Sally Bowles’ character in the musical cabaret sings that “money makes the world go round” and despite many wishing that was not the case the harsh reality is that for nuclear medicine in 2019 it is very true. Over the past few weeks I have spent many an hour in meetings discussing money and the impact of various pressures on nuclear medicine.  There are significant upcoming price pressures which we all need to be aware of. Their impact will depend on the service you and your department will provide. The one price pressure we all hope for is a staff pay rise though I think we all know that what politicians promise rarely happens unless it is to their advantage. There are other issues one of most fundamental is that the price paid for Mo-99 is only 67% of the cost of production. The rest is made up from government subsidies. This effectively means that a few countries taxpayers are subsidising the rest of us. The unfairness of this system is not the main issue. The primary issue is it discourages other players to invest in the market. Why invest in making something you can only make a loss on? This can be seen in the slowing of investment in accelerator based production of Mo-99 that 5 years ago was going to save us all but in reality may still be 5 years away. As this situation is not sustainable there will be price increases in Mo-99 over the next few years. However, the effect on total costs of any Tc-99m scan will be on average £3 per test which we can probably cope with. Unless ,the economics attract investment the supply of Tc-99m will dry up as aged reactors go off line.

A second cost pressure is that it appears that transporting radiopharmaceuticals around the UK is likewise not sustainable at present costs and we must expect an increase in the cost of delivery over the next few years. Again without this the provision of radiopharmaceuticals will not be sustainable.

I will not even mention Brexit and the possible cost pressures that will bring which at present are unknowns.

So what can the BNMS do? Firstly communicate these likely pressures as pre warned is pre-armed when you are negotiating budgets with your Trust or hospital. Secondly we are actively trying to get NHS England to recognise these price pressures in the tariffs that are offered for tests with hope a similar re-calculation will occur in the devolved nations. The third action is to collect and collate information. So if you find the total cost of radiopharmaceuticals you use changing, please let us know as this data is vital in our fights with our paymasters.

On a more optimistic note, I wish all of you that can get away on holiday a wonderful break and all those who cannot get away not too much additional work.

Dr John Buscombe

BNMS President