North Middlesex Hospital

Updated in Dec 2020

The North Middlesex University Hospital (NMUH) 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 current overall CQC rating is “requires improvement”. Concerns about the A & E department were raised by CQC in 2016 urging for extensive improvement. In 2020, according to CQC, the urgent and emergency services had improved to good in responsive and well led which gave the service an overall rating of “good”. The medical care ratings for responsive and well led went up to good, caring remained good and ratings for safe and effective remained requires improvement.

The Royal Free and North Middlesex formed a clinical partnership in September 2017 to transform the standards of care based on evidence and best practice – nationally and internationally.  The Chief Executive of Royal Free London NHS Foundation Trust, took over as “interim accountable officer” at NMUH as part of the Royal Free’s hospital chain project in 2016. Now, NMUH have its own separate board and hospital chief executive.

2 Respiratory trainees will be posted here (usually 1 year rotation) at each time and both are the only respiratory SpRs in the hospital.

Consultant speciality interests

• Dr B Jayaraman – ILD
• Dr S Lozewicz – TB (also does Allergy at Barts and only does outpatient clinics now)
• Dr H Makker – Lung cancer, Sleep (also does Sleep at UCLH)
• Dr Z Mangera – Lung cancer
• Dr IK Moonsie – COPD, NIV
• Dr B Sheinman – Allergy/asthma, EBUS
• Dr C Valerio – Pleural disease
• Dr Jess Potter – TB and QIP lead
• Dr Carl Reynolds – Asthma and occupational lung disease
• Dr Iris Vlachantoni

Typical week for SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Admin	Lung MDT	Ward round	TB clinic	Ward round
Lunch			Dep. teaching
PM	Referrals	Bronch/ EBUS list	Gen Resp clinic	Bronch/ EBUS list	Admin/ Referrals

• Hospital grand round available in the hospital.
• Recent trainees tell us that the amount of ward work is more limited now. This is partly because the consultants are usually happy to have just an FY1 or SHO with them on ward rounds, and will encourage you to prioritise referrals due to the amount of referrals taking up a large amount of time; usually between 1 to 6 referrals per day. However, the consultants will support with these, especially if stretched. 
• Trainees also attend the Infections MDT.
• Opportunity to attend ILD meeting.
• The departmental M&M meeting is run every 3 months.
• Consultant body is now expanding and they are all extremely supportive with a wide variety of practice. Consultants will always discuss and review SpRs’ queries.
• There is a new SpR-friendly referral system by an app which all the consultants and SpRs accept reviews on. Therefore, consultants see how busy the referral load is and they will help to see patients. With the new app, SpR bleep has now rarely gone off.

Other clinic opportunities include:

• Sleep
• Allergy
• ILD (monthly)
• Cough
• Lung cancer

Bronchoscopy

• Two protected bronchoscopy/EBUS lists per week (shared between 2 SpRs)
• 2 – 3 EBUS procedures per list

Estimated number of bronchoscopic procedures in 6 months per trainee: 21 – 30 (with 11 – 20 endobronchial/brush biopsies)

Estimated number of EBUS/TBNA in 6 months per trainee: 20 – 25

Thoracic US and pleural procedures

• There is now a dedicated pleural service with its own portable US machine available 24/7
• Dr C Valerio is a level 2 trained thoracic ultrasonograher who will help sign you off for level 1.
• There are occasional opportunities for indwelling pleural cathether insertion and medical talc pleurodesis.
• Trainees have reported no opportunities for pleural biopsy and medical thoracoscopy.

Estimated number of thoracic US in 6 months per trainee: 41 – 50

Estimated number of pleural aspirations in 6 months per trainee: 11 – 20

Estimated number of chest drain insertions in 6 months per trainee: 11 – 20

NIV/Sleep

• The intensive care unit runs the NIV service meaning frustratingly poor access for respiratory trainees.
• There is a sleep service in this hospital with overnight pulse oximetry and limited polysomnography facilities available.
• There is also a great respiratory physiology department who loves to teach as well including CPET.

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 1 – 10

GIM

• Shifts are spread through the year with an average of approximately one on call per week. In 21-week block – 2 weeks nights, 1 week day on calls 1st on, 1 weekend AMU cover, 1 weekend ward cover, 1 week twilight SPR.
• On weekdays, there is a second twilight SpR and there are 4 SHOs (staggered start times) and 1 FY1. On nights, there are 2 SpRs and 5 SHOs.
• Medical take can be between 25 – 35 admissions during the day and 15 – 25 at night. Busy GIM on-call with good opportunity to see a wide range of pathology.
• You will probably have to manage cardiac arrests approximately 60% of your shifts.

GIM experience has been rated “average to good” here.

Teaching

• Observed undergraduate teaching (lots of students around and opportunities to teach)
• Observed postgraduate teaching (eg. CMT)

Management/leadership

• Rota and teaching organisation
• Opportunities to engage with management
• Junior doctor forum
• SpRs are not involved in departmental management meetings

Specialist training opportunities

• The Respiratory Physiology department is fantastic and offers a huge range of investigations including Bronchial challenge, CPET, fit to fly, amongst others. A great opportunity to get hands-on experience with lung function and be taught by some very knowledgeable staff.
• You will have the opportunity to gain some pulmonary rehabilitation and palliative care experience.
• As above, there are limited opportunities to gain ILD and allergy experience.
• There is now a possibility for some experience in occupational lung disease with Dr Carl Reynolds.
• There is no opportunity to gain experience in CF, pulmonary hypertension and genetic/developmental lung diseases.

Research

• No clear opportunities. Many QIP opportunities.
• SpRs are also involved in BTS audits.

Stage of training best suited to this rotation

• ST3+

 Recent trainee comments:

“Excellent general experience with advanced pathology and high rates of TB.”

“Very good post for exposure to pathology with good support from consultants.”

“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.” 

“I understand North Mid has a reputation for being busy and a hard place to work. GIM can be busy but I couldn’t rate my Respiratory training experience more highly thus far, in spite of COVID-19. I’ve gone from nil experience in EBUS to feeling very capable having done over 40. Secondly, the consultant body is large including 3 new consultants who are supportive and they all chip in with seeing referrals. I do recommend it for junior trainees especially to complete level 1 US thorax sign-off. They also have a great physiology department which is keen to teach trainees. Yes the GIM is busy but it’s far outweighed by their strong emphasis on your overall general Respiratory training.”