Clinical Fellow - Viral Hepatitis and Liver in Birmingham

This is an exciting post for 12 months aimed at a Gastroenterology registrar wishing to garner further experience in hepatology. The successful applicant will spend 12 months at the Royal Liverpool Hospital Site, a large teaching hospital hepatology unit (Tier 2 liver centre) The successful candidate will joining one of the most prestigious departments in the UK, containing the previous HepatologyNational Clinical Director, Past Royal College of Physician's President, past BSG president andcurrent BASL secretary. The team consists of 6 Consultant Hepatologists, 7 consultant luminalGastroenterologists and 10 specialist endoscopists (including 5 HPB Consultant Endoscopists), 5Nurse Consultants and 8 Specialist Nurses, 1 Endoscopy Fellow, 1 Research Fellow, 5 SpRs, 1CMT and 6 F1/2 doctors., A Senior Clinical Fellow in Hepatology will provide clinical leadership and support the development of hepatology services, with a particular focus on establishing and enhancing a comprehensive Hepatitis B service. The post holder will lead service improvement initiatives aligned to GIRFT principles, helping to reduce variation in care, improve access to diagnosis, surveillance and treatment, and optimise patient pathways across primary, secondary and community settings. They will contribute to the design and evaluation of innovative models of care, strengthen links with regional liver and viral hepatitis networks, and support implementation of national guidance. The fellow will also play an active role in hepatology research, quality improvement and service evaluation projects, presenting findings at regional and national meetings and publishing work in peer reviewed journals. In addition, the role offers opportunities to develop expertise in advanced hepatology and endoscopy, contributing to pathway redesign, service efficiency and improved patient outcomes. Working closely with multidisciplinary teams and regional partners, the post holder will support the future development of liver services and viral hepatitis care across the network.

Liver transplantation

A liver transplant clinic is held every week on a Tuesday afternoon. This is for the management ofpre and post transplant patients. 3 consultants cover this clinic. There are currently ~ 100 posttransplant patients being managed at the Royal.Every 6 weeks a consultant from Birmingham provides a satellite clinic. Patients are fully workedup at the Royal and presented at this clinic to the Birmingham team prior to formal presentation atthe Birmingham transplant MDT. Other local trusts have the opportunity to refer into this clinic.Between 15-20 patients are referred for transplantation each year. The successful candidatewould be expected to ensure patients are worked-up and presented in a thorough and timelymanner.

Viral Hepatitis

Currently ~ 500 patients are treated annually for HCV infection across the ODN. The Royal is the host site for the Cheshire and Merseyside HCV ODN. All DAA patients discussed at a MDT in conjunction with infectious disease colleagues. There is a weekly complex viral hepatitis clinic with the regional infectious disease department on Wednesday mornings.HBV is managed jointly with ID and on average a trainee would see 15-20 patients/ month.

HCC Clinic

A dedicated HCC clinic and service is jointly run by the Hepatology team along with interventionalradiology weekly affording experience in staging liver cancer and locoregional / transplant work up/ best supportive care management strategies.

NASH intervention service

A dedicated multi disciplinary NASH service benefiting from a joint diabetes clinic and healthtrainers manages the needs the NAFLD cohort at high risk for poor outcomes.

Autoimmune liver disease

The Royal runs the regional PBC ODN hub for second line therapies and this includes a monthlyPBC MDT which discussed complex regional patients with PBC who are suitable for additional treatment.

General Hepatology

There are currently 2 general hepatology clinics / week. These manage all aspects of liverdisease. Currently there are > 250 patients on the PBC data base, ~ 60 patients on the PSC database ~ 200 AIH on the data base all of which are under regular follow up in these clinics. Patientswith cirrhosis are also managed in these clinics in conjunction with a comprehensive automatedHCC surveillance program with > 600 cirrhotics registered. The hepatology ward has between 25-30 hepatology and HPB patients at anyone time. A largevolume of the ward based work is management of the complications of cirrhosis.Currently ~ 2-3 patients / month are managed with severe alcoholic hepatitis. In parallel with theFriday liver clinic there is a Medical Alcohol Clinic run by Dr Lynn Owens a noted nationalspecialist in management of alcohol addiction with particular emphasis in anti-addictionpharmacotherapy. A weekly session with a consultant psychiatrist is also available to assesspatients for alcohol related brain damage. There is a comprehensive alcohol team embeddedwithin the hepatology department.The hepatology unit has a close working relationship with ITU colleagues and in the last year ~5% / year of patients on the 18 bed ICU were patients with complications of liver disease theseinclude patients with hepato-renal syndrome which also benefit from the input from the regionalrenal unit based in the RoyalThe Royal acts as a tertiary centre for the management of PHTN bleeding an on average 20-25emergency TIPS are performed each year for variceal bleeding. With cases discussed a a portalhypertension MDT. The hepatology unit works closely with the Pancreatic Unit for themanagement of biliary and pancreatic benign and malignant MDTs. Cases are discussed atweekly benign and malignant MDT with the pancreatic team. Complex non-cirrhotic portalhypertension secondary to pancreatic pathology is also managed in the benign MDT.The Royal manages ~ 30 -40 new HCC /year; all patients are discussed in a weekly MDT andmanaged subsequently in a weekly HCC treatment clinic. There are close working relationshipwith the Professorial oncology clinic led by Prof Dan Palmer Specialist clinics.

Endoscopy

Endoscopy There is extensive opportunity for a trainee to continue endoscopy training with particularemphasis on endoscopic portal hypertensive lists. Potential exposure to complex HPB endoscopywith 4 ERCP and 4 EUS lists per week may be accommodated. A hepatology SpR would beexpected to contribute to the UGI bleeding rota and will be supervised and trained until sufficientlyexperienced to perform this role.

Time Table

Time Table Below is an example of a current time-table for a clinic block of work whilst at the Royal, but this will be flexible and aimed to meet the trainees needs. Currently we are working in 4 week blocks of work to allow concentration of exposure to ward, all OP clinics and endoscopy lists to ensure a comprehensive training package.

• MB, ChB/MBBS
• Full registration with GMC
• MRCP (UK), Pursue Higher degree (Masters or MD)
• Evidence of Audit
• Evidence of presentation in Research Meeting
• Evidence of publications
• Vision For Fellowship, Pursue Higher degree (Masters or MD)
• Evidence of Audit
• Evidence of presentation in Research Meeting
• Evidence of publications
• Vision For Fellowship

Disclosure and Barring Service Check This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Liverpool University Hospitals NHS Foundation Trust comprises Aintree University Hospital, Broadgreen Hospital & Royal Liverpool University Hospital. We are part of NHS University Hospitals of Liverpool Group, formed on 1 Nov 2024 from the coming together of LUHFT and Liverpool Women's NHS Foundation Trust. The Group was born from a shared aim to improve the care we provide our patients. UHLG is one of the largest employers in the region, with over 16,800 colleagues dedicated to caring for our communities - from birth and beyond. For the 630,000 people across Merseyside, we are their local NHS. We provide general and emergency hospital care, alongside highly specialised regional services for more than two million people in the North West. Aintree University Hospital is the single receiving site for adult major trauma patients in Cheshire and Merseyside and hosts a number of regional services including an award-winning stroke facility. Broadgreen Hospital is home to elective surgical, diagnostic and treatment services, together with specialist patient rehabilitation. Liverpool Women's Hospital specialises in the health of women and babies, delivering over 7,200 babies in the UK's largest single site maternity hospital each year. The Royal Liverpool University Hospital is the largest hospital in the country to provide inpatients with 100% single bedrooms and focuses on complex planned care and specialist services.