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Information for members

Contents

  1. Joint Statement from the British Society of Interventional Radiologists and The Vascular Society
  2. NICE Guidance for Prostate Artery Embolisation (PAE)
  3. RCR and BSIR response to GIRFT report for vascular surgery
  4. BSIR 2018 Elections
  5. BIAS Registry 2018
  6. Retained interventional radiological sheaths in obstetric cases Final
  7. Mechanical Thrombectory for Ischaemic Stroke
  8. BIAS Registry
  9. BSIR statement_Obtaining informed consent after the Montgomery ruling
  10. Health Education England’s Learning Solution – Alpha phase complete and service assessment passed
  11. Training of Existing Consultants in Interventional Radiology
  12. NHS Reference Cost Collection 2016/17
  13. NHS Improvement - Patient Safety Alert
  14. HYBRID FACILITIES
  15. Analysis of Thrombolysis in acute DVT Surveys
  16. E Referral Changes
  17. BSIR Statement on UFE
  18. Re: NICE Guidance CG147 update
  19. Radiologist Recruitment
  20. Updates on national tariff related publications from NHS Improvement
  21. Letter to members and medical directors re IR data submission to NVR 2016
  22. Data capture paper tool for NVR
  23. Benchmarking Consent in Nephrostomy
  24. Out Of Hours Intervention for Haemorrhage - Snapshot Survey Results
  25. RCR statement on the junior doctors’ industrial action
  26. Duty of Candour
  27. FSSA Position Statement - Appointment to Heads of School
  28. RCR position statement on the appointment of a radiographer as Head of the Yorkshire and the Humber School of Radiology
  29. SEED GRANTS UK IO Practicioners Information
  30. Cancer Research UK research brief: The skills and capacity of the UK’s non-surgical, oncology workforce
  31. Registries & Audit Newsletter

Joint Statement from the British Society of Interventional Radiologists and The Vascular Society

Please see statement available to download below.

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Joint Statement from the British Society of Interventional Radiologists and The Vascular Society

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NICE Guidance for Prostate Artery Embolisation (PAE)

https://www.nice.org.uk/guidance/ipg611

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RCR and BSIR response to GIRFT report for vascular surgery

RCR and BSIR response to GIRFT report for vascular surgery

 

The Royal College of Radiologists (RCR) and the British Society for Interventional Radiology (BSIR) welcome the publication of the Getting It Right First Time (GIRFT) programme report1 for vascular surgery and the drive to achieve efficiencies in delivery of services and improve the quality of patient care.

 

We welcome especially the recognition given to the need for an increase in the interventional radiology workforce who are essential to the delivery of vascular services, particularly in patients who need care urgently. The challenges in delivering seven-day services are all too familiar to radiologists, who already deliver this for diagnostic imaging in a very challenging environment of personnel and funding.

 

We concur that the formation of networks to deliver consistent standards of care across organisational boundaries is important. However, unlike vascular surgery, interventional radiology services more regularly deliver emergency and urgent care to patients, including treatment of sepsis, acute bleeding, obstetrics, renal replacement and trauma. While being supportive of the recommended NHS England model of hub and spoke networks, it is critical that these do not destabilise the ability to deliver urgent care to patients located outside the vascular networks.

 

One important objective of the GIRFT process is the efficient procurement of devices and consumables. We welcome progress in this regard with the implementation of the NHS Future Operating Model. However, the coding process and tariff reimbursement of interventional radiology procedures remains problematic for many trusts and we would welcome further tariff development beyond HRG4+. This would enable funding of the minimally invasive and innovative treatments which patients call for.

 

We agree that there is a need to improve the collection of outcome data. The national audit programme for interventional radiology procedures is incompletely delivered by the National Vascular Registry, which was adapted for interventional radiology procedures and requires modification. Work is continuing in this regard. Such registries are only as good as the data that is included, and trusts are urged to support the development of infrastructure and allow physicians sufficient time to record meaningful data.

 

There are now over 30 clinical leads for the GIRFT programme and we look forward to integration across those workstreams. The radiology GIRFT process is continuing and will inevitably explore effective cross-specialty partnerships, which we are confident will clarify the direction of travel.

 

We also hope the positive outcomes of the GIRFT process, which apply to England only, can be extended to the three devolved UK nations and we look forward to helping in that process.

 

1 Vascular Surgery: GIRFT Programme National Specialty Report [link]

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BSIR 2018 Elections

Dear BSIR / BSIRT / Foundation Dr F1/2 / Medical Student Members,

The BSIR elections are now open.

For further information and link to the nomination form please visit:

BSIR Full Members - https://www.bsir.org/society/bsir-subcommittee-elections-2018/#col_right

BSIR Junior Members - https://www.bsir.org/bsirt/bsirt-elections-2018/#col_right

BSIR Foundation Dr F1/2 / Medical Student Members - https://www.bsir.org/bsirt/bsirt-foundation-year-medical-student-representative-elections-2018/#col_right

(You must be logged into the BSIR website to view these pages).

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BIAS Registry 2018

The British Society of Interventional Radiology

Fourth Iliac Angioplasty Study Report 2018

Foreword

My thanks to the many people who have contributed to the British Iliac Angioplasty and Stenting (BIAS) registry. The BSIR is very proud to have instigated and supported this project, which is now in its fourth (and nal) report stage. BIAS has been one of the vanguard registries in the United Kingdom. This report joins its three predecessors, and is not only useful for its content, but is also a tribute to all those BSIR members who have taken the time to complete data entry. The society realises that much of this has been given freely, and often in individuals’ spare time. As President, on behalf of The Society, I thank you all for that. 

Trevor Cleveland

 

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Retained interventional radiological sheaths in obstetric cases Final

The below has been forwarded to BSIR from the Patient Safety Team at NHS Improvement The Safety and Quality Committee and Council Officers wish to make members aware of the review, and to bring the subsequent reflections to the attention of BSIR members.

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Mechanical Thrombectory for Ischaemic Stroke

Training to deliver mechanical thrombectomy

In order to achieve the desired delivery of a 24/7 service in MT across England, the number of operators capable of contributing to MT services needs to expand more rapidly than will be achieved by current INR trainee numbers. This means training other specialists to perform MT.

The British Society of Neuroradiologists (BSNR) has produced “Training guidance for mechanical thrombectomy” (Lenthall R, McConachie N, White P, Clifton A, Rowland-Hill C. BSNR training guidance for mechanical thrombectomy. Clin Radiol 2017; 72(2): 175.e11–175.e18.) which details the training that will be required for practitioners from different clinical backgrounds to achieve the necessary skills and experience to effectively contribute to the acute stroke service. This guidance will underpin all routes to increasing the workforce.

https://www.rcr.ac.uk/clinical-radiology/being-consultant/mechanical-thrombectomy-ischaemic-stroke

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BIAS Registry

8000+ cases entered since last publication (BIAS III, 2008) 13000+ cases altogether. Largest registry of iliac intervention worldwide as far as I know 50+ cases per week at peak recruitment in 2013. Substantially better recruitment so far compared with NVR. Follow up data excellent - 97% for most data points. Very low complication rates High success rates. read more..

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Obtaining informed consent after the Montgomery ruling - please see BSIR statement attachment below, available to view and print.

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BSIR statement - Obtaining informed consent after the Montgomery ruling

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Health Education England’s Learning Solution – Alpha phase complete and service assessment passed

Dear Colleagues

Please see below for an update on the progress of Health Education England’s Learning Solution project.  Many of you have been involved in the project at some point to date so we were keen to share with you the exciting milestone it has now reached.  

Health Education England’s Learning Solution – Alpha phase complete and service assessment passed

Health Education England’s (HEE) Learning Solution project has reached a new milestone by completing the alpha* phase of the development.  This phase culminated in passing all aspects of the service assessment giving permission for it to move onto the next part of the process, which is the beta* development phase.

HEE’s Learning Solution will provide access to a full range of resources, guidance and educational innovations across the NHS, social care and higher education which can also be shared, signposted, evaluated and developed. As well as helping to drive up quality, the Learning Solution will help promote and harness innovation and draw on the best practice, talent and projects within and beyond the NHS.

Neil Ralph, Health Education England’s National Programme Lead for the Technology Enhanced Learning Programme, said: “This is a very exciting and much anticipated project for HEE.  As well as being a resource for the wider health and social care workforce we believe it will support and feed into the work that is taking place right across HEE.”

The report from the 18 point Digital Service Standard assessment, which provides feedback and recommendations for the beta phase, can be found on the Digital Health blog.

For more information about the Learning Solution project visit www.hee.nhs.uk/tel

*Alpha and beta phases refer to the agile methodology being used for the development of the Learning Solution, which is commonly used in the development of digital products.

With kind regards

Alex

Alex Drinkall

Stakeholder Manager

TEL Programme and e-Learning for Healthcare

Health Education England 
2nd Floor | Stewart House | Russell Square | London | WC1B 5DN

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Training of Existing Consultants in Interventional Radiology

Training of Existing Consultants in Interventional Radiology - please see BSIR statement attachment below, available to view and print.

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Training of Existing Consultants in Interventional Radiology

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NHS Reference Cost Collection 2016/17

NHS have now published this year’s reference cost collection (2016/17 costs) all the spreadsheets and supporting documentation can be found here: https://improvement.nhs.uk/resources/reference-costs/

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NHS Improvement - Patient Safety Alert

Please see below Patient Safety Alert - Confirming removal or flushing of lines and cannulae after procedures, from NHS Improvement for your information.

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HYBRID FACILITIES

BSIR has been asked to advise on the development of so called hybrid facilities. These facilitate combined image guided procedures and open surgery. They may also be referred to as Interventional Radiology Theatres and others. A number of hospitals and organisations are investing substantial funds into such facilities, to improve the care of vascular, cardiac and trauma patients. Most will not find it financially viable to have more than one such suite.

BSIR was invited by the MHRA, to contribute to a Joint Working Group, which issued a report in 2010. This report was precipitated by a number of reports to the MHRA of EVAR (endovascular aneurysm repair) devices being placed in environments with poor imaging equipment. This was resulting in poor device placement, and high radiation doses to patients and operators. The subsequent report highlighted the need for improved facilities, and provided information intended to give details on the facilities that NHS and other organisations should aspire to provide. Of note, it was specifically stated that there was a need for back up imaging facilities in close proximity.

It was also recognised that, at the time, there was a preference for such facilities to be located close to a theatre environment (to allow for anesthetic and recovery areas). In the intervening time, Major Trauma Centres have developed, and the need to accommodate the rapid treatment of such patients. As a consequence of this, and other, changes there has been an expansion of the routine nature of delivery of anesthetic and recovery facilities outside theatre complexes. It has also become clearer that there is a pivotal role of Interventional Radiology (IR) in bleeding control. Trauma investigation and treatment (including image guided techniques) need to be co-located with Emergency Departments.

As a result, BSIR considers that, whilst the underlying principles of good imaging and environments remain current, requirements (and modern practice) of trauma care have changed the landscape of hybrid facilities. In the modern environment, these need to not just cater for EVAR delivery, but also trauma care. IR departments are generally located close to diagnostic radiology, CT scanners and Emergency Departments, ensuring safe and rapid patient treatment pathways. Such places offer considerable advantages in terms of back up imaging, power supply, power injectors and disposables, which are essential to the resilience for delivery of trauma care and combined image guided/open surgery. In many circumstances, these needs may outweigh other factors, making them more functional and economically viable if placed close to other IR and imaging facilities.

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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]

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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

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BSIR Statement on UFE

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Re: NICE Guidance CG147 update

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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.

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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/

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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

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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

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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

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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

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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.

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Duty of Candour

Statement below for your information.

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FSSA Position Statement - Appointment to Heads of School

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FSSA position statement regards heads of school

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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.

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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>>
 

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Research brief - Non-surgical oncology workforce

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Registries & Audit Newsletter

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Registries & Audit Committee Newsletter July 2016

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