Job responsibilities
Care Group 2 is the largest and most diverse in the Trust, encompassing over half the consultant workforce over nine speciality areas. It provides diagnostic and logistic support by way of Theatre Pre-assessment and Sterile Services as well as Allied Health Professional-led services such as Orthoptics, podiatry, podiatric surgery and orthotics. Always ready to embrace change, it has an ambitious 3-year development strategy to develop its services both in house and in partnership with other organisations across the Integrated Care System to maintain its position as a leading provider of surgical services across the region.
Facilities and support services
There are dedicated outpatient facilities within the main hospital. Patients have their BMI checked, are routinely weighed and their urine tested at each appointment. There is direct access to the electronic patient record as well as the paper notes.
We no longer have dedicated in-patient beds, so if a patient needs admission they are admitted under the acute medical take and then we will review as necessary.
There is a shared day case facility (12 chairs and 4 beds) with others requiring chemotherapy and biologics. The facility is run by highly skilled nurses who are all chemotherapy trained. There is rarely a significant wait for therapy. Rheumatology patients are reviewed by the nurse specialist on the day.
We have dedicated physiotherapy and unusually have access to two hydrotherapy pools, one of which is on site.
Our occupational therapists can do home visits, are expert at splinting, hand therapy and can teach pacing and mindfulness as needed.
The hospital has an in house orthotics service with a dedicated gait analysis laboratory.
The osteoporosis service is based at the hospital and provides both scanning and an outpatient service as needed. The department has excellent relationships with the orthopaedic surgeons. Patients who are unknown to the rheumatologists and who present with an acute hot joint are usually cared for by the Orthopaedic team. We have a good arthroplasty service including wrist and elbow replacements.
Ultrasound scans of joints are undertaken in the radiology department and on-demand by the rheumatology department. We have good access to CT, MRI and PET scanning. We have a vascular ultrasound service for patients with suspected giant cell arteritis (GCA). Intra-articular joint injections that require imaging are undertaken either by rheumatology department, our orthopaedic colleagues or the radiologists as appropriate.
The hospital does not yet have a chronic pain service although the acute pain team will help where possible. There is an established consultant led pain service in Sheffield.
Clinical services provided by Rheumatology
New patient clinics are unselected and each referral is read and prioritised by a consultant. Patients with soft tissue problems are seen by the local physiotherapy led MSK service. We are given 40 minutes per patient and are expected to see 6 patients in a session. We have dedicated/protected early inflammatory arthritis and GCA, ensuring speedy delivery of care to these patients.
Most follow up clinics are arranged with a mix of patients - although there is the possibility of holding a special interest clinic once a month. Patients are seen from the age of 16 and above. Twenty minutes is allocated per patient with 12 follow-ups booked per session.
The specialist nurses undertake the counselling for patients starting new DMARDS/biologics and provide the monitoring for the first 3 months. At that point, local GPs enter into shared care monitoring. Three of our nurses are non-medical prescribers. They are trained to teach patients how to use Acupins to manage methotrexate nausea.
Locally we do not have to ask individual permission to start a patient on a biologic as long as it fulfils NICE guidance. Data on our compliance is gathered on Bluetech by the ICB.
Ward referrals are divided across the consultant team.
Governance
Rheumatology governance meetings are held monthly and are followed by a team meeting.
Clinical Effectiveness
Rheumatology clinical effectiveness meetings are held bi-monthly. Each member of the team is encouraged to contribute to an audit / service review annually.
Teaching and supervision
Medical students from the University of Sheffield rotate to Rotherham and can choose to do a specialist attachment with the team.
It is expected that each consultant will present a Grand round once to twice a year. There are many other opportunities to teach including foundation year doctors and other specialists across the Trust. Once or twice a year, the consultant will lead a postgraduate afternoon alongside a specialist trainee. There is an opportunity to act as a clinical supervisor for both the F2 and specialist trainee.
Liaison with local rheumatologists/specialists
There is a monthly MDT with colleagues across South Yorkshire to discuss difficult cases as well as those where an application to NHS England is to be made. This is a supportive environment and is a great place to learn. There is an excellent connective tissue disease service at the Royal Hallamshire Hospital in Sheffield. They provide specialist clinics for SLE, scleroderma, vasculitis and Behcets. MDT services are provided for neurovasculitis, pulmonary hypertension (national service) and pregnancy. Patients can be referred for an opinion. Renal clinics are held within the Trust. The genetics service in Sheffield have a special interest in collagen vascular disease. An in depth neurophysiology service is provided in Sheffield whilst more simple testing can be undertaken within the department of orthopaedics.
Continuing Professional Department
Grand round weekly within the Trust
Postgraduate meeting weekly within the Trust covering a wide range of topics with both internal and external speakers
Fortnightly postgraduate rheumatology meetings with colleagues from South Yorkshire. Once a month a difficult case discussion forms part of this meeting. Many external speakers are invited.
Yorkshire wide meetings are held several times a year
Research
There are many opportunities to enter into a research project and this is encouraged by the Trust.
The strengths of the department
It is a friendly department with supportive colleagues especially important when starting out as a consultant. We offer a consultant led and delivered service which allows long term doctor patient relationships to develop which are rare in the current NHS. If you enjoy patient care then this is the place to work.
There are opportunities to develop a special interest as well as undertake research to allow you to grow your career. There are no on call duties nor GIM commitments.
