The North Middlesex Hospital is a District General Hospital in Edmonton, serving communities in Enfield, Haringey, Barnet, Waltham Forest and beyond. It began life as a workhouse in 1840 and an infirmary was added in 1907. The modern hospital was built in 2010 with a new diagnostic centre, 5 inpatient wards, 8 operating theatres, a spacious outpatients and an A & E department. The North Mid has had some challenges recently, and the current CQC rating overall is “requires improvement”. An updated investigation by the CQC published in December praised the organisation for demonstrating improvements for patients across the board. The A&E department went from “inadequate” to “requires improvement.” The Royal Free is providing support for ongoing improvements, with the Chief Exec acting as accountable officer on an interim basis.
Consultant speciality interests
- Dr B Jayaraman – Intersitial lung disease
- Dr S Lozewicz – Tuberculosis
- Dr H Makker – lung cancer, sleep apnoea
- Dr Z Mangera – lung cancer
- Dr IK Moonsie – COPD, NIV
- Dr B Sheinman – Allergy/asthma, FOB + EBUS
- Dr C Valerio – pleural disease
- Weekly attendance at Lung cancer MDT/Radiology meeting
- Infrequent attendance at clinical meeting/journal club
- Rare attendance at M&M
- Hospital Grand Rounds
- Opportunity to attend ILD meeting
- Mixed experience in Bronchoscopy – recently improved access.
- One protected bronchoscopy list per week (shared between 2 registrars) with opportunity to attend 2nd list
- EBUS is present in the hospital but attendance requires initiative
- Suitable for ST4/5
- Previously only 1 clinic a week but now 2 TB/General clinics per week.
It is unusual to have both registrars on the ward at the same time. There is reasonable consultant presence, however. Limited number of juniors can make it feel busier than it should. A busy AMU provides plenty of referrals. Whilst radiology traditionally perform drains there is opportunity to use the respiratory ultrasound should you wish. The Bronchoscopy list is on Tuesday (and possibly Thursday afternoon should time permit). The intensive care unit run the NIV service meaning frustratingly poor access for respiratory trainees.
Procedures (estimated per year done by each Resp SpR)
- Chest drains: 5-10
- NIV initiation: 5-10
- No level 2 Consultant. There is the opportunity to develop the ambulatory pleural service for Level 1 trainees as there is a dedicated slot and a dedicated Respiratory Department machine.
- NIV is undertaken on the HDU adjacent to the Intensive care unit
- Busy GIM on calls but since it is done in random days rather than blocks it doesn’t feel too hectic. 2 registrars (one for ward, one for take) on call including night shifts. Gaps in rota can mean this is not always the case however.
- Observed undergraduate teaching (lots of students around and opportunities to teach)
- Observed postgraduate teaching (eg CMT)
- Rota and teaching organisation
- Opportunities to engage with management
- Junior doctor forum
Specialist training opportunities
- There is an ILD MDT that happens once a month.
- No clear opportunities. Many QIP opportunities.
Stage of training best suited to this rotation
- ST4-6 (less supervision, some complex patients)
Recent trainee comments:
“Can be intense, but good opportunities for slightly more senior trainees.”
“Interesting pathology, nice Consultants who have listened to feedback and made changes for benefit of trainees. I really enjoyed my time at North Mid.”