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THE CHRISTIE NHS FOUNDATION TRUST CONSULTANT IN CLINICAL ONCOLOGY with an interest in the non-surgical management of oesophageal and lung cancers 1. Background Information This new post is supported by the Greater Manchester and Cheshire Cancer Network and The Christie NHS Foundation Trust. The candidates must by law be on the General Medical Council Specialist Register in Radiotherapy (Clinical Oncology) or they must provide evidence that they will be on the register by the time that they take up this appointment. The purpose of this post is to develop the clinical oncology service for patients living in the North East/North West Sectors of the Greater Manchester and Cheshire Network, with particular emphasis on oesophageal and lung cancer. The successful applicant would become an active member of the Upper GI and Lung Cancer Network and The Christie Disease Orientated Groups consisting of surgeons, physicians, clinical oncologists, pathologists, radiologists, nursing and allied health professionals. The new consultant would be based at The Christie, but also work closely with the upper GI team in Salford and Rochdale Hospitals in terms of providing advice on radiotherapy/systemic therapy; in addition they would provide clinic support and development of lung cancer services at Salford and Macclesfield. 2. The Cancer Centre The Christie and Holt Radium Institute moved to the present Withington site in 1932 and has grown to be the largest single site cancer hospital in the United Kingdom. The hospital has been designated a separate teaching hospital of the University of Manchester. Along with the Paterson Institute for Cancer Research and North Western Regional Medical Physics Department, it formed The Christie NHS Foundation Trust in 1991. The hospital became a Foundation Trust in 2007. 200 beds are in use at The Christie. Beds have recently been reconfigured into 4 non surgical wards with a total of 100 beds designated by disease group, as well as an Acute Admissions Unit and general chemotherapy ward. There is a Haematological Transplant Unit with a full transplant program. There is a new Critical Care Unit with a rolling programme of staff recruitment well underway. 1 There is an Out Patient Department and designated Outpatient chemotherapy suite. The Department of Clinical Oncology presently provides a service to Greater Manchester and Cheshire, and parts of Lancashire, through regular clinics (mainly weekly), staffed by its consultants (see appendix 1). The population of the Hospital’s catchment area is approximately 3.2 million. A total of 11,000 new patients with cancer were seen by the hospital and associated clinics in 2006. In 2006, 8,000 patients were treated with radiotherapy. We have close links with the Rosemere Cancer Centre at Preston. The Radiotherapy Department has eleven service linear accelerators, a research linac suite (Wade Centre), and a Pantak superficial x-ray therapy unit. Two of the linacs are Elekta Synergy linacs with facilities for image guided radiotherapy. There are three simulators, 2 with CT attachments, one with cone beam imaging and an application for a CT-Sim is ongoing. There is an ADAC Pinnacle computerised treatment planning system. IMRT has been in use for several years. There are plans to develop Satellite Radiotherapy facilities over the next 3 years away from the Withington site. These are most likely in the first place to be built at a site in the north of the conurbation. The successful candidate would be expected to take a role in supervising treatments at one of the satellite units. There is a purpose built Radiotherapy Theatre housing a high dose rate microselectron used for endobronchial brachytherapy;this service is provided in conjunction with Dr Phil Barber, visiting Chest Physician.. Adjacent to one ward is a low dose rate Selectron remote afterloading suite for Gynaecological patients. There is a fully equipped Mould Room. Facilities are present for interstitial therapy (including brachytherapy) and manually afterloaded brachytherapy. prostate The Isotope Department provides facilities for the therapeutic use of I 131, P 32, Sr 89 and Samarium. There are three rooms for the management of patients being treated with unsealed Isotopes. The hospital has dedicated Histopathology, Haematology, Biochemistry and Diagnostic Radiology Departments. In addition to standard radiological and radionuclide imaging facilities the Radiology Department has three whole body CT scanners, two MRI scanners and CT - PET. The Radiotherapy Department has access to CT scanning & MR scanning sessions for treatment planning. An electronic PACS system for viewing radiological images is in place across the hospital. There is a large group of therapeutic radiographers. The hospital is a teaching unit of the University of Liverpool, School of Therapy Radiography. 2 The North West medical physics group is based at The Christie, is directed by Professor Peter Williams and supports the Radiotherapy Department. IMRT has been developed for prostate cancer, breast cancer, head and neck cancer, and will be introduced in other tumour sites in due course.Image guided radiotherapy and stereotactic radiotherapy are being explored for management of thoracic cancers. The University of Manchester, CRUK and The Christie established a Chair in Radiation Oncology in September 2000. Professor Price is supported by a full time academic Clinical Oncologist, Dr Andrew Jackson. The University, the Trust and the CRUK have built the Wolfson Molecular Imaging Centre with a dedicated cyclotron, PET scanners and associated clinical and research facilities. Professor Tim Illidge is the lead for targeted radio-immunotherapy. The Christie has a University Department of Medical Oncology headed by Professor Robert Hawkins. There are 17 other Consultant grade appointments in Medical Oncology. There is a close working relationship with the medical oncology group who are responsible for the systemic management of stomach, hepatobiliary and small cell lung cancers as well as sharing the chemotherapy service for non small cell cancer and oesophageal cancer The Department of Surgical Oncology is actively involved in research. Clinical Oncology and Surgical Oncology Consultants work closely together in site specialised Disease Orientated Groups The hospital also has clinical groups specialising in Palliative Medicine, Paediatric and Adolescent Oncology, Endocrinology, Psychological Medicine and Clinical Genetics. The hospital has a Statistics Department, directed by Mr R Swindell, which offers support to clinicians involved in clinical studies and trials. The Trust has opened a Trial Support Unit for ongoing clinical studies and trials. The hospital has a specific intranet with IT support. Sectorisation of the Greater Manchester and Cheshire Network The Network (3.2 Million) has been ‘divided’ into 3 sectors, each with a catchment population of approximately 1 million. In addition to the Christie the aim is to have an ‘associate cancer centre’ for each sector: Wythenshawe Hospital for South, Hope Hospital for the North West and MRI for the North East/Central Sector. The non surgical lung team have 2-4 specialists for each sector; the non surgical oesophagus radiotherapy service will be shared with Dr Andrew Jackson(South Sector).In addition each sector has a medical oncologist for upper GI:Dr Mansoor for South, Dr Thistlethwaite for NW and Prof Hawkins for NE/Central. 3 3 Details of the Post a) Oesophagus Cancer Service Oesophagus cancer service in the Greater Manchester and Cheshire Cancer Network is divided into 3 sectors, the northwest, northeast and south. Each sector has a designated surgical site and to host the weekly MDT. . The appointee, in conjunction with Dr Jackson, would provide a (chemo) radiotherapy service to patients with cancer of the oesophagus within the northeast sector comprising the Pennine Acute Hospitals (Bury, Oldham, North Manchester and Rochdale) and Manchester Royal Infirmary, with a total population of approximately 1 million as well as within the northwest sector comprising Wigan, Leigh, Bolton and Hope Hospitals with a catchment population of a further 1 million. Patients with pre op oesophagus cancer for chemotherapy are managed primarily by medical oncology colleagues. Hope Hospital has recently been designated as the oesophagus surgical treatment centre for the NW sector and all major surgery is planned to be done there. The current surgical team includes Miss Formela, Mr Vickers and Mr Axisa. For the NE/Central sector, discussions continue on centralisation of surgery; the current surgical team includes Mr Aktar, Mr Senapati, Mr Pearson, Mr Amori and Mr Sheen. At The Christie approximately 150 oesophagus cancer patients are treated annually with radical external beam radiotherapy(ie about 100 new cases per year for the appointee).External beam is routinely provided by standard conformal therapy but there is potential to use IMRT for selected patients. The upper GI team have a nurse clinician and a full time clinical nurse specialist. The team is actively involved in clinical and translational research. b) Lung Cancer Service The appointee, in conjunction with a new appointment (in lung/breast), will provide radiotherapy treatment for patients from the North West sector(Salford) with lung cancer(approx 2 new cases per week from Salford)and be involved in the NW sector MDT held weekly in Bolton(approx 14 new cases discussed each week).Currently there are no facilities at Hope Hospital to deliver solid tumour chemotherapy though there are plans to do so. Patients would have access to the full range of clinical trials as agreed through The Christie Disease Group for lung cancer. At Macclesfield there are appropriate facilities for delivering chemotherapy and we would wish for palliative NSCLC chemo to be delivered locally if possible. The lung Disease Group has an international reputation for clinical trial activity. Chemoradiotherapy protocols are evolving and technical radiotherapy developments include stereotactic approaches and image guided techniques. The Clinical Oncology lung group comprises Drs Stout, Burt, Faivre-Finn, Harris, Lee, Chittalia and Pemberton. 4 c) Consultant in Clinical Oncology Employing Authority - The Christie NHS Foundation Trust Clinical Staff in Clinical Oncology The medical staff establishment provides for twenty-seven Clinical Oncology Consultants, (see appendix 1) 3 full time academics and fifteen Specialist Registrars in Clinical Oncology. There is a junior doctor team at F2 level, working jointly with medical oncology, within the Division of Networked Services. d) Duties of the Post The appointee will be based at the Christie and a member of the Clinical Oncology consultant group. The post will involve the care of patients with oesophageal cancer particularly from the NW, NE/Central Sectors as well as lung cancer patients from Salford and Macclesfield. At The Christie they will be required to conduct Out Patient clinics involving chemotherapy delivery, radiotherapy planning sessions , to supervise patients receiving radiotherapy and chemotherapy and to conduct ward rounds in a manner providing optimum patient care and efficient use of the hospital’s resources. The initial allocation of Programmed Activity if the appointment is full time is expected to be: SERVICE Location Direct Clinical Care Programmed Activity Oesophagus and lung Out– patient Clinics, and MDT Hope Hospital; MDT for NE sector; clinic in Macclesfield Ward Rounds, The Christie Radiotherapy simulator computer planning The Christie Outpatient clinic The Christie 3.0 Research 0.5 0.5 2.5 1 5 Supporting professional Activities (training, CPD, teaching, audit, clinical governance, appraisal and clinical management) 2.5 Total 10 This may be altered in response to the requirements of the Clinical Oncology service in agreement with the Director of Clinical Oncology. The agreed work plan will be subject to annual review in line with Trust Board policy. This review will also include an assessment of professional development and defines goals for the future. In the event of the consultant electing to work part time a pro rata adjustment of fixed sessions would be anticipated. This will be discussed and agreed with the Trust. The Department has evolved, over many years, a policy of mutual cooperation between the consultants. The department consultant group meets monthly to discuss joint management policies. Consultants are grouped in teams of two to four supported by junior staff and the teams accept responsibility for agreed fields of work. All consultants are expected to cooperate in these arrangements and to be involved in a number of clinical areas of work. A Clinical Director, Dr NJ Slevin, chairs the department. The clinical oncology department works with the departments of medical oncology, haematology, young oncology and palliative care as part of the Network Services Division, chaired by the Divisional Director, Dr. W.P. Makin, with Fiona Isacsson as General Manager. All consultants in the department share in an on-call rota that involves a commitment to a full week in every six months. A mobile phone is provided. This covers the Specialist Registrar who is second on-call. The appointee will have office accommodation and access to a secretarial service. e) Administration The appointee will be a member of the Department of Clinical Oncology Consultant Group. The appointee will also be a member of The Christie Medical Liaison and Advisory Group. The Clinical Director within the consultant group negotiates administrative duties within the Clinical Oncology Department and consultants are expected to accept responsibility for at least one area. This responsibility is regularly reviewed and can be altered following consultation and agreement with the Director and colleagues. 6 The present Executive Directors of the Trust are: Ms C Shaw Mr I Moston - Dr C Harrison Mr R Spencer Ms Alison Norman - The Trust board is chaired by f) - Chief Executive Director of Finance and Business Development Medical Director Chief Operating Officer Director of Nursing and Governance Jim Martin Teaching The Department of Clinical Oncology participates in the clinical undergraduate teaching programme of the University of Manchester and students visit the hospital for seminar, outpatients and bedside teaching at different stages in their training. There are dedicated courses designed for postgraduate students studying for the Part I and II examinations of the Fellowship of the Royal College of Radiologists. Consultants are expected to participate in the specialist registrar and F2 teaching programme. Post-graduate training is co-ordinated by the clinical oncology specialty training group, chaired by Dr J Loncaster. The Regional Postgraduate Adviser in Clinical Oncology is Dr JP Logue. The hospital has a Medical Library staffed by professional librarians offering a range of services including a modern journal collection, extensive book library and on line search facilities. g) Research Attached to the hospital is the University of Manchester Paterson Institute, an extensive complex of laboratories supported by the Cancer Research UK (Director - Professor N Jones). The Institute is dedicated to fundamental and clinically orientated cancer research in many fields including radiobiology, haematology, molecular biology, immunology, tumour chemotherapy and cytogenetics. A translational research facility is being planned. 4) Particulars of Contract Any consultant who is unable for personal reasons to work full-time will be eligible to be considered for the post. The job content will be discussed on a personal basis and agreed with the Trust. 7 5) Job Planning All job plans will be reviewed annually. The annual review will examine all aspects of the job plan and should be carried out jointly by the Clinical Director and the postholder. 8 THE CHRISTIE NHS FOUNDATION TRUST TERMS AND CONDITIONS OF EMPLOYMENT The terms and conditions of the New Consultant Contract are applicable Salary: Will be on the New Consultant Contract payscale Annual Leave: six weeks per annum (pro rata for part time employees) Bank Holiday: 8 public holidays Resident: The successful candidate will be required to live within a reasonable travelling distance of the Trust. Arrangements to visit the hospital may be made direct with the: Dept of Clinical Oncology The Christie NHS Foundation Trust Wilmslow Road Withington Manchester M20 4BX Telephone number: 0161 446 8457 Clinical Director: Tel: 0161 446 3361 Dr N Slevin 9 APPENDIX 1 Clinical Oncology Consultant Staff (October 2008) NAME PERIPHERAL CLINIC SERVICE PRINCIPAL INTEREST(S) Crewe Head and Neck Dr R A Cowan Wigan/Hope Genito Urinary Lymphoma Dr J P Logue Stockport Genito Urinary Director Dr N J Slevin Deputy Directors -------------------------------------------------------------------------------------------------------Dr P A Burt Crewe /MRI Lung Dr A Chittalia Stockport Dr A Choudhury Oldham/MRI Breast Lung Urinary/Sarcoma Dr S E Davidson Hope MDT Gynaecology Dr T Elliott Bolton Hope Urology Dr C Faivre-Finn Lung Dr H R Gattamaneni Hope (CNS) Childrens Hospital Children/Young Adult CNS Dr M Harris Tameside Lung/Lymphoma Dr L Barraclough Macclesfield Wythenshawe Breast Gynaecology Prof T Illidge Lymphoma Dr A Jackson Upper GI Dr L Lee Bury /NMGH Head and Neck Lung Dr E Levine Bolton/Wigan/MRI Gastro Intestinal Dr JE Livsey Oldham Gynaecology/urology 10 Dr J Loncaster North Manchester Breast, PDT for skin cancer Dr L Pemberton Oldham/Wythenshawe Lung Dr B Magee Hope Breast cancer Dr V Misra Oldham Breast Colorectal Dr C McBain Macclesfield (GI) Hope (CNS) Colorectal CNS Prof P Price Upper GI Dr M Saunders Hope Gastrointestinal Dr E Smith North Manchester Children’s Hospital Lymphoma Paediatric/Young Adult Dr A L Stewart Bury Breast Dr R Stout Oldham Lung Dr A Sykes Tameside Head & Neck/Melanoma Dr R S Welch Bolton/Hope Ovarian Cancer Testicularcancer Breast cancer Dr J Wylie Crewe/South Manchester Genito-urinary Soft Tissue Sarcoma Dr B Yap Wigan/Leigh Thyroid/Head & Neck Dr E Allan (Part-time) PDT for skin cancer 11 APPENDIX 2 PERSON SPECIFICATION - CONSULTANT IN CLINICAL ONCOLOGY ATTAINMENTS Education ESSENTIAL DESIRABLE RCR Fellowship or equivalent Higher Degree Training Certificate of completed specialist training or equivalent (or within 6 months of CCT by interview) Job experience With reference to oesophagus/lung GENERAL INTELLIGENCE SPECIAL APTITUDES Demonstrates knowledge, logic and efficiency Integrity, management and communication skills including teaching Developments in oncology practice INTERESTS DISPOSITION Acceptability Is a team player prepared to adapt to changing circumstances. Leadership Dynamic, decision-making motivator. Self-reliance Confident in ability, but knowing own limitations. Motivation Hardworking, enthusiastic achiever. Good attendance record. Patient friendly. Professional demeanour Must be resilient and well organised 12 Research experience Computer skills Knowledge of continuing NHS and Royal College Reforms.