On the weekend for writing this I visited my Granddaughter who in her own words is just 3. As always my visits are a joy but normally also contains some experimentation. Using some small marsh mellows my grand daughter clearly stated to me that taking way 10 mini marshmallows was not the same as adding 2 marsh mellows. However, like all good experimenters I repeated the procedure 3 times and she provided the same answer, then she got bored and wanted to play with her very nice paw-patrol fire engine. Why do I mention this? Well NHS England are reducing the tariffs we receive for nuclear medicine tests by up to 10%. The reason they say is they need to fund a 2% pay rise. The logical conclusion is the maths being done at NHS England is being done by someone who is not “just 3”. I know many of the BNMS members would find this an illogical and Charnie Kalirai from Nottingham has provided a comprehensive document to NHS England concerning this tariff cut. However, in my experience like maths that could be done by a 3 year old, logic is also in very short supply.

On a different matter I was recently involved in a legal case concerning a patient who had been denied radionuclide therapy for a treatable cancer because she was on renal dialysis. She then suffered disease progression. Radionuclide therapy was again refused on the same grounds, she was given chemotherapy and was dead in a week. The case was won on the principle that someone cannot be denied radionuclide therapy just because they have another illness that makes such treatment difficult and inconvenient.

A further area we are interested in is the post-code lottery for new forms of radionuclide therapy. In some areas of the U.K. it is very difficult for patients to access the radionuclide therapy they need even when it is funded. Sometimes there is no trained ARSAC licence holder at their local or regional hospital and sometimes there may be several such ARSAC licence holders but NHS England have decided that that centre will not be funded on nothing less than an arbitrary decision. Both issues need to be resolved over the next few months especially as the tsunami of Lu-177 PSMA therapy is about to hit these islands! The BNMS, RCP, RCR and IPEM are trying to work together with industry and other partners to find ways we can move forward and solve these issues. You may be asked over the next few months to fill in surveys about radionuclide therapy provision in your area, please fill these in. Only with data can we look at what we can do.

Dr John Buscombe

BNMS President