Poorly run department. The rota is understaffed so it is difficult to get time off and there is no capacity for sickness. Rota staff don't know who is working or when. At times we had 2 doctors looking after >60 patients over the entire hospital with infrequent registrar or consultant reviews. There are next to no learning opportunities, it is all service provision. Doctors office has hardly functioning computers and is shared with multiple specialties.

This is a poorly run department, consultants appear disinterested in supporting junior doctors. As a surgical trainee it is difficult to achieve your competencies with regards to clinics and theatres due to ward cover responsibilities. Surgical practitioners take operating opportunities. Some consultants are unapproachable. A&E referrals are often poor. There is almost no space designated to the junior doctors who have to share 3 hardly functioning computers between all surgical trainees. The only reprise is the weekly inhouse teaching sessions.

Really great, tight-knit group with extremely supportive registrars. Well staffed. Opportunities for both theatres and clinics plus extra curriculars (audits etc). Barely see consultants, but interactions with them are always good. Only caveat is doing general surgery on calls which are busy. However, as with most surgical on calls this is often the result of an overwhelmed A&E and hospital too small for the population.

Well supported department. Frequent consultant rounds. Reg on cover for wards daily. Initially daunting as sometimes you daily review patients yourself and discuss with senior if needed. Also cover haem/onc emergency assessment bay which sees around 10 patients daily for various medical issues. A lot of general medicine issues with in patients. Interesting and specialised conditions and their management. Quite busy in patient ward (shared with oncology which is a different team but often end up helping them if not busy). Hence lack of clinic and training opportunities, but loads of impromptu teaching by regs and consultants. On calls: renal onc and haem, generally fairly busy with non resident seniors (very approachable). Staffing levels: generally good

So like all EDs, this place is catering to a population it can't deal with. I'll break down my review into positives and negatives. Positives: - Consultants and seniors are amazing! That is without a doubt, super supportive, have taken a massive stance on yours and patient safety, they don't care about breaches. - Seniors are extremely approachable. Very very kind in my opinion and treat you like an adult. - One of the consultants is my all time favourite, one of thee most inspirational consultants I have ever worked with, just how they deal with everything and the phrase: 'kill you with kindness' comes to mind. I seriously will never forget this person and aspire to become like them. This consultant genuinely wants to help people, both doctors and patients. - It's a DGH, everyone eventually knows everyone and everyone (including different specialities) will try to help out. Negatives: - The place can't cater to the population, there is a lot of rubbish that enters the ED and its often exhausting trying to bat away this rubbish, leaves you feeling demoralised. - The place is small; I will go into detail. So there are 9 resus beds; this includes 1/2 trauma bays, one paeds and the rest are normal resus beds. 'Fit stop' is like the triage area and generally where patients are offloaded from the ambulances, its hard to use this space for patients that aren't in it as there is always a demand to offload the patients so you can't bring a patient from the waiting area and clerk them there. This area is chaotic, the nursing staff are always short, its busy, gruelling and messy and the fit stop nurse in charge is literally overwhelmed by everyone and somehow manage to stay nice. There is in then the GEM or geriatric emergency majors, where geriatric patients are moved from fit stop, these are full and patients often end up waiting >24 hours for a bed on the ward Then there is a further 5 major beds - waiting for ward beds Then there is covid corridor with another 6 beds, patients with covid will come here admitted/discharged from here. Waiting area one is where patients wait and have sort of urgent treatment. Waiting area 2 - comfortable recliners, patients are moved after being clerked and are awaiting beds, often >24 hours in ED and can be monitored. In waiting area 2 there are 4 rooms in total, 3 can be used to examine patients if they don't patients in them waiting for beds. They have opened the corridors because...well they have no choice. Patients will stay here on trolleys waiting for a bed. - Largest problem is there is no space to see patients. Literally none. You will spend about 20 minutes looking for a place to see them and you have to be very creative when there is none - Nursing are always short staffed and when there are plenty of them it''s still rubbish. - There is a culture developed where you as a doctor will be expected to do everything. So when a patient is triaged you will go to find the paper with their name in pitstop on a pile, the HCAs try to help but with no spaces and stuff you all are fighting to sort out your patient basically. You will pick up your patient, they won't have obs, ecg and bloods, you will be expected to basically do all of that yourself. It has now become the culture and it's not going to change. It's atrocious as a clinician. - The stuff that is 'accident' like minor injuries is run by ENPs, while they are excellent, they take away a large portion of the training.

This was my 4th hospital as a medical reg. It was by far the worst. GIM Oncall here is just dire. The rota organisation is awful, it essentially runs from a WhatsApp group, and the team "responsible" for it are very difficult interact with. This means as you start your shift, you often have no clerking team. And this is no one's responsibility but the med sprs to sort out. Frequently came on to 15+ to see, with just yourself and +1 other, you know any subsequent referrals are being seen the next day. Peak hand over was 32 to clerk. ED refer and move on, quickly ED resus becomes entirely medical and the ED team (with very few exceptions) move away. The acuity of the patients is at expected standard, but you are responsible for everything from that point on, bloods, testa, chasing, the nurses ring you as the first port of call. Managing that, along with the stroke bleep, the arest bleep, 2 separate mau's and the pts to clerk is impossible you just don't have the resources. It's a weird place to be, as you cannot ring the ITU team direct you have to go through a medical consultant, this is quite infantilising. ITU basically treat you as their bitch, as an st7 this was very difficult to understand and absorb. As the med reg here you have zero power to change anything really. Northampton runs on a large IMG cohort, the standard is variable, but what it roughly translates to is that you can't trust things you are told and you have to really check up on your team to make sure things are done. The GIM consultants overall seem to be of a reasonable standard, they do all display a learned helplessness where when you raise issues to them they just go vacant and nod sadly. The problems at ngh are institutionalised at this point. The standard of the acute med consultants on the other hand is pretty woeful, all locums, none have trained properly appear to simply have just locumed long enough as shos to then get a reg job, and then onto consultant. You have to be really careful with them, clinically really poor and very lazy. There are pockets of normality, stroke, renal and haem.onc appear to be good jobs. As with any firm, if the F1 and shos are tight you will get by ok, but really across the board this site is a landmine. The worst thing about Northampton however, is not that no one knows it is like this, it's that everyone knows but doesn't tell you, and pretends it's ok. It's telling that no trainee who has worked there seems to take a consultant job in any med spec. Be careful at Northampton.