Title of post - South West Peninsula Deanery

CHEMICAL PATHOLOGY
TRAINING PROGRAMME
Peninsula SpR RMA 11

Title of post
Specialty Registrar
Plymouth and Royal Cornwall Hospitals NHS Hospitals Trusts
Name of Specialty
Chemical Pathology with Metabolic Medicine
Location and Population
Derriford Hospital is situated in the north of the city of Plymouth and provides most acute
healthcare for 450,000 people and tertiary services for a population of up to 2 million. The Royal
Cornwall Hospital is located in Truro and serves just under the 500,000 population of Cornwall.
It represents all major specialities including cardiology, nephrology, neonatal, and
gastroenterology including bariatric surgery.
Devon and Cornwall are beautiful counties with outstanding coastlines and offers a good quality of
life with plenty of opportunities for outdoor activities including sailing, surfing, walking and golf.
There are many excellent local schools and good road, rail and air links to the rest of the country.
Housing is cheaper than many areas in the country with city, rural and seaside properties to
choose from.
Numbers of beds and specialties
Derriford is a large hospital with 1,164 beds and over 6,000 staff. The hospital deals with over
270,000 outpatients, 63,000 inpatients and 86,000 accident and emergency attendances per year.
Most major specialties are provided including haematology and bone-marrow transplantation,
immunology, nephrology and renal transplantation, neurosurgery and cardiology including
interventional cardiology and cardiothoracic surgery. The hospital also provides medical support to
the British Antarctic Survey.
Royal Cornwall Hospital has 800 beds and 500 staff. It represents all major specialties including
cardiology, nephrology, neonatology, gastroenterology and bariatric surgery.
University Links
Both hospitals are campuses for the Peninsula Medical School.
Postgraduate Education Facilities
There is a Postgraduate Medical Centre on both hospital sites where weekly Grand Rounds,
internal clinical audits and external meetings and seminars are held.
Library facilities
The hospitals have medical libraries with on-line access to common journals. The departments
have a range of standard clinical biochemical textbooks and small journal collections.
Pathology Departments
Royal Cornwall Hospital
The laboratory is well equipped with Roche Modular chemistry/Immunoassay analysers and a
pre/post-analytical systems. Other major equipment includes HPLC and GC-MS. The department
provides a wide range of assays including Down’s screening.
Derriford Hospital
Other pathology departments within the hospital include haematology and immunology sharing an
integrated laboratory with biochemistry (Derriford Combined Laboratory (DCL). Microbiology and
histopathology are situated on the floors below
Peninsula SpR RMA 11

Personnel
Consultant Chemical Pathologists
Dr Ruth Ayling
Dr Hannah Delaney
StR
This post
Clinical Scientists
Grade 8b Dr Jinny Jeffery
Grade 8b currently vacant
Grade 7 Ms Vicky Clough
Graduate Trainee Ms Francesca Mills
Biomedical Scientists
BMS 8a 2
BMS 7 7
BMS 6 8.5
Trainee BMS 3
SATO 1
ATO 2
Managerial Staff
Mr Richard Miles Directorate Manager
Mr Simeon green Pathology Manager
Mr Simeon Green Operations Manage
Departmental Workload
DCL provides biochemistry, haematology, immunology, molecular biology and cell culture. The
workload is >550,000 requests/year of which >450,000 are chemistry with 40% of workload from
GPs.
Automated section
The automated laboratory is equipped with a Roche Modular System, for general biochemistry,
routine endocrinology, trooping, haematinics, tumour markers and therapeutic drugs and a DPC
Immulite for specialised endocrine tests. There are also two Menarini HA 8150 for HbA1c
measurement
Special Investigation section
The special investigation section carries out trace metal analysis on a Unicam Solar atomic
absorption system and has a Unicam uv/vis spectrophotometer for manual tests. There is a
Waters LC-MS/MS for measurement of immunosuppressant drugs, vitamin D and drugs of abuse
identification and a Hewlett Packard HPLC system.
The department is computerised using an Apex laboratory system with electronic links to wards
and GP surgeries.
Management arrangements
Clinical Biochemistry is part of Derriford Combined Laboratory (DCL) with Haematology,
Immunology and Molecular Biology. DCL together with Microbiology and Histopathology form the
Pathology Directorate. Dr Ade Oriowolo, Consultant Histopathologist, is Clinical Director.
Departmental meetings are held monthly for senior staff. The Clinical Biochemistry meets
regularly to discuss specialty specific issues.
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Liaison with major units
Review meetings are held weekly with the department of endocrinology and medical and scientific
staff participate in a journal club within the department of medicine.
Tertiary referrals
The laboratory maintains a wide investigative repertoire offering tests to other laboratory within the
South West and beyond.
Standard operating procedures
Standard Operating Procedures are available for all areas of the departments.
Health and Safety
The departments comply with current health and safety regulations.
Accreditation
The Derriford department has full CPA accreditation following inspection in 2008 and Truro was
fully accredited in 2010
Education and Training Programme
Training Programme Director and Educational supervisor (Plymouth)
Dr Ruth Ayling. Tel 01752 792291. email ruthayling@clinicalbiochemistry.org.uk
Educational Supervisor (Cornwall)
Dr Simon Fleming Tel 01872 252541 email simon.fleming@rcht.cornwall.nhs.uk
Training programme
Induction
The StR will complete a compulsory Trust induction day. The initial part of his/her training will be a
four week induction period enabling familiarisation with all sections of the laboratory and its staff,
the computer equipment, the clinical environment of the hospital and opportunities for study and
research
Laboratory Training
The laboratory training programme follows the Royal College of Pathologists Core Training
Programme (curriculum) for Chemical Pathology (see Appendix). The Specialist Registrar will be
expected to familiarise him/herself with all the methods carried out in the laboratory. Following an
induction period, and training in generic issues such as computing and quality control, the trainee
will rotate through all the sections of the laboratory.
According to experience, and within the bounds of competence judged by his/her Educational
Supervisor, the Specialist Registrar will participate in the Duty Biochemist rota. He/she will
contribute to the provision of a consultative service for hospital clinicians, GPs and ancillary staff,
and be responsible for the authorisation of reports before they leave the laboratory.
Clinical Training
Training is offered in all elements of Metabolic Medicine and in the more general use and
interpretation of biochemical tests in diagnosis and monitoring of disease. It is anticipated that
trainees will reach a high level of competence in two of the Metabolic Medicine elements although
they will gain some experience of all five. Eligible trainees who undertake formal sub-specialty
training in Metabolic Medicine will have to reach the levels of competence specified by the JCHMT
in all five elements.
The amount of time devoted to each element will depend on the interests and experience of the
trainee, guided by the Educational Supervisor and Specialty Training Committee. It is anticipated
that trainees will attend an average of two outpatient clinics per week.
Peninsula SpR RMA 11

The following training opportunities are available:
Lipid Disorders
50 clinics (minimum, 6 patients per clinic)
Cardiovascular Risk Clinics
Dr Hannah Delaney Consultant Chemical Pathologist (Plymouth)
Dr Simon Fleming, Consultant Chemical Pathologist (Truro))
Hypertension Clinic
Dr Peter Rowe, Consultant Nephrologist (Plymouth)
Additional experience, if necessary, can be arranged at lipid clinics at Bristol Royal Infirmary,
Frenchay Hospital, Bristol or Weston General Hospital.
Diabetes Mellitus
40 clinics and 6 eye clinics (minimum, 6 patients per clinic)
Diabetes Clinic
Dr Ann Millward, Senior Lecturer and Consultant Diabetologist (Plymouth)
Dr Simon Fleming, Consultant Chemical Pathologist (Truro)
Dr Duncan Brown, Consultant Endocrinologist (Truro)
Short attachments will be arranged to paediatric and adolescent diabetic clinics, diabetic
nephropathy and foot clinics and the joint antenatal diabetes clinic
Bone/Calcium
40 clinics (minimum 6 patients per clinic)
Derriford Hospital
Rheumatology Clinic
Dr Mark Perry, Consultant Rheumatologist (Plymouth)
Endocrinology clinic
Dr Daniel Flanagan, Consultant Endocrinologist (Plymouth)
Renal stones Clinic
Dr Charlie Tomson (Bristol)
Short attachments will be arranged to the Paediatric endocrinology and Dexa reporting sessions
Nutrition
25 ward rounds, 15 clinics (minimum 6 patients per clinic)
Derriford Hospital
Nutrition Support Team
Dr Stephen Lewis, Consultant Gastroenterologist (Plymouth)
Dr Ruth Ayling, Consultant Chemical Pathologist (Plymouth)
Dr Simon Fleming, Consultant Chemical Pathologist (Truro)
Dr James Bebb, Consultant Gastroenterologist (Truro)
Obesity Service
Dr Duncan Browne, Consultant Endocrinologist (Truro)
Dr Steven Creely, Consultant Endocrinologist (Truro)
Short attachments will be arranged to gastroenterology/nutrition clinics nutrition specialist nurse
and dietitian sessions, eating disorders ward rounds Glenbourne Unit, paediatric obesity service
Inherited metabolic disease
40 clinics (minimum 4 patients per clinic)
Paediatric inherited metabolic disease clinics
Dr Helen Mundy Consultant Paediatrician (Guy’s/Plymouth)
Dr Prem Sundaram Consultant Paediatrician (Plymouth)
Dr Ruth Ayling Consultant Chemical Pathologist (Plymouth)
Peninsula SpR RMA 11

Formal attachments will be arranged to the paediatric clinical biochemistry units at Southmead
Hospital/Bristol Royal Infirmary (4 months) and to the clinical genetics service at Royal Devon and
Exeter Hospital (2 weeks)
Other clinical training
The programme will provide experience of the outpatient management of a range of general and
endocrine medical disorders and exposure to paediatric clinical biochemistry.
It is expected that the trainee will become proficient in the performance of dynamic function tests
and be able to advise others on their appropriate use.
The Specialist Registrar will be encouraged to pay visits to the wards to follow-up cases
encountered in the laboratory and to advise clinical colleagues. Where it is considered
appropriate, after discussion with the educational supervisor, regular participation in ward rounds
in addition to those specifically indicated for metabolic medicine training (e.g. in the Intensive Care
Unit), will be arranged.
Throughout the programme there will be an emphasis on the importance of liaison between the
laboratory and clinical staff. Good communication skills and the ability to provide knowledgeable
data interpretation and specialist advice about patient management will be accorded a high
priority.
Accommodation and equipment
A desk is provided in a shared office. A secure locker will be provided for storage of personal
belongings and a space for books and files.
Training agreement
A training agreement will be drawn up and reviewed during regular appraisal between the trainee
and the educational supervisor.
Appraisals
Appraisals will be held with the educational supervisor in protected time, after one month and then
at 3 month intervals. The outcome of these appraisals will be used for the supervisor’s ARCP
report.
IT facilities
The trainee will have access to a PC. Access to intranet, internet and email facilities will be given,
subject to relevant Trust policies.
Proposed Timetable
This is subject to change according to clinical commitments and the educational needs and wishes
of the Specialty Registrar
Plymouth Monday Tuesday Wednesday Thursday Friday
Clinic
Duty
Biochemist
Clinic
Clinical Cases
Department
Meeting
monthly
Tutorial
Laboratory
Work
Duty
Biochemist
Journal Club Grand Round Nutrition MDT
Laboratory Endocrine Clinic
Work
Meeting
Cornwall Monday Tuesday Wednesday Thursday Friday
Lipid clinic Nutrition Duty
Biochemist
GI
Investigations/
nutrition
Laboratory
Work
Laboratory
Work
Dept Meeting Grand round Nutrition MDT
Diabetes clinic Duty
Clinic
Tutorial
Biochemist
Peninsula SpR RMA 11

Principal service responsibilities
Clinical service
The trainee will be instructed in the functions of a duty biochemist and, when judged to have
gained sufficient experience, will take part in the authorising of laboratory reports.
The trainee will attend outpatient clinics and see patients under supervision of his/her educational
supervisor or another consultant. The number of clinic sessions attended per week will be
appropriate to the educational needs of the trainee but will be on average three per week for those
training in metabolic medicine and two for other trainees.
On-call commitment
Depending on experience the trainee may participate in an on-call advisory service on a 1 in 6
basis. A Consultant will be available during this time if advice is required. This duty attracts a
Banding Payment of 1C.
Objectives and targets
Learning is facilitated by service experience. Through the framework of appraisal and workplacedbased
assessment the educational supervisor will ensure that as the skills and knowledge of the
trainee develop, as specified by the Royal Colleges of Physicians and Pathologists, the service
experience remains challenging and appropriate.
Teaching responsibilities
There will be opportunities for the trainee to participate in training of BMS within the department
and in teaching of medical students. Formal instruction in teaching from the University will be
provided prior to teaching Undergraduates.
Research possibilities
There are opportunities for research, most readily within all sections of the laboratories and this is
supported and encouraged.
Clinical audit
Clinical audit is encouraged and the trainee would be expected to take part, with support, in
suitable projects.
Management training
In the latter stages of training, the trainee will gain experience in management by attendance at
relevant departmental meetings in order to gain appreciation of issues involved. Direct experience
will be achieved by sharing managerial responsibilities and by attending suitable management
courses.
Peninsula SpR RMA 11

General Information
This document forms part of the job description for Specialist Trainees working in the South West
Peninsula Deanery.
The Terms and Conditions of Employment (including those related to leave and sick pay) are in
accordance with the nationally agreed Terms and Conditions of Service of Hospital Medical and
Dental Staff (England and Wales) and General Whitley Council Conditions of Service currently in
force and as amended from time to time.
Appointments are superannuable unless you opt out of the scheme or are ineligible to join, and
your remuneration will be subject to declaration of superannuable contributions in accordance with
the National Health Services Superannuation Scheme.
Hours of Work
Your duty hours will be between 40 and 56 hours per week (part-time staff pro rata) depending
upon the pattern of work offered by the employer, which should be in accordance with paragraph
20 of the national terms and conditions of service for hospital medical and dental staff and doctors
in public health medicine and the community service (England and Wales), “the TCS”, as
amended from time to time. This may (or may not) include work in evenings, at night and
weekends. The TCS may be viewed at:
http://www.nhsemployers.org/PayAndContracts/JuniorDoctorsDentistsGPReg/Pages/DoctorsInTra
ining-JuniorDoctorsTermsAndConditions150908.aspx
Salary scale
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/Pages/Pay-and-contracts.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/PayCircularsMedicalandD
ental.aspx. The pay supplement is not reckonable for NHS pension purposes. The pay supplement
will be determined by the employer and subject to monitoring.
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.
Assessment of Training
Training appointments are subject to regular local and annual assessment confirming satisfactory
progress through the programme. The requirements of the assessments will be detailed in the
“Gold Guide” which may be viewed at
http://www.mmc.nhs.uk/pdf/Gold%20Guide%202010%20Fourth%20Edition%20v08.pdf
Peninsula SpR RMA 11

Disclosure of Criminal Background
This position is exempt from the Rehabilitation of Offenders Act 1974. This means that you must
declare all criminal convictions, including those that you would otherwise be considered “spent”.
Where the appointment involves substantial access to children and/or vulnerable adults, the
appointment is subject to a police check. The Criminal Records Bureau will be asked to verify that
you have no convictions and cautions or pending prosecutions, convictions, cautions and bindover
orders. This will include local police force records in addition to checks with the Police
National Computer and the government departments lists held by the Department of Health for
Education and Employment, where appropriate.
Police checks will only be requested for candidates recommended for appointment and will be
carried out by the employing Trust.
Medical Clearance
Offers of employment to the rotation will be subject to satisfactory medical clearance including
Hepatitis B status.
Medical checks will only be requested for candidates recommended for appointment and will be
carried out by the employing Trust.
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/JuniorDoctorsDentistsGPReg/Pages/DoctorsInTra
ining-JuniorDoctorsTermsAndConditions150908.aspx. You are advised to check eligibility and
confirm any entitlement with the employer before incurring any expenditure. The current
Relocation Expenses guidelines can be accessed via the South West Peninsula Deanery website
(www.peninsuladeanery.nhs.uk).
Less Than Full Time Working
Less than full time working is available for doctors in the training grades for whom full-time training
is not practical for “well-founded individual reasons”. Trainees wishing to take up the option of less
than full time training will need to have successfully obtained a post in the relevant specialty and
grade in open competition. However, they will be expected to approach the Deanery prior to
applying for posts to confirm that they are eligible for funding for less than full time working.
A copy of the “Less Than Full Time Working” policy can be obtained from the South West
Peninsula Deanery website (www.peninsuladeanery.nhs.uk). Doctors wishing to work on a less
than full time basis should be aware that they will be expected to “slot share” with another less
than full time trainee.
Peninsula SpR RMA 11