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Hospital Trust

Whipps Cross Hospital

Whipps Cross Hospital was founded in 1917. It has over 700 beds and has one of the largest and busiest A&E departments in the UK. It is part of Barts Health NHS Trust. The hospital serves a diverse community from Chigwell to Leyton, with notable celebrities David Beckham and Richard Ayoade both born in the hospital. Whipps Cross hospital housed the country’s first hyperbaric unit!

Whipps has had its challenges, and the latest CQC report rating was “requires improvement” which is an improvement on the previous rating of “inadequate”. Despite this, it is a caring place and morale is generally good. Many of the problems come from inadequate staffing, particularly nurses, and problems with the surgical service. There are many gaps on the rota, but these are generally filled by local trainees or those on F3 years.

Whipps_Cross_Hospital_old_building

Consultant speciality interests

  • Dr Simon Quantrill: Asthma, Bronchiectasis, Education
  • Dr Mathina Darmalingam: TB
  • Dr Ali Mohammed: Lung Cancer incl EBUS, Pleural disease
  • Dr Rowena Taylor: Sleep Medicine (outpatient only, no ward cover)
  • Dr Alistair Reinhardt: Clinical Lead, Lung Cancer
  • Dr Savi Kibe : COPD, pleural
  • Dr Jason Gittens: ICU/HDU (no Resp ward cover), NIV lead

Meetings

  • Weekly lung cancer MDT
  • Weekly Radiology meeting
  • Weekly journal club/educational meeting
  • Weekly TB MDT
  • Morbidity and mortality meetings monthly

Bronchoscopy

  • Previously it was felt that there was adequate experience in diagnostic Bronchoscopy including endobronchial biopsy at Whipps. As at many centres, transbronchial biopsies are rarely done and EBUS is not available. Unfortunately, accessing Bronchoscopy training recently has been more challenging and numbers are now felt to be inadequate. Due to problems with negative pressure rooms at Whipps, all TB cases are now done at Newham. Theoretically trainees should be able to attend Newham or Barts to do lists but staffing levels have made this inconsistent.
  • There are mixed views on whether the post is suitable for an ST3 or 4, mainly due to the low numbers of Bronchoscopies felt to be inadequate for up-skilling in early training. When bronchs do happen it is a good, well supported training environment.

Clinics

  • Weekly general respiratory clinic x 2 (incl an asthma clinic)
  • TB clinic weekly
  • Weekly lung cancer clinic
  • Pleural clinics/lists are now theoretically 2 times a week but may only go ahead once a week, depending upon on-calls/demand etc. They are well supervised, so good experience for ST3s who need to get signed off.

Typical week

Monday: Clinic in the morning. Xray meeting, pleural clinic/referrals in the afternoon.
Tuesday: Clinic in the morning, referrals in the afternoon.
Wednesday: Bronchoscopy list in the morning, and referrals in the afternoon
Thursday: MDT in the morning, then ward round and pleural clinic/referrals
Friday: Ward round in the morning, then referrals and admin incl reporting lung function tests

Referrals are made by email and bleep, and all referrals outside AMU are seen by the SpR(s). Consultants see referrals on AMU daily. They are manageable, as often phone advice can be given, or they can be deferred to the following day or the next pleural list. Clinics were previously busy, with up to 12 patients on an SpR list. This felt pressured for more junior SpRs. In response to feedback SpRs now have 2 new and 4 follow-ups on their lists. Clinics are very manageable and are well supervised with very helpful feedback.

Ward work is very consultant-led. There is a daily Consultant ward round on one of the 2 wards. On alternate days the Consultant sees new patients only. There is a good balance, therefore, of SpR rounds and Consultant input.

2016: The teaching programme has recently been improved and is now reliable, on a weekly basis, and includes device innovations as well as clinical teaching and M&M. There is also weekly lung function reporting with a consultant and consultants are available to discuss every referral.

Procedures (estimated per year done by each Resp SpR)

  • Chest drains: 20-25
  • NIV initiation: 25+

Pleural USS

  • The department has a dedicated bedside USS machine.
  • There is a Level 2 competent Consultant, meaning Level 1 sign-off for trainees is achievable.
  • There are dedicated pleural clinics so there are plenty of opportunities to practice, and to seek a second opinion from a Consultant or Radiologist when necessary.

NIV

  • Jason Gittens runs the NIV service. NIV is delivered in ACU or on the Respiratory wards, as well as in HDU. The organisation and delivery of NIV is suboptimal, but it undergoing significant amounts of work following the NCEPOD report. Trainees can expect to be involved in plenty of NIV initiation and weaning, with support.

GIM

  • The acute commitment is approximately 1 in 7-8 interspersed with normal duties. The take is busy but the hospital has in the past responded to winter pressures with additional SpR cover, making it manageable.
  • The referral load is heavy when on take and the Medical SpR is busy day and night.

Teaching

  • The usual informal on the job teaching of medical students and junior doctors
  • PACES is run at Whipps Cross three times a year, so there is the opportunity to get involved in helping to run this, and to teach CMTs who are preparing for PACES on a mock-exam.

Management/leadership

  • There are opportunities to co-ordinate M&M, and to run the Monday education meeting schedule.
  • You will need to organise allocation of juniors to the two wards and to outliers, factoring in leave, and on call commitments.

Specialist training opportunities

  • Asthma specialist service is at Barts but patients are referred regularly from Whipps and there is the chance to attend the Barts meeting
  • EBUS is done at Barts by Dr Mohammed and he is keen for trainees to attend when staffing is sufficient
  • There is a good palliative care team and the hospice is on site so there are opportunities to make contact and attend meetings/visits
  • There are good links with the cardiothoracic team through the lung cancer MDT. Ms Wilson is particularly helpful and very happy to have trainees attend surgical lists.

Research

  • No specific opportunities highlighted. QIP opportunities always available.

Stage of training best suited to this rotation

  • ST5/6/7 – traditionally felt to be ideally suited to a more senior trainee who functions well with less day to day supervision.
  • Recent changes to the structure and level of supervision means that this would be a good job for an ST3/4 with opportunities to up-skill in many of the core Respiratory skills.

 Recent trainee comments:

” An excellent place to gain pleural procedure experience and competence, including sign off for level one.”

“Dr Rowena Taylor is an excellent teacher and runs the sleep clinic – previously not formally on the timetable but recommended.”

“General medicine is busy but there is some good experience to be gained and it is relatively well run.”

“Whipps is busy but friendly, with a really interesting case mix and a lovely department. There are great opportunities for training in lung function reporting, and USS. The hospital management is not ideal, but is not terrible. The Respiratory department is in contrast very well run. Consultants get on well, and work closely with physios, specialist nurses, and physiologists.  They provide a supportive, flexible environment for training and are keen to ensure trainees identify and fulfil individual training needs.”

About drlj

Respiratory Registrar in North East London

Discussion

One thought on “Whipps Cross Hospital

  1. Spr clinics have 2 New and 4 Follow up patients in response to Spr feedback. Hopefully this will not be regarded as taxing.

    Re. All referrals being seen by SpRs: Respiratory referrals on the 70-bedded Admissions Unit are seen by Consultants on a daily basis.

    There is a weekly TB MDT.

    Posted by Alistair Reinhardt | February 22, 2017, 11:20 pm

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