Detailed job description and main responsibilities

The aim of this post is to contribute to the increasing ambulatory and inpatient capacity of the respiratory service at St Georges and further develop the service and its research profile. We also aim to provide linked outreach clinics. The post holder will receive referrals from other consultants and specialties, from PICU and NICU, and from General Practice. These will be seen as either inpatients or outpatients as appropriate. Patients may be local or from outside the region. The post holder would be fully responsible for the management of such patients. The postholder would be expected to take an active role in the investigation of oncology patients with respiratory disorders in conjunction with the oncology and PID services. Similarly, joint care of those with sickle cell.  We have a growing cohort of children on invasive and non-invasive long term respiratory support and there are plans to develop a respiratory led transitional care unit.

There is a comprehensive diagnostic service with excellent support from four paediatric radiologists with state of the art facilities for MRI, CT and Ultrasound.

The respiratory service is supported by a dedicated paediatric physiology service with facilities for spirometry, plethysmography and gas exchange and exhaled nitric oxide. The physiologists also run sleep studies including respiratory semi-polysomnography (no EEG) and oxy-capnography, predominantly as domiciliary studies.

The post holder should be competent in performing flexible bronchoscopy for children in the PICU or in theatre. There are close links with ENT for managing children with tracheotomies and those who require rigid bronchoscopy.

At present children requiring chest drains are managed in conjunction with the paediatric surgeons. The surgical team, led by Mr Bruce Okoye also offer VATS for management of congenital lung abnormalities, complex effusions and lung biopsy.

Outpatient Clinics

The post holder will participate in the weekly hospital based MDT asthma and respiratory clinics. It is envisaged that these will be shared with the other consultants. The team offer over 750 new patient appointments and 2300 follow up appointments. These clinics are supported by the respiratory nurse specialists, physiologists, physiotherapists and psychology. There is a monthly MDT difficult asthma clinic for CYP identified to require additional support from the Tuesday asthma clinic. It is anticipated that the postholder will contribute to the leadership of this clinic and associated MDTs. We are awaiting approval to prescribe biologics. The two general paediatricians offer additional level 2 asthma clinics alongside the MDT.

There is an expanding team of speech therapists who can offer videofluoroscopy and other feeding assessments. Future developments may include some clinics being held off site in other secondary or primary care facilities within the boroughs. A community based asthma diagnostic hub is being established. Referrals are from primary care, and tertiary referrals from SW London and Surrey Regions. The service also follows up children with congenital lung lesions (CPAMs, CDH and TOF).

On average the post holder will perform 2-3 clinics per week except when on ward duty when the clinic load will be reduced.

Other Joint Clinics

There are a number of joint specialty clinics. At present, there are monthly clinics with:

·         Mr. Hamid Daya and Mr Prince Modayil (ENT surgeons) managing children with complex airways and tracheostomies – Dr Kappos & This post

·         Dr Sandeep Shetty (Consultant Neonatologist) for infants with chronic lung disease of prematurity and other congenital lung problems – Dr Kappos.

·         Dr Irene Hadjikoumi (Consultant in Neurodisability) for children with complex neurodisability and pulmonary issues – Dr Chavasse.

·         Dr Konstantinos Karampatsas (Consultant in Immunology and Infectious Diseases) for children with immune deficiencies (6 monthly)- This Post

·         Prof Asma Khalil (Fetal Medicine) – Counselling of parents expecting a child with a congenital lung lesion – This post

·         Dr Rubina Malik (Consultant in Haematology) to offer respiratory care for children with sickle cell disease – Dr Kavaliunaite

·         Dr Sachelle Ruickbie (Consultant Respiratory Physician) – Asthma Transition Clinic – Dr Kavaliunaite

·         Tadworth Children’s Trust (Variable) – This post

Ward Duties

The postholder will share ward attending for children admitted to hospital with respiratory conditions with the other three respiratory consultants (Respiratory Consultant of the week - RCoW) on a 1:4 basis. They will be available to consult on children admitted under the general paediatric team or any of the other specialties. The respiratory team will review all children who are admitted with asthma to ensure adequate management and appropriate follow-up to drive up standards of asthma care. The RCoW will have time dedicated to attend the wards on a daily basis. At present we operate a system of a week on duty at a time transferring care on a Monday. They will also be available for telephone advice service out of hours (category B on call).

The RCoW will attend the PICU ward round on a weekly basis to discuss children with chronic respiratory issues as well as interval visits as requested by the PICU consultants. They will have time to undertake urgent bronchoscopies on PICU according to need.

The RCoW will attend a joint neonatal MDT respiratory meeting with the attending neonatal service to review infants with severe chronic lung disease of prematurity, congenital conditions affecting the lungs those admitted with possible cystic fibrosis. Children discharged home in oxygen will be followed up in the neonatal respiratory joint clinic.

There is a weekly MDT meeting for the whole respiratory team to discuss relevant patients. There is a weekly academic meeting for academic presentation, discussion and service development. It is anticipated that there will be a monthly sleep physiology meeting. There is also a weekly MDT radiology meeting.

Bronchoscopy

There is a monthly theatre list available for elective flexible bronchoscopy under general anaesthesia. There is the facility to undertake CT scans under the same GA if needed. There is facility to perform pH studies. There is also a daily paediatric CEPOD list for more urgent bronchoscopies. Patients referred from PICU needing bronchoscopy can be performed on the unit.

General Paediatrics

At present, it is not envisaged that the post holder will have any general paediatric responsibilities.

Network responsibilities

The nature of this collaboration will be finalized following the appointment process.

There will be the development of joint protocols, governance, radiology sessions, research and audit projects. The team will continue to develop regional and national links. The aim is to provide outreach clinics in the region and maintain links with other specialist units in London. The post holder will be encouraged to participate in National and International groups, audit and research.

Research & Teaching

St. George’s University of London has identified paediatrics and paediatric infectious diseases as key areas for research and so would welcome candidates with a research interest that complements the clinical interests of the department. Research will be encouraged. The postholder is also encouraged to be involved in teaching undergraduate medical students.