The Neurology Training Programme in HEKSS; the Surrey rotation between the Atkinson Morley’s Wing, St George’s Healthcare NHS Trust, Frimley Park Hospital NHS Foundation Trust and the Royal Surrey NHS Foundation Trust, Guildford.
This programme runs at the following Trusts
Frimley Park Hospital NHS Foundation Trust
Royal Surrey County NHS Foundation Trust, Guildford
Training Programme Director, KSS Neurology Programme
Dr Damian Wren
Dr Anthony Pereira: St. George’s Hospital
Dr Damian Wren; Frimley Park Hospital
Dr Graham Warner: Royal Surrey County Hospital
Anticipated duration of program and start date
– 5 years to include higher specialist training in neurology
– Annual recruitment to start first week of March
– Expected outcome, i.e. completion of CCT in neurology
– OOP opportunities leading to higher degree/ other qualification to fit individual needs/ desires
Neurology Training Program
Neurology training is entering a new phase. Neurology used to be an isolated specialty managing a low volume of highly complex cases. Today, many more diseases of the nervous system are treatable and neurology expertise is essential early in a patient’s care for better diagnosis and management.
We are rolling out a residency program which will cover all aspects of neurology and produce trained consultants well equipped for the job market of the future and able to practice to the exacting standards our specialty demands. These posts are recognised for training and attract an NTN in HEKSS. These posts include an on-call commitment based at St. George’s Hospital.
St. George’s Hospital NHS Trust
Trust Vision & Values:
By 2015 we will be a thriving Foundation Trust at the heart of an integrated healthcare system. One that delivers improved patient care at a community, hospital and specialist setting, supported by a unique and nationally recognised programme of research, education and employee engagement.
We expect all our staff to share the values that are important to the Trust, being Excellent, Kind, Responsible & Respectful, and behave in a way that reflect these.
St. George’s Healthcare NHS Trust is one of the largest healthcare units in the United Kingdom accommodating around 1170 beds. It treats around 80,000 inpatients, day cases and over 300,000 outpatients annually. The Trust employs over 4000 staff incorporating 575 Medical & Dental Staff. It provides general acute services together with speciality services including neuroscience, cardiothoracic, and specialist children’s services.
St. George’s Hospital is the main teaching hospital in the south-west sector of London and as such has developed links with most district general hospitals throughout Surrey and Sussex and supports a significant training programme for junior doctors who rotate through the Trust.
The Trust serves a resident population of about 350,000. In 2003, the Atkinson Morley’s Hospital closed and moved to a new, purpose-built wing on the Tooting site, sharing accommodation with the regional cardiothoracic unit. The new Atkinson Morley Wing is arranged over four floors, around inner courtyards and incorporates 233 in-patient and day-case beds, eight operating theatres, and a range of state-of-the-art diagnostic and treatment facilities. The Trust continues to achieve and provide excellent standards of patient care and offers exceptional teaching programmes delivered by highly skilled specialists
There is an excellent multi-professional medical library in the Medical School of St. George’s Hospital in which the main medical and neurological/neurosurgical journals are kept, together with a wide range of reference books and facilities for photocopying.
There is an extensive range of educational resources for access. These include printed and electronic resources and cover a wide range of books and journals. The staff are extremely knowledgeable and will help you access training material. If the materials are not available on site, information can be obtained online or through the system of inter-library loans and literature searches.
Computers with internet access are available and there is access to a wide range of relevant databases such as Embase and Medline. Library Services also offer a training programme which covers literature searching, finding evidence based resources and critical appraisal.
St. George’s Hospital is based in the heart of Tooting and is well served by excellent public transport links to the City and West End. Tooting Broadway’s Northern Line Underground station is a 5 minute walk away. The National Rail station of Tooting Junction is a 15 minute walk away. Numerous bus routes serve the area, two of which stop inside the Hospital grounds, the G1 and the 493. Parking on the St. George’s Hospital site is restricted to permit holders, permits are allocated by ballot and a charge is made.
Staff accommodation is subject to availability at a reasonable rent for single occupation. A limited amount of family accommodation exists.
Further information is available from
Nuria Burset, Medical HR Officer on Tel: 0208 725 3173 or e-mail firstname.lastname@example.org
Adam Gray, Asst Service Manager on T: 02087254667 or email@example.com
Neurology Training at St. George’s Healthcare NHS Trust
Department of Neurology, St. George’s Hospital
The district neurology service is closely linked to the regional neuroscience service in the Atkinson Morley Wing. There are 29 consultant neurologists. St. George’s provides a comprehensive neurology service as well as many specialist clinics.
The Neurology Staff
|Dr. Ali Al-Memar||Kingston Hospital||Neuromuscular|
|Dr. David Barnes||Ashford St Peter’s Hosp||MS|
|Dr. Camilla Blain||SGH||MS|
|Dr. Geoff Cloud||SGH||Stroke/Geriatrics|
|Dr. Jan Coebergh||Ashford St Peter’s Hosp||Movement Disorders|
|Dr. Hannah Cock||SGH/SGUL||Epilepsy|
|Dr Catherine Dalton||SGH||Neuro-rehabilitation|
|Dr Joe Flowers||SGH||BTX|
|Dr. Oliver Foster||SGH||Movement disorders|
|Dr. Adrian Fowle||Ashford St Peter’s Hosp||Neurophysiology|
|Dr Collette Griffin||SGH||Head injury|
|Dr. Peter Garrard||SGH/SGUL||Dementia|
|Dr. Paul Hart||St Helier’s Hospital||HIV & oncology|
|Dr. Min Htut||St Helier’s Hospital||Neurology/Neuro-physiology|
|Dr. Jeremy Isaacs||Kingston Hospital||Dementia|
|Dr. Usman Khan||SGH||Stroke|
|Dr. Al Khyatt||SGH||Neurophysiology|
|Dr. Geoff Kimber||East Surrey Hospital||Autonomic|
|Dr. Dora Loszardi||SGH||Epilepsy|
|Dr. Caroline Lovelock||Epsom Hospital||Stroke|
|Dr. Bridget MacDonald||Mayday Hospital||Epilepsy|
|Dr. Hamid Modarres||SGH/Mayday||Neurophysiology|
|Dr. Barry Moynihan||SGH||Stroke/Geriatrics|
|Dr M Mula||SGH||Epilepsy|
|Dr Niran Niranalanathan||SGH||Neuromuscular & headache|
|Dr. Arani Nitkunan||Mayday Hospital||Neuro-opthalmology|
|Dr. John O’Dwyer||Frimley Park Hospital||Movement disorders/BTX|
|Dr. Salah Omer||Kingston Hospital||Genetics|
|Dr Dominc Paviour||St Helier’s Hospital||Movement disorders|
|Dr. Anthony Pereira||SGH||Stroke|
|Dr. Fred Schon||Mayday Hospital||Teaching|
|Dr. Michael Sheehy||Royal Surrey County||Neurophysiology|
|Dr. Jeremy Stern||Frimley Park Hospital||Tourette’s|
|Dr. Graham Warner||Royal Surrey County||Epilepsy|
|Dr. Damian Wren||Frimley Park Hospital||MS|
Neurological Services at St George’s
St. George’s Stroke Service
The stroke service at St. George’s is located within the Atkinson Morley Regional Neuroscience Centre. This is housed in a new building on the main St. George’s Hospital site. It offers unrivalled access to all support services such as neuroradiology including interventional neuroradiology, neurosurgery, intensive care and therapy services. Stroke within London is being reorganised by Healthcare for London and St. George’s has been successful in being designated one of 8 hyperacute stroke centres as well as a TIA service.
We have 20 Hyper-Acute Stroke Unit (HASU) beds and 16 Stroke Unit (SU) beds in the AMW. Consultants rotate to cover both units providing daily consultant ward rounds and excellent training supervision. St. George’s offers all aspects of hyper-acute care including a regional thrombolysis service. We have all the necessary support facilities including monitored beds on the HASU and access to interventional procedures such as hemicraniectomy, posterior fossa compression, stenting of stenosis and coiling of aneurysms with access to neuro ITU. We also offer a daily rapid access TIA service. St. George’s also acts as a regional and national referral for specialised stroke cases. We have a well-developed carotid intervention service offering endarterectomy and stenting in collaboration with the regional vascular surgery group. We run a national service for genetic causes of stroke.
Within the unit we have groups working on stroke genetics, advanced imaging (MR and ultrasound) as applied to stroke, cerebral small disease and vascular cognitive impairment and clinical trials in stroke. We co-ordinate a number of multicentre trials and studies in stroke including CADISS (looking at treatment of carotid dissection), VIST (looking at vertebral stenting) and large scale genetic studies (e.g. UK Lacunar DNA Study). We are the highest recruiting centre to Stroke Research Network adopted studies in the UK.
The unit houses a total of 44 beds, comprising 24 adult male and 20 female beds including HDU beds. There are 12 beds in a dedicated neuro intensive care unit. In addition to these beds there are 8 dedicated paediatric neuro beds within the Paediatric Unit located in Lanesborough Wing. The catchment area comprises a population of approximately 3.1 million and annual admissions totalling around 2,500 neurosurgical patients.
There are three operating theatres for sole neurosurgical use. A stealth neuro navigation system, as well as CRW frame based stereotaxy system is available. Each theatre has an operating microscope and there are two ultrasonic aspirators available. Operations total over 2000 procedures annually.
The Neuroradiology Department contains one 16-slice spinal CT scanner with facilities for CT angiography and a 1.5T and 3T MRI Unit. There are two rooms for digital subtraction angiography; 1 with bi-plane angiography equipment and the other with a single plane with flat plate technology. A Doppler ultrasound is also available.
Neuro Intensive Care
St. George’s Hospital in London has three adult intensive care units on site; general intensive care, cardiothoracic intensive care and neurosurgical intensive care. The hospital has recently been designated as a major trauma centre and to meet the increased demand for intensive care facilities we are increasing the capacity within the neuro Intensive Care Unit. The neuro-intensive care is a 14 bedded unit located within the Atkinson Morley’s Wing of St. George’s Hospital. It has links with both the anaesthetic department as well as the other critical care units within St. George’s Hospital. We act as a tertiary referral centre for south-west London and Surrey.
Neuro-Rehabilitation: Wolfson Neurorehabilitation Centre
The Wolfson Regional Neurorehabilitation Centre (WNRC) has moved to the main St. George’s site and has strong links with Roehampton. There are currently 12 beds for further rehabilitation of patients attending the local stroke service.
Neurology training at St George’s
6 SpRs in Neurology, Health Education South London
3 SpRs Neurology, HEKSS
2 Academic SpRs: 1 NIHR Clinical Lecturer & 1 junior clinical lecturer
3 CCT SpRs in Stroke
1 SpR in Rehabilitation
1 SpR in Neurophysiology
1 SpR Neurology HEKSS Frimley Park Hospital
1 SpR Neurology HEKSS Royal Surrey County Hospital, Guildford.
All London trainees appointed to St. George’s are part of the St. George’s neurology programme. They will spend most of their training based at St. George’s. Some registrars may have the opportunity to spend up to a year of their training programme at NHNN. Not all registrars go to NHNN.
Trainees appointed to the HEKSS (Surrey) rotation will join part of the St. George’s neurology programme. The same overall group structure will be used to administer the rotation. There are three sites on the rotation: St. George’s (SGH), Frimley and Guildford. The rotation is 5 years long. We envisage that most trainees will spend some time out of programme engaged in higher study. This would result in a 4-year clinical rotation for most people alternating years between a Surrey Hospital and St. George’s. Should a candidate be in the rotation for a fifth year, they may spend a third year in a Surrey hospital.
There is one HEKSS neurology trainee from the KSS (Kent) rotation at AMW to gain tertiary Neuroscience experience (a second KSS (Kent) trainee rotates to Kings College Hospital Neuroscience Centre.
The exact rotation will depend on the candidates appointed and their preferences for taking time out for research.
- Registrars: Anthony Pereira
- ST1/2s: Bridget MacDonald
Group educational supervisors will oversee most training
Blue: Damian Wren
Green: Dominic Paviour
Red/stroke: Anthony Pereira
Academic/stroke: Barry Moynihan
Neurophysiology: Adrian Fowle
In addition, each trainee will have a personal mentor. For trainees here for more than 1 year, your mentor may change each year. The educational supervisors should in general remain responsible for formal paperwork etc.
This is a 1 in 12, resident, shift-based rota. Prospective cover applies. Band 1B applies. “Resident” means the SpR must be available in A&E in 15 mins. However, the new target for thrombolysis is a door to needle time of 30 mins, so registrars must remain nearby at all times.
Normal day: 9am-5pm. There should be an average of less than 48 hours per week of work in hospital.
Every 18 weeks there is a week of nights. This starts on Friday night and continues until Thursday, finishing on Friday morning. The registrar has the rest of the Friday and the weekend off and returns to work on Monday.
The “evening” shifts are as follows:
Weekends (not nights):
This set of shifts comes round 1 in 12.
Additional weekends (not nights):
Prospective cover applies
DUTIES OF THE POST
Registrar in Neurology
- The registrar duties are to
- Cover the Neurology ward/ Stroke wards and Head injury beds including assessment of all admissions to the wards and where necessary in A & E.
- Attend a weekly neurology clinic
- Neurology on-call rota as agreed
- Teach medical students and other staff on the unit.
- Attend the weekly multidisciplinary meetings.
- Collect data for the research/audit/governance projects and assist in departmental research and trials.
- The registrars are expected to present cases on the ward rounds. They will be expected to review new patients with the Consultant and review the continuing care of other patients on the ward. They will work closely with other SpRs and StRs.
- In addition, there is a 7-bed day case unit. The registrars have some responsibility for day to day running of the day unit. They also contribute to academic meetings and departmental audit.
- Neurology out-patient clinics are held in the Atkinson Morley Wing OPD which has 12 examination rooms. Each registrar will do one neurology clinic. There are specialised clinics in multiple sclerosis, epilepsy, stroke, CADASIL, neuro-ophthalmology, Botulinum toxin treatment, Parkinson’s disease, Tourette’s syndrome, muscle disease and peripheral neuropathy. Registrars have the opportunity to observe and assist in these, as well as to observe the recording and interpretation of electroencephalography and other techniques of evoked potentials, including auditory, visual, somatosensory and brainstem evoked responses. Registrars will also learn about skin biopsies and greater occipital nerve injections.
There are a large number of training opportunities in Neurology, so that the full Neurology curriculum is covered over the rotation. The Neurology curriculum is available on the GMC website, all trainees should familiarise themselves with how they will be assessed to meet each curriculum competency.
|Major Topics within the Curriculum||Atkinson Morley’s||Royal Surrey||Frimley Park|
|2.1 Head Injury||Yes||No||Yes|
|2.3 Disorders of Consciousness||Yes||Yes||Yes|
|2.4 Disorders of Sleep||Yes||Yes||No|
|2.5 Disorders of Higher Function||Yes||Yes||Yes|
|2.7 Cerebro-vascular Disease||Yes||Yes||Yes|
|2.8 Tumours of CNS||Yes||Yes||No|
|2.9 Infections of CNS||Yes||Yes||Yes|
|2.10 CSF Disorders||Yes||No||No|
|2.11 Demyelination & vasculitis||Yes||Yes||Yes|
|2.12 The Neurological Complications of immuno-suppression||Yes||No||No|
|2.13 Parkinsonism & Movement disorders||Yes||Yes||Yes|
|2.15 Toxic & Metabolic states||Yes||Yes||Yes|
|2.16 Visual System||Yes||Yes||Yes|
|2.17 Cranial Nerves||Yes||Yes||Yes|
|2.18 Spine, Cord & Roots||Yes||Yes||Yes|
|2.19 Peripheral Nerve||Yes||No||No|
|2.20 Autonomic nervous system||Yes||No||No|
|Allied Topics within the Curriculum||Atkinson Morley’s||Royal Surrey||Frimley Park|
|3.1 Clinical Neurophysiology||Yes||Yes||Yes*|
|3.4 Neuro Intensive care||Yes||No||No|
|3.6 Neuro paediatrics||Yes||No||No|
* limited service
Education and Study Schedule
There is a lot of teaching available. The main timetable is given below:
|AM||0900 Stroke X-ray meeting||1100 Fred Schon Neurology teaching||10.00 Monthly CPC
11/00Consultant on-call teaching
1130 Neurology grand round & Audit
|PM||1500 Jeremy Stern teaching||1230 Journal club||1500 Bridget MacDonald ST1/2 teaching||1230 Anthony Pereira stroke teaching||1230 Neurology X-ray meeting
1330 Adrian Fowle Neurophys teaching
- All leave must be co-ordinated through and authorised by the Senior Resident
- Then all leave must be notified to Adam Gray on the leave request forms.
- You must plan your leave early so you get what you want. It should be possible for everyone to take the holidays they want. However, if you leave it until the last moment to plan and the ward risks being left poorly staffed then we will draw lots for who gets what.
- Try to keep night on-call as quiet as possible:
- All jobs that can be completed, must be completed before handover
- 6 weeks notice is needed to cancel clinics
Junior Doctors Hours
The posts have to comply with the law on Junior Doctor hours. Therefore, what follows, may appear overly officious but it is important.
- Rotas are designed to try to allow everyone good quality training without undue stress and fatigue.
- If training is too arduous, please let your educational supervisor know as soon as possible.
- Trainees are responsible for their time.
- Trainees have responsibility to organize their time so they can enjoy their natural breaks.
- Trainees are under no obligation to stay beyond their shift handover period (except, obviously, for a clinical emergency).
- Therefore, at the end of a shift, trainees are expected, either to organise work to be completed the next day or hand over tasks to the next shift.
- We are always grateful to people who do work in their own time, either by coming in early or staying late. However, this is not policy and will not be counted in the assessment of junior doctors’ hours.
The London Neurology STC have arranged a two year rolling programme of lecture and training days covering the curriculum. We would envisage the Surrey KSS trainees attending these days.
Active participation in audit, case report writing, clinical research project etc is encouraged.
Basic pay referring to national salary scales
Travel and relocation expenses policy
Website Address: St. George’s Healthcare NHS Trust
Telephone: 020 8725 4483
London SW17 0QT
Phone: 0208 672 1255
Royal Surrey County Hospital
Phone: 01483 571122