The winter seems to have come early in the NHS this year. Last weekend may have been the busiest in NHS history! What we see in acute and emergency care is mirrored in elective care. More patients are waiting than ever and since GPs are still using a high proportion of non-face-to-face appointments imaging demand is climbing disproportionately as we are being used as a surrogate for clinical examination. The ‘so what?’ for us is we will have even more work to do than ever in nuclear medicine. This on a background of tired and exhausted NHS staff is a real issue. Normally as we go into winter we know it will be tough but we are ready for it having had a decent summer break and recharge. This year is different given the last 18 months of the pandemic.
 
We need to support each other and be particularly compassionate to any people we lead. We need to guard against cracking the productivity whip or coercing people in to working lots of extra shifts. All this will do is produce burnout and people in turn leaving our community. Instead we must focus on each other’s welling being as well as the wellbeing of our patients. Fundamentally be kind. Embrace any technology that can help us deliver our jobs more effectively and be realistic in what can be achieved.  
 
The BNMS survey will be landing in your inboxes soon. This collects vital data about the state of nuclear medicine in the UK. Please take the time to complete it as we use these data for many purposes including advocating for you and our patients. The results of the survey will be published so you can reflect on it too.
 
We are making progress on technologist’s professional registration. DHSC have employed KPMG to do a review which includes professional registration so we shall make sure our voice is heard in this. Finally, thank you for all you doing for each other and our patients and I look forward to seeing you virtually at our forthcoming Autumn meeting.

Prof Richard Graham

BNMS President

We have heard from Curium that the surcharge applied to radiopharmaceuticals has not been sufficient to cover the cost due the decreased amount ordered because of COVID-19. They will be returning to road delivery but will still need to charge the surcharge to cover this for the foreseeable future to pay for the airfreight costs they have incurred. The BNMS has written to Prof Powis, Medical Director at NHS England, to ask the NHS to cover this cost for trusts. We will let you know the response as soon as we hear it.

Demand on Nuclear Medicine Departments continue to rise as the bulge of cancer recovery is happening and I am aware that some departments are struggling to deliver with the perfect storm of sickness, isolation from covid contacts and summer annual leave. All we can do is to prioritise the most important studies and do our best. This will be a marathon not a sprint. We must protect ourselves and our teams from burnout. If we don’t our patients will suffer the most in the long term through diminished services.

ARSAC has agreed that virtual training can count towards recognised experience for an ARSAC licences. They have reviewed the experiences of virtual working from the pandemic and concluded that some training can be delivered remotely. They will be issuing guidance on this in 2022 with their net round of notes for guidance.

The autumn 2021 BNMS meeting programme has been finalised and the meeting is open for registration.  The content looks excellent with large array of international and national speakers. This 3-day event features the re-worked programme from the BNMS Annual Spring 2020 meeting which was cancelled. We have now delivered 2 virtual meetings and continue to iterate how we deliver these based on your feedback. I am confident this will be a really excellent virtual meeting and encourage you to register now.  I would like the Scientific & Education Committee ably led by Sabina Dizdarevic and Vineet Prakash who have delivered this.

I am sure many of you are currently grieving and transitioning through the Kubler Ross stages of dying with regard to the England Team’s defeat last night. I think we should reflect on their wonderful achievement of reaching their first international final in 55 years and reframe this as a great success. We in the nuclear medicine community have much to learn from Gareth Southgate’s humble leadership which I am sure has helped achieve the transformation of the England team and sets them on the road to a great outcome in next year’s world cup. This style of leadership will enable our teams and set the conditions for success to allow us to image and treat our patients to the best of our abilities.

Prof Richard Graham

BNMS President

By the time you read this I will no longer be President of the BNMS and Richard will have taken up the mantle. I wish him every success for his term of office. Richard has previously been the BNMS Secretary and also President-Elect for 2 years so he is probably the best prepared President we have ever had.

In China it was said that the greatest wish was that we be saved from interesting times well clearly that has not been the case for my presidency. We have all lived through probably the most “interesting times” we will experience in our lives. It started with the divisive process of Brexit which left many of our colleagues feeling their contribution to our specialty and country was not fully appreciated. Just as Brexit seemed to be finally settling-down we were hit by the pandemic. I do not think many of us in March 2020 felt we would still be suffering at this present time. The general feeling was it would be over by Christmas not knowing then that for most of us Christmas would be cancelled. A few wise heads looked at the infection curves of the 1918-1920 influenza pandemic with waves of infection rolling round the globe and said this would not be over till 2022 at the earliest. However, at least we can see the end of it here in the UK.

Though, many of our nuclear medicine community have family in South Asia and look on with mixture of horror and helplessness as the infection rips through India, Pakistan and Bangladesh. I have many Facebook friends working in these countries and every day someone posts a relative has died. It is all too awful and we must remember the saying non one is safe until we are all safe.

We have learnt so many lessons over the last 2-3 years but most of all I think we have learnt we need to value and cherish each other. When we can finally meet together hopefully in Glasgow it will be so good to see each other in person.

It is normal at hand over for the President to say a few words of thanks to all those who have made the job workable and remind me of deadlines and what I need to do. Charlotte and Caroline have excelled in this role. Over the past 3 years a lot of work has proceeded to future proof our Society and make it fit and sustainable for the coming years. I had the opportunity of travelling to Nottingham and on a beautiful sunny day in April to share a thank you lunch in a riverside pub garden with Charlotte and Caroline. I am grateful every day for their enthusiasm and encouragement.

The President is just a team leader and the most active of that team are my fellow officers who in my term of office have been Sobhan, Jilly, Richard and Stewart. They have shared the burden of work that needs to be done often at short notice and have always been there to defend and expand the role of nuclear medicine. I think the profile of nuclear medicine is as high as it has ever been within the Department of Health, with Members of Parliament and the Royal Colleges. This has been a joint effort. I thank them all.

Much of the work is done in committees. Bev has led the Professional Standards Committee with efficiency over the past 3 years and turned it into a committee that does things and not just talks about things. Sabina led the Scientific and Education Committee but after passing this to Vineet and Drake became our Scientific Advisor and the first fruits was our COVID paper published in NMC this year. More is to come. The RTN committee has increased in importance under the leadership of Richard and Chris and our fight for technologists registration continues. They have scored a major success over employing non-UK technologists when needed. Long may they continue to thrive. Sarah, Charnie and Andy have been an invaluable link to the Medical Physics community as well as taking on battles concerning reimbursement and starting our mentoring service. A grateful thanks to all of these teams. We as a Society have been blessed with a great Council and many volunteers not on Council who represent us on a variety of Committees, thanks to you all.

Well, this is the end. The last of 37 Presidential blogs. I hope they were useful in giving you all a window onto what I was doing and my thoughts over the past 3 years.

Dr John Buscombe

BNMS Past-President

How flexible are you? If you have been doing your Joe Wicks exercises you may now be very flexible as well as fit. However, I was thinking not about your physical flexibility but working practices. We in nuclear medicine are what he Piagest psychologists would call “concrete operational”. There is nothing we love more than a standard operating procedure. In fact such an SOP is the cornerstone of good and safe practice. It helps train new staff members and ensures consistency of results. However, they can become an excuse for ossification of practice. How many times have I heard the phrase “we have always done it that way”. It is a mantra of comfort. We know when we go to work we will be following the SOP like a cook follows a recipe. Any variation brings shrieks of distress “its not on the protocol” and can sometimes induce a state of near panic.

However, we live in strange times. I think that we have come to realise we will not go back to what we considered normal. Before the black death in the 1340s if you wanted to eat you had to work unpaid for 3-4 day a a week for the Lord of the manor. He (and was always a he) would then allow you to scratch a living from a small strip of farmland. The black death killed half the population of Britain and such labour could no longer be relied on. The Lord of the manor now had to pay his worked real money which they could spend in shops. This lead to the rise of a merchant class who would sell things from a new invention called shops. Also people had money to spend on services such as medical practitioners, teachers for their children and no longer had to make their own clothes, shoes etc. The rest as they say is history.

Well fortunately coronavirus will not kill 50% of us but its changes on society may be just as profound. The country is deep in debt, the overall cost of the pandemic to all of us will surpass the cost of 2 world wars. The last time Britain owed so much money was after 18 years of war with revolutionary and Napoleonic France. The resulting social crisis was so severe it resulted in the country becoming urbanised and industrialised with the consequence rise of trade unions, general taxation and the welfare state. Will there be similar changes ahead, time alone will tell. We can see some changes already. Instead of having to go to an office for meetings we can zoom* from our desks or even better home. I do agree hospital IT departments generally still live in a pre-pandemic world. There are dangers; none of us relish spending the whole day on zoom* meetings and just because they may be easier does not mean you should have more meetings.*Other videoconferencing platforms are available

Hospital managers seem to finally understand that attendance is not the same as work. Instead of insisting that you travel into the hospital to do your work it is now seen possible you can, if applicable, work from home. Many departments have found innovative ways to do this. I could never understand why a manager thought it was a good a good idea to get their employees to spend 2-3 hours a day exhausting themselves commuting when they wanted people to be productive. Ah you cry this is not for us. Well yes and no. I do agree injecting and scanning patients means you physically have to be with the patient in the department. However, there is a range of things which do not require you to be in the hospital such as booking the scan, ordering radiopharmaceutical doses, reviewing SOPs, writing new SOPs, doing dosimetric calculations or reporting scans. AGH you are now screaming I need the security blanket of my favourite computer or a special screen or talking to colleagues. All are true but not true every hour of every day.

There is another major issue commuting is killing our planet. Whilst some people would like you to feel guilty about taking a holiday for the average family less than 5% of their carbon emissions are spent going on holiday. The vast majority of transport based carbon emissions is going to and coming home from work. We may not be able to stop commuting altogether but a smarter way of working means we can reduce the work travelling we do. It would be wonderful if we were going to “spend” our carbon emissions we did on things that brought us pleasure not just drudgery. Also why are work patterns built so we expect parents to take children to school at the same time as they need to come to work, it is stressful, results on over use of cars and to be honest is straight bonkers. Why not have work patterns which allow one parent/care giver to start late so they can walk their children to school and the over starts and finishes early enough to collect their children for the walk home. Yes I did write walk. Children do not die if they walk to school. From age 5, I walked over a mile to school and back again every day often chatting with friends. In fact not only do children not die walking to school they may actually live longer.

Then there are clinics. We run clinics in a way that has not changed for nearly 200 years when physicians would only see the rich and in their own homes. In the post Napoleonic world social changes saw the rise of the infirmary and provision of health care to the main population. In 1870 it made sense for the doctor to sit in a room and patients queue up to see him (again at this time it was always a him). However, since than we have had telephones. This device enables us to talk to someone who is not in the same room. Whilst a few brave souls would use this technology including our brilliant Clinical Nurse Specialists before COVID it was generally considered not a proper consultation unless the patient suffered a long commute, had to queue to get into the hospital car park, arrange a bank loan to pay for parking (not in Wales I know), sit in a room with other people some of whom can give you a disease you do not already have (some estimates are that 15% of patients get new infections attending hospital), by the time you see the doctor you are both tired. Then the process takes so long you parking ticket has run out (OK not in Wales) and you need to re-mortgage your house so you can get your car out the car park and have the pleasure of sitting in a stationary traffic jam before getting home exhausted. This is not fantasy as a patient I have known this all too well. Therefore it comes as no surprise that when I ran the Friday thyroid clinic by phone on Wednesday my patients were thankful, happy and communicative. They were not so tired they forgot to ask those important questions. To a person they said how much better it was then trapesing up to the hospital. Of course they did need to come for their scan and treatment but that was all done in under an hour with smiles all round.

Now you are a clever lot. I am sure you have worked out ways to work smarter and more effectively during this pandemic. We have coming up the perfect opportunity of sharing that and in September the BNMS will be running the team innovation prize again. Start thinking what you can share with the rest of us. Remember what the French say “plus de la change”.

Dr John Buscombe

BNMS President

Well it is a new year. Hopefully, some of you have received the first dose of the COVID vaccine by now. It does look like this wave may be worse than the first especially related to the new variant of COVID. We may face new disruption to nuclear medicine services as hospitals fill up and resources are diverted from routine care though we hope at least cancer services will be retained. Some of you may volunteer for extra duties to help your hospitals and we as a Society appreciate all you are doing in this difficult time. Also, you may end up as a part-time child carer or teacher. Well hopefully you will be able to teach biology, maths and physics.

It is with a heavy heart I report that this horrible virus has taken the life of Dr Donal O’ Donaghue, the Registrar to the Royal College of Physicians in London. Donal was a true friend of nuclear medicine. He would always tell us his truthful opinion and suggest ways we can proceed with the issues important to the practice of nuclear medicine. He supported the registration of nuclear medicine technologists and his passing is a great loss.

Whilst all this was going on the transition period part of Brexit ended. We will have to see how this will impact on the delivery of radiopharmaceuticals throughout the UK. There were some delays in delivery of some Mo/Tc generators in the first week of January but this appears to be related to the change in the law in the Netherlands. The best answer is for us to have a UK based source of Mo-99 and generator production. A couple of years ago this seemed impossible but there are now two proposals for such production using two different technologies. Maybe in the future the UK can become one of the world’s leaders in radionuclide production as we were in the 20^th century.

We need something to look forward to. In May the team at the Royal Free Hospital, London will host a virtual spring meeting and we hope to expand our offering allowing for 2 streams giving more choice. We will offer hub registration again so all nuclear medicine departments in the UK can participate in the meeting. With over 300 attendees in the last virtual meeting we hope that many more can join this meeting. During this meeting we hope to have some company symposia and we will also have our AGM.

New radiopharmaceuticals are coming our way. We hope to get a HRG for Tc-99m PDP for cardiac amyloid and Tc-99m PSMA. In the world of PET F-18 DOPA has been approved and we expect at least one form of PSMA PET imaging to be authorised and we may also have Lu-177 PSMA therapy so despite everything feeling a bit bleak at the moment there are some really exciting developments coming to us in 2021

Lastly can I wish you all a very happy and healthy 2021.

Dr John Buscombe

BNMS President