Acute and General Medicine

Programme aims

The programme is aimed at those who wish to extend their clinical expertise in acute and general medicine within Guy’s and St Thomas’ Hospital.

The aims of the programme include:

• The opportunity to have direct experience and exposure to clinics and ward rounds at an outstanding A&E department as well as general and acute medicine departments
• Participation in multidisciplinary team meetings
• The opportunity to develop networks and close links for future close working relations through peer mentorship throughout the programme from a named mentor
• The opportunity to complete specialty projects, audits and research with a view to submission for peer review

Individual weekly timetables will be created depending on each visiting professional’s requirements.

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

Format

The Acute and General Medicine programme is delivered within the hospital workplace and it includes exposure to clinics, inpatient ward rounds, multidisciplinary team meetings, depending on the length of programme that visitors request.

Visiting professionals will be aligned with supervisors from within the clinical teams who will facilitate agreed learning and development needs. We would expect visiting professionals to be totally integrated in the day to day service within our acute and general medicine teams.

We will also provide visitors with the opportunity to get involved in research, audit and improvement projects.

Who can apply

This programme is intended for non-U.K. doctors looking for exposure to a NHS emergency department.

Visitors can apply for an observership programme. Those wishing to apply 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

It is recommended to undertake a placement of 4-12 weeks. The programme’s duration can be tailored to the specific learning requirements of those visiting the Trust. 

Acute and General Medicine Service

Guy’s and St Thomas’ Hospital has eight ward areas, five outpatient departments and many specialities dedicated to the field of acute medicine and emergency care including:

• Accident and emergency
• General medicine
• Respiratory medicine
• Ageing and health
• Stroke and neuro rehabilitation
• Hypertension

Emergency Services

We offer three distinct emergency department (A&E) services

• A&E at St Thomas’ Hospital
• Urgent Care Centre at Guy’s Hospital
• Children’s emergency department

A&E

We see approximately 140,000 patients per year, making us one of the busiest emergency departments in London. We also see around 100 ambulances every day. Our emergency department (A&E) was recently rated ‘outstanding’ by the Care Quality Commission after an inspection they carried out at the end of 2015.

We aim to provide gold-standard emergency care and improved health outcomes for all our patients through education, research, and leadership development. In 2016, the emergency department got an ‘outstanding’ rating from the Care Quality Commission inspection.

We treat patients who have suffered a recent injury or accident or who have developed a sudden illness. All A&E departments use a priority system where the most seriously ill patients are seen first.

Urgent Care Team

The urgent care centre at Guy’s Hospital offers an alternative to the emergency department (A&E) for a range of minor injuries and urgent medical problems.

It is a walk-in NHS service for patients whose condition is urgent enough that they cannot wait for the next GP appointment (usually within 48 hours) but who do not need emergency treatment at the emergency department (A&E). It is staffed by a GP working alongside emergency nurses.

We have facilities to x-ray limbs for suspected fractures and prescribe medicines and will usually treat patients with less serious injuries more quickly than the emergency department (A&E).

Injuries and illnesses treated at the urgent care centre include:

• broken bones
• bites
• burns and scalds
• infections
• minor illnesses in children and adults including fever, infections and rashes
• sprains
• wounds

General Medicine

General medicine provides acute medical services for adults of all ages across a wide range of specialties.

Most of our general medicine patients are admitted through accident and emergency (A&E). Only 2% of our general medicine admissions are planned.

Admissions from A&E generally go to the Admissions Ward. Here, patients are reviewed by a team of doctors, nurses and therapists. Some patients may be discharged home the same or following day (often with rapid outpatient follow-up and your appointment may be either at Guy’s Hospital or St Thomas’ Hospital), whereas other patients may need to stay for a few days or longer. Those who need to stay in hospital will be transferred to one of our general medical wards at St Thomas’ Hospital or to a speciality ward either at St Thomas’ or Guy’s Hospital.

There are many medical conditions often looked after by the general medicine team, such as sickle cell disease, HIV/AIDS, infectious diseases, rheumatology and neurology.

Wards for general medicine:

• Admissions Ward
• Albert Ward
• Hillyers Ward
• William Gull Ward

Respiratory medicine services

We provide services for all respiratory disorders except for cystic fibrosis. Our specialist outpatient clinics are run at both Guy’s Hospital and St Thomas’ Hospital.

They include:

• Asthma clinic
• Chronic obstructive pulmonary disease (COPD) clinic
• Endobronchial ultrasound (EBUS)
• Interstitial lung diseases
• Lung cancer
• Pleural diseases
• Pulmonary hypertension
• Pulmonary rehabilitation
• South London oxygen assessment
• Tuberculosis (TB)

Our service also includes the sleep disorders centre at St Thomas’ Hospital.

We also provide a range of diagnostic services and have close links with other specialties such as allergy, thoracic surgery, cancer and the Lane Fox unit.

Clinics include:

• General chest clinic
• Lung cancer clinic
• Tuberculosis (TB) clinic
• Pleural clinic
• Difficult asthma clinic
• COPD clinic
• Pulmonary hypertension clinic
• Pulmonary rehabilitation clinic
• LTOT Oxygen assessment clinic
• Ambulatory oxygen assessment clinic
• Sarcoidosis clinic
• Interstitial lung diseases clinic

Ageing and health services H3 sub-heading

We provide a range of specialist medical services across both hospitals and in the community. Inpatient services are provided from dedicated wards at St Thomas’ Hospital, with outpatient clinics held at both hospitals.

We provide general and geriatric medicine services:

• comprehensive geriatric assessment
• continence
• falls clinic
• syncope assessment
• memory
• heart failure in older people
• assessment of older people at high risk having surgery
• orthopaedic/geriatric follow-up

We provide the following specialist services:

• an inpatient acute and rehabilitation stroke care unit at St Thomas’
• an older persons assessment unit (OPAU) at Guy’s, providing outpatient services
• our proactive care for older people undergoing surgery (POPS) team
• inpatient and outpatient continence service for older people
• three inpatient wards at St Thomas’
• specialist ortho-geriatric liaison
• an older persons assessment and liaison (OPAL) team who assess all acute medical inpatients aged 70 years and over
• Southwark and Lambeth integrated falls service (SLIPS)
• consultant input to the Lambeth and Southwark home intermediate care teams
• general elderly, general medical and specialist clinics at Guy’s, St Thomas’, Whittington Centre, LambethCommunity Care Centre and Pulross Indermediate Care Centre.

Heart failure clinic

At Guy’s and St Thomas’ we have a comprehensive service for patients with heart failure, which includes:

• rapid assessment and diagnosis of patients with suspected heart failure
• development of a comprehensive management plan
• appropriate education and advice for patients and their carers

We aim to make sure all patients receive evidence-based treatments in accordance with national and international guidelines.

We have good links with GPs and community services to help make sure patients’ needs are dealt with efficiently, with great emphasis on their concerns and wishes. For our local patients, we work in partnership with King’s College Hospital to provide a specialist community heart failure service.

Clinics

• Rapid access one stop heart failure clinic – a one stop heart failure clinic for newly suspected or patients with heart failure. Investigations done at the clinic visit could include: echocardiography, ECG (electrocardiogram), cardiopulmonary exercise testing, blood tests, x-rays and spirometry.
• Nurse-led heart failure clinic – this is a nurse-led clinic for patients already diagnosed with heart failure, providing close observation and follow-up, monitoring and up-titration of (increasing and adjusting) medication, assessment of educational needs and management strategies.
• Elderly care heart failure clinic – a specialist clinic for older patients with heart failure and other serious conditions. The clinic has close links with our elderly care and cardiology hospital and community based services.
• Bexley heart failure clinics – Guy’s and St Thomas’ heart failure specialist nurses support this clinic with daily nurse-led clinics. It is a community based heart failure clinic with diagnostic facilities including ECG and echocardiography.

Hypertension

The Cardiovascular Clinical Pharmacologists run the following clinical services:

• Specialist hypertension clinics at Guy’s and St Thomas’
• ‘HOT’ clinic facility for rapid access within ~1 week from St. Thomas’ A&E/General Medical Admission with the aim of avoiding/shortening admissions and providing definitive management
• Inpatient hypertension ward referrals
• Multidisciplinary Team approach

Specialist hypertension clinics at Guy’s and St Thomas’

• Patients are referred locally and nationally by GPs, community cardiovascular clinics, and as tertiary referrals.
• New referrals reviewed per year: ~700
• Follow-up Patients reviewed per year: ~2,800
• The hypertension clinics lead in evidence-based medicine with expertise in the investigation and management of complex/resistant hypertension in patients with multi-morbidity/polypharmacy and through recruitment into local and National trials
• The clinic serves a large African-Caribbean population, many of whom have resistant hypertension and hyperaldosteronism

‘HOT’ clinic facility

• We provide rapid access within ~1 week for patients from St. Thomas’ A&E/General Medical Admission with the aim of avoiding/shortening admissions and providing definitive management.

Inpatient hypertension ward referrals

We liaise closely with the vascular surgeons, especially for the medical management of patients with Type B aortic dissection; also aortic aneurysms, peripheral arterial disease, carotid surgery.

We review medical inpatients with severe or resistant hypertension, including patients with stroke, emergency admissions with accelerated hypertension, pregnancy.

Multidisciplinary Team approach

We link with other MDTs – especially the Adrenal/NET MDT for review of patients with potential Endocrine causes of their hypertension, such as hyperaldosteronism, pheochromocytoma/paraganglioma and renal/interventional radiologists/vascular surgeons for renal artery stenting in patients with fibromuscular dysplasia and atherosclerotic renal artery stenosis.

Stroke services

Our stroke service cares for patients at our rehabilitation stroke unit on Mark Ward. Our stroke service has achieved an ‘A’ star rating in the Sentinel Stroke National Audit Programme (SSNAP).

Patients who have suffered an acute stroke, will be cared for at a hyper acute stroke unit such as King’s College Hospital. Patients who come to accident and emergency, or have an acute stroke while they are in hospital will be transferred to a hyper acute stroke unit.

We work closely with colleagues across London to ensure that patients can be looked after in a hospital closer to their home for the remainder of their care. We will transfer patients back to Mark Ward around 48-72 hours after admission to a hyper-acute stroke unit.

Stroke and neurovascular clinic

This clinic covers:

• Assessing and treating patients with a stroke or suspected TIAs (transient ischaemic attacks or mini-strokes)
• Rapid assessment and treatment for low-risk TIA patients, with all necessary investigations performed onthe day of the clinic
• Urgent referrals for carotid surgery if indicated
• Stroke follow-up appointments for further investigations or a review of the long-term impact of a stroke.

Toxicology

Our clinical toxicology service is led by three consultant clinical toxicologists, along with a team of junior doctors. We’re further supported by two dedicated clinical toxicology database scientists, and a number of research assistants/fellows.

We have close links with the information and liaison psychiatry services at our hospitals and with the laboratory services at King’s College Hospital, London.

Medical toxicology clinic

Patients with recognised or suspected poisoning are seen and assessed in the medical toxicology clinic, held weekly at in Gassiott House, St Thomas’ Hospital. This clinic receives patient mainly from greater London and south east England, but can accept referrals from anywhere in the UK.

Part of this clinic is a weekly dedicated ‘club drug clinic’, where patients are seen jointly with a clinical toxicologist and addiction psychologist.

Patients must be referred by their GP or local hospital; we do not take direct referrals from patients.

Paediatric cases will normally need to be reviewed by a local paediatrician prior to referral, for clinical assessment and examination.

The clinic is supported by a team of consultant psychiatrists and psychologists.

Inpatient clinical toxicology service

This inpatient service provides specialist advice in the management of poisoned patients presenting to St Thomas’. Patients who have been admitted to the emergency medical unit (EMU), a medical ward, critical care ward or Evelina London Children’s Hospital with the diagnosis of poisoning are seen and assessed on the twice daily clinical toxicology ward round.

Where appropriate the ongoing care of these patients is provided by the clinical toxicology team.

A specialist registrar in clinical toxicology and/or consultant is available on call to assess and/or provide advice on acutely poisoned patients who come to A&E.

Example Timetable

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