Beruflich Dokumente
Kultur Dokumente
OF
NICHOLAS HOWARD JENKINS
August 2015
SUMMARY
I am an Expert in Emergency Medicine (A&E) and my
clinical work encompassed the spectrum of Emergency
Medicine presentations. I do, however, have a particular
interest and expertise in the management of trauma, from
minor injuries to major trauma.
I am an effective clinical manager and throughout the 21
years in Consultant post at Nevill Hall Hospital I managed
the Emergency Department under the varying titles of
Clinical Lead, Clinical Director etc. I also had several years
experience as Clinical Director of all Emergency Department
services across the Aneurin Bevan Health Board (and
previously Gwent Healthcare NHS Trust). I have particular
interest and expertise in relation to clinical governance and
undertook the role of the Safety Lead in the Royal
Glamorgan Hospital Emergency Department.
As a teacher /trainer I have been a Course Director for
Advanced Life Support, Advanced Trauma Life Support and
Advanced Paediatric Life Support Courses.
I was Chair of The Royal College of Emergency Medicines
Training Committee (Training Standards Committee) 20102012 and Vice Chair of the Royal Colleges Welsh National
Board 2009-2012. As Chair of the Training Standards
Committee I was a member of the Department of Health /
Royal College of Emergency Medicine Workforce Task
Group and represented the Royal College in the sub-group
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STATEMENT
I worked within the NHS as a Consultant in Emergency Medicine
since 1991 following training in both Emergency Medicine (A&E)
and also Orthopaedic Surgery. The majority of my working life as
a Consultant (21 years) was spent establishing a modern
Emergency Medicine (A&E) service in Nevill Hall Hospital,
Abergavenny. I thereafter moved hospitals to the Royal
Glamorgan Hospital, undertaking the same role, in August 2012
because my wife and I, who were both born and raised in Cardiff,
decided to return to the Capital. In 2013 the Welsh Government
announced plans to downsize the Emergency department in the
Royal Glamorgan Hospital and I therefore moved to the University
Hospital of Wales, Cardiff in November 2013, partly for
convenience of travel but primarily to allow me to continue to
work as an Emergency Medicine Consultant and continued in that
role until my retirement from clinical practice in 2015.
I have undertaken a significant amount of work in clinical
management and developed particular interests in clinical
governance and safety. As a result of this work I have gained
considerable experience in dealing with clinical complaints and
litigation and, as I also have in excess of twenty years experience
as an Expert Witness involving the provision of expert opinions in
alleged clinical negligence cases, I believe that I have a balanced
overview of matters involving clinical complaints and alleged
clinical negligence. Further, my work as a Forensic Medical
Examiner provided a grounding in certain complex ethical issues,
especially those surrounding consent
As an accredited Expert Witness I have been trained in report
writing and continue to work as an Expert in Emergency Medicine.
I also have an interest in education, remain an active teacher /
trainer and have been trained to teach.
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INDEX
General Education
Page 6
Medical Education
Page 7
Post-Graduate Qualifications
Page 8
Posts held
Page 9
Other positions
Page 11
Service Delivery
Page 12
Clinical Governance
Page 14
Management
Page 15
Page 17
Medicolegal
Page 19
Forensic Medicine
Page 20
Page 21
Academic activities
Page 25
Page 26
Publications
Page 27
GENERAL EDUCATION
School - Cardiff High School
10 'O' Levels in 1972
Grade A
Biology
Grade A
Physics
Grade A
MEDICAL EDUCATION
Medical School
Welsh National
School of Medicine
Year of qualification
1980
Undergraduate Distinctions
Biochemistry
Pharmacology
Community Medicine
Psychological Medicine
Undergraduate Prizes
Alfred Hughes Memorial Medal in Anatomy
1976
1977
1980
Scholarship
Wellcome Scholarship in Biochemistry
1975
Postgraduate Degrees
BSc (1st Class Hons) Anatomy
1977
MB BCh
1980
MCh
1989
Postgraduate Diplomas
FRCS (London)
1984
1993
Postgraduate Prizes
Welsh Surgical Society Prize (Winter Meeting)
Robert Jones Medal and Prize
British Orthopaedic Association
1985
1989
GMC Registration
Full Registration since 1 August 1981
Included on Specialist Register since 12 June 1996
Registration Number 2639990
Medical Defence Union
Membership number 244701E
CURRENT POST
Medical Adviser. Driver and Vehicle Licensing Agency, Department of
Transport.
March 2015 onwards
PREVIOUS POSTS
Consultant in Emergency Medicine, University Hospital of Wales, Cardiff
November 2013 March 2015
Consultant in Emergency Medicine, Royal Glamorgan Hospital, Llantrisant
August 2012 November 2013
Consultant in Emergency Medicine and Lead Clinician, Nevill Hall
Hospital, Abergavenny
April 1991 August 2012
Senior Registrar in Accident and Emergency
Royal Gwent Hospital/Cardiff Royal Infirmary
Royal Gwent Hospital 18 July 1988 30 September 1990
Cardiff Royal Infirmary 1 October 1990 31 March 1991
Registrar in Accident and Emergency
Peterborough District Hospital, Peterborough
Dr J R Glover
28 December 1987 17 July 1988
Lecturer and Honorary Senior Registrar
Dept. of Traumatic and Orthopaedic Surgery
University of Wales College of Medicine/
South Glamorgan Area Health Authority
1 July 1986 27 December 1987
Registrar in Traumatic and Orthopaedic Surgery
Cardiff Royal Infirmary/University Hospital of Wales/Prince of Wales
Hospital, Rhydlafar
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OTHER POSITIONS
I was the Lead for Higher Specialty Training in Emergency Medicine for the
Royal College of Emergency Medicines Training Standards Committee
May 2012 April 2014, having previously chaired that committee May
2010 May 2012.
I am an Examiner for the Fellowship examination of the Royal College of
Emergency Medicine.
I was Vice Chair of the Royal College of Emergency Medicines Welsh
National Board 2009 2012.
I was the Chair of the Welsh Regions Specialty Training Committee in
Emergency Medicine until August 2007.
I was the Welsh Representative of the British Association of Accident and
Emergency Medicine 1993 - 1999
I was, until 1999, the Welsh Representative of the Resuscitation Council
(UK) Advanced Life Support Course
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SERVICE DELIVERY
Nevill Hall Hospital
I was appointed Consultant at Nevill Hall Hospital Emergency Department
(ED) in 1991, and worked as a single-handed Consultant for many years. I
personally introduced clinical systems which resulted in the Nevill Hall
Hospital ED being recognised as one of the best performing EDs in Wales:
I organised the departments working practices, the result being that
the department was often the highest performing Welsh unit regarding the
Welsh Assembly Government (WAG) 4 hour target (2009 NHH average.
= 92.4%, all Wales average = 89.6%; 2010 NHH average = 88.67%, all
Wales average = 86.54%)
Many of the practices that I introduced (e.g. the re-direction of
patients to a more appropriate provider) have subsequently been widely
adopted and are now regarded as standard practice throughout the NHS
I introduced various clinical pathways to ensure optimal evidencebased management of certain conditions (e.g. a clinical pathway for the
investigation of the clinical scaphoid fracture)
I introduced fast-track pathways to ensure timely hospital admission
for selected conditions (e.g. blood loss in early pregnancy)
In 2007-08, as a result of the clinical pathways that I developed, 77%
of suitable myocardial infarction (heart attack) patients received
thrombolysis within 30 minutes of arrival in the ED in 2007-08 (Welsh
National average 67%) (4th best performing unit in Wales) (Myocardial
Ischaemia National Audit Project)
I introduced and supported the concept of autonomous nurse treatment
I introduced planned out-of hours Consultant shop floor presence to
Nevill Hall Hospital many years before it became routine practice in the
UK
I developed and led a multi-disciplinary (ED, Physiotherapy,
Rheumatology and Radiology) Sports Injury Clinic based in the ED. This
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service increased the quality and time to definitive treatment for this group
of patients. My own role in this clinic was the initial assessment of
patient, undertaking arthroscopic treatment of knee conditions, and
subsequent follow up
I introduced procedures / policies into the ED to increase quality and
safety for patients and thus, for example, un-planned re-attenders were
seen by senior doctors, and I introduced the daily review of clinical
notes/X-rays allowing for early identification and correction of potential
errors
My management of Nevill Hall Hospital ED resulted in the following
statistics in 2011 which reflected that the quality of performance and
safety of patient care provided was superior to UK average (UK average
figures from Health Episode statistics in brackets):
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CLINICAL GOVERNANCE
I have a particular interest and, I believe, expertise in relation to clinical
governance with a proven track-record in clinical governance activity.
I established and oversaw a programme of clinical audit upon my
appointment as Consultant in 1991. I led that programme until a colleague
assumed the lead role in 2006.
Whilst in Nevill Hall Hospital I continued to lead the audits in relation to
thrombolysis in myocardial infarction and also in relation to diagnostic
errors (both false-negative and false-positive).
The risk management systems that I developed in Nevill Hall Hospital
ensured a low number of complaints/litigation reflecting a high quality of
patient care
I established the Nevill Hall EDs Clinical Quality Group. This multidisciplinary group met on a regular basis to co-ordinate the departments
audits, performance, complaints and litigation with an executive function to
initiate any changes of practice required from these outcomes.
I was the Safety Lead in the ED at the Royal Glamorgan Hospital. In that
role :
Established the formation of a multi-disciplinary governance
committee
Introduced clinical pathways / proformas (e.g. for chest pain
presentations, children presenting with feverish illness etc.)
Introduced policies / procedures previously used with success at
Nevill Hall Hospital (e.g. for un-planned re-attenders) and also others
in relation to the use of Early Warning Systems and the recognition of
potential clinical problems in pateints taking anti-coagulant
medication
Introduced extended hours Consultant clinical presence
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MANAGEMENT
I was Clinical Lead in the ED Department of Nevill Hall Hospital following
my appointment in 1991, and at various times since that time, and in various
management structures, I occupied a Clinical Director position managing the
Nevill Hall ED, the Royal Gwent and Caerphilly District Miners Hospital
EDs, and also the Trauma and Orthopaedic and Rheumatology Departments
in Nevill Hall Hospital. I assumed the Lead role regarding the management
of the Royal Glamorgan Hospital ED although this was not a formal
appointment.
In my managerial role at Nevill Hall Hospital, and also as Safety Lead at the
Royal Glamorgan Hospital I dealt with all complaints and litigation cases
relating to the Emergency Department. I have also had experience in giving
evidence at Coroners inquests. This activity and work was then fed into the
Clinical Governance programme and risk management strategies developed
from the lessons learned in such cases. . I have also had experience in
giving evidence at Coroners inquests and also experience in acting as an
external advisor to Coroners. As Clinical Director I have had experience and
involvement in hospital investigation and also disciplinary procedures.
Between 1999 and 2010 I Chaired the Nevill Hall Hospitals Hospital
Clinical
Management
Group
co-ordinating
the
hospitals
clinical/management interface ensuring efficient management and provision
of quality patient care.
Other managerial positions / functions have included:
Wales Representative for the Council of the British Association of
Accident and Emergency Medicine (BAEM) 1993-2001. In this
position I represented the Wales Emergency Medicine Consultants and
implemented BAEM policies to enable EM development in Wales
As Chair of Specialist Training Committee (STC) for EM in Wales in
2006-07 I was responsible for Emergency Medicine training in Wales
and in 2007 implemented Modernising Medical Careers (MMC) for
Emergency Medicine
Until 2010 I was Aneurin Bevan Health Boards Clinical Lead for
Minor Injury Units (MIU) developing the MIUs to provide quality
Emergency Care in geographical proximity to patients needs. I was
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1988
1989 &1990
1990
1990 &1993
1992
1993
1995
1995
1999
1999
Jan. 2001
Jan. 2001
Dec. 2003
Feb. 2004
Feb. 2004
Hospital major Incident and Support. Provider Course. ALSG. Jan. 2006
BestBETS course on critical appraisal. ALSG.
March 2006
June 2006
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Dec. 2006
Jan. 2007
Jan. 2007
April 2007
June 2007
Oct. 2007
Nov. 2008
Nov. 2009
June 2010
Sept. 2011
July 2011
Sept. 2011
Sept. 2011
June 2012
Oct. 2012
Nov. 2012
Nov. 2012
April 2013
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MEDICO-LEGAL EXPERIENCE
I was awarded The Certificate of Expert Witness Accreditation by Bond
Solon / Cardiff University, March 2004 and have regularly undertaken the
educational activities (courses, eLearning etc.) required to recertify in that
accreditation.
I have undertaken medico-legal work since 1988, producing reports
primarily for Solicitors in personal injury cases, e.g. road traffic accidents,
injuries at work, etc. I also undertake Expert Witness work in relation to
cases of alleged Clinical Negligence as they affect the Emergency
Department.
The approximate ratio of work for Claimant : Defendant : Joint Instruction is
of the order of 94 : 5: 1 %
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FORENSIC MEDICINE
I worked as a Forensic Medical Examiner (FME) employed by Reliance
Medical Services and covering the South Wales area from November 2011
to July 2012.
My duties included:
Custody Medicine providing medical care to detainees in custody
Collection of samples from suspects / injured parties
Attendance at scenes of sudden death to advise the police as to the
possible presence of suspicious circumstances
I was an Affiliate Member of the Faculty of Forensic and Legal Medicine
(FFLM) although discontinued membership when I ceased to undertake
Forensic work.
As a Forensic Medical Examiner I became acquainted with aspects of
criminal law. The work also involves managing certain difficult aspects of
consent and I developed a personal interest in this issue during my time
working as a Forensic Medical Examiner.
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courses that I have personally directed and many more have achieved this
certification on courses in which I have personally taught. This training
ultimately translates into the provision of a high quality of care to patients.
Until 1999 I made arrangements between the Management of Nevill Hall &
District NHS Trust and Jersey Hospitals for all of the Trusts Consultant
Anaesthetists, Surgeons and Orthopaedic Surgeons to attend, and gain
qualification in ATLS.
During 1994-98 I was the Wales representative of the Resuscitation Council
(UK)s ALS courses. In this role I oversaw and monitored the standards of
such courses throughout Wales.
I was the Clinical Lead for the Cwm Tafs Advanced Emergency Practitioner
(AEP) grade. I developed the grades curriculum / assessment system and
provide regular clinical supervision / teaching to the Practitioners. I was the
Advanced Nurse Practitioner for the Emergency Department Clinical Lead
at the University Hospital of Wales.
Developing teaching skills in others:
I developed a base of certified Instructors in the various Resuscitation
disciplines (ALS, APLS, ATLS) in the Nevill Hall Hospital ED thus
allowing courses to be run internally within the ED and for all permanent
ED staff to becomes certified as Providers in the disciplines.
I have taught as an Instructor on the various Resuscitation Instructor Courses
(Training the Trainers courses). I estimate that approximately 200 doctors,
nurses and paramedics have qualified as Instructors on courses on which I
have taught.
I co-ordinated and hosted the first Royal College of Emergency Medicines
Examiners workshop to be held in Wales, thus developing future College of
Emergency Medicine Examiners for both the Membership (MRCEM) and
Fellowship (FRCEM) examinations.
Involvement in examinations:
I was an Examiner for the Royal College of Emergency Medicines
Fellowship (FRCEM) examination 2007 - 2014. The examination is the
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the UK (I enrolled approx. 800 trainees), this work entailed ensuring that
their previous training was of adequate quality and calculating their dates for
the award of CCT (including re-calculations resulting from Maternity Leave,
Less than Full-Time Training, lack of progress etc.).
I Chaired the Training Standards Committee 2010 2012 and during that
time:
I was been responsible for setting and monitoring the standards and
quality of EM training throughout the UK (approx. 1000 trainees)
I worked with other Medical Royal Colleges (MRC) in development
and Quality Assurance of training programmes
I worked closely with Academy of MRC and GMC in ensuring
Quality Assurance of training
I worked with the RCEMs Exam and Education Committee and with
the GMC in developing and updating the RCEM curriculum
I was responsible for overseeing the assessment of past experience
and subsequent recommendation of non-trainees for the Certificate of
Eligibility for Specialist Registration (CESR)
I was a member of the Department of Heath / Royal College of
Emergency Medicine Workforce Task Group and represent the Royal
College in the sub-group dealing with the development of the
Advanced Nurse Practitioner / Advanced Care Practitioner role.
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ACADEMIC ACTIVITIES
I have a strong academic background and one of the first EM Consultants in
the UK to hold a Masters degree (MCh). As an Orthopaedic Trainee I
was the first Welsh-based Orthopaedic Surgeon to be awarded the
British Orthopaedic Associations Robert Jones Gold Medal and Prize
(1989). Whilst my current commitments are primarily directed towards
service and to training I have maintained academic activity as follows:
I personally developed a tool to assist the assessment of
cervical spine radiographs in trauma. This has proved popular with
doctors throughout the UK
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PUBLICATIONS
Jenkins NH. Avoidance of tracheostomy in sleep apnoea syndrome. British
Medical Journal 285, 648, 1982 (Communications).
Aubrey DA and Jenkins NH. Septotal chains in soft tissue infection. 13th
International Congress of Chemotherapeutics. Local treatment of bone and
soft tissue infection using antibiotic releasing carriers. Pp 79-83, Vienna
1983. Spitzy KH and Karrer K.
Aubrey DA, Morgan PW, Jenkins NH and Harvey J. Treatment of the
perineal wound after proctectomy by intermittent irrigation. Archives of
Surgery 119, 1141-1144, 1984.
Morgan WP, Jenkins NH, Lewis P and Aubrey DA. Management of
obstructing carcinoma of the left colon by extended right hemicolectomy.
American Journal of Surgery 149, 327-329, 1985.
Aubrey DA, Jenkins NH, Morgan WP and Thomas M. The use of
Gentamicin-PMMA chains and abdominal surgery: a pilot study of
prophylaxis against wound infection. Parmacothereapeutica 4 (8), 536-540,
1985.
Jenkins NH and Mintowt-Czyz WJ. Compression of the biceps-brachialis
compartment after trivial trauma. Journal of Bone and Joint Surgery (Br)
68-B, 374, 1986.
Jenkins NH and Jones DG. Simultaneous Colles' and scaphoid fractures:
Treatment by combined internal and external fixation. American Journal of
Emergency Medicine 4, 229-230, 1986.
Jenkins NH and Aubrey DA. Metastases to the spermatic cord: route of
spread. British Journal of Sexual Medicine, 13, 176-177, 1986.
Jenkins NH AND Mintowt-Czyz WJ. Bilateral fracture-separations of the
distal radial epiphyses during weightlifting. British Journal of Sports
Medicine. 20, 72-73, 1986.
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