Clinical Genetics

Introduction

The Guy’s and St Thomas’ NHS Foundation Trust Clinical Genetics Visiting Professional Programme (VPP) is designed to provide international visiting professionals with the opportunity to experience our highly acclaimed genetics department first hand. The programme is a unique chance to be fully integrated within a genetics service which is at the forefront of clinical activity, training and research; regional genetics clinics offer services to diagnose and assess the risk of families inheriting a genetic condition; the genetic counselling service involves explanation and risk assessment with any available options for family members, the genetics clinic is part of the Division of Medical and Molecular Genetics at King’s College London and we also take part in the 10,000 Genomes Project which focuses on cancer and rare diseases. 

Our Genetics department is divided into a range of specialist or multidisciplinary services and clinics including: Bardet Biedl Syndrome, BRCA family services, Breast cancer risk assessment, Connective tissue disorder, Dermatology (cancer), Dermatology (general), Endocrine, Eye genetics, Fetal cardiology, Fetal medicine unit (FMU), Sickle cell and thalassaemia, Haemophilia genetics, Huntington’s disease, Inherited Cardiac Conditions, Metabolic, Myotonic dystrophy, Neurofibromatosis (NF1 and NF2), Paediatric neurology/genetics, Pre-implanation genetic diagnosis (PGD), Pre-natal diagnostic service, Rapid access, Skeletal dysplasia, Tay Sachs, Von Hippel Lindau (VHL) and Xeroderma Pigmentosa (XP). We offer specialised visiting professional programmes within all of our services for those that wish to hone their expertise in a subspecialty area of interest in genetics. Alternatively visitors may apply to rotate throughout our genetics department and we even offer the opportunity for visitors to gain professional certification depending of the duration of their stay. 

The programmes are designed by our clinical leads to provide unique development experiences which enable visiting professionals to broaden their clinical expertise and learn new skills that can be transferred back to their work place. We are excited to deliver exclusive access to observe and work alongside our renowned genomics faculty and to provide an opportunity for international professionals to gain insight into our Trust and the role that genetics consultants play within the NHS.

Programme aims

The programme is aimed at those who wish extend their clinical expertise in genetics, and who wish to learn more about the treatment pathways and specialist technology within Guy’ and St Thomas’ NHS Foundation Trust.

The programme aims to include:

• Direct experience and exposure to outpatient based services through our 27 specialist and multidisciplinary genetics clinics
• Participation in multidisciplinary team meetings
• Access to monthly lectures and internally organised courses
• Involvement in genetic counselling including diagnosis, testing and counselling with family members on risk assessments and available options (attachments only)
• Opportunities to receive bespoke training from our expert clinicians and to gain a professional certification
• The opportunity to create networks and close links for future learning and development through peer mentorship from junior and senior doctors
• Support of a small project/audit with an intention of presenting in international meetings or for publication
• Access to and the chance to actively contribute to clinical research with the Division of Medical and Molecular Genetics at King’s College London
• Experience of the NHS and working in a genetics centre with advanced clinical and technical expertise amongst an internationally renowned faculty of experts.

A Certificate of Attendance will be awarded to visitors upon the end of their programme.

Format

The Clinical Genetics programme is delivered within the hospital work place and it includes exposure to genetics clinics, inpatient ward rounds, multidisciplinary team meetings, and access to training courses depending on the length of programme that visitor’s request. Visiting professionals will be aligned with supervisors from within the clinical teams who will ensure that all of the learning and development needs and expectations are met. The supervisors will also ensure that visiting professionals are totally integrated in the day to day service within our genetics team, regardless of the speciality and duration that visitors apply for.

Who can apply

This programme is intended for non-U.K. trainee geneticists, specialist registrars and consultants. Visitors have the choice of applying for a hands-on clinical practical attachment or observership programme. Those wishing to apply for a practical attachment must have GMC registration. You can apply for GMC registration directly through the main GMC website, alternatively The Royal College of Physicians run a medical training initiative which facilitates GMC registration and provides sponsorship for a Tier 5 visa. You can find out more about their Medical Training Initiative by visiting their website.

Programme duration

We are able to offer visiting professional programmes for periods from 12 weeks up to one year. The programme’s duration can be tailored to the specific learning requirements of those visiting the Trust.

Genetics service

The Guys and St Thomas’ NHS Foundation Trust’s Regional Genetics service serves a population of 4.9 million in South East England and aims to provide a comprehensive and integrated clinical and laboratory service. As one of the largest genetics services in the UK and a member of SEEGEN, (South East of England Genetics Network), our focus remains on delivering and continuing innovative models to enhance patient care. We remain committed in developing a responsive and flexible service.

We also keen to ensure that patients benefit from our strong track record in new gene discoveries, translational research and emerging treatment modalities for patients with both rare and more common genetic disorders.

We retain a strong ethos in both undergraduate and postgraduate teaching and training. Over the past few years we have solidified our links with a number of specialities as genetics moves into mainstream medicine.

The service is part of the GRIDA directorate (Genetics, Rheumatology, Infection, Dermatology and Allergy) which comprises 395 whole time equivalent staff across both the Guy’s and St. Thomas’ campuses. The department provides large ambulatory services for severe chronic inflammatory disease of the skin and joints, musculoskeletal services, complex connective tissue disorders such as lupus, complex skin cancer, clinical diagnostic services for infectious diseases, the regional clinical genetics service and clinical care for sexual health including HIV. The directorate is also a key provider of clinical diagnostic specialist laboratory services within GSTS, including the areas of virology, microbiology, dermapathology and genetics.

Clinical Genetics is the medical specialty which provides a diagnostic service and “genetic counselling” for individuals or families with, or at risk of, conditions which may have a genetic basis. Genetic disorders can affect any body system and any age group. The aim of Genetic Services is to help those affected by, or at risk of, a genetic disorder to live and reproduce as normally as possible.

Genetic disorders include:

• Chromosomal abnormalities, which cause birth defects, mental retardation and/or reproductive problems.
• Single gene disorders such as cystic fibrosis, muscular dystrophy, Huntington’s disease and sickle cell disease.
• Familial cancer and cancer-prone syndromes such as inherited breast or colorectal cancer and neurofibromatosis.
• Birth defects with a genetic component such as neural tube defects and cleft lip and palate.

In addition a large number of individuals with birth defects and/or learning disabilities are referred and investigated for genetic factors. Individuals identified through childhood or pregnancy screening programmes also require genetic services. In the future, as the genetic contributions to common later-onset disorders such as diabetes and coronary heart disease are identified, genetic services may be required for those at high risk. Testing for genetic factors that affect drug prescribing will also increasingly become an important activity.

What are Regional Genetics Services?

Specialist genetic services have developed in the UK largely as regional centres of expertise. All support the network of Regional Genetics Centres and the need for close functional interaction between centres and between elements of the service within an individual centre. Specialist genetic services can be distinguished from other medical services by the fact that they deal with families, often over several generations, and that they can provide genetic expertise for any age group affected by, or at risk of, disorders in any body system. 

The clinical team includes Clinical Geneticists (medical doctors who increasingly may have subspecialty expertise), junior doctors in training, Genetic Counsellors (sometimes referred to as genetic associates or genetic co-workers) and, in some centres, genetic family register staff. Services are delivered in clinics in the regional centre, in outreach clinics in district general hospitals, in ward or hospital department consultations. 

Following referral to the service for most patients, a clinic appointment with a member of the clinical team is organised (and any follow up appointments as necessary) to allow examination, investigations, diagnosis and further management. A detailed summary letter is sent to the family and to hospital and primary care doctors. In some situations the genetics team maintains long-term contact with the family. Services are offered to the extended family as necessary. 

Referrals as appropriate are triaged for mainstreamed genetic services such as the haemoglobinopathy service or the familial hypercholesterolemia service. 

Most regional genetics services have developed areas of specialist expertise in areas of mainstream medicine to deliver coordinated care for patients. Specialist services provide both diagnostic and management services for patients with rare conditions with regular multidisciplinary meetings. Some specialist services also maintain patient registers and databases for ongoing care of patients. 

Genetic counselling

Because diagnosis and testing will often have an impact on the wider family, the genetic counselling process includes an explanation and risk assessment with any available options for family members. It can take time to adjust to new diagnoses and to decide on the best possible course of action. Our team provides upto-date and unbiased information. We ask for an update when the affected person and family members reach reproductive age, and before a new pregnancy. Testing, risk-reducing treatment and research options change over time. 

Commitment to research

The genetics clinic is part of the Division of Medical and Molecular Genetics at King’s College London. We are committed to genetic research and academic excellence

100,000 Genomes Project

The South London Genomic Medicine Centre (GMC), hosted by Guy’s and St Thomas’, is one of the centres taking part in the 100,000 Genomes Project. 

The national programme will focus on cancer and rare diseases and will enable pioneering research to decode 100,000 human genomes, a scale not seen anywhere else in the world. 

Genetics clinics

The specialist clinical genetic service provides services to the South East of England south of the Thames, a population of approximately 4.7 million. It is provided by Guys and St Thomas’ NHS Foundation Trust located on the Guys hospital site. Most clinics are based centrally at guys Hospital for patients referred by clinicians in this area. 

Peripheral Clinics

The service holds a number of clinics in local DGH’s and Child Development clinics. These peripheral clinics aim to improve access to genetic services and provide patients and families a choice of location for a genetics assessment. 

Outreach Clinics

The monthly Outreach Clinics in Whitstable, Hastings and Brighton remain very popular with our patients and we have high demand for appointments at these venues. We have reconfigured the clinic to ensure most appropriate utilisation of available slots. We have negotiated rooms in health centres allied to GP practices enabling us to see patients of all ages in a local site more convenient to them. 

The genetics service also runs specialised subspecialty services including: 

• Cancer 
• Cardiac 
• Fetal medicine 
• PGD 
• Skeletal dysplasia 
• NCG funded services 

The Genetics Service runs a range of specialist or multidisciplinary clinics, held at Guy’s and St Thomas’ and Evelina London Children’s Hospital, including: 

• Cancer Dermatology Clinic 
• Dermatology (general) 
• Endocrine genetics 
• Eye genetics
• Metabolic clinic 
• Paediatric neurology/genetics 
• Rapid access clinic for pregnant patients 
• Tay Sachs 
• Von Hippel Lindau (VHL)

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email vpp@gstt.nhs.uk.

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.