I specialise in General (Internal) Medicine, Stroke Medicine, and Syncope. I was appointed Consultant Physician in 1991. I have a vast amount of experience in the diagnosis and management of autonomic dysfunction (dysautonomia) including Autonomic Mediated Syncope – also known as Neurocardiogenic Syncope/Vasovagal Syncope – and Postural Tachycardia Syndrome (PoTS).I established the Cheltenham Syncope Service, a part of Gloucestershire Hospitals NHS Foundation Trust, in 1992. This service specialises in the diagnosis and treatment of unexplained Transient Loss of Consciousness (TLoC). It was one of the first of its kind in the UK and is widely used by local GPs, Consultant Cardiologists, and Consultant Neurologists. A wide variety of patients are referred to the Syncope Clinic including those suffering from Blackouts, Faints, Postural hypotension, Orthostatic hypotension, Postural tachycardia syndrome (Postural orthostatic tachycardia syndrome, PoTS), Dizziness, Vertigo and Benign Paroxysmal Positional Vertigo ( BPPV). Tilt table testing (Head up tilting, HUT) is an invaluable test used to investigate all types of dysautonomia and is provided by the Syncope Service.I also established the Cheltenham Stroke service in 1992. In 2012 the Syncope service and Stroke service relocated to Gloucestershire Royal Hospital as part of a centralisation of services programme championed by the Trust. Close liaison between Consultant Stroke Physicians, Consultant Vascular Surgeons and Consultant Radiologists the Stroke Service has enabled the provision of daily one-stop Transient Ischaemic Attack TIA/Minor Stroke clinics, a perfect example of interdisciplinary cooperation.I am an international examiner for the Royal College of Physicians.