Well the barmy days of summer now seem so long ago. The world moves forward, and we are heading into the second wave of COVID-19. We do not know how long this will last but it could be 3-6 months. What must be a priority is non-COVID patients must be seen and treated in a safe way and without delay. We have updated our recovery guidelines with some ideas how out-patient therapies can be done safely within nuclear medicine and we hope this is useful. We in the NHS will need to learn how to live in a COVID world. We may not be able to do everything, but we need to do everything we can.

Due to COVID the government is planning to extend professional registration through the HCPC to more health professionals. The BNMS believe this should include nuclear medicine technologists. We have secured support from various professional bodies, but an Act of Parliament is needed. This is planned but we need to ensure Nuclear Medicine Technologists are included. Here I need the help of every BNMS member and every colleague who works in nuclear medicine who is not a member. This is an issue that affects all of us not just technologists. By now you may have received a letter from me asking you to write to your MP. This is now an essential step and Jilly Croasdale has kindly provided an outline letter you can personalise. Without your support nothing will happen.

It is October so it must be Brexit time again. At the present time it looks as though we are heading into a no deal scenario. We hope this is not the case, but we foresee an extra issue we did not have in 2019.  At that time, it was possible for companies to fly radiopharmaceuticals into a variety of regional airports within the UK using the cargo capacity in passenger aircraft. However, due to COVID-19 the situation is now very different. Most UK commercial airliners are either in a field in Gloucestershire or have been sent to Arizona to be broken up. The pilots have been sacked and pilot Sainsbury delivery vans around Berkshire and Surrey and not Airbus A320s. This could lead to potential delivery issues. We will continue to monitor the situation.

At the AGM last month those present voted that I should continue as President till the next AGM in May 2021 but there will be elections for the next President-Elect in early 2021. You need to think whether you or someone you know would be the correct person. There are a few requirements listed on the BNMS website but remember our President does not need to be medically qualified, but they do need to have a passion for nuclear medicine.

Dr John Buscombe

BNMS President

Normally August is holiday season but this year for many of us working for the NHS any form of holiday has not been possible. Fortunately, some of you have been able to take some time off maybe with family and/or partners. Some of you have had a staycation and explored parts of this country you may not have been to before. The brave among you may have left the shores of Britain to play quarantine roulette; can you get to and from your holiday destination before quarantine comes down on you.  For those unlike me working through August I hope you get some rest before too long. My own staycation was a lovely week repainting my lounge. My pet hate is ceilings and my hair is definitely a shade whiter (actually its not called white but “polar star”). Anyway, all done now and the furniture is back and after a few washes my hair is back to grey.

A few days after I wrote the July President’s blog I heard about the death of Prof Sanjiv (Sam) Gambhir. He died of cancer just a couple of years after his teenage son also died of cancer. He was one of the true innovators in nuclear medicine he used molecular imaging methods to identify many pathways involved in cancer and its treatment. He found a home at Stamford University and embraced the spirit of innovation coming from the adjacent Silicon Valley. He was an amazingly generous teacher and would take time to talk to his or anyone else’s students. With Peter Ell he edited our standard textbook of Nuclear Medicine. Even though we only met a few times he would always stop and talk to me and discuss what we were doing in Cambridge. He was a leading light for our specialty and his passing leaves us all the poorer.

As the grip of COVID on our world continues we are finding we have to do more in the virtual world. Our Autumn BNMS will be on the same date the 23^rd of September but will now be a virtual meeting. Though it will still be oragnised by the Leeds nuclear medicine team. As an innovation a department can have a group registration so you can all share in with the autumn BNMS together. We hope this new idea will allow more of our members to become involved in the meeting. Later the same day will be our virtual AGM so please remember to log on for this. This year’s EANM will also be a virtual meeting so look out for registration details for this meeting as well. Maybe you could cook your own Sachertorte and eat this during the virtual EANM to get that Vienna feeling. What will happen next year we do not know. I am meant to be in South Korea in January 2021 but will the second wave cause further cancellations. Meanwhile the conference centre that we are meant to be going to in February 2021 for the South African Society Meeting has gone out of business. We must accept we live in a time of uncertainty.

However, we must not be too depressed we still have our patients to look after and they still need our care. We will get out of this horrible disease or just learn how to live with it, things may be a bit different but hopefully we still have our family, friends and extended nuclear medicine family.

Dr John Buscombe

BNMS President

As well as the COVID pandemic the other news item to touch all our lives has been the black lives matter campaign which burst on to our streets again after the murder of George Floyd. We in the NHS are incredibly proud of our ethnically diverse workforce and in the UK we have been very privileged that so many people from around the world have come to work for us. Many of our departments reflect this amazing ethnic diversity but it is true that in many of our hospitals that this diverse ethnic mix is not reflected at senior level.

For those who think we are untouched by racism here in the UK I suspect we have just looked hard enough. I suspect if we ask our black, asian and minority ethnic workmates if they have ever suffered racial discrimination every single one would say yes. We know the situation is chronic but that is not a reason to accept the status quo. 30 years ago my wife was an obs and gynae SHO and her boss was born in the UK but his parents were from Ghana. He drove a second hand BMW and every day on his drive to and from work in London he would be stopped by the police and would have to prove the car was his and undergo a drugs search. Because he worked at the same hospital he would be stopped by the same policemen day after day. 25 years later I had a brilliant Omani trainee. She wore a Hajib but otherwise western clothes. She was with her 3 children in a park when approached by a group of young white men calling her “rag head” and throwing her youngest son and his buggy into a pond. Fortunately, he came to no harm but at my insistence she reported the incident to the Police who said it was just “high jinks” and nothing to worry about. Neither of these stories are meant to be critical of the Police who do a difficult job but they do reflect the underlying attitudes that permeate our society. Now is the time to call a stop.

Before 2020 zoom was a noun or an adjective. Now it is a verb, I zoom, you zoom, they zoom etc. In the heady days before March a Zoom was a multicoloured ice lolly which looked a bit like a rocket. You could of course zoom through something or like my grand-daughter you could “zoom, zoom we are going to the moon”. Now all of us on Council and many others zoom maybe everyday. It is free as long as you only stay on line for 45 minutes. The BNMS has decided to buy a version so we can work a bit longer. However, zooming has led to a new etiquette. For example it is good to be fashionably late. If you try to join a Zoom call before the host it just will not work. Secondly what do you wear. Should you be formal or relaxed. The best thing is as long as you keep the camera pointed in the correct direction you can mix and match. Shirt, tie and jacket on the top. Surfing shorts and no shoes down below. If you are the host and you really fed up with someone you just mute them. It does not matter how hard they try to unmute or how energetically they wave at the host they are not going to get heard until the host wants to hear from them. On the other hand you have to remember you may be zooming from home and if you do not mute in time everyone will hear the tale of your 4 year old’s metre long poo as she rushes into your room to give you an update. Then there is the hair issue as lockdown progresses the nation’s hair situation is not good. For all of us have started to look as though we live in a 1960s style hippy commune. If you were the type of person who’s hair roots are a different colour from your other hair there is now a good 10cm of hair root colour. Before men think that is not a problem. Do we really want to see hairs growing from eye brows in every direction not to mention ear and nasal hair. Then there is the bald patch. Now many men are what we call “thin on top” Most men when they look in the mirror do not see this but leaning down to try and find the “leave meeting” button the all seeing computer camera sees all. The experts say we will all just have to learn to live with this pandemic for months ahead. If that is the case and there are no barbers or hairdressers we may decide that we can only Zoom with the video off

Where do you zoom from, indoors and your wall paper choice becomes a matter of debate. You could use the supplied backgrounds like a tropical beach which sounds great but Zoom seems to have a defect in its edge detection. I remember talking to a doctor in Australia who for some reason had palm tree eyebrows. There was a report of a poor lady who changed her face into a mouse face but was unable to change it back for the rest of the zoom call. Then there is the issue of band width. In our house you can only have 1 zoom on our broadband so if my wife is using that I have to use my mobile. However, the only good 4G signal is in the garden by the bird table. What is the etiquette of zooming and eating. We know we should not talk with your mouth full of food but what about zooming. I have seen people tuck into a full roast dinner on zoom, not good if you are hungry. My personal bug bear is people zooming from a sunny garden with a very large glass of red wine in hand!

Finally if you know someone who works in Nuclear Medicine who has done something truly extraordinary during the COVID-19 crisis and should be considered for an honour, please contact Charlotte Weston in the office who has an on line form you can fill in. we must have these completed by June 30^th so we can send to the cabinet office.

Keep safe.

Dr John Buscombe

BNMS President

We now all live in unprecedented times. In years to come we will all tell our children and great grand children what we did in the pandemic of 2020. We live in such a connected world that we can find out what is happening around the world. For many of this it may be a frightening time for others they may just be exhausted by the work we have to do.

For some members of the BNMS it may mean work as normal with extra precautions slowing procedures as it is required to wear PPE. For others some departments have closed or reduced activity leading to some of you being furloughed. Other of you have been reassigned to help in the fight against COVID-19 working on COVID wards, working in X-ray or CT, repairing ventilators or PAT testing new equipment. Some of you may have even been sent to new hospitals where everything is unfamiliar. For all our members this has been a trying time and I am immensely proud of all you have been doing and continue to endure.

We have started a special COVID page on our web site for people to share any relevant scans, information etc and of course we have our guidelines written primarily by the nuclear medicine teams in Liverpool and Birmingham and this will be updated each week if there is new advice we need to give.

As for the BNMS there have been changes which we have to implement. The office staff now work from home which because of our new web-based systems we installed last year has worked well. The next major issue was the annual meeting of the BNMS we were due to have been held next month in Liverpool. The officers of the BNMS needed to consider what to do. Clearly, we would not be able to meet partly as the lockdown may still be in place and also many of you have had all your leave cancelled. The next question was could we delay the meeting to the autumn and replace the Leeds autumn meeting but we were unable to find a suitable time Liverpool could rebook the conference and in reality, we do not know how the situation will resolve. It was therefore decided with a heavy heart to cancel this years Annual meeting. We will transfer all this year’s lectures and accepted talks and posters to Belfast in May 2021. This decision was not taken lightly we were all aware that this would be a major disappointment to all those who put so much work into their abstracts.

One bit of good news is that the present scientific and education committee have agreed to stay in post for an additional year so the planned changes for May 2020 will take place in May 2021.

We hope to hold the AGM in the autumn meeting in Leeds which we really hope as many of you can come to as possible. This will mean the present BNMS council and Officers will remain in place till then. As a consequence, you are all stuck with me as President till September and elections for council will be held in August. These are just plans. Circumstances may still change everything and we ask for your patience. We will be looking at holding some of our June meetings by teleconferences.

My final wish, keep safe all of you.

Dr John Buscombe

BNMS President

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