Medical Specialist Group

- ENT and Audiology -

In recent years, the ENT service at the Medical Specialist Group has changed substantially and been radically upgraded.

Prior to 1998, more complex ENT surgery was not available at a local level and all major cases were referred off-island for opinions and treatment. The appointment of Mr David Beaumont as the island's first Accredited Consultant in January 1998, meant that all patients could be seen and assessed locally and, in the vast majority of cases, have their surgery performed in Guernsey. Only patients requiring very major surgery, Radiotherapy, Cochlear Implantation or Bone Anchored Hearing Aids are now referred to the mainland.

In 1999 the Medical Specialist Group also appointed a fully trained specialist Audiologist to upgrade and expand the island's audiological services. With the completion of a new state of the art Sound-proof audiology Suite at Alexandra House, all of the island's Hearing and Audiological services are now provided by a trained Audiologist at a single location.

In May 2000 a second Accredited ENT Consultant (Mr Richard Vowles) was appointed to share and complement the work of Mr Beaumont. This has enabled a degree of subspecialisation to occur thus further enhancing the service to General Practitioners and the people of Guernsey.

Personnel:

Consultants	Mr David Beaumont MBBS FRACS Mr Richard Vowles MB ChB FRCS
Audiologist	Miss Jane Lloyd
Specialist Nurses	Nurse Julia Coquelin SEN Nurse Zofia Mahy RGN Nurse Alexis Beaumont RGN
Secretarial Staff	Mrs Marilyn Adkins (PA to Mr Beaumont) Mrs Janet Cave (PA to Mr Vowles)

Mr Beaumont was trained as a general ENT specialist with an emphasis on Otology and Head and Neck Surgery. He practices in all areas of ENT Surgery at the Medical Specialist Group and subspecialises particularly in Complex Otology, eg. Stapedectomy, Ossiculoplasty, Revision and Reconstructive Mastoidectomy.

He and Mr Vowles perform Major Head and Neck procedures jointly (eg. Laryngectomy, Neck Dissections) in an attempt to optimise patient care and maintain current levels of experience and surgical expertise.

Together with Miss Lloyd, Mr Beaumont additionally directs the island's Audiological and Paediatric Hearing Aid Services. A new island-wide Neonatal Hearing Screening commenced in February 2001. It was the first comprehensive Neonatal Screening Service introduced in the UK.

Services Provided by the ENT/Audiology Department:

Clinics:	10 Clinics per week in Guernsey (5 per Consultant) Monthly visiting Alderney Clinic (Consultants alternating) Ward Consultations - Mon pm, Tues pm, Wed am, Thurs am
Operating Sessions:	Mr Beaumont - Monday am and Friday pm Mr Vowles - Tuesday am and Friday am Joint Head and Neck Lists - all day Friday as required
Referrals:
A) To ENT	All referrals for ENT assessment are allocated randomly to both Consultants to minimise waiting times for appointments. The only exceptions are in-house subspecialty referrals, requests for Second-opinions and Private Referrals to a named Consultant.
B) From ENT	All Cancer cases are "worked-up" on island and then seen at the next Combined Head and Neck Cancer Clinic in Southampton (under the direction of Dr Virginia Hall). Subsequent management decisions are made jointly with the local specialists including decisions about which surgical procedures are performed locally. All follow-up occurs in Guernsey. Cochlear Implant surgery and Major Skull Base surgery is performed in Southampton (Mr Mike Pringle and Miss Anne Davis) Occasional other subspecialty referrals are made to London (Rhinology), Oxford (Bone Anchored Hearing Aids) and Brighton (Voice Clinic)
Emergencies:	08.00am - 17.00pm through the Clinics at Alexandra House After hours and weekends - shared 1 in 2 on-call through the PEH
In-patient care:	All in-patients are managed by the same Consultant throughout their stay in hospital (Monday through Saturday am) to ensure continuity of care
Discharge Advice:	All patients are provided with a discharge advice booklet specific to their operative procedure on discharge from hospital
Sleep Studies:	Sleep studies and CPAP Titration Tests are performed at the PEH (Ozanne Ward) on weekend nights every week as needed. These are interpreted and reported by the Consultants themselves.
Allergy Testing:	Performed by the ENT Nurses during Clinic times (with additional Specialist referrals to Dr Peter Standring's Allergy Clinic as indicated)
Audiology Services:
A) Hearing Tests:	All adult and children's hearing tests are performed in the Audiology Suite at Alexandra House, including Age-appropriate Tests for Under Threes and Neonates, and advanced objective tests of hearing (eg. ABR's OAE's)
B) Children's Hearing Aids:	This service, previously run by the Education Authority, is now coordinated through Alexandra House by Miss Lloyd as a Contracted service to the Board of Health.
C) Screening Tests:	As of January 2001, all newborn babies in Guernsey are screened for genetic/congenital hearing problems utilising a simple non-invasive test performed by Health Visitors. Older children failing Health Visitor or School Screening Hearing Tests are retested and seen at Alexandra House at dedicated Board of Health Sessions run jointly by Miss Lloyd and Dr Bryan Lean. Direct referrals are made from these clinics to Mr Beaumont as needed. There is no provision in the Contract for a screening service for adults. Adult Hearing tests are only performed via a direct referral from one of the ENT Consultants to the Audiologist. Adults without overt ear disease who require hearing tests are screened through their own GP practices and referred to the ENT clinic as indicated.
D) Adult Hearing Aids	The provision of Adult Hearing Aids remains outside the Contract and currently occurs through Private Dispensers who remain independent of the MSG.

Approximate Waiting Times for Clinic Appointments and Surgery:

1.	Emergencies	Same day
2.	Urgent referrals	Within 7 days
3.	Routine referrals	Approximately 4 weeks
4.	Emergency Surgery	Same Day
5.	Urgent surgery	Next List
6.	Routine surgery	Approximately 2 ½ months

Services for Private Patients:

All of the above services are provided for both Contract and Private Patients.

In addition, patients referred Privately will be:

A) seen out of normal clinic hours, as "add-ons" both before and after normal Clinic Sessions;
B) seen by the Consultant of their (or their GP's) choice;
C) cared for Privately as In-patients on Victoria Ward.

Detailed Clinical Services Provided by the Consultants:

General ENT:	A full and comprehensive general adult and paediatric ENT service is provided including the assessment and management of Major Otology, complex Balance and Swallowing disorders and Head and Neck Cancer.
Special ENT:	Snoring and Sleep apnoea (including Sleep studies and CPAP) Cosmetic Rhinoplasty Cosmetic Pinnaplasty Skin lesions of the Face and Neck Endoscopic Sinus Surgery Head and Neck Oncology Reconstructive and Restorative Ear Surgery
Special Tests that cannot be performed locally:
	Vestibular Function Tests (ENG/Calorics) Tests for Central Auditory Processing Disorders MRI Scanning Voice Clinic (Stroboscopic Assessment)

Operative Procedures performed locally:

NB. This list is meant to be illustrative rather than exhaustive. The complete list of procedures provided by the Consultants at the Medical Specialist Group/PEH incorporates more than 400 hundred separate and related procedures.

All Emergency procedures
Otology	Grommet insertion Tympanoplasty Mastoidectomy Ossicular Reconstruction Stapedectomy Removal of Exostoses Surgery for Balance Disorders Revision Ear Surgery Pinnaplasty
Rhinology	Septoplasty/Turbinate surgery Post-traumatic Rhinoplasty Cosmetic Rhinoplasty Functional Endoscopic Sinus Surgery Advanced/Complex FESS Resection of Nasal Tumours
Laryngology	Microlaryngoscopy Laser Microlaryngoscopy Laser Resection of Early Laryngeal Tumours Laryngectomy Voice Restoration after Total Laryngectomy Vocal Cord Medialisation Procedures (for VC paralysis)
Head and Neck	Resection of Skin Lesions Resection of tumours of the	Outer and Middle ear Nasal Cavity Sinuses Oral Cavity Pharynx Larynx Neck
	Local and Regional Flap Reconstruction (NB. Major resections requiring Free-flap Reconstruction are managed in Southampton) Thyroid Surgery Open and Endoscopic Pharyngeal Pouch Surgery Rigid Endoscopy (Oesophagoscopy and Bronchoscopy) Adeno-tonsillectomy Surgery of the Salivary Glands (incl. Parotidectomy)
Snoring Surgery	Laser assisted uvulopalatoplasty (LAUP) Uvulopalatopharyngoplasty (UPPP)
Procedures that cannot be performed locally
	Management of Facial Fractures (other than Nasal) Skull Base Surgery (eg Acoustic Neuromas) Cochlear Implantation Bone Anchored Hearing Aids Major Head and Neck Tumours requiring Plastic Surgical Reconstruction Radiotherapy Temporomandibular Joint Disorders Cosmetic Facial Surgery (other than Rhinoplasty and Pinnaplasty)

NB Patients requiring treatment for these conditions should still be seen by the local Consultants for assessment prior to any referral to the mainland. This is to ensure that the local Consultant is aware of their pre-treatment status (as we are invariably involved in their followup care) and to also ensure that referrals are made to the most appropriate mainland center.