Multidisciplinary Haematology Team

Like many nurses working on a ward, the daily duties include overseeing the day-to-day running of the unit, supporting the running of any outpatient clinics, and meeting the needs of patients. Nurses will also coordinate with several other specialist healthcare professionals and perform observation checks.

At least two A-levels are usually required to enrol in a nursing degree, which is the typical route into nursing. Some places offer a four-year nursing degree apprenticeship, which includes part-time study.

Haematology nursing specifically can involve administering chemotherapy, preparing IVs and sampling bone marrow. Nurses also provide supportive care for blood transfusions and bone marrow transplants.

Haematology nurses will develop specialist knowledge, from information about related conditions to recognising and managing haematology emergencies.

Clinical nurse specialists are often expected to have Masters-level education and an advanced level of knowledge about the care of haematology patients. Because of this more experienced background, these nurses can practice autonomously. They run nurse-led clinics and provide ward-based education.

Clinical nurse specialists work with doctors, nurses and other healthcare professionals to support the patient as much as possible. Their technical knowledge may help to tailor the pathway for individuals.

A clinical nurse specialist may be named as a patient’s key point of contact during their treatment. They can offer support and advice to patients and their families about their illness, medications and side effects.

Research nurses experience a mix of direct patient care and research involvement.

They coordinate and monitor the care of patients on several studies, from small early-stage safety trials to major clinical trials with a national profile. Depending on the specialty of the unit, this could include testing new forms of chemotherapy for haematology malignancies or drugs for haemophilia.

Research nurses work within a team of data managers and consultants. They work closely with the inpatient and outpatient support services and actively contribute to multi-disciplinary team meetings. They assist with reviewing the trial protocols, identifying resource implications and setting up the trial on site.

As part of their duties, research nurses help to educate patients and colleagues, coordinate care of patients on trials, collect and prepare biological samples, collect trial data and monitor the side effects of treatments. They also provide support to haematology patients and their families during their treatment.

Becoming a research nurse means developing specialised skills and knowledge about the conduct of clinical trials, the therapies and the relevant disease sites. Research nurses will help to identify new trial volunteers by attending clinics and multi-disciplinary team meetings. They discuss trials with patients and enable them to make informed choices concerning their involvement in clinical trials by providing advice and information and acting as the patient’s advocate.

Research nurses are responsible for ensuring the regulatory aspects of clinical trials meet Good Clinical Practice standards, so they need a good understanding of the research process. Being a research nurse often includes opportunities to attend research conferences and seminars relevant to clinical trials.

Physician associates (PAs) are dependent practitioners, which means they must work in collaboration with a named consultant or general practitioner (GP). However, PAs work independently in assessing, investigating and diagnosing patients with appropriate consultant/GP oversight and support.

Physician associates complete a two-year, intensive masters’ level postgraduate degree (minimum 3,150 hours) leading to the award of PGDip or MSc in Physician Associate studies. Prior to this, PAs need to have completed an undergraduate degree in a life science or healthcare for entry to a PA course.

Physician associates are primarily trained in adult general medicine, with speciality rotations during their training in general surgery, obstetrics and gynaecology, paediatrics, psychiatry, community medicine and emergency medicine. They must complete a minimum of 1,400 hours in clinical practice during the two-year training programme, such as on wards, in clinics or general practice settings. They must also complete a further 200 hours of designated clinical learning in addition to the above, which can be in simulation.

Upon graduation, PAs are then expected to sit the independent PA National Certification Examination at the Faculty of Physician Associates, Royal College of Physicians, to be deemed safe to practice.

Physician associates are predominantly medical generalists, working within the speciality team. They graduate being able to assess, investigate, diagnose and manage a vast array of general medical conditions, for example asthma, COPD, diabetes and thyroid dysfunction as well as assessing, investigating and then referring on more complex medical diagnoses.

With time spent in clinical practice, the individual PA will gain speciality knowledge from within the area they work. This is through both clinical exposure as well as dedicated consultant/GP mentorship and teaching. With appropriate oversight and time, the individual PA will begin to take on a greater level of autonomy for patient care within their speciality, all the time maintaining their generalist knowledge and skill set. This generalist approach and knowledge is useful within the specialist haematology team, as many patients with haematological issues will also have other medical conditions that need managing. To ensure that this generalist medical knowledge is retained, PAs are assessed every 6 years through the mandatory PA National Recertification Examination.

Physician associates are employed directly by an NHS organisation and usually by a specific department. As such, they predominantly remain within the same department and do not rotate like doctors in training (e.g. FY, IMT doctors). This enables PAs to offer long-term medical continuity for patients at the non-consultant level, becoming the institutional memory for many departments. This can benefit doctors in training who rotate through the speciality, with the PA offering speciality and local knowledge as well as being able to teach and supervise speciality-related procedures.

Physician associates who choose to work within haematology will gain exposure to a wide array of general medical and speciality related diagnoses. As medical generalists, PAs are able to assess and routinely manage medical co-morbidities, perform chronic disease assessment and reviews (e.g. asthma, COPD, diabetes), as well as manage acute medical emergencies that arise on the haematology wards and outpatient settings.

Upon initial graduation, PAs would be expected to be able to recognise and investigate patients presenting for the first time with more common haematological diagnoses, such as immune thrombocytopenic purpura or genetic haemochromatosis. With time spent in practice alongside their supervising consultant, the PA in haematology will then start to take on a greater level of autonomy in managing these conditions, as well as start to gain exposure to more complex patients such as acute leukaemia or high-grade lymphomas. Again, with time in the speciality, the PA in haematology will then start to take on more individual autonomy in assessing and managing these complex diagnoses. This is all within defined levels of supervision from their named supervising consultant haematologist.

Physician associates practising within haematology are able to be trained in speciality-related additional skills, for example PAs can be taught to perform bone marrow aspirate and trephines, lumbar punctures, PICC line insertion, femoral line insertion and venesection. They are able to conduct inpatient ward round reviews independently, with remote consultant supervision, conduct outpatient consultations independently within consultant led clinics, as well as alleviate some of the administrative burdens such as discharge summaries and referrals to other specialities.

PAs can also become involved in audits and quality improvement projects, helping to drive standards and ensure compliance with both national and local policies. PAs are also starting to become involved in departmental and speciality related research and clinical trials, as well as leading on PA-related practice and education focused research.

The system for junior doctors changed in August 2019. After completing their two-year Foundation training, junior doctors will then do Internal Medicine Training (IMT). For specialities that do not focus on supporting acute hospital care, such as haematology, junior doctors will do two years on Internal Medicine before specialising. The first year of specialty training is known as ST3, and the doctor will then be known as a specialty registrar.

During their Internal Medicine Training, junior doctors will become familiar with a range of conditions and presentations, including haematology conditions. They will complete six four-month rotations between specialisms in their Trust, which may offer the option of haematology. During this time, the junior doctors will be involved in the day-to-day management of acutely ill inpatients and attend outpatient clinics.

After completing their second year of Internal Medicine Training, junior doctors will need to decide whether to choose a specialty, such as haematology, or complete another year of IMT before specialising in an acute setting.

To enter Foundation training, you would need to have completed a (typically) five-year Medicine degree at university. Places for Medicine are very competitive and you would be expected to have good grades at A-level (or Advanced Highers in Scotland) in chemistry and biology, as well as relevant extra-curricular experience.

A haematology specialty registrar will have completed five years for their Medicine degree, two years of Foundation training and two years of Internal Medicine Training (from August 2019).

Specialists in haematology are both clinicians involved in direct patient care and pathologists practising in the laboratory. The specialist training covers both aspects, and specialty registrars work towards a Fellowship of the Royal College of Pathologists (FRCPath) qualification to become consultants. Specialist training in haematology is five years, from ST3 to ST7.

The training covers different areas and specialities in haematology, including oncology, paediatrics, haemostasis, stem cells transplantation and blood transfusion. This training gives the specialty registrar experience in working with a broad range of disease of the bone marrow and blood.

The training is carried out under the supervision of a consultant. The first year of training focuses on the presentation and management of haematological disorders as well as laboratory work. In later years, the training covers the more practical aspects of haematology. Under the responsibility of a consultant, this would include managing chemotherapy delivery, managing stem cell transplants, sampling bone marrow, and performing lumbar punctures for diagnosis and chemotherapy.

Specialty registrars do regular ward rounds, both with a consultant and independently, where they will review each patient under the care of their consultant. As part of their training, specialty registrars spend at least six months in a District General Hospital to provide experience in a variety of settings.

Over time, the registrar will develop the skills to work unsupervised. At that stage, the registrar takes the FRCPath exams, where Part 1 tests the knowledge gained by the registrar and Part 2 tests the practical skills and understanding.

To become a consultant haematologist, specialty registrars must hold a Certificate of Completion of Training (CCT). To receive this, registrars must gather evidence of their work and competencies, including appraisals, case reports and publications. This can be applied for once the FRCPath qualification has been completed and is typically after five years as a specialty registrar.