GUM

Croydon University Hospital

SHO LEVEL IN GENITO-URINARY MEDICINE

The Department of GU Medicine (GUM) provides a comprehensive service for the diagnosis, treatment and support for people with Sexually Transmitted Infections and HIV. The department has close links with the respective department at St Georges Teaching hospital due to two of its Consultants working at both sites and due to the existence of a HIV/sexual health network.

The clinic serves the Croydon and adjacent area with a population of approximately 350,000.

DEPARTMENT OF GENITO-URINARY MEDICINE

i. Current Service

The GUM department is situated on new purpose built premises on the acute hospital site, with its own entrance from the London Road.

The clinic is the base for the following key services: -

Outpatient GUM Clinics – male and female. The current workload is approximately 22,000 per annum.
Sexual health advice and counseling
Young persons Sexual and Reproductive Health clinic
HIV Out-Patient clinics. There are more than 500 regular attendees, 70% of whom are on treatment.
HIV In-Patient care. Inpatient numbers range from 1 to10 at any time. During first four months of 2006 there were 40 inpatients episodes
Community nurse specialist HIV support and voluntary sector HIV support.

ii. GUM Out-Patients

The GUM Outpatient clinics currently operate on combined appointments and ‘walk-in’ open access.

Clinic times are Monday /Tuesday and Thursdays 9.00am – 6.00pm Wednesdays 12.00 pm – 7.30pm

Fridays: 9.00 am – 1.00 pm

Routine investigations performed include:

Direct microscopy for the diagnosis of Candida, Bacterial Vaginosis, Trichomonas, Syphilis and Gonorrhoea.
2-Culture for Trichomonas, Herpes and Gonorrhoea.
Chlamydia and Gonorrhoea NAAT testing.
Venepuncture for Syphilis, HIV and viral hepatitis.

The clinics are multidisciplinary with doctors, nurses, and health advisors working together. For new or rebook patients histories are doctor or senior nurse led. Doctor or nurse depending on the history performs the examination and specimen collection.

Nurse led clinics exist for asymptomatic patients or female patients with discharge only as well as wart follow-ups etc. Gonorrhoea test of cures are not performed routinely.

Consultations for post exposure prophylaxis and following sexual assault are also frequent. The former also includes trust employees.
Following publication of the governments National Sexual Health Strategy a Young Persons clinic has began since September 2003 offering a comprehensive sexual health service including STI screening and contraceptive provision.

iii. HIV

The majority of the patient cohort is made up of gay men and heterosexual black Africans which mean that women make up a significant proportion of the current attendees. The majority of new diagnoses are late presenting Black Africans with interesting pathology.

Inpatients

All adult patients admitted to Croydon University Hospital with HIV related problems are placed under the care of the HIV Physicians. All three of the Consultants are involved in their care. An HIV ward SHO (part of the medical rotation) is responsible for the day to day management of the HIV in patients.

Late presentations are frequent providing a plethora of clinical signs and pathology. The necessary medical specialty support for the management of opportunistic conditions is available.

Access to the inpatients for teaching will allow those planning on a career in GU/HIV medicine or another medical specialty excellent experience and aid in postgraduate examinations such as the MRCP or the Diploma of GU medicine.

Out-Patients

Nine HIV outpatient clinics are held weekly in the Department of GU Medicine led by the Consultants and an honorary HIV Physician.

All key services are available for the management of patients including those with advanced disease and multi-drug resistant HIV.

These include:

Therapeutic drug monitoring.
Viral resistance assays (including sub 1,000 copies)
Availability of expanded access medication (e.g. TMC-114)
Adherence clinics led by two HIV Specialist Pharmacists
One full time Clinical Nurse specialist who leads the HIV nursing outpatient services
One full-time Community Clinical HIV Nurse Specialists offer support and facilitates the discharge of in-patients back into the Community

There is a monthly viral load meeting where all resistance tests and key treatment changes are discussed.

TB/HIV co-infected patients

Croydon University Hospital has one of the largest cohorts of dually infected patients in the UK that are primarily managed by the Respiratory TB Physician and TB specialist nurse. Most of the patients undergo directly observed therapy and there is very close liaison with the HIV team.

Obstetric services

Women make up a large proportion of the Croydon University Hospital HIV cohort and hence pregnancy is common. At present antenatal screening for HIV achieves 90% coverage. To facilitate good quality care a three monthly multi-disciplinary team meeting exists between the necessary midwives, obstetricians, paediatricians, HIV physicians and health advisors.

Paediatric/Family Services

The consultant paediatricians at Croydon University Hospital care for children with HIV related problems, working in close liaison with their colleagues at St George’s Hospital. The paediatric clinical nurse specialist provides close liaison between paediatric and adult services.

iv. Staffing Complement

Consultants

Dr Ian Cormack (5 days) interests include HIV inpatient care.
Dr Mette Rodgers (3 days), interests include vulval dermatoses and HIV in pregnancy.
Dr John Watson (4days Croydon University Hospital, 1 day St Georges Hospital), interests include HIV pharmacology, general medicine and teaching.
Dr Mark Pakianathan (1 day Croydon University Hospital, 4 days St Georges Hospital) interests include HIV/Sexual Health Networks and Young persons sexual health.

SpR in GUM/HIV

Educational Approval for One post

1 Clinical Fellows (SHO) in GUM/HIV
1 VTS SHO GUM
1 Ward based HIV SHO
Clinical Assistants

Dr Alyson Elliman – Lead SCMO in Family Planning for Croydon.

Nurses

1 Senior Nurse/Business Manager- Kris Teelwah
2 GUM sisters
2 HIV CNS and 1 Community HIV CNS
7 Staff nurses and 2 Health care assistants

5 Health Advisors

Administrators

2 Medical Secretaries
5 Receptionists

2 HIV Specialist Pharmacists and 1 Pharmacy Technician

DUTIES OF THE POST

This is a six month post only.

i. Core

Approx 25 hrs General GUM outpatient Clinics: Clinics run from 900-18.30 and one of these clinics will be the Young Persons Sexual health and Family planning clinic.

3 hours administration weekly to allow for letters, results checking

1 HIV clinic (4 hours), sitting in with the consultant to enable the applicant the opportunity to widen his/her knowledge in this field. We envisage once confidence gained for the applicant to see new patients and conduct follow up visits. If the applicants’ educational requirements change during the course of the post another educational activity can be undertaken during this session.

ii. Education

A. A 3-hour weekly audit session or mini research project session. If the later is preferred this can be conducted under the auspices of the academic head of the department of GUM at St Georges hospital, Dr Tariq Sadiq.

Encouragement and support will be given to enable abstracts to be submitted to the British Association for Sexual Health and HIV (BASHH) annual meeting or the BHIVA annual meeting.

B. 3 hours teaching per week

Croydon University Hospital weekly medical grand round that is co-chaired by Dr John Watson (one hour)
A weekly 2-hour departmental educational session with one hour of consultant led case based tutorials.
An additional two hours weekly of Croydon University Hospital SHO teaching is available for personal study.
Dr John Watson is also happy to facilitate and conduct MRCP part II clinical teaching.
VTS half day release Wednesday afternoon

C: Individuals will have regular appraisal meetings and an educational supervisor

iii. Time Table for VTS SHO (also known as CF1)

	9-12	12-1	1-2	2-4.15	4.15-6.30	6.30-0
Mon	SpR CF2	SpR	CF1	CF1 (4.30) CF2 Watson (2-4.30)	CF2 SpR
Tues	CF1 Cormack	CF1	Cormack	The Point 3pm	CF1 CF2
Wed	Teaching	CF1	CF2	CF1 Watson (2-5.30)	CF1 Philips (5pm) CF2 (4.30)	CF2 SpR
Thur	CF2 CF1	CF2	CF1	CF2 Rodgers (2-5) CF1 sit in HIV	CF2 CF1 (5-6.30)
Fri	SpR Elliman (9-12) CF1	SpR

Clinic admin/ audit/research Mon am /Fri pm and other free slots as per timetable

iv. Study Leave

Study leave will be granted for recognized courses, or examinations to aid fulfillment of career aspirations. Expenses are also available up to 750 pounds per annum.

These posts have educational approval by the Royal College of Physicians but have not been given manpower approval by the deanery.

v. Annual leave and Salary

This will be 5 weeks per annum
Salary will be according to the SHO scale
There is no on-call

vi. Main Conditions of Service

The successful candidate will be employed under terms and conditions of service determined by the Trust which currently shadow those laid down by the Hospital Medical and Dental staff (England and Wales) Terms and Conditions of Service and General Whitley Council, until such time as local arrangements have been reached and implemented by the Trust. Any subsequent changes will be notified to the successful candidate and thereafter form part of his/her contract of employment.
The post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and applicants are not entitled, therefore, to withhold information about convictions which for other purposes are ‘spent’. In the event of employment, failure to disclose such convictions will result in disciplinary action by the Trust which could result in dismissal.
The successful candidate is required to be fully registered with the General Medical Council.
The Trust will be responsible for handling claims of medical negligence against medical and dental staff within the Trust, but staff are advised and encouraged to take out adequate defence or insurance cover, at their own cost, in respect of activities which fall outside the scope of their contract of employment (e.g., for defence costs involved in GMC disciplinary proceedings).
Medical and dental staff will be required to assist management and it’s agents during investigations into claims alleging medial negligence and where requested to provide related factual statements.
The Trust will not be responsible for a practitioner’s private practice, even when this is undertaken in the Trust’s Hospitals.
Within the terms of DHSS Circular HC(88)9 – Protection of
Children – applicants are required when applying for this post to disclose any records of convictions, bind-over orders or cautions.
Any offer of appointment will be subject to receipt of satisfactory references and to health clearance by the Trust’s Occupational Health Department.

Informal Enquires and discussions are welcomed

Please contact:-

Drs Mette Rodgers, Ian Cormack or John Watson

Consultants in GUM/HIV

Telephone: 0208 401 3006/3813