the on-call analytical work. There is a
duty rota of Chemical Pathologists or Clinical Scientists on site from 0830h to 2100h,
Monday to Friday and 0830h to 1300h on Saturday. Outside these times and on
Bank Holidays, a rota of trainee medical staff provides a non resident on call service.
This may require coming into the hospital to carry out consultative and analytical
work. Consultant cover is provided.

Compensatory Time should be taken off in lieu of extra time worked as a result of the
daytime duty rota so that the number of core hours is not exceeded. The number of
hours worked should be recorded. Staff should try not to accumulate Compensatory
Time.
b) Clinical Responsibilities

Attendance at Diabetes, Endocrinology (general, specialised), Lipid, Osteoporosis or

other appropriate Outpatient clinics in accordance with training and service needs;
minimum one session per week, maximum two per week

c) Teaching Responsibilities

Lectures to clinical, pre-clinical and science students.

Training of Biomedical Scientists.

Teaching biomedical scientists, scientific and medical colleagues and medical

students of Oxford University.

d) Participation in clinical audit

You will be expected to participate in the audit programme of the Department.

E.g. Clinical, teaching, audit/research, administration

Main Conditions of Service

Appointments to this programme are subject to the Terms and Conditions of Service
(TCS) for Hospital Medical and Dental Staff (England and Wales). In addition
appointments are subject to:
Applicants having the right to work and be a doctor or dentist in training in the
UK
Registration with the General Medical Council
Pre-employment checks carried out by the Trust HR department in line with
the NHS employment check standards, including CRB checks and
occupational health clearance.

The employing Trusts offer of employment is expected to be on the following

nationally agreed terms:

Hours The working hours for junior doctors in training are now 48-hours (or 52-
hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors
in training also have an individual right to opt-out if they choose to do so, but they
cannot opt-out of rest break or leave requirements. However, the contracts for
doctors in training make clear that overall hours must not exceed 56 hours in a
week (New Deal Contract requirements) across all their employments and any
locum work they do.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/EWT
D/Pages/EWTD.aspx
Pay you should be paid monthly at the rates set out in the national terms and
conditions of service for hospital medical and dental staff and doctors in public health
medicine and the community health service (England and Wales), the TCS, as
amended from time to time. The payscales are reviewed annually. Current rates of
pay may be viewed at http://www.nhsemployers.org/PayAndContracts/Pay
%20circulars/Pages/PayCircularsMedicalandDental.aspx Part time posts will be paid
pro-rata

Pay supplement depending upon the working pattern and hours of duty you are
contracted to undertake by the employer you should be paid a monthly additional
pay supplement at the rates set out in paragraph 22 of the TCS. The current
payscales may be viewed at http://www.nhsemployers.org/PayAndContracts/Pay
%20circulars/Pages/PayCircularsMedicalandDental.aspx . The pay supplement is
not reckonable for NHS pension purposes. The pay supplement will be determined
by the employer and should be made clear in their offer of employment and subject
to monitoring.

Pension you will be entitled to join or continue as a member of the NHS Pension
Scheme, subject to its terms and rules, which may be amended from time to time. If
you leave the programme for out of programme experience you may have a gap in
your pension contributions. More information can be found at
http://www.nhsbsa.nhs.uk/pensions

Annual Leave your entitlement to annual leave will be five or six weeks per annum
depending on your previous service/incremental point, as set out in paragraphs 205-
206 of the TCS. The TCS may be viewed at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx

Sick pay entitlements are outlined in paragraph 225 of the TCS.

Notice you will be required to give your employer and entitled to receive from them
notice in accordance with paragraphs 195-196 of the TCS.

Study Leave the employer is expected to offer study leave in accordance with
paragraphs 250-254 of the TCS. Local policy and procedure will be explained at
induction.

Travel Expenses the employer is expected to offer travel expenses in accordance

with paragraphs 277-308 of the TCS for journeys incurred in performing your duties.
Local policy and procedure should be explained at induction.

Subsistence expenses the employer is expected to offer subsistence expenses in

accordance with paragraph 311 of the TCS. Local policy and procedure should be
explained at induction.

Relocation expenses the employer will have a local policy for relocation expenses
based on paragraphs 314 315 of the TCS and national guidance at
http://www.nhsemployers.org/PAYANDCONTRACTS/JUNIORDOCTORSDENTISTS
GPREG/Pages/DoctorsInTraining-JuniorDoctorsTermsAndConditions150908.aspx.
You are advised to check eligibility and confirm any entitlement with the employer
before incurring any expenditure.

Pre-employment checks all NHS employers are required to undertake pre-

employment checks. The employer will confirm their local arrangements, which are
expected to be in line with national guidance at
http://www.nhsemployers.org/RecruitmentAndRetention/Employment-
checks/Pages/Employment-checks.aspx

Professional registration it will be a requirement of employment that you have

professional registration with the GMC/GDC for the duration of your employment.
Though the post is covered by NHS Indemnity, you are strongly advised to register
with the MPS for professional indemnity.

Health and Safety all employers have a duty to protect their workers from harm.
You should be advised by the employer of local policies and procedures intended to
protect your health and safety and expected to comply with these.
Disciplinary and grievance procedures the employer will have local policies and
procedures for dealing with any disciplinary concerns or grievances you may have.
They should advise you how to access these, not later than eight weeks after
commencement of employment.

Educational Supervisor the employer or a nominated deputy (usually the Director

of Medical Education) will confirm your supervisor on commencement.

General information on the Deanerys management of Specialty Training

programmes, including issues such as taking time out of programme and dealing
with concerns or complaints, is available at www.oxforddeanery.nhs.uk and in the
national Gold guide to Specialty Training at http://www.mmc.nhs.uk Please ensure
that you inform Oxford Deanery of any changes to your contact details.

December 2011