Gloucestershire Royal Hospital
Gloucestershire Royal Hospital, Great Western Road, Gloucester, Gloucestershire GL1 3NN, Tel: 0300 4222222
Overview
Gloucester is a Cathedral city situated on the banks of the River Severn in the heart of the beautiful and historic county of Gloucestershire. The countryside is varied: to the west is the ancient Forest of Dean and Wye Valley; to the east rises the Cotswold escarpment with the hills, vales, Roman sites and market towns of the famous Cotswolds. Gloucester is home to the “Cherry and Whites” Premiership Rugby Team and the notorious Kingsholm “shed”! It is only 8 miles from the lively Regency spa town of Cheltenham.
Gloucestershire Royal Hospital (GRH) and Cheltenham General Hospital (CGH) together provide the acute medical care for Gloucestershire.
The Hospital and Trust
Gloucester Royal Hospital is a large District General Hospital situated close to the city centre. The hospital has a total of 725 beds serving a population of approximately 320,000 and is part of the Gloucestershire Hospitals NHS Foundation Trust which employs more than 6000 staff including 722 medical staff, 1988 Nursing staff, 1136 therapists/scientific staff and 2393 ancillary, administrative and support staff.
Over the course of a year the average activity for the Trust is more than 17,000 Planned Inpatient Admissions; 62,000 Emergency Inpatient Admissions; 74,000 Day Case Admissions; 430,000 Consultant OP attendances; 100,000 A&E attendances at Cheltenham General and Gloucestershire Royal Hospitals.
The Department
The Anaesthetic Department is located on the ground floor of the Tower Block with the main theatres complex and the Department of Critical Care on the 1st floor. The department is staffed by 33 consultants; 2 associate specialists and 10 staff grades; 18 anaesthetic trainees: seven ST5-7, nine CT1 and 2s (three CT2, five ACCS, one CMT), currently two Intermediate Trainees ICU/Anaesthesia; and one F2 and two F1 doctors.
The trainees have a large dedicated room equipped with 4 computers, a printer and an over head projector. There are desks and comfortable seating for relaxing.
Educational Experience
Each morning there are well organized, themed educational meetings:
Monday: short programme each 6 months of teaching dedicated for Novice Anaesthetists
Tuesday: Anaesthetic journal club
Wednesday: M&M meeting with interesting cases
Thursday: Anaesthetic related topics
Friday: ICU topics
Novice Anaesthetists receive a 3 month training programme prior to obtaining their Initial Assessment of Competency. The programme includes 4 simulation sessions, an airway training morning and novice tutorials in addition to in theatre one-to-one teaching from a small group of Consultant Anaesthetists.
Simulation training is being actively developed and promoted in Gloucestershire and in GRH we have both a Simman and Simbaby. Regular in theatre simulation sessions with SimMan are organized to give you a chance to practice management of anaesthetic emergencies.
Gloucester participates in the Severn Deanery Regional Teaching Programme for both Primary and Final FRCA Examinations and trainees are timetabled to attend these. There is also a Post Fellowship teaching programme aimed at developing wider professional skills required to be a Consultant.
Specialties
There are a total of 16 operating theatres undertaking the following specialties:
- General Surgery
- Upper GI surgery centre for 3 counties including oesophagectomies and gastrectomies
- Established bariatric service
- Enhanced Recovery for colorectal surgery
- High proportion of laparoscopic surgery
- Trauma and Orthopaedics – many cases involve regional blocks and there is both expertise and enthusiasm for performing and teaching USS guided blocks. There are full day trauma lists 7 days a week and around 400 patients with hip fractures admitted per year.
- Gynaecology (proposed centre for Gloucestershire)
- Obstetrics – the new Obstetric Unit for Gloucestershire opened on the GRH site in January 2011. This will be one of the biggest Obstetric Units in the country with an anticipated 5,500 deliveries per year.
- Maxillo-Facial surgery and ENT surgery
- Gloucestershire centre for inpatient ENT services and major Max-Fax
- Referral centre for Major Head and Neck cancers from Herefordshire
- Paediatrics – all inpatient paediatric care in Gloucestershire provided at GRH
- Department of Critical Care – this is a modern 13 bedded unit providing both level 2 (HDU) and level 3 (ITU) care. In addition, there is a fast track HDU for patients requiring overnight postoperative HDU. There are 7 Consultant Intensivists.
- Day Case Surgery
- Chronic Pain Service
Anaesthetic training is provided in all of these specialties with additional attachments at CGH for Ophthalmological Anaesthesia if required.
ACCS and Core Anaesthetic Trainees are based solely in GRH where there is a wide range of surgical specialties. Senior trainees are based at Gloucestershire and during this time will be allocated to modules which will include a 3 month block in CGH to gain experience in vascular, major urology and gynaecology oncology lists as well as fulfilling their on call commitment at CGH. ICU higher training will be completed either at GRH or CGH. The College Tutors at GRH and CGH work closely together and are progressively developing a cross county training programme to achieve this.
The Work
The major commitment is in providing an anaesthetic service to the theatres throughout the hospital. In addition, anaesthetic cover is provided as needed for radiological studies (eg CT scans) and ECT (performed at Wotton Lawn on the GRH site). There is an Emergency Theatre (Theatre 2) staffed 24 hours a day (1st On-call Anaesthetist) with Consultants covering the weekday sessions 0800-1700. Each weekday there is a dedicated ‘star consultant’ who offers advice and support for trainees doing solo lists.
The Acute Pain Team provides advice and follow up for the ward management of epidurals and PCAs during weekdays. Over weekends acute pain issues are referred to the 1st On Call.
We provide obstetric cover with an on-demand epidural service and an anaesthetic service for caesarean sections and other obstetric interventions 24 hours a day (2nd On-Call Anaesthetist).
Medical staffing for the Department of Critical Care is provided by the anaesthetic department both at junior and consultant level. Cover is provided 24 hours a day (ICU Resident) by a dedicated trainee or staff grade with daily consultant ward rounds. The Medical Trainees working in ICU have 3-4 weeks experience of airway management before starting work on the ICU. Our 7 Consultant Intensivists are experienced and enthusiastic teachers and you will get plenty of opportunities to perform practical procedures.
As a brand new CT1/ACCS just starting out in Anaesthesia, GRH offers you a good grounding in anaesthesia for all major specialties. You will also get some experience later in peripheral nerve blocks and regional techniques. Basic competencies are acquired over a 3 month period with gradual exposure to out-of-hours on call when you are paired with an experienced ST5-7 trainee (3rd on call Anaesthetist) who will provide you with dedicated support allowing you to gradually work more independently as your confidence and experience grows. At first, the majority of your lists will be with a consultant, however once you pass your initial assessment of competencies (at about 3 months) you will be allowed to ‘fly solo’ giving you the opportunity to run lists on your own (with plenty of support) and ultimately to be on call on your own too.
For Senior Trainees there is plenty of exposure to major surgery, paediatrics and interesting cases to further your clinical experience in your senior years. We are able to offer “clinical modules” to complement the ST5-7 curriculum (for example: Difficult Airways, Regional Anaesthesia, Bariatric Surgery, ITU) and also a Management Module. We have developed a highly successful Management Training module and provide active support for Service Improvement projects. We have also developed an advanced airway module and an advanced obstetric module You will also have the opportunity to take on a supervisory role for junior anaesthetic trainees both on call (3rd on call Anaesthetist) and on elective lists.
Feedback on the Post
We continue to receive excellent feedback on the training that we deliver at GRH.
Areas that are consistently highlighted as being good are:
- Morning Teaching
- Excellent training opportunities
- Clinical Hands on Experience
- Workload (“just right”)
- Educational Supervision
- Clinical Supervision
- Feedback on Clinical Performance
Contact Details
Department of Anaesthesia Tel: 0300 4226812 or 0300 4226194
Chris Finch - Administration Manager
Anthony Bee - Secretary
Dr Alex D'Agapayeff - Clinical Director
Dr Tracey Eastaugh-Waring - College Tutor