MEMBERS INFORMATION

Information for members

Contents

  1. Analysis of Thrombolysis in acute DVT Surveys
  2. E Referral Changes
  3. BSIR Statement on UFE
  4. Re: NICE Guidance CG147 update
  5. Radiologist Recruitment
  6. Updates on national tariff related publications from NHS Improvement
  7. Letter to members and medical directors re IR data submission to NVR 2016
  8. Data capture paper tool for NVR
  9. Benchmarking Consent in Nephrostomy
  10. Out Of Hours Intervention for Haemorrhage - Snapshot Survey Results
  11. RCR statement on the junior doctors’ industrial action
  12. Duty of Candour
  13. FSSA Position Statement - Appointment to Heads of School
  14. RCR position statement on the appointment of a radiographer as Head of the Yorkshire and the Humber School of Radiology
  15. SEED GRANTS UK IO Practicioners Information
  16. Cancer Research UK research brief: The skills and capacity of the UK’s non-surgical, oncology workforce
  17. Registries & Audit Newsletter

Analysis of Thrombolysis in acute DVT Surveys

Dear Colleagues,

I would like to offer my sincere apologies for the delay in the publication of the analysis of my two recent Surveys about Thrombolysis in acute DVT and the second on the possible reasons behind not providing this service. Also, I would like to thank those who participated in these surveys.

Since the introduction of NICE guideline* for Thrombolysis in acute Ilio-Femoral DVT in 2012, a selection of Interventional radiologists (IR) started providing this form of treatment to patients with a history of DVT of less than 2 weeks’ duration.

The second survey showed that several IR’s colleagues have shown an interest in providing this form of treatment even though a small number (22%) are put off by the recent presentation of ATTRACT trial which claimed that there was no benefit in acute DVT thrombolysis in terms of preventing Post Thrombotic syndrome (ATTRACT fails to meet primary endpoint, but experts agree results are “hypothesis-generating” Vascular News 6th March 2017).

The purpose of both surveys is to pave the way to establish a registry on Thrombolysis in acute Ilio-Femoral DVT sponsored by BSIR. The surveys show that a number of Interventional radiologists and vascular surgeons, albeit small, do offer both Mechanical and or Catheter directed Thrombolysis.

As you can see from my summary report below, we are all providing the recommended pathway of treatment and utilizing available technologies to achieve the best outcomes. However, to gain some insight into the efficacy of these techniques, I would recommend a formal registry, run by the BSIR. I would recommend at least two years’ follow up. In addition, the registry is going to be used as a tool to determine how we define a successful primary outcome (i.e. preserved valve function, speed of flow, absence of reflux and whether there is a residual clot or stenosis) and whether this translates into good medium to long term outcomes.

Meanwhile, there are two controversial issues which require a consensus. The first issue is related to the use of IVC filter prior to thrombolysis and rather than putting my views on this topic I would like to share with you several publications on this issue which are worth reading:

PREPIC-1 (Decousus et al.  A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis.  NEJM 1998; 338:409)

PREPIC-1 Follow-Up Study (Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism.  Circulation 2005; 112: 416-422)

PREPIC-2  (Effect of a retrievable inferior vena cava filter plus anticoagulation vs. anticoagulation alone on risk of recurrent pulmonary embolism: A randomized clinical trial.  JAMA 2015; 313: 1627)

Prasad V, Rho J, Cifu A.  The IVC Filter: How could a medical device be so well accepted without any evidence of efficacy?  JAMA Internal Medicine 2013; 173(7) 493-495.

The second issue which is equally very important and is to do with the future follow up of our patients following thrombolysis and whose responsibility it is.

Please, enjoy reading the analysis of the surveys’ outcomes and don’t hesitate to reply with your invaluable thoughts and suggestions on what questions should be included in any planned future registry.

Best wishes

Said Habib

Consultant IR, Nottingham University Hospitals

*NICE guideline:

Deep vein thrombosis

1.2.6Consider catheter-directed thrombolytic therapy for patients with symptomatic iliofemoral DVT who have:

  • symptoms of less than 14 days' duration and
  • good functional status and
  • a life expectancy of 1 year or more and
  • a low risk of bleeding. [2012]
image

2nd survey datasets

Back to top


E Referral Changes

Many RCR Fellows are routinely consulting with patients in an out-patients setting, particularly before and after interventional procedures.  Some of these referrals will be coming from consultant teams, others from GPs. Such out-patient activity is encouraged by the RCR and GMC, to allow patients to consult with an expert before undertaking invasive treatments, and to ensure appropriate aftercare. Radiology clinics, like any other, are subject to a tariff payment, should be programmed into routine work, and be available for booking via e-referral.

Fellows should be aware, that the NHS e-referral Roadmap states an expectation that there will be availability of online patient booking and that for 2017/2018 there is a CQUIN payment available to incentivize Providers to publish all services and appointment slots on the NHS e-Referral service. In addition, from October 2018, appointments not available to e-referral will no longer attract a payment tariff.

Therefore, we would encourage all radiologists to consult with patients undergoing elective interventions in out-patients, have these available on the Trust Directory of Services, attract the appropriate tariff income for your department, and ensure availability for e-Referral.

http://content.digital.nhs.uk/media/24761/NHS-e-Referral-Service-Roadmap-July-2017/pdf/e-RS_Roadmap_July_2017.pdf

http://content.digital.nhs.uk/referrals

Back to top


BSIR Statement on UFE

Back to top


Re: NICE Guidance CG147 update

Back to top


Radiologist Recruitment

RCR have now introduced a Radiology Jobs corner on the colleges website, which is linked to the jobs site https://radjobs.co.uk/

This site is free of charge and allows employers to advertise vacant positions without the fees incurred on other recruitment sites.

Please share this information with your colleagues and contacts, to enable departments to actively engage in the recruitment process.

Back to top


Enquiries and frequently asked questions

NHS Improvement now publish the queries they receive on the national tariff.  The 2016/17 enquiries log now updated with questions and FAQs up to January and this can be found here:

https://www.gov.uk/government/publications/nhs-national-tariff-payment-system-201617

NHS Improvement have also launched the 2017/19 document with a selection of FAQs, that document can be found here:

https://improvement.nhs.uk/resources/national-tariff-1719/

 

Tariff doc corrections

NHS Improvement have updated a number of documents on the 2017/19 webpage due to small errors.  The main national tariff has had a date correction made in paragraphs 271 and 272 (relating to MFF recalculation).  They have corrected a column header issue on the MFF page of the national prices spreadsheet and further to feedback have removed the non-mandatory price for adult hearing services from the non-mandatory prices spreadsheet.  The documents can all be found here:

https://improvement.nhs.uk/resources/national-tariff-1719/

 

Reference cost collection guidance.

NHS Improvement have now published the reference cost guidance for 2017, it can be accessed here:

https://improvement.nhs.uk/resources/approved-costing-guidance/

 

Whole population budget webinars.

Following NHS Improvement latest webinar on new payment approaches, a page as been set up to bring all of the webinars on the subject together.  This will be added in the next month or so with further material.

https://improvement.nhs.uk/resources/whole-population-budgets/

Back to top


Letter to members and medical directors re IR data submission to NVR 2016

Please find attached a position statement from the BSIR about time allocation (in job planning) and administrative support for IR data entry into NVR. We hope that members may find this useful in negotiations with trust management over these issues.

Yours faithfully,

Chris Hammond

Chair: BSIR R&A Committee

Back to top


Data capture paper tool for NVR

Please find attached a paper consent and data collection tool that you may find helpful in data collection for peripheral angiographic procedures for the NVR. While this document does not circumvent the requirement for eventual electronic data submission, we hope that IRs will find it useful to collect data immediately after a procedure. Ideally some administrative support should be made available by trusts to enable data entry direct from the document without the need for the IR to do this personally.

The BSIR is progressing a number of other projects that may eventually assist in electronic data entry.

Yours faithfully

Chris Hammond

Chair: BSIR R&A Committee

Back to top


Please see attached a survey of nephrostomy outcomes (also performed earlier in 2016), which we hope may aid you in benchmarking your practice and assisting in consent processes.

Chris Hammond

Chair: BSIR R&A Committee

Back to top


Out Of Hours Intervention for Haemorrhage - Snapshot Survey Results

Please see attached a summary of results of the OOH intervention for haemorrhage snapshot survey done in October 2016.

Chris Hammond

Chair: BSIR R&A Committee

Back to top


RCR statement on the junior doctors’ industrial action

Friday 2 September 2016

The Royal College of Radiologists is unable to support the statement issued yesterday by the Academy of Medical Royal Colleges (http://www.aomrc.org.uk/wp-content/uploads/2016/09/Proposed_further_strike_action_010916-5.pdf) because it does not advance a positive solution for patient care or the provision of safe and sustainable NHS services.  We remain of the view that the dispute between junior doctors and the Government can only be resolved by resuming negotiations. Once again, we call on both parties to re-start the discussions and reach a workable solution as soon as possible, to avoid further distress to and impact on patients.  Each individual junior doctor will make up their own mind on taking strike action – and we should all respect those decisions.

The underlying problem remains that the NHS is under resourced, under staffed and overstretched.

Back to top


Duty of Candour

Statement below for your information.

Back to top


FSSA Position Statement - Appointment to Heads of School

image

FSSA position statement regards heads of school

Back to top


RCR position statement on the appointment of a radiographer as Head of the Yorkshire and the Humber School of Radiology

'BSIR fully support the position of the RCR and agree's with the statement that the appointment of a Radiographer to the head of school is an ill conceived appointment by Health Education England' 

Raman Uberoi

BSIR President

The RCR position statement can also be viewed at: https://www.rcr.ac.uk/posts/rcr-position-statement-appointment-radiographer-head-yorkshire-and-humber-school-radiology and http://www.bsir.org/mediacentre/news/

RCR position statement on the appointment of a radiographer as Head of the Yorkshire and the Humber School of Radiology

Wednesday 3 August 2016

The RCR was informed last week that the post of Head of the Yorkshire and the Humber School of Radiology has been offered by Health Education England (HEE) to an individual who is not a radiologist and not medically qualified. The RCR was not consulted about this appointment and was not involved in the appointment process in any way. We understand that there was no radiologist member of the appointment panel and also that a suitably qualified and experienced consultant radiologist was interviewed for the post.

Radiology training and service delivery involve specific and complex challenges.  The role of Head of a School of Radiology includes the management of issues including trainees in difficulty, trainers about whom concerns are raised, the interface with clinical departments including the provision of out of hours services, the management of reporting discrepancies, radiology service whistleblowing concerns and the provision of strategic leadership and planning. The RCR considers that only consultant radiologists have the skills and experience to command the respect of radiology trainees and trainers in this role.

The RCR has unambiguously communicated in writing to HEE that the College does not support this appointment. We have requested an urgent meeting with the local Postgraduate Dean to explore how the damage caused by this ill-informed and ill-conceived decision can be limited.

The RCR recognises the anxiety and distress that this will cause radiology trainees and trainers not only in Yorkshire and the Humber, but also across the country.

Back to top


Back to top


Cancer Research UK research brief: The skills and capacity of the UK’s non-surgical, oncology workforce

Cancer Research UK research brief: The skills and capacity of the UK’s non-surgical, oncology workforce

Cancer Research UK would like to commission research on the UK’s non-surgical oncology treatments workforce. The brief for this study is attached. The closing date for submissions is 1st September 2016.

We know that delivering world-class cancer outcomes relies on a vast array of health professionals. They are crucial at all stages of an individual’s journey, ranging from GPs offering smoking-cessation advice to the therapeutic radiographers and clinical nurse specialists involved in cancer treatment.

We are seeking to commission a new study to focus on current and future capacity and demand as well as providing potential solutions such as new models of care and changes to education and training programmes.

The findings will input into our policy development on workforce in all four nations and it will be used to inform our evidence and recommendations to Health Education England’s review of the cancer workforce in early 2017.

We would like the research to start by October 2016 with the view to complete by end of March 2017, for publication at the end of May 2017.

Please respond with expressions of interest by 22nd August 2016 and your full proposal for this work by 5pm, 1st September 2016.

All enquiries should be sent to Helen Beck, Policy Research Manager, helen.beck@cancer.org.uk<mailto:helen.beck@cancer.org.uk><mailto:helen.beck@cancer.org.uk<mailto:helen.beck@cancer.org.uk>>
 

image

Research brief - Non-surgical oncology workforce

Back to top


Registries & Audit Newsletter

image

Registries & Audit Committee Newsletter July 2016

Back to top