The Royal National Hospital for Rheumatic Diseases

The RNHRD is a specialist hospital that is part of the Royal United Hospitals Foundation Trust. It provides clinical services in Rheumatology, Pain Management and Chronic Fatigue Syndrome/ME.

There is a large outpatient department with dedicated specialist nursing and therapy staff. On-site facilities include radiology, musculoskeletal ultrasound, echocardiography, microvascular imaging and bone densitometry. There is a large on-site dedicated physiotherapy, occupational therapy and orthotics department with a hydrotherapy pool. There are unique Ankylosing Spondylitis Rehabilitation and Fibromyalgia Coping Skills programmes and nurse-led educational packages for rheumatoid arthritis, connective tissue disease and osteoporosis. There is a day-case unit for provision of biologic and intravenous medication and urgent patient assessment. There are approximately 8 inpatient beds for Rheumatology. There is also hostel accommodation for patients attending programmes for Ankylosing Spondylitis and Pain Management.

The hospital has 8 Rheumatology Consultants whose interests include Autoimmune Connective Tissue Disorders, Ankylosing Spondylitis, Psoriatic Arthritis, early synovitis, metabolic bone disease, sports medicine and hypermobility. The RNHRD has the largest cohort of patients with AS in the UK and one of the largest cohorts of patients with PsA and has large prospective databases in AS, PsA and CTD offering a wealth of opportunities for research and clinical projects.

There are three Rheumatology STR posts, one Core Trainee and one GP Trainee post and two Clinical Research Fellow posts. There are no pre-registration house officers. There are also a number of externally funded research fellows undertaking full-time research. A non-resident on-call system operates with a current commitment of 1 in 7. The job plans fulfil the European Working Time Directive. Six of the Consultants offer the second on-call cover.
There are 6 Specialist nurses, a dedicated Rheumatology nursing team for inpatients and specialist physiotherapists, occupational therapists, podiatrists, orthotists, dietiticians and radiographers.

The 3 STRs share a 4-monthly rotation. During one of the 4 months one of the STRs is ward-based and has no out-patient responsibilities but is responsible for the inpatients, daycases and referrals from the RUH. The ward-based STR also has a monthly procedures clinic with the opportunity to learn and perform caudal epidurals. The ward-based STR manages 2 ST1/ST2 from either CMT training or GP training. There are approximately 8 rheumatology in-patient beds as well as inpatients on the pain and CRPS programmes and sometimes medical patients transferred from the RUH site. The ward-based STR will be expected to take calls from the GPs (there is a regular GP advice line) and provide support for the biologics daycase unit.

When on out-patient duty alone, the STR undertakes 5 outpatient clinics. Although the clinics at the RNHRD are busy, they are all supervised. For a first year STR the numbers of patients seen is reduced, but by the time the STR is in year 4 of their training the numbers they are expected to see is equivalent to that seen by the consultant. The General Internal Medicine component of the job will alter the clinic templates to allow time for dually accrediting but the logistics of this will need to be decided. This may be incorporated into the STR timetable together with Rheumatology or may be done in blocks. It is likely that the GIM training will be done at the RUH site.

At the time of appointment to the hospital, the STR is allocated an educational supervisor. However, all the consultants act as clinical supervisors through whom the various training requirements can be met. The STRs are encouraged to set goals for their training whilst at the RNHRD.

The 4-monthly rotation ensures that the STRs have the opportunity to go through the different specialties of rheumatology. If there is a particular gap in an STR’s training, then the rotation can usually be adapted to fulfil any unmet need. All new STRs undergo a period of training in the injection clinic and, when competent, are signed off by the supervising Consultant.
There is a weekly Radiology MDT, Journal Club and Postgraduate afternoon. All doctors are required to present on a rotational basis. The Postgraduate meeting takes place on a Tuesday afternoon. There are also regional meetings specialising in Connective Tissue Disease, Spondyloarthritis and Metabolic Bone Disease. All STRs are encouraged to attend the relevant national and international rheumatology meetings.

There are several musculoskeletal Radiologists that work at the RNHRD and RUH. They lead the weekly radiology MDT. A Radiologist and 2 of the Consultant Rheumatologists undertake weekly musculoskeletal ultrasound sessions. The STRs are encouraged to attend the ultrasound on a rotational basis and can attend a more formal training programme and obtain a qualification.

There are specialist combined clinics in Dermatology, Respiratory, Obstetrics and Pulmonary Hypertension. There are also Orthopaedic clinics on site with specialist clinics in shoulder, hand and elbow, hip and knees. There is also an opportunity to take part in Pain clinics run by the specialist pain services.

All STRs are encouraged to take part in research and research methodology and there are lots of opportunities to take part in both clinical and basic science research. There are several academic Rheumatologists at the RNHRD with affiliations to the University of Bath. Where appropriate an OOPE is encouraged in order to obtain a higher degree.