Ophthalmology Specialist Trainee’s

Induction Booklet

August 2013

Sandwell General Hospital

Lyndon Road

West Bromwich

B71 4HJ

Contents

Ophthalmology at Sandwell and West Birmingham Hospitals NHS Trust3Trust profile3Ophthalmology in Birmingham4Ophthalmology at Sandwell and West Birmingham Hospitals NHS Trust4The Birmingham and Midland Eye Centre5Specialist clinics held at Sandwell5Ward cover6Main contact numbers6On call7Out-of-hours on-call71st on call72nd on call74th on call8Sickness and compassionate leave8Planned leave8Authorisation of annual leave8Study leave9Appendix A Study leave application process10Appendix B Risk Focus alerts13

Ophthalmology at Sandwell and West Birmingham Hospitals NHS Trust

Trust profile

Sandwell and West Birmingham Hospitals NHS Trust is one of the largest teaching trusts in the United Kingdom with a reputation for excellent, friendly staff who provide high quality care from City Hospital in Birmingham and Sandwell General Hospital in West Bromwich. Both are busy acute hospitals providing many specialist services and a broad range of emergency services, including A&E at both sites. In addition, the trust provides comprehensive community services to the Sandwell area, including from Rowley Regis Community Hospital, Leasowes Intermediate Care Centre and the Lyng Centre for Health and Social Care.

The trust has an income of £418 million and employs around 7000 WTE staff. It has circa 900 beds and serves a population of over 500,000.

The trust is a key partner, along with the local clinical commissioning group and local authorities, in the Right Care Right Here programme, which seeks to deliver an ambitious redevelopment of local health services. Following a very successful public consultation, implementation of the programme is underway, with a wide range of secondary care services now being provided via new models of care in community locations. The programme includes one of the largest investments in the UK in new facilities in both the acute and community sectors. Included within this is a new single site acute hospital, for which business case approval is currently being sought.

The trust has reconfigured a number of services between its acute sites so as to ensure their quality and sustainability. This programme of change will continue over the coming period. Alongside this, the trust has embarked on a five year Transformation Plan, designed to ensure that the quality and safety of our services can be maintained and enhanced, while responding to national requirements for increased efficiency. The plan takes in all of the trust’s key clinical and non-clinical workstreams. In the light of its strategic, operational and financial strength, the trust is applying to become a NHS foundation trust, which is expected to be achieved by April 2014.

The trust is a pioneer in developing new and more effective approaches to staff engagement through its Listening into Action programme, which harnesses the energy and ideas of front line staff to improve services. This is the largest programme of its kind in the NHS and has received widespread national recognition. These techniques are also increasingly used to obtain the view of patients and carers.

The £35m Birmingham Treatment Centre on the City Hospital site provides state of the art facilities for one-stop diagnosis and treatment. It includes an Ambulatory Surgical Unit with six theatres, extensive imaging facilities, an integrated breast care centre and teaching accommodation.

The £18m Emergency Services Centre on the Sandwell site incorporates a comprehensive A&E facility, Emergency Assessment Unit and Cardiac Care Unit.

Aside from being one of the largest providers of patient services in the Midlands, the trust also has a substantial teaching and research agenda with several academic departments including rheumatology, ophthalmology, cardiology, gynaecological oncology and neurology.

The trust hosts the Birmingham and Midland Eye Centre (BMEC), which is a supra-regional specialist facility, as well as the Pan-Birmingham Gynaecological Oncology Centre, Birmingham Skin Centre, Sickle Cell and Thalassaemia Centre and regional base of the National Poisons Information Service.

Ophthalmology in Birmingham

Ophthalmology services in Birmingham are provided on a hub and spoke principle. The main operating facilities, as well as most of the specialist clinics and the Academic Unit, are provided at the BMEC. The more general outpatient facilities are located locally at hospitals around the city. Major developments have taken place at these other centres to improve local access to high quality ophthalmology services. The main partnership hospitals are Good Hope, Heartlands and Solihull Hospitals at Heart of England NHS Foundation Trust, Birmingham Children’s Hospital, University Hospital Birmingham NHS Trust and Dudley Group of Hospitals NHS Trust. Many consultant staff at these partnership hospitals also work at the Birmingham and Midland Eye Centre (BMEC), which is based at the trust’s City Hospital site. All these hospitals and the BMEC share junior staff on training rotation, rotating through the spoke hospitals and the BMEC.

Ophthalmology at Sandwell and West Birmingham Hospitals NHS Trust

Services are provided at three hospital sites:

· City Hospital, which accommodates the BMEC

· Sandwell General Hospital, which includes outpatients and day case surgery

· Rowley Regis Hospital, where outpatient activity is undertaken.

At Sandwell Hospital, the eye theatre is in the Day Unit. It is equipped with an Alcon Phaco emulsification machine and a Zeiss microscope. There are six patient chairs on the Day Unit, with dedicated ophthalmic nursing staff. Almost all surgery is done on a daycase basis.

Services provided include:

· Paediatric refraction

· Photo dynamic therapy

· Lucentis injection service

· Visual field testing

· Medical photography

· Biometry

· B-scan ultrasound

The present consultant staff at Sandwell includes (with an indication of their special interest):

Mr S P Aggarwal

Glaucoma

Mr J Al-Ibrahim

Medical retina and diabetes

Miss L Butler

Paediatric ophthalmology

Mr D Cheung

Oculoplastics

Mrs B Mushtaq

Medical Retina Lead

Mr M Nessim

Glaucoma

Mr M Quinlan

Cornea and anterior segment

Mr A Tyagi

Vitreo-retinal, medical retina and Divisional Director

Associate Specialists

Speciality Doctors

Mr T Karthigeyan

Mr Qusay Al-Fahad

Mr Mazen Tahan

Mr Muhammed Jawad

The Birmingham and Midland Eye Centre

The Birmingham and Midland Eye Centre (BMEC) is one of the largest specialist eye hospitals in Europe. The centre has 33 consultants, each sub-specialising in particular areas of ophthalmic practice. The centre is the main site for eye surgery and A&E in Birmingham and Sandwell. In the year ending March 2012, the overall attendances in the outpatient department were 101,065, and there were 9,518 surgical attendances. The total number of BMEC A&E attendances in 2012 was 29,318.

Specialist clinics held at Sandwell

Corneal Services

The cornea is the transparent, dome-shaped window covering the front of the eye. It is a powerful refracting surface, providing 2two-thirds of the eye's focusing power. Like the crystal on a watch, it gives us a clear viewing window.

Our team treats any disorder pertaining to the cornea from disease, infection, degeneration and conditions such as keratokonus, endothethial failure and scarring.

Glaucoma Services

Glaucoma is responsible for 15% of blindness in the UK. The glaucoma service at the Birmingham Midland Eye Centre looks after the full spectrum of the disease and provides leading edge care with world-class audited results. We specialise in ethnic glaucoma, have recently set up a complex glaucoma service. We offer glaucoma filtration, operation glaucoma drainage devices. This comprehensive service is much valued by our long-term patients.

Medical Retina Services

The Medical Retina Team treats full range of medical retina disorders, conditions associated with diabetes and old age, including treatments for Age-Related Macular Degeneration (AMD) and intravitreal injections such as Lucentis. The diabetic eye disease is treated by intra vitreal Anti-VEGFs. There is a dedicated Laser suite with Laser machines, Krypton and YAG. This is situated on the first floor of the OPD with keys held in the Eye OPD sister’s office. There is also weekly intravitreal injection list done in the DSU theatres.

The medical retina AMD/vascular clinics run on Thursday and Friday afternoons.

Topcon OCT facility supported by the Medical Illustration Department is available Monday - Friday.

Ocular Plastic Services

The Ocular Plastic Team corrects lid malposition, blocked tear ducts, problems of the orbit (eye socket) and offer surgical correction to trauma of eyelids and face.

Vitreo-retinal Services

The Vitreo-retinal Team treats trauma, retinal detachments, severe diabetic eye disease, intra ocular infection and complex cataracts.

Paediatric ophthalmology

The Eye Centre has a dedicated ophthalmology service for children, from Retinopathy of Prematurity (ROP) screening through to corrective squint surgery, cataract and paediatric glaucoma treatments, as well as joint genetic clinics.

Retinopathy of Prematurity (ROP) Screening

Our Consultant Ophthalmic Surgeon, Miss Lucy Butler, has historically responded to an on-call request for assessment of premature babies suffering with this condition within the West Midlands and beyond. Of all the children screened for ROP, it is estimated that half will be affected to some degree and that about 90% of these cases are in the mild category, whereby the disease improves and leaves no permanent damage.

ROP is a potentially eye-blinding disorder that primarily affects premature infants weighing about 2¾ pounds (1250 grams) or less that are born before 31 weeks of gestation (a full-term pregnancy has a gestation of 38–42 weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder which usually develops in both eyes is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

Urgent Care Clinics (Red Eye) A&E Service

This service is ideal for patients with red eye symptoms who have not responded to topical treatments and who do not require same day treatment (can wait 48-72 hours to be seen), post ops, uveitis etc. There are two sessions at Sandwell OPD, Tuesday morning and Friday afternoon.

Ward cover

Specialist trainees are responsible to provide ward cover after liaising with nursing staff to take referrals from inpatients and direct them to appropriate clinics in Eye A&E at Sandwell. At times trainees will be expected to provide ward cover and discuss the patients with consultants in clinic.

Main contact numbers

The Outpatient Sister at Sandwell is Claire Westwood who can be contacted on 0121 507 3277 or claire.westwood@nhs.net

The Booking Coordinator at Sandwell is Tracey Edwards who can be contacted on 0121 507 3392 or traceyedwards1@nhs.net

On call

Sandwell trainees participate in the out of hours on call rota based at the BMEC.

Out-of-hours on-call

· When you are on-call you are part of a team. All on call doctors must be available and contactable by other team members and switchboard.

· Each doctor should sort out his or her own swap; there should be no RSO involvement. Each person swapping informs switchboard/A&E/Management Office (Bhajan Kaur/ Marion Butler) and the RSO. If the person you have swapped with fails to attend, unfortunately you will not be paid.

· All emergency admissions must be discussed with the on call consultant that evening or night. When informing about an emergency admission, the 4th on call should clarify with the on call consultant about the future management plan (including subspecialty referral, and any preference for a named consultant referral) and document a plan in the notes. If possible and where this is agreed, the referral for this transfer can be made the evening before the next working day (e.g. Sunday evening). The point of contact will be the Fellow/ASTO/specialist trainee in that order. However, until the subspecialty team has seen the patient the next day and taken over, the care of the patient shall be with the admitting consultant.

· Worcester and Kidderminster patients: All emergencies during daytime (Monday to Friday 9 am to 5 pm) to be seen by local eye services and not at BMEC A&E. Emergencies out-of-hours should be discussed with the 4th on-call and only urgent cases that cannot wait till next day to be seen at BMEC A&E. All other non-urgent patients to attend next day to local eye services.

1st on call

Hours of duty (weekdays):

5pm until start of next normal working day (9am)

Hours of duty (weekend):

9am Saturday until Sunday morning (9am) 1pm Sunday until Monday morning (9am)

During these hours they are responsible for seeing patients in A&E and on the ward and for taking referrals from City A&E. In addition they can be tasked by the 2nd and 4th on call.

They should usually expect to leave casualty at 7pm and go up to the ward to do all remaining jobs there before returning to casualty. If casualty is busy this may not be possible, but it is then good etiquette for the 2nd on to help with ward work later.

Overnight, the hospital at night team should be the first port of call for non-ophthalmic issues.

2nd on call

Hours of duty (every day)

5pm until start of next normal working day (except weekends when they do a longer ward round on Saturday/Sunday mornings)

During these hours they are responsible for seeing patients in Eye A&E and on the ward, covering the first on call, performing emergency lasers (retinopexy, PRP) in A&E and seeing patients at City Hospital who cannot come to the Eye A&E or ward. They are also responsible for taking referrals from other hospitals and taking calls throughout the night. In addition they can be tasked by the 4th on call at any time. They should see patients on the ward the morning after an on call and handover to the appropriate team.

After a Friday/Saturday night on call (i.e. on Saturday/Sunday morning respectively) they are expected to assist the 4th on call in a ward round (usual finish time 12 noon).

4th on call

Hours of duty (weekdays)

5pm until the start of the next normal working day (9am)

Hours of duty (weekend)

9am Saturday until Monday morning (9am)

During these hours they are responsible for seeing patients in peripheral hospitals and taking patients to theatre. They also cover the 2nd on call in A&E/on the ward and assist when necessary. They should take ownership of patients and are responsible for ensuring appropriate handover of admissions.

On Saturday and Sunday mornings, they do the ward round with the 2nd on call.

Sickness and compassionate leave

If you are taken ill, you must contact the Eye Clinic by 8am on 0121 507 3277 on the first day of your absence, and if possible give an approximation of how long you expect to be off. It is important that you keep in touch during the period of your sickness absence, so that we can ensure that all clinical commitments are appropriately covered. It is the trainee’s responsibility to ensure that Bhajan is informed on return back from sick leave, Bhajan will organise a sickness return to work interview in line with the Trust policy.

You will also need to notify Bhajan Kaur, Medical Staffing and Capacity Manager, based at the BMEC, on 0121 507 6879 or bhajan.kaur@nhs.net.

Planned leave

Please note when applying for leave you need approval from all hospitals you work at. Medical staffing and the Deanery have the right to refuse any leave (even if sanctioned by the consultant) if the minimum period of eight weeks’ notice is not given. Each individual is responsible for their own on call swap. When doing this it is best to send an email to switchboard and Bhajan Kaur to notify of any change. A summary of leave is sent to colleagues bi weekly, please check that your absences have been correctly reflected and advise Bhajan Kaur in the event of error.

Authorisation of annual leave

This should be booked through the Management Office at BMEC through Bhajan Kaur. Leave forms should reach the office eight weeks in advance with appropriate consultant signatures to ensure leave will be granted and then to the RSO for approval and checking. You need to know the reply in writing before making any holiday plans. If your base hospital is not BMEC, you still need to give eight weeks’ notice to BMEC for BMEC clinics and the appropriate consultant needs to sign your leave form. Forms will not be accepted without consultant signature.

Study leave

There is a detailed study-leave process for trainees of the West Midlands Programme in Appendix A.

Appendix A Study leave application process

POSTGRADUATE SCHOOL OF OPHTHALMOLOGY(West Midlands Deanery Workforce)

STUDY LEAVE APPLICATION PROCESS FOR TRAINEES IN OPHTHALMOLOGY

(Ophthalmology Specialty Trainees (OST1-7), FTSTAs, LATs, SpRs)

Prior to submission

The new electronic completion study leave form has been designed to improve legibility. Please complete your name, grade, study leave details and costs electronically, together with details of the consultant sessions you will be missing and on-call cover.

Notes:

· The form should now be printed off and signatures obtained in the normal way.

· The new study leave form enables electronic sign-off. For those Trainers and Tutors who wish to digitally sign, may do so. This is the first step towards electronic submission of study leave requests.

· Study leave should be discussed with your Educational Supervisor and signed off.

· If attending a conference, you must be first author on a paper/poster presentation in order to be eligible to request study leave.

· Please take into consideration that additional time may be required (>8 weeks) if you are planning to take leave around bank holidays, high intensity bank holiday periods or popular conferences (e.g. ARVO, college congress), for clinical sessions to be reduced accordingly. Please give as much notice as possible.

Obtain sessional sign-off from Consultants in charge of clinical sessions.

Please note:

· Research, study, teaching and audit sessions must be signed off by the clinical or educational supervisor. These are not “free” sessions.

· Postgraduate sessions must be signed off by your trainers and you should complete a validated absence form for the postgraduate session.

Please ensure cover arrangements have been made.1

· Please name the doctor who will provide day to day cover as well as any on-call you were scheduled to undertake during that period.

· Obtain signature from local rota coordinator to confirm service provision can be met in your absence.

· If applicable, make a copy of the completed form and append a local hospital study leave form, for local submission. This is purely to ensure there is a reduction in service provision and your leave is logged locally. Authorisation of study leave and expense claims is coordinated through the WMSoO.

Failure to make adequate cover arrangements, or inform local workforce coordinators, could jeopardise future study leave approval.

AT LEAST 8 WEEKS PRIOR TO THE STUDY LEAVE DATE

Study leave form with appropriate paperwork e.g. programme for the course, meeting or conference to be submitted to Mrs Bhajan Kaur, BMEC, email bhajan.kaur@nhs.net. This can be by hand delivered or scanned /email.

Notes:

· It is up to the trainee to confirm receipt of the form at BMEC when sending by email as during Mrs Kaur periods of absence, forms left in her inbox cannot be considered for approval.

· On receipt, forms will be stamped, dated and then passed to Miss Rauz for weekly approval. 2,3

· Keep a copy of all paperwork for your records.

Within 5 working days

Study leave to be approved or rejected by Miss Saaeha Rauz, Academic Tutor, WMSoO, email s.rauz@bham.ac.uk

When Miss Rauz is on leave or not available, forms will be signed and approved by Prof Philip Murray, Academic Tutor, WMSoO, email p.i.murray@bham.ac.uk

Within 7 working days

Mrs Kaur will forward approved Study leave forms, either via scanned email or by post, to:

Ms Janet Porter

Postgraduate Office, Clinical Science Building

University Hospital Coventry & Warwickshire NHS Trust

Clifford Bridge Road

Coventry CV2 2DX

Janet.porter@uhcw.nhs.uk

Approximately 2-4 weeks

Copy of approved form or rejected forms will be available for collection from Ms Bhajan Kaur

When course, conference or meeting complete 4

Please submit approved copy of the form with completed expenses form and receipts, together with a copy of the abstract presented, poster or précis of what was learnt on the designated feedback form to Bhajan Kaur for Academic Tutors to audit study leave attendance. This information may be used for ARCPs.

· The expenses form must be completed electronically and itemised by a breakdown of your expenses e.g. travel, registration fee etc.

· Expenses MUST be claimed within one month of leave or the claim will not be valid.

· Expenses will not be approved without receipts and evidence of the abstract presented, poster or précis of what was learnt.

Once précis’s have been received, expenses will be approved.

Ms Bhajan Kaur will submit to Ms Porter for reimbursement

For study leave where expenses are not claimed, and a précis of the study leave learning outcomes has not been submitted, this will jeopardise further approval of study leave.

1-2 Weekly electronic update

Ms Porter to electronically distribute 1-2 weekly updated WMSoO study leave database reports, detailing days taken and expenses claimed, to Miss Rauz and Mrs Robinson

Foot Notes:

1. Failure to make adequate cover arrangements, or inform local workforce coordinators, could jeopardise future study leave approval.

2. No Retrospective Study Leave will be Approved

3. Regulations regarding private study and RSTA sessions

· Owing to the reduction in working time and reduced clinical exposure during your training, the Deanery is keen to discourage private study leave.

· If you feel it is essential that you have private study leave, you must discuss this with your educational supervisor before applying, stressing the reasons why you feel you need to take the leave.

· Private Study Leave will be restricted to 5 days per 1st sitting of any exam.

· Please also note that your RSTA (research/study/teaching/audit) sessions are not part of your study leave budget. So if you have two RSTA sessions in a week, and take 5 days study leave, then 5 days of your study leave budget will be deducted, not 4.

· You are expected to be in hospital environment for your RSTA sessions and a points system is in place to validate RSTA activity.

· The same applies for the Wednesday PM Postgraduate Training Afternoon. Even though these constitute circa 15 days of mandatory study leave (i.e. you have 30 days of study leave in total when including your flexible 15 days), the Wed PMs remain protected during the summer months and holidays. (This means you are in effect obtaining an extra 6-7 days of study leave for “free”).

4. Expenses will not be approved without evidence of the abstract presented, poster or précis of what was learnt. Failure to do so may jeopardise further approval of study leave.

Appendix B Risk Focus alerts

2