//
you're reading...
Hospital Trust

The Whittington Hospital

IMG_0648The Whittington Hospital provides general hospital and community services to 500,000 people living in Islington and Haringey as well as other London boroughs including Barnet, Enfield and Camden.

The organisation was established in April 2011 following the merger of The Whittington Hospital NHS Trust with NHS Islington and NHS Haringey community health services. Since it provides both hospital and community services, it is an “Integrated Care Organisation.” This is apparent when working at the Whittington, particularly in Respiratory medicine, as many staff members work both in the hospital and in the community. There are also strong links with local GPs.

The hospital has 360 beds. The Respiratory ward has 21 beds, with the potential for outliers on the ward next door.

The latest CQC rating was “requires improvement” overall, although medical services and A&E received a “good” rating.

Consultant speciality interests

  • Dr Louise Restrick – Integrated care, Emergency oxygen, smoking cessation, leadership
  • Dr Myra Stern – Bronchiectasis, integrated care, smoking cessation, service development
  • Dr Sara Lock – Lung cancer, asthma, research
  • Dr Ruvini Dharma – Pleural disease, Bronchoscopy, integrated care
  • Dr Anna Gerratt  – general respiratory care, education and training
  • Dr Mel Heightman- Interstitial Lung Disease, integrated care

NB. TB clinics at the Whittington are run by the UCL team, as part of a co-ordinated TB service for North Central London.

Meetings

  • Weekly lung cancer MDT (present cases and record summaries of discussions/decisions)
  • Weekly non-malignant radiology meeting
  • Weekly departmental meeting (case discussions, journal club, service evaluations)
  • Weekly grand round (with lunch)

Bronchoscopy

  • Weekly Wednesday afternoon list (2 consultants alternate to supervise)
  • Low volume of bronchs so not best place to get your numbers up – perhaps 2 per week (split between 2 trainees)
  • Supportive training environment for Bronchoscopy when they happen

Clinics

  • Weekly general/lung cancer clinic (Thurs am/pm)
  • Weekly general clinic (Mon am/pm)

Typical week

Monday: Clinic and Consultant ward round, and Respiratory departmental meeting
Tuesday: SpR ward round + referrals + admin
Wednesday: Lung cancer MDT, non-malignant Radiology meeting, Grand Round, Bronchoscopy list
Thursday: Clinic and Consultant ward round
Friday: SpR ward round + referrals + admin

There are two SpRs but each of your schedules are independant and you do not cover each other’s clinics. The SpRs see all referrals which can be a burden when only one of you is present, but Consultants who are not on the wards do ‘in-reach’ to MAU which lightens the load.

Procedures (estimated per year done by each Resp SpR)

  • Chest drains: 5-10
  • NIV initiation: 0 (NIV is run by the physiotherapist with Consultant oversight)

Pleural USS

  • Dedicated Resp department portable USS machine available 24/7
  • No level 2 trained Consultant (yet), but this should change soon, meaning it will be possible to get signed off for Level 1 USS

GIM

  • GIM time is not organised into blocks, but instead in single day shifts on different days across different weeks. This can make ensuring the right clinics are cancelled a bit of a hassle so plan ahead. Weekends are Fri-Sun. Nights are in blocks of 3 (weekend) or 4 (weekdays).
  • Takes are very manageable– days average 10-15 admissions (1 early SHO, 2 late SHOs and an FY1 from 5pm clerking), nights average 8-10 (1 ward SHO and 1 clerking SHO). There are not many arrests on the wards. Not too busy but with enough experience to easily cover GIM curriculum requirements.
  • The ambulatory care department is fantastic, and makes it possible to discharge many young and mobile patients, freeing up beds for those who really need them. There are ambulatory care pathways for many acute conditions, and you can also bring people back there to review/do procedures sooner than a clinic appointment would be available.
  • The post-take setup is not ideal for educational feedback as it is split into 3 (2 acute medicine Consultants post take on each of the acute admission units, and 1 medical Consultant post-takes the outliers). This is good for patients as they get seen earlier, but means you need to make more effort to get feedback. Plan ahead to get ACATs done as you may have to do 1 ACAT for a set of nights to ensure you present sufficient cases to a single Consultant.

Teaching

  • Regular bedside teaching commitment of undergraduate medical students on Tues morning 11am
  • Opportunities to give seminars to undergraduate students on Resp/Cardio block
  • Opportunities to teach CMTs and help with PACES teaching
  • Opportunities to be undergraduate OSCE examiner

Management/leadership

  • Run the weekly educational meeting
  • Plenty of QIP opportunities – talk to the Consultants, particularly Dr Restrick

Specialist training opportunities

  • Integrated care – attend community MDT, go on visit with CoRe team, attend Care Planning Conferences, work with respiratory psychologist
  • Smoking cessation – work with quit smoking advisors, and lead Elizabeth Pang and get level 1 trained. Department provides some training in motivational interviewing techniques
  • Consultants are involved in lots of service improvement projects locally and regionally so opportunities to get experience
  • Opportunity to attend ILD clinic with Dr Heightman if make particular effort
  • Opportunity to undertake Advanced Development Programme (training in supporting people with long term conditions to optimally self manage)

Research

  • No in-house research, but the department takes part in several studies, particularly related to lung cancer (eg TracerX, Streamline L)

Stage of training best suited to this rotation

  • ST4-5 (more senior trainees may find the degree of oversight frustrating)
  • Any stage, including more senior trainees, for those with an interest in integrated care

 Recent trainee comments:

“My experience at the Whittington will change my practice forever. Acquiring skills in motivational interviewing has made me approach smoking cessation in a new, more successful, more satisfying way. The strong focus on integrated, holistic care, and frequent care planning conferences can be exhausting, but have shown me what impact a motivated MDT can have on the lives of people with chronic conditions. I now can’t believe other departments function without a dedicated psychologist!”

” The Whittington is a really nice hospital with friendly consultants and a focus on the patient as a person. You do not come to the Whit to experience specialist procedures or technologies – instead what you learn is how to work in a team that crosses boundaries of primary and secondary care, how to treat the whole person and how to make an impact on individual lives. If you can let go a little and get down with the quirks of the NIV service and the high involvement of Consultants in day to day decisions, you will have a great rotation.” 

“My training at the Whittington encouraged an approach to holistic patient care and my ability to work in a team that crosses the boundaries of primary and secondary care. My integrated care post gave me exposure to dealing with respiratory illnesses in patients with complex mental health issues, how to work effectively with a community integrated team to improve patient care and the value of pulmonary rehabilitation.”

About drlj

Respiratory Registrar in North East London

Discussion

Trackbacks/Pingbacks

  1. Pingback: King George, Ilford | Resp NET - February 21, 2016

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: