Rheumatology Training at North Bristol NHS Trust (NBT)

North Bristol Trust NHS Trust is a large Trust with regional academic services in neurosciences, renal medicine, plastic surgery and burns, and is the regional trauma centre. There are also academic services in rheumatology, respiratory medicine and endocrinology. In May 2014 the Trust moved into a fantastic new hospital building and also provides outpatient services at Cossham Hospital and Yate Health Centre.

Trainees: We have 2 dually accrediting trainees (GIM/Rheumatology) There is a dynamic and flourishing Rheumatology Service. You will be supervised in OPC with plenty of opportunities for discussion of both inpatients and outpatients with a team of approachable and friendly consultants.

The Rheumatology post involves 3 outpatient clinics per week plus access to specialist clinics and combined clinics (see below). You will be involved in review of inpatient referrals and in responding to GP queries via the on-call ‘phone. There is no on-call. There is protected research time. Trainees have the opportunity to attend community musculoskeletal clinics (see below) to ensure they have experience of soft tissue problems, OA and joint and soft tissue injections.There is broad medical experience in the Medical Admissions Unit. There is a shift system when on take. There are dedicated take Physicians, ward rounds twice daily and good supervision and feedback. Dr. Pounsford, Consultant Physician, supervises the GIM part of the post and the trainee is involved in the care of his medical inpatients.

In addition, 1 trainee from UH Bristol spends Mondays and Fridays in NBT and does 2 clinics per week here.

Education and Teaching: We have a weekly PG meeting at which trainees will be expected to present and also to present at Grand Rounds. Trainees will be expected to attend the excellent regional monthly training days for STs and clinics are cancelled to allow them to do so. They will also be able to participate in UG teaching. We have a “Living Well with Arthritis” programme run by the team and trainees may contribute to medical sessions. There are regular specialist combined meetings in connective tissue disease, spondyloarthropathy and osteoporosis in Bath and Bristol.
Research and Audit: There are excellent opportunities for research both with the academic team and with other consultants involved in research projects. All trainees are expected to participate in audit and attend our regular audit meetings.

Rheumatology Department: We have 8 Consultants. Professor Jon Tobias is Head of Specialty, Head of Academic Rheumatology and with Dr. Emma Clark (Senior Lecturer) leads the Osteoporosis/Metabolic Bone Service. She also heads the UG Teaching Programme. Dr. Val Kyle has an interest in GCA and vasculitis. Dr. Paul Creamer has an interest in ankylosing spondylitis and osteoarthritis and also is actively involved in research. Dr. Sam Patel directs the Acute Medical Unit as well as doing Rheumatology and has an interest in Behcet’s. Dr. Nicky Minaur leads in the Musculoskeletal Interface Services, runs transition clinics and is developing our ultrasound service. Dr. Harsha Gunawardena leads on Connective Tissue Disease and is the Regional lead for this and a national expert on myositis. Dr Lynsey Clark is locum Consultant also with an interest in CTD.

We have three nurse specialists, one specialist Pharmacist and two Extended Scope Physiotherapists. There is a multi-specialty Day Case Unit with nurses who have particular expertise in Rheumatology patients. The Specialist Nurses carry out outpatient clinics under the supervision of Consultants, help to run the biologics service, the osteoporosis and with our specialist physio, the ankylosing spondylitis service. Some are non-medical prescribers. They also man the Advice Line which is electronically linked to our database. We have a specialist Psychologist, Specialist Physiotherapists and Occupational Therapists. Physiotherapy facilities include hydrotherapy.

Outpatients: We provide a wide range of general and specialised clinics (CTD, osteoporosis, transition service and a HOT clinic for GCA) with EIA slots in most clinics and facilities to see CTD patients urgently in Dr. Gunawardena’s clinic. We provide consultant led emergency clinics in the evenings. There are regular combined clinics with orthopaedic surgeons (hands, shoulder and elbows, difficult hips). There is a joint interstitial lung disease/rheumatology clinic with Dr Huzaifa Adamali. Professor Chris Denton and his team from the Royal Free attend bi-annually for the outreach scleroderma clinic. There is a community musculoskeletal service run by GPs and ESPs with an interest in Rheumatology which allows our department to focus on inflammatory and complex disease. This service is audited regularly and participates in our postgraduate meetings.

Inpatients: We have access to 1 Rheumatology bed but most inpatient work consists of seeing patients in the Acute Admissions Unit and ward referrals with advice available at consultant level on a daily basis. Trainees gain excellent experience in managing acute rheumatology.

Other Services: There are excellent radiology services with 5 dedicated musculoskeletal radiologists, MRI, ultrasound, Yttrium, Fluoroscopy guided injections and a weekly meeting with the radiologists. Orthotics is provided at Southmead and Cossham. There is an active patient support group run by the patients.