Locum Consultant Gastroenterologist

Gastroenterology and Endoscopy service The Department of Gastroenterology is part of the Surgery, Anaesthetics, Critical Care and Theatres (SACCT) Division and physically comprises a Gastroenterology and Endoscopy Unit and a Gastroenterology ward. Our large JAG accredited Endoscopy unit has 5 Endoscopy procedural rooms with funding secured for expansion of the unit with addition of a 6th Endoscopy procedural room in 2023. Endoscopy recovery and restoration is also being supported through activity at a temporary modular unit run by an insourcing company until May 2024. We are a performance driven and responsive service utilising an Endoscopy performance dashboard to improve and maintain standards. The appointee will assist the Endoscopy unit in providing a high-quality endoscopy service maintaining best practice with reference to standards outlined by the JAG global rating scale (GRS) for endoscopy We carry out approximately 15,000 endoscopic procedures per annum and are a spoke centre for the North-West Endoscopy training academy and admin hub for Bowel cancer screening within the Lancashire region. We have 7 Clinical Endoscopists, 1 trainee Clinical Endoscopist and have also been successful in securing funding to recruit to an Endoscopy Nurse Consultant post as well. An open access endoscopy service (triaged by Clinical endoscopists) and straight-to-test fast track upper and lower GI endoscopy services are well-established. A wide range of diagnostic and therapeutic endoscopic procedures are carried out including banding of oesophageal varices, thrombin injection for gastric varices, oesophageal, duodenal and colonic stent insertion, balloon dilatation, colonoscopy and polypectomy, upper and lower GI endoscopic mucosal resection, push enteroscopy, ERCP, EUS and capsule endoscopy. The department has an established EUS service for UGI and HPB (diagnostic including FNA). Single balloon enteroscopy is also performed on an as required basis. We also provide a Nutrition CNS led PEG service and also provide PEXACT (direct puncture gastrostomy) as well as placement of NJ tubes. We have recently secured funding to support a new TNE service which will be delivered in the outpatient clinic setting. We have Olympus 290 series HD equipment. We offer a consulting service in Gastroenterology with dedicated IBD, Nutrition and Liver clinics. The current Gastroenterology workforce comprises 6.8 WTE Consultants, 3 Specialist Trainees (from the North-West Deanery) and 2 Trust Grade Registrars/Clinical Fellow equivalent. We are also supported by 3 IMT and 2 FY1 doctors who are ward based. Our Gastroenterology Registrars rotate between the existing Gastroenterology Consultants on a 4-monthly basis. Experienced secretarial support is provided to each Consultants on a 2:1 ratio with each secretary further supported by additional Admin support and typists. We adopt a multidisciplinary team approach for many conditions including upper GI cancer, Inflammatory bowel disease, Liver disease and Nutrition. We have 3 IBD Specialist Nurses, 3 Nutrition Specialist Nurses, 3 Upper GI CNS, 3 Liver Specialist Nurses and 4.5 WTE Alcohol support liaison nurses. We are in the process of recruiting an UGI/Pancreatic/NSS pathway ACP to support these cancer pathways. The IBD service has undergone recent expansion with 3 WTE IBD Specialist Nurses supported by Admin staff. There is a well-established pathway for access to biologics including Infliximab, Adalimumab, Vedolizumab, Ustekinumab and Tofacitinib, for home administration of Infliximab and access to anti-TNF drug antibody and trough level estimation as well as faecal calprotectin measurements. We have a bi-monthly IBD MDT meeting and actively participate in National IBD related research. We have a well-established dynamic Nutrition Support Team which includes 3 Nutrition Specialist Nurses, 2 NST Specialist Dieticians, 2 Home Enteral feeding Specialist Dieticians along with an NST Speech and Language Therapist and an NST Pharmacist. Our Nutrition team manage complex nutritional issues, intestinal failure and patients admitted on home parenteral nutrition. The NST team undertake a daily Nutrition ward round, weekly ward round with the Nutrition clinical lead and a weekly Nutrition MDT meeting as well. We have established a monthly NST multidisciplinary clinic where patients with complex nutritional needs are reviewed by the NST Multidisciplinary team. We have established good links with expert colleagues at the Intestinal Failure unit at Salford Royal Hospitals and support blood monitoring for patients under their care on Home parenteral nutrition and have opportunity to participate and present patients at the weekly Intestinal Failure Supra-Regional MDT meeting as well. The Hepatology service includes nurse led dedicated Fibroscan clinics, stable cirrhosis clinics and a Hepatitis C service. Our Hepatitis C Specialist Nurses manage Hepatitis C patients independently following discussion at the Lancashire and South Cumbria Hepatitis C ODN. They proactively support identification and eradication of Hepatitis C through outreach initiatives into the community and through in-reach into the Emergency Department. We have a busy nurse-led outpatient day-case paracentesis service for resistant ascites and were one of the first units to set up such as service for ascites management. We also monitor and manage patients requiring venesection on the Gastroenterology unit. We have a dedicated 7-day Alcohol liaison service. There are plans in place to expand and reconfigure the Liver services as part of our outpatient transformation strategy. The department also has a well-established GI physiology service delivered by a GI physiologist offering high resolution manometry and pH testing, urea breath testing, and breath tests to exclude lactose intolerance, small bowel bacterial overgrowth and intestinal methanogenic overgrowth. The Radiology department also provide strong support with a full range of GI radiological techniques with the new multi-slice and spiral CT and MRI diffusion weighted imaging and a Tesla MRI scanner. We have access to SeHCAT scans and CT Colonography where clinically appropriate. We have weekly multidisciplinary meetings in Radiology, Upper and Lower GI as well as HPB cancer. We are integrated into a clinical network with Lancashire Teaching Hospitals for UGI Cancer and with East Lancashire Teaching Hospitals and Leeds for HPB services and Liver transplant services respectively. We encourage active participation at our weekly Nutrition MDT meeting, monthly Complex Liver MDT meeting, bi-monthly IBD MDT meeting and bi-monthly Large polyp MDT meeting. In addition, we have a monthly Mortality and Morbidity meeting, monthly GI histopathology meeting as well as a monthly Gastroenterology teaching programme managed by our Gastroenterology Registrars. The Gastroenterology Senior management team consists of the Gastroenterology Head of Department, Endoscopy and Decontamination Unit manager, Gastroenterology matron and Directorate Manager with additional support provided by an Associate Directorate Manager, Directorate Support Manager along with an Administration Manager and a Booking Manager. We have a weekly SMT meeting, monthly Gastrointestinal Directorate meeting, bi-monthly Gastroenterology Business and Endoscopy user group meetings as well.