Whipps Cross Hospital

Updated in Jan 2023

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 overall 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.

3 Respiratory trainees will be posted here (usually 1 year rotation) at each time. The 3 trainees are the only respiratory registrars in the hospital. During the recent COVID pandemic, they have recruited 2 additional fellows/locum doctors to the registrar body.

Consultant speciality interests

• Dr Simon Quantrill: Clinical lead, Asthma, Bronchiectasis, Sarcoidosis, Undergraduate education
• Dr Mathina Darmalingam: TB, Pleural, Bronchoscopy
• Dr Ali Mohammed: Lung cancer, EBUS, Pleural 
• Dr Rowena Taylor: Sleep Medicine, Chronic cough (outpatient only, no ward cover)
• Dr Nadia Gideh: Sleep/NIV, Bronchoscopy, Post-graduate education, LTFT/maternity lead and Junior doctors’ rota co-ordinator
• Dr Aarash Saleh: COPD lead, Bronchiectasis and infection, Bronchoscopy, Pleural
• Dr Richard Toshner: ILD
• Dr Rohan Gell: Acute Medicine and Respiratory, Sleep/NIV
• Dr Yejide Odedina: Lung nodules and cancer, EBUS

Typical week Shared between SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Sleep clinic/ Bronch list (alternate weeks)	Sleep and Vent clinic	TB clinic/ Bronch list (alternate weeks)	Lung cancer clinic	WR
Lunch	Radiology meeting/ departmental teaching	Lung MDT or NIV MDT		TB MDT
PM	Pleural clinic	Admin/ Referrals	Admin/ Referrals	Pleural clinic	Admin/ Referrals

• If there are a few SpRs around, then some can see referrals. 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.
• All clinics (including pleural, sleep, lung cancer and TB clinics) and bronch lists detailed above are shared between the SpRs. All SpRs generally attend 2 clinics (of any mixture as per the timetable above) a week when not on-call.
• 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 – 3 news and 4 follow-ups on their lists with discussion and teaching alongside. Clinics are very manageable and are well supervised with very helpful feedback.
• Ward work is very consultant-led. There is a daily Consultant ward rounds and supervision. The consultants work in a 1 in 8 consultant of the week on the wards. There is a good balance, therefore, of SpR rounds and Consultant input.
• Departmental M&M meetings are held monthly.
• Admin on Friday afternoon includes lung function tests reporting with a consultant.
• Consultants are available to discuss every referral.

Other optional clinic opportunities that you could join:

• Cough clinic
• COPD MDT every 4 – 6 weeks

Bronchoscopy

• Previously, it was felt that there was adequate experience in diagnostic bronchoscopy including endobronchial biopsy at Whipps. However, bronchoscopy lists have been increased (average of 2 a week) which are run by 3 consultants. These lists are shared between the SpRs.
• There are also 2 bronchoscopy simulators with software to practise with which can be easily accessible by the SpRs.
• There is now a consultant who can perform EBUS so we should see increasing number of patients undergoing EBUS in this centre.
• There were previously mixed views on whether the post is suitable for an ST3 or 4 mainly due to the low or non-existent numbers of bronchoscopies which was felt to be inadequate for up-skilling in early training. Given the increasing number of bronchoscopy lists now, these views will sure to change over time.

Estimated number of bronchoscopic procedures in 6 months per trainee: Undetermined at present

Estimated number of EBUS/TBNA in 6 months per trainee: Undetermined at present

Thoracic US and pleural procedures

• Dedicated respiratory department portable US machine available.
• Dr Ali Mohammed is a Level 2 competent consultant, meaning Level 1 sign-off for trainees is achievable.
• There are opportunities for medical talc pleurodesis.
• 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. They are well supervised, so good experience for ST3s who need to get signed off.
• It has been reported to have no opportunities for pleural biopsy, medical thoracoscopy and IPC insertion.

Estimated number of thoracic US in 6 months per trainee: 21 – 40

Estimated number of pleural aspirations in 6 months per trainee: 21 – 30 (some has reported to be 1 – 10)

Estimated number of chest drain insertions in 6 months per trainee: 1 – 10

NIV/Sleep

• 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 is undergoing significant amounts of work following the NCEPOD report. Trainees can expect to be involved in plenty of NIV initiation and weaning, with support.
• There has been significant improvement on pathways to refer for home NIV.
• There is link with the NIV MDT at Barts on Tuesdays at 12pm which SpRs can attend via Teams.
• There is also a local Sleep MDT with the outreach team that SpRs can attend.
• Dr Nadia Gideh runs a Tuesday morning clinic with urgent slots following up all patients who have required NIV for the first time and successfully weaned or those in ongoing type 2 respiratory failure who need monitoring.
• This centre not only manages OSA and OHS but also PLMD, restless legs, parasomnias, circadian rhythm disorders and insomnia with onward referral to tertiary centres for polysomnography where indicated.
• SpRs will have options to learn interpretation of sleep studies.
• Overnight pulse oximetry and limited polysomnography services (including SOMNOtouch) available.
• There are ongoing projects with ENT for OSA treatment and care with the hope to provide an integrated service in the future.

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 11 – 20

GIM

• Frequency of shifts:
  • About 1 first on-call take SpR weekend and 1 second on-call ward SpR weekend in 4 months.
  • About 1 week of nights on-call, split into two, in 4 months
  • Approximately 1 – 2 random on-calls per week (take and/or ward). However, there is a period of 3 – 4 weeks where there are no on-calls in every 4 months.
• The take is busy but the hospital has in the past responded to winter pressures with additional SpR cover, making it manageable. Day take includes 30 patients and night take includes 15 patients.
  • Weekday Day take team – 1 long day SpR, 1 FY1, 2 SHOs and 1 clerking SpR from 2pm.
  • Weekday Evening ward team – 1 SpR, 1 FY1 and 1 SHO.
  • Weekend Day take team – 1 SpR, 1 FY1, 2 SHOs.
  • Weekend Day ward team – 1 SpR, 1 FY1, 2 SHOs.
  • Night team – usually 1 SpR for ward and take, 2 clerking SHOs and 2 ward SHOs – hope is to bring this up to 2 SpRs but currently insufficient trainees.
• Wards during on-calls are not usually busy.
• Threshold for admission to hospital is very low.
• Some reported that they would have to manage a cardiac arrest on each on-call shift or about 30% of their shifts. Where as, other trainees have reported that they would rarely have to manage a cardiac arrest on their on-call shifts.

GIM experiences rated by trainees have been variable, from “very poor” to “good”.

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.
• The juniors including the SpRs organise the weekly Monday lunchtime teaching.

Management/leadership

• There are opportunities to co-ordinate M&M, and to run the Monday education meeting schedule.
• You will have the opportunity to organise the juniors’ rota by organising allocation of juniors to the two wards and to outliers, factoring in leave and on call commitments.
• SpRs are not involved in departmental management meetings.

Specialist training opportunities

• Asthma specialist service is at Barts but patients are referred regularly from Whipps and there is the chance to attend the severe asthma meeting with Barts (Monday lunchtime on Teams).
• EBUS is done at Barts by Dr Mohammed and he is keen for trainees to attend when staffing is sufficient.
• There is also a COPD MDT on teams once a month.
• 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 Barts cardiothoracic team through the lung cancer MDT. Mr Stamenkovic/Ms Wilson are particularly helpful and very happy to have trainees attend surgical lists.

Trainees have reported inadequate experience in allergy, ILD, CF, occupational/genetic/developmental lung disease, pulmonary rehabilitation and pulmonary hypertension.

Research

• No specific opportunities highlighted. QIP opportunities always available.
• SpRs are not involved in BTS Audits.

Stage of training best suited to this rotation

• ST3 – trainees may not get bronchoscopy experience but this should be balanced by the abundance of pleural experience.
• ST4 – trainees that have had a good bronchoscopy experience in ST3 but would like to get more pleural experience

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.”

“The Respiratory Consultants are all individually very kind and supportive however the experience has been affected by the pandemic, as everywhere. Unfortunately there has been no opportunity for bronchoscopy but there is plenty of pleural work including supervised pleural OP lists- generally populated by the SpRs. The GIM is busy but quite manageable, the hospital works fairly well for a DGH and the medicine is interesting, but the opportunities for learning/feedback is limited.”

“GIM generally decently staffed but often lots of locums so depends on who they get. Consultants can be less reliable at times. The respiratory department – lots of respiratory experience with looking after referrals and inpatients. Clinics quite sparse. Pleural experience dependent but usually a consultant available in pleural clinic. No bronch experience at all. Consultants can be quite disinterested in the respiratory department – lots of locum consultants on the ward.”

“Poor experience, extremely limited educational opportunities, consultants are not interested in your training or development, general medicine in this hospital is of questionable standard. For 4 weeks, the respiratory wards were covered by a locum endocrine consultant.”