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Royal Bolton Hospital
Hospital and its surroundings:
The Royal Bolton Hospital is based within
, a town in the Greater Manchester
Metropolitan Borough of Bolton
. It is located 5 minutes from Junction 4 of the M61, about 25 minutes drive from Manchester, 30 minutes from Preston and Warrington.
The hospital geography largely consists of a long spine connecting blocks of wards of varying ages. The spine works its way up the hill of Minerva Road, meaning the catering porters have to do some impressive run-ups to get the lunch trollies back to the kitchens! Entering the hospital site from Minerva Road entrance, the Security Office and Children's Out-Patients are located to the right, with a visitor's car park. On the left lies the site of the old Townley's Workhouse (later "L" block) which became the first part of the modern Royal Bolton site but was demolished in early 2012.
Entering the hospital on the right at A block finds you in the Pathology department, with the Breast Unit and A4 ward. The MRI scanner and Nuclear Medicine are also based here. The next B block houses B1-B4 wards. The corridor between B & C blocks has a handy WRVS shop and the way to the Doctor's Mess. C block has the Cardiology (C1), CCU and Gastro (C3) wards. Cardiology Investigations is on the link corridor to D block, which contains the medical assessment wards ("AMRU") and Respiratory wards. E block houses the main entrance, surgical wards (E3/4) and the Children's Unit (E5). Night time food is available from the cafe in the main entrance, and the main Reception (for accomodation keys, maps, cashier's office), which has a postbox and cash machine (fee-free) and WRVS shop are also here, along with the Pharmacy department.
F block has main radiology, orthopaedic out-patients and the plaster room on the ground floor, with surgical/orthopaedic wards and HDU above. G block has A&E on the ground floor & Main Out-Patients (including "Blue Bay" - a daytime medical rapid access clinic), with Orthopaedic wards and ICU above.
A link corridor here contains the Neonatal Unit, where the corridor splits. Turrning left goes past the chapel, mosque and switchboard towards the Bolton Community Unit (BCU), H block (with Ophthalmology (H2/4), Women's Health (H1) and the Stroke Unit (H3). A WRVS kiosk is open here during the mornings. Further down the corridor are the J & K blocks, containing the mental health wards (Redwood, Hazelwood, Oak, Beech, K3 & Maple House). If you continued outside, you would pass Hawthorn House (mental health) and ultimately the Dialysis Unit (run by
Heading back to the Neonatal Unit, you could continue along the corridor to Maternity (M block), where Obstetrics and Gynaecology is based. A WRVS shop is located at the entrance the unit, the Princess Anne Maternity Unit.
The L-shape this corridor spine creates houses the main clinical services, but some other services on site are in other buildings; most Human Resources & Therapy services are in N block. The Education Centre & Library is on the outskirts of the site, near CAMHS and the Minerva Day Hospital.
The 501 bus route, calling in Bolton town centre, travels through the hospital grounds with stops at B block, the Main Entrance, H block and the Ambulance station, with a frequency of every 10 minutes, Monday-Saturday daytime. Journey time from Bolton is 15 minutes.
The 521 bus runs hourly on weekdays from Blackrod via Westhoughton and the hospital to Little Lever. The 685 bus also runs hourly from
to Royal Bolton.
GMPTE Royal Bolton Hospital Bus Routes/Map:
The nearest train station is Moses Gate, which is about 25 walk away (though not a walk you'd want to do in the dark) but only runs local routes on an hourly basis. Probably easier is to go to
and catch the 501 bus from there. There are frequent trains (3-5/hour) to Manchester Piccadilly/Victoria with a journey time of about 25 minutes. Other routes cover stations to Preston, Blackpool, Ciltheroe and Manchester Airport.
Although many staff complain; compared to the surrounding Trusts of Wigan, Blackburn, Salford & Bury, parking at Bolton is pretty good. A non-designated space is £10/month and there is usually somewhere to go, with the furthest space about 10 minutes walk from the main entrance. Security run a good service at night, either personally accompanying or following you on camera to improve safety.
Visitors car parking is more sparse, with a maximum charge of £2.50/day.
The old Musgrave House building which used to house junior doctors is now an office building. An on-call block behind remains, with 2 rooms allocated per speciality. The rooms are well equipped, with a good kitchen (with washing machine, fridge and oven) and a TV lounge.
Located in the Sports & Social Club, off the main hospital corridor between B and C blocks, the Doctor's Mess is a large one that is unfortunately a little neglected, both in terms of condition and populace. It's location combined with the busy hospital means that the few occupants are usually locums or house officers on supernumeray posts, with the occassional resident consultant at night.
Exceptionally busy hospital (busiest A&E/medical take in the North West, despite having fewer A&E staff and medical beds than most NW hospitals), but you'll see loads of pathology. Major downside is that many of the middle management posts are filled by nurses, who often have more power than the juniors and it's even a nurse that writes the medical rota - very different power balance to almost all other hospitals. I worked here for 4 years and including time as a medical student and have therefore worked on just about every ward, so I speak with confidence when I say you'll never be busier or work harder, but you'll see more patients and more pathology than anywhere else. Also a really great bunch of consultants to work for.
A fantastic choice for Foundation training - can only echo the sentiments above that you'll have opportunities far greater than at the larger, more authoritarian "Teaching" hospitals. An inspiring team of consultants work closely with their junior staff and keen to allow you to develop your competency through responsibility. The difficult circumstances the hospital often operates in fosters a great team spirit amongst medical and nursing staff alike. Less of the snide culture of apportioning blame and 'not-my-problem'ism that is rife within other hospitals.
Medical Students in a number of specialities are taken from the University of Manchester. These are almost entirely from the Salford/"North" sector students. Bolton is classed as an "Associated Teaching Hospital".
At any one time there are 2 firms of 3rd year clinical students on the cardiorespiratory module; 1 firm of 4th year students in Obs & Gynae; 1 firm of 4th year students in Paediatrics; 8 4th year students in Psychiatry; and 8-12 final year students based across all specialities. In addition, a number of 1st and 2nd year pre-clinical students are based in Bolton area GP practices, and also participate in selected hospital experience days.
is usually pretty good, largely due to the smaller firm sizes than exist within Salford. Some students report problems within Obs & Gynae, especially since the doubling of intake in 2009 (due to the closure of Trafford General's Obstetrics department).
There 39 F1s and 39 F2s based in Bolton. 2 posts within 1 track are labelled as Academic and involve research within the Pathology department. A further two posts in a different track are labelled as Leadership posts, and involve 1 session a week doing various fun activities (audit, quality improvement etc).
All posts have a GP block (which will be banded at 1B in the 2010-2011 academic year, and then downgraded after that, to unbanded or possibly 1C)
In F1 year, most posts include a more supernumerary-style post (such as Paediatrics, Psychiatry or Pathology) where the post is more training focussed. These posts are quickly becoming unbanded by the Trust!
Some F2 posts are based within Bolton PCT (Intermediate Care, Musculoskeletal, GUM), but most F2 jobs (excepting GP) attract a 1A banding, at least in 2010.
A particularly good hospital for GP VTS training I think, with very good VTS rotations and teaching.
All GP VTS posts include one Integrated
Lots of F2s applying for GP training choose to stay at Bolton.
The "AMRU" or Acute Medical Recieving Unit is Bolton's MAU, based on two wards, D1 and D2 in the middle of the hospital.
Staffing: 3 consultants, 3 Acute Medicine StRs (who all appear to be on-call simultaneously), 2 ACCS trainees, 2 F2s, 2 F1s. Joined by on-call CMT trainees and on-call Medicine StR.
Nights: 1 StR on 2100-0900, 1 StR on a twilight shift (til midnight), 2 SHOs, 1 F1 (on ward cover plus AMRU)
Weekends: Consultant Round in the morning. 2 StRs (one on ward cover, one on AMRU), 2 SHOs on ward cover, 2 SHOs on AMRU. one F1 (on AMRU)
Weekend Nights: A character building experience for all grades. 1 StR, 1 SHO and 1 F1.
Working on AMRU is pretty demanding but pretty sociable. Head to the back of D1 to find the action.
Legendary Dr Kevin Jones keeps spirits up and patients out with his great humour and proactive nature... he walks around A&E daily identifying potential referrals and ensuring only relevant ones make it past the gates.
There is no medical take system at Bolton, patients admitted from A&E/GP arrive on AMRU and are then despatched to appropriate wards as and when beds become available. Until recently there was no formal handover or ward round of patients, and so no opportunity to present patients you had clerked. There is now a half hour tacked onto shifts to enable a better medical handover. This takes place in a little room just to the right as you enter D2 ward.
Based on 2 wards (D3 and D4) with 5 consultants. An absolutely superb team to work for in a demanding but highly educational environment.
Bolton is a hub of respiratory pathology, probably due to the old milling industy... as well as love of fags.
Constant source of misery is that the respiratory wards trialled the electronic blood ordering system, universally hated by all staff, but somehow deemed a success and thus due for hospital-wide roll-out (and possible mass suicide as a result).
Junior Staffing: 3 F1s, CMT1, CMT2, GPVTS1, GPVTS2
Cardiology & CCU
Modern ward and 8 bedded CCU based in C-block.
Nearby cardio-respiratory function testing suite.
Junior Staffing: 1 F1, 1 F2, CMT1, CMT2
Based on C3 in modern ward.
Staffing: 4 consultants and juniors will work for one of two "firms"
Excellent Liver Specialist Nurse and Alcohol Liasion Team.
Junior staffing: 2 F1s, 1 F2, 1 CMT1, 1 CMT2, 2 SpRs
Share B3/B4 wards with Complex Care patients.
3 Consultants, 1 is Associate Medical Director, other two are PCT employed.
2 StRs on rotation.
Excellent Specialist Nursing team providing limited on-call service.
Many clinics based off-site at Diabetes Centre on Chorley Street in Bolton town centre.
Junior Staffing: 2 F1s, 2 or 3 SHOs
The B3/B4 wards are akin to hell, with poor doctor and nursing staffing levels and heavy workloads. Every F2 has a story about a patient crying "Don't send me to B4" in A&E/AMRU. It's perhaps a little unfair - hardship does bring people together, but when even the consultant systems for these wards promote regular swapping out, it does kind of indicate no-one wants to work there for extended periods. It doesn't help that chronic nurse understaffing leads to burnout and frequent departures.
And beware! North West CMT1 trainees can be conned into believing their tracks consists of "Complex Care/Respiratory/Diabetes"; however, the Diabetes roatation actually consists of a second Complex Care stay on B3/B4, with "opportunity" to attend clinics when staffing allows (i.e. not once in 4 months, with the express knowledge of the department lead).
Complex Care (aka Elderly Medicine)
Based across 5 wards. Each has a permanent F1 and a complex rotating system of SHOs to enable all to experience some time on the stroke ward. SHOs will regularly be pulled from one ward to another to cover the gaps made by the on-call rota. Leave is difficult to arrange and out-patient clinic time is virtually non-existent. Most trainees start by attempting to complete ward jobs before going home, but after a few weeks of 7pm finishes, will simply give up and walk at 5pm. On-calls are something to look forward to.
Most consultants will encourage this and recognise the difficulties, and provide good training and teaching where and when possible.
3 Geriatric StRs do 4 months placements on B2, N3/C2 and Orthogeriatrics.
aka the ASU (Acute Stroke Unit). Well staffed and excellent nurses. perhaps not coincidentally run by the Head of Complex Care, this ward is never left unstaffed, regardless of what this leaves the other wards with.
Junior staffing: 1 F1, 2 SHOs and a Geriatric StR. Plus a very hands-on consultant and shithot/terrified nursing staff. You'll be drinking tea from 1030.
B3 - Female Complex Care/Diabetes & B4 - Male Complex Care/Diabetes
See above. Living hell. Busy wards with poor doctor/nurse staffing. Although should be staffed by 6 doctors (2 F1, CMT1, CMT2 and two other F2/GPVTS SHOs) regularly left with 1 doctor per ward with one SHO floating between the two due to on-call rota. Disillusioned nurses. First wards
"miss out" when busy.
B4 Complex Care Consultants are PCT employed and rotate every 3 months between B3, B4 and community.
The 3 endocrine consultants rotate every month and each have varying levels of input: one barely attends the ward, one never leaves.
C2 - Female Complex Care
Includes some side-rooms for Haematology patients. 3 Consultants each share responsibility for this ward.
N3 - Mixed Complex Care
Located away from the main hospital spine and so supposedly with less acutely unwell patients - though the "Winter" (i.e. August to April) pressures usually nip that idea in the bud. A permanent consultant who runs a tight ship and values his trainees. Well staffed and pleasant to work in.
N4 - Stroke Rehabilitation
The forgotten ward, largely run by physios and OTs, a random lone SHO will be despatched here to review the patients daily and complete all jobs. And call for ambulances to transfer to "the main hospital" when the going gets tough (i.e. daily in Winter).
Average take is 15-20 patients, including urology patients which are always seen and taken on by the Urology team.
Firms include: Breast; Vascular; Upper GI; Lower GI; General; ENT and Urology.
Permanent gaps on middle grade rota mean variety of Registrar locums. Can cause problems for F1s/SHOs if they are not prepared to see specialty patients (i.e. Urology/Vascular)
Participates in a shared Vascular-on-call with Wigan, Preston and Southport out of hours.
Patients based on F5 ward with specialist nurse. One Core Surgical Trainee, one F1 and training registrars. Consultants are excellent and encourage learning of skills early in posts.
The surgical SHO on-call also covers ENT when ENT SHO not in and Bolton accepts all Preston/Chorley ENT patients on alternate weeks (so check when week you agreed to locum!)
Day-time weekdays only, out of hours is covered by Royal Blackburn hospital.
The life of SHOs is drought or flood.
To make rota compliant half days are randomly awarded but staff are encouraged to "choose" to come in to "catch up" on their patients or engage in "optional educational activity" (such as ward rounds, clinics or theatre lists). Monitoring forms mysteriously go missing.
Nevertheless, a fun department with largely great consultants and good training and exposure - budding orthopods speak very highly of the department.
Based on wards F4, G3 and G4.
One GP VTS post in orthogeriatrics includes Orthopaedic on-call.
Often quoted as the busiest A&E in the North West region - and it's easy to see why, especially in the winter months. Actually sees less patients than Manchester Royal Infirmary, but wins on a patients-to-staff ratio.
Small department given numbers seen: 4 Resus bays, 14 Majors cubicles, 4 Minors Cubicles, Eye Room, 2 Paediatric resus bays, 5 Paediatric Cubicles and 3 Paediatric Observation bays.
Great consultant support and very rota compliant.
Having said that rota is can feel extremely busy and understaffed (especially at middle grade, which leads to some interesting locum experiences, especially at night) compared to similarly busy sites. Take teaching and training seriously.
3 F1s - each work one of 8-4, 1-9 or 4-12 shifts. 1 in 3 weekends, working 8-6. No nights.
12 SHOs (4 F2s, 2 ACCS, 2 GPVTS2, 4 GPVTS1). 1 in 2 weekends. 2 full weeks of nights per 12 weeks. Annual leave can only be taken in rota slots.
4 StRs & 3 Staff Grades (with 2 vacancies). Work a miserable rota with split nights 1 in 4.
Friendly department which is one of the 3 Greater Manchester Women's and Children's supercentres. Consultants vary between great and utterly fantastic. All very keen to teach and ensure trainess get best out of post.
Now based on the second-floor Children's Unit (E5), consisting of a 7 bedded Assessment and Observation area, 7 bedded Surgical bay, and a ward area consisting mainly of en-suite cubicals and one 4 bedded bay. New ward is spralling and lends itself to the general feeling of chaos and inefficency felt whilst working... pretty much all staff spend much of the day pacing up and down the various corridors looking for each other.
Rota means junior staff become quite fragmented, and also do a large number of on-calls within a short period (nightmare when someone gets ill). Banded at 1A. Work 1 long (0900-2200) and 1 short (variable shifts totalling 16 hours) weekend in 8, and 1 set of split nights.
Four daily handovers(!) Morning handover is 9-10am, followed by split wards rounds. Further handover after this, to allocate jobs. Handovers also at 5pm and 9pm.
Assessment Unit covered by 1 SHO, 1 SpR, 1 Consultant and usually an Advanced Nurse Practitioner through the day.
2 Playworkers work 8-8 daily.
Junior staffing: 2 F1s, 2 F2s, 2 Paeds SHOs, 6 GPVTS
11 bedded HDU and 9 bedded ICU.
Good feedback from trainees.
Nurse Consultant runs many of the ALS-type courses and Critical Care Outreach and is a friendly wealth of useful information.
Obstetrics & Gynaecology
Each "firm" has one Reg and one SHO. Each do a ward round in the morning and then depart, leaving the "ward cover" SHO to decipher all patients ward round entries and action all plans. Needless to say things get forgotten.
Reg's duty to triage most A&E/hospital bleeps and deflect where possible.
And midwives are midwives...
Uses a full rainbow of cards to request scans but very few are refused... at least if you have some vague idea what the scan is for:
White A5 card: General X-Ray, USS and CT
Yellow A5 card: Nuclear Medicine
Buff A5 card: Old style General X-Ray (still in use by GPs/Psychiatry)
Green A4 card: VQ/CTPA request
Purple A4 card: MRI Request
Pink A5 card: Vascular Studies Request (which no-one is quite certain who to send to)
Pink A4 paper: CT Head in Suspected Stroke
Blue A5 card: 2 week rule CT scans
(Don't confuse with green A5 ECG requests or pink A5 Echo Requests!)
Based in two locations:
in A block is mainly out-patient X-ray, but also location of MRI scanner & Nuclear Medicine. Bring MRI requests (purple A4 card) here directly. List is ofen in flux - as one scan is ending all pending requests are scrutinised and next most urgent is prioritised.
F block Radiology
is where most inpatient X-rays take place. Also location of Ultrasound suites and 2 CT scanners. Direct access to A&E.
Boxes to request scans at recpetion, or discuss with Consultant of the Day, indicated at reception.
Bolton is divided into 3 sectors each with an adult and old-age team, headed by a consultant. Additional consultants in Crisis team, Substance Misuse, Rehab, Old Age Liasion and Learning Disability. Each sector consultant has one SHO. Some SpRs but a lot of staff grades (and a few perpetually unfilled middle-grade posts).
One F1 is split between Substance Misuse, Old Age Liasion & CAMHS, whilst an F2 is split between Crisis team, Old Age Liaison and an adult sector consultant.
SHO on-calls are variable, largely dependant on Crisis Team staffing. The team are great but have some difficulty filling out-of-hours rota, meaning the SHO spends a night in A&E.
Second-on-call covers Bolton, Salford and Trafford (so gets to know the M60 junctions 8 through 15 well).
K1, K2 and K3 are mixed adult wards, with K3 consisting solely of private rooms and a large lounge. The 4-bedded PICU (Maple House) is behind K3...which is not really near K1 and K2 at all!
Hazelwood (formerly J2) is the older people's assessment ward. Redwood (formely J1) is the older male unit, and Hawthorn House is the older female unit, located in a separate building just across from K3.
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