The British nuclear medicine research strategy - the framework.

The British Nuclear Medicine Society (BNMS) has developed a Research Strategy framework led by the Research Champions of the BNMS and overseen by the BNMS Research and Innovation Committee. The objectives of the Research Strategy are to improve translation of cutting-edge nuclear medicine research from bench to bedside, the implementation of state-of-the-art multimodality technologies and to enhance multicentre radionuclide research in the UK. It strives to involve patients and the public in radionuclide research and to contribute to and work with the multi-professional national and international organisations involved in research with an ultimate aim to improve nuclear medicine services, and patients' outcomes and care.

Impact of COVID-19 on nuclear medicine in the UK.

PURPOSE: COVID-19 brought about unprecedented challenges to healthcare, with nuclear medicine (NM) being no exception. The British Nuclear Medicine Society (BNMS) COVID-19 survey assessed the impact of the first wave of pandemic on NM services in the UK. With COVID-19 resurge compounded by seasonal winter pressures, we reflect and share lessons learnt from the first wave of pandemic to guide future strategy. METHODS: A questionnaire consisting of 34 questions was sent out to all BNMS members over 2 weeks in May 2020, to evaluate the impact of 'lockdown'. RESULTS: One hundred thirty-eight members (92 sites) from a multidisciplinary background responded. There was a 65% reduction across all services; 97.6% of respondents reported some reduction in diagnostic procedures and 71.3% reduction in therapies; 85% worked with a reduced workforce. The North East of England, Greater London and South East and Wessex were most affected by staff absences. The North East reported the highest number of COVID-19 positive staff; London reported the greatest lack of testing. The reported time required to clear the backlog was 1-12 months. Seventy-one percent of participants used BNMS COVID-19 guidance. CONCLUSION: The first wave caused a major disruption of NM service delivery and impacted on the workforce. The departmental strategies should tailor services to evolving local and regional differences in prevalence of COVID-19. A blanket shutdown of services with a 'one size fits all' strategy would likely have a severe impact on future delivery of NM and health services in general. Timely testing of staff and patients remains of paramount importance.

Role of the Advanced Nurse Practitioner Within Teenage and Young Adult Oncology. What is the Impact on Patient and Staff Experience of a New Nurse Practitioner Role to a Teenage and Young Adult Service?

Background: Advanced Practice is recognized by the Royal College of Nursing as a distinctive level of practice encompassing direct care provision, education, research, and management. Advanced Nurse Practitioners (ANP) are educated to MSc level and assessed as competent in their field. A teenage and young adult advanced nurse practitioner (TYA ANP) was introduced in 2015, one of few within the United Kingdom. This service evaluation assesses the impact of the new role on patient and staff experience. Aims/Objectives: To evaluate the impact of TYA ANP role on the experience of TYA oncology patients and the multidisciplinary team (MDT) and to assess perception of quality, safety, and efficiency of this role. Methodology: Retrospective data collection using Australia Nurse Practitioner Study Questionnaire to MDT and patients treated within the TYA unit since the ANP role was introduced. Descriptive statistics were used to analyze outcomes of the data collected. Results: Eighty-six percent of patients and 90% of staff felt they understood the ANP role. While 100% of patients felt the TYA ANP service was a success, met their needs, prescribed correctly, offered holistic and safe care, and had a positive impact on care. Furthermore, 86% of patients felt the TYA ANP service was easy to use and 90% of staff felt the TYA ANP service met the needs of the patients. Discussion/Conclusion: Overall patients and staff reported a positive experience particularly on correct diagnosis, safe prescribing, and having a positive impact on care. Areas for improvement include wider understanding of the role.

GP Training practices in England: a description of their unique features based on national data.

Postgraduate general practitioner (GP) training structures have been reorganised with the formation of Health Education England (HEE). We aimed to broaden the findings of previous studies and identify key features of GP training practices. In particular, we wanted to extend previous findings regarding QOF achievement and patient experience derived from the General Practice Patient Survey (GPPS), with recent data on the use of urgent cancer referral pathways ('Two Week Wait', or '2WW,' referrals) and secondary care utilisation by GP training Practices. We compared training and non-training practices, adjusting for differences in practice size and demographic features. Compared with non-training practices, we found reported patient satisfaction with 'access' was 2.0% higher (p < 0.001), 'communication' 0.75% higher (p < 0.001), 'overall experience' 2.8% higher (p < 0.001), 'continuity of care' 2.2% lower (p < 0.001). Mean QOF scores were 11 points higher in training practices (p < 0.001). There were few differences between the two types of practice in terms of Emergency hospital admissions, Ambulatory Care Sensitive (ACSC) admissions, Accident and Emergency attendances and Out-Patient attendances. Training practices used the 2WW referral pathway more frequently than non-training practices resulting in a 1.1% higher 'cancer detection rate' (p = 0.007).

Long term condition morbidity in English general practice: a cross-sectional study using three composite morbidity measures.

BACKGROUND: The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. This study aimed to determine the characteristics of general practices with high morbidity burden. METHOD: Retrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity measures (MMs) were constructed to quantify LTC morbidity at practice level: a count of LTCs derived from the 20 LTCs included in the UK Quality and Outcomes Framework (QOF) disease registers, expressed as 'number of QOF LTCs per 100 registered patients'; the % of patients with one or more QOF LTCs; the % of patients with one or more of 15 broadly defined LTCs included in the GP Patient Survey (GPPS). Determinants of MM scores were analysed using multi-level regression models. Analysis was based on a national dataset of English general practices (n = 7779 practices); GPPS responses (n = 903,357); general practice characteristics (e.g. list size, list size per full time GP); patient demographic characteristics (age, deprivation status); secondary care utilisation (out-patient, emergency department, emergency admission rates). RESULTS: Mean MM scores (95% CIs) were: 57.7 (±22.3) QOF LTCs per 100 registered patients; 22.8% (±8.2) patients with a QOF LTC; 63.5% (±11.7) patients with a GPPS LTC. The proportion of elderly patients and social deprivation scores were the strongest predictors of each MM score; scores were largely independent of practice characteristics. MM scores were positive predictors of secondary care utilization and negative predictors' access, continuity of care and overall satisfaction. CONCLUSIONS: Wide variation in LTC morbidity burden was observed across English general practice. Variation was determined by demographic factors rather than practice characteristics. Higher rates of secondary care utilisation in practices with higher morbidity burden have implications for resource allocation and commissioning budgets; lower reported satisfaction in these practices suggests that practices may struggle with increased workload. There is a need for a readily available metric to define the burden of morbidity and multimorbidity in general practice.

Does COPD risk vary by ethnicity? A retrospective cross-sectional study.

BACKGROUND: Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking. METHOD: A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, severity (% predicted forced expiratory volume in 1 second [FEV1]), smoking status, and treatment were compared between ethnic groups, adjusting for age, sex, smoking, deprivation, and practice clustering. RESULTS: Among 358,614 patients in 47 general practices, 47.6% were white, 20% black, and 5% Asian. Prevalence of COPD was 1.01% overall, 1.55% in whites, 0.58% in blacks, and 0.78% in Asians. COPD was less likely in blacks (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI] 0.39-0.51) and Asians (0.82; CI, 0.68-0.98) than whites. Black COPD patients were less likely to be current smokers (OR, 0.56; CI, 0.44-0.71) and more likely to be never-smokers (OR, 4.9; CI, 3.4-7.1). Treatment of patients with similar disease severity was similar irrespective of ethnic origin, except that long-acting muscarinic antagonists were prescribed less in black COPD patients (OR, 0.53; CI, 0.42-0.68). Black ethnicity was a predictor of poorer lung function (% predicted FEV1: B coefficient, -7.6; P<0.0001), an effect not seen when ethnic-specific predicted FEV1 values were used. CONCLUSION: Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to COPD.