Paediatric Respiratory Medicine

Introduction

Guy’s and St Thomas’ NHS Foundation Trust Paediatric Respiratory Visiting Professional Programme (VPP) is designed to provide international visiting professionals with the opportunity to experience and learn from a team working in a busy tertiary Paediatric Hospital. The Paediatric Respiratory Department, part of the Evelina London Children’s Hospital at Guy’s and St Thomas’ NHS Foundation Trust, is situated in the centre of London and it is one of the providers of specialist respiratory care for children in England. 

Our Visiting Professional Programme is a unique development experience that allows visitors to observe our leading respiratory team in all its settings. The attachment will be tailored to the learning needs of the observer and can be form broadly generic to highly specific. We are dedicated to broadening international professionals’ clinical expertise and enabling them to observe new skills that can be transferred back to their work place.

The merger of Guys and St Thomas’ and Royal Brompton and Harefield NHS Foundation trusts on 1st February 2021 has created unprecedented opportunities for outstanding clinicians and teams to work alongside each other in both developing clinical services and in research.

From April 2022, children’s cardiac, respiratory and intensive care services will operate as a combined service across both Evelina London and Royal Brompton sites, organised as a single clinical directorate with joint leadership overall, whilst maintaining strong site-based leadership. The formation of the new clinical directorate has already been supported through close collaborative working between the two teams. Bringing the two teams together in a single directorate will also enable us to take maximum benefit from the work on Apollo, our new electronic patient record programme, which will go live in 2023. Full integration will ultimately be enabled by a major development programme of the current Evelina London site at St Thomas’ Hospital, subject to regulatory approvals. Subject to public consultation, we expect inpatient children’s respiratory services to transfer from the Royal Brompton site to create a single combined inpatient unit when the expansion of the Children’s Hospital is complete in 2027.

Making the necessary changes to have a single service across two sites will mean more opportunities for staff to work across sites and to improve our services for patients. Our working assumption is that inpatient services will not move site permanently until the Evelina London extension is completed, however, as the Covid pandemic has clearly shown, we need to be agile in responding to challenges and opportunities.

Programme aims

The programme is aimed at those who wish to extend their experience within a leading paediatric respiratory team and who wish to gain an understanding of the way this is practiced and organised within the NHS and how it integrates with patient care pathways.

The programme aims to include:

• Direct experience and exposure to Paediatric Respiratory Medicine
• Opportunities to get involved with short quality improvement projects during your visit
• Opportunities to attend our in-house teaching sessions
• Opportunities to attend our clinical governance meetings
• The opportunity to share knowledge and expertise with doctors, consultants and the wider multidisciplinary team who works closely with the respiratory team i.e. Paediatric ENT, Paediatric Intensive Care, Paediatric Surgery, Neonatal Unit and Paediatric Cardiology.
• The opportunity to develop and extend visitors’ work portfolios by gaining experience of observing one of the largest teaching hospitals in Central London, whilst gaining direct insight into the workings of the NHS

A Certificate of Attendance will be awarded to visitors upon the end of their programme.

Format

The clinical observership is delivered in the work place and participants will receive guidance and direction from Dr Zehan Rahim, Lead for the Paediatric Respiratory Visiting Professionals Programme, for the duration of their stay. The visiting professionals will be provided with a programme for the first couple of weeks and then encouraged to tailor their experience to attending areas that are of specific interest to them. They will be provided with information regarding all the available clinics, day cases and research activity and will welcome to observe practice in those areas. They will have access to trust email and will be given the details of the members of faculty with whom to communicate about observing in their specific areas. We find that this self-directed approach to learning is better than a didactic approach. Some visiting professionals become involved in research projects or audits and tailor their time to that; others want to spend more time learning about day case procedures and some prefer to see more clinics. The observer will be nominated a supervisor to coordinate their individual programme and mentor progress each week.

Who can apply

This programme is intended for non-U.K. advanced trainee clinicians at the level of specialist registrar or consultant looking for exposure to a leading NHS Paediatric Respiratory team.

Visitors can apply primarily for an observership (with no hands-on element) or a practical attachment programme.

Those wishing to apply must have GMC registration. You can apply for GMC registration directly through the main GMC website, alternatively The Royal College of Physicians run a medical training initiative which facilitates GMC registration and provides sponsorship for a Tier 5 visa. You can find out more about their Medical Training Initiative by visiting their website.

Programme duration

We are able to offer clinical observerships for overseas doctors for any duration. However, it is best to stay for at least 3 months to take advantage of all there is on offer but we are happy to discuss shorter attachments as well. We do not usually have people for more than 12 months but it is sometimes possible to extend the time beyond a year if desired. The experience can be tailored to the applicants needs from a generic overview of our Respiratory services to a specialised attachment to one specialised clinical area e.g.: Difficult asthma, Long Term Ventilation, Paediatric Airway and Clinical Paediatric Sleep Medicine.

Paediatric Respiratory Medicine service

The Respiratory team at the Evelina London Children’s Hospital (ELCH) is providing specialist respiratory care arising from the increased number of tertiary referrals to the respiratory, airway, sleep and ventilation services and also the need to provide additional support to the wide-range of specialist children’s services based at the Evelina London Children’s Hospital.

This post will provide clinical service to the following sub-specialist areas:

• Long term ventilation service
• Complex Airway and Interventional Bronchoscopy Service
• Asthma and Severe and Difficult to Control Asthma Service
• General Respiratory and The Respiratory Assessment Unit

The respiratory service is a busy service, reflecting the needs of the local service and tertiary needs of other services within the Evelina. There are an increasing number of children with complex respiratory conditions and requiring discharge on long-term ventilatory support. There are close links with Lane Fox Respiratory Unit, The Paediatric Sleep, PICU, NICU and ENT teams.

Respiratory consultants are Dr Simona Turcu, Dr Jane Heraghty, Dr Meredith Robertson, Dr Zehan Rahim and Dr Anna-Louise Nichols all based at the Evelina London.

There are six specialist nurses separate for asthma and long-term ventilation. The team works closely with PICU consultants Dr Andrew Nyman and Dr Paul James regarding complex airway patients, Dr Jo Perkins for long-term ventilated patients and with sleep consultants Prof Paul Gringras, Dr Michael Farquhar, Dr Desaline Joseph and Dr Federica Trucco regarding children with sleep disorder breathing.

There are usually around 25 inpatients across all the wards with around 50 admissions under respiratory each month this includes reviews of patients within the trust. Initiation of long term ventilation (invasive and non-invasive) occurs in about 5-7 patients per month and there are 6 dedicated long term ventilation beds. There is a diagnostic bronchoscopy list every week and an interventional bronchoscopy list (bronchogram and brochial stent insertion) every month. There are 9-10 respiratory clinics per week in addition to nurse led asthma clinic, nurse led long-term ventilation clinic and chest physiotherapy led clinic.

The Paediatric Sleep Service at the Evelina is a rapidly expanding tertiary service which assesses diagnoses and manages children presenting with complex sleep problems across the whole spectrum of paediatric sleep medicine. It has particularly strong links with the paediatric neurodisability and respiratory services, as well as the adult sleep service at Guy’s Hospital.

The team is staffed by three consultants in paediatric sleep medicine (Professor Paul Gringras, Dr Michael Farquhar and Dr Desaline Joseph), a Highly Specialist Clinical Psychologist (Dr Rebecca Martyn), a Chief Sleep Physiologist (Jane Orgill) and a team of physiologist.

MDT clinical opportunity

• Spinal/orthopaedic respiratory pre assessment clinic: 2/month
• Diagnostic Bronchoscopy list: weekly
• Interventional Bronchoscopy list: once per month
• MDT meeting for complex respiratory patients: weekly Tuesday mornings
• MDT for complex patients with general paediatrics weekly Wednesday afternoon
• Airway meeting Tuesday lunchtime

Non-fixed teaching sessions

• MSc in Paediatrics with Respiratory modules King’s College Hospital
• Thursday lunchtime respiratory teaching Evelina
• Sleep physiology teaching
• London Paediatric Sleep Group meeting: 3 times per year
• UK Paediatric Sleep Videoconference: 4 times per year
• London Paediatric Respiratory Group LPRG: 4 times per year
• Lung in childhood teaching: 4 times per year
• Attendance at conferences is encouraged eg BPRS, BTS, ERS, ATS

Example Timetable

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email [email protected].

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.