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BASP Spring Newsletter
May 2015
Presidents Column
The various committees of BASP have been
working hard and have been highly productive
since the last Newsletter in Autumn 2014 and
their reports speak for themselves. I thank all of
the committee members and their chairs sincerely
for their impressive efforts and it really just leaves
me to flag up what I consider to be some particular highlights.
Strengthening BASPs Contribution to Stroke
Research
It is, of course, one of BASPs principle objectives
to promote and disseminate research in stroke.
I’m delighted to report that we have successfully
strengthened our commitment to doing this in a
very practical way.
The NIHR Stroke Research Network (SRN) had
great success in the submission of successful
grant applications, in large part due to twiceannual calls for structured support of writing
groups that developed grant applications. These
were designed to support multidisciplinary stroke
professionals and patient and carers in undertaking a series of meetings to develop a grant application. This process enhanced the NIHR SRN
portfolio of randomized clinical trials and other
well-designed studies in acute stroke, and stroke
prevention and rehabilitation.
With the transition from the NIHR SRN to NIHR
CRN: Stroke on 1 April 2015, the infrastructure to
support such writing groups was compromised.
We have been in discussion with NIHR SRN and
with The Stroke Association (TSA) to attempt to
ensure the writing groups would continue.
We have agreed to provide funding to support
multidisciplinary writing groups across the whole
stroke pathway on an open, competitive, peer-
reviewed basis, implemented as soon as possible
after 01 April 2015, and there is likely to be two
writing group calls per year, supporting up to
three writing groups per call (maximum funding of
£2,000 per writing group). The current NIHR
CRN: Stroke application forms will be adapted for
use as will the current outcome metrics, namely,
success of a submitted grant application. TSA
have also been supportive in providing in-kind
support by the provision of venues for meetings,
and it is anticipated that this would significantly
reduce costs for writing groups. This process will
be co-ordinated by the Chair of the BASP Scientific Committee in consultation with the National
Specialty Lead for Stroke, with shared administrative support. Members of the BASP Scientific
Committee and the SNSG will provide peer review, and/ or recommend appropriately qualified
peer review for writing group applications.
There will be a condition of funding that NIHR
CRN: Stroke and the British Association of Stroke
Physicians are acknowledged in outputs from the
writing groups, including grant applications and
any future publications from funded studies.
Review of BASP Strategy
The process for reviewing our 5 year strategy
continues. We gathered the opinions of the BASP
membership by questionnaire at the end of 2014
and I shared the key findings at the AGM. The
next significant step is to determine what our
stakeholders consider the role of BASP should be
in the future and to this end we are holding a
stakeholder engagement event in London on 15
June. I will keep you apprised of the key themes.
BASP SPRING NEWSLETTER 2015
continued/
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Mechanical Thrombectomy Trials
With the recent flurry of positive results from the
thrombectomy RCTs, the BASP executive considers that it is important to agree a national perspective on the potential implications for stroke
services. To this end, the BASP Scientific Committee has invited key players, including the College of Emergency Medicine and the British Society of Neuroradiologists, to agree to a joint meeting, whilst the Clinical Standards Committee will
work to update the Endovascular Consensus document.
[email protected] by 5 pm on Monday 8 June
2015. This gives the BASP Clinical Excellence
Awards subcommittee just over a week to score
applications and create our recommendations.
This deadline will have to apply whether you are
seeking RCP plus BASP nomination, or solely
BASP nomination. Also, this applies to new applications and to renewals.
Damian Jenkinson
BASP Trainee Weekend 20-21 March
Patricia Fearon covers this in the Trainees Newsletter but I did want to comment that I was highly
impressed, when I attended, with both the very
high calibre of the programme and also—and
possibly more importantly—with the large number of highly enthusiastic and well-informed trainees present. I realise one of our major challenges
is recruitment both into stroke consultant posts
and indeed into stroke training posts, but the cohort I saw in Leicester will provide us with excellent leaders of stroke services!
MHRA Review of Alteplase
A third meeting of the MHRA review group examining the evidence base for the licencing of Alteplase in England is planned for 30 June 2015. It
was originally anticipated that only two meetings
would be required.
2015 Clinical Excellence Awards
The latest round of National Clinical Excellence
Awards for England and Wales opened on 14
April 2015. All applications, new or renewal, must
be made on the online system. The round will
close on Wednesday 17 June 2015 at 5pm.
If you want BASP support, you will have to submit a copy of your ACCEA application by email to
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Medicine for trainees and if the pilot is success-
Secretary’s Report
ful there is a hope that stroke departments will
be able to setup appropriate post-CCT stroke
Current Membership Numbers
Full
426
Associate
259
Affiliate
Honorary
fellowships.
Update on BASP website
12
Following positive endorsement at the AGM
6
there is now enthusiasm for pushing ahead with
a complete overhaul of the BASP website. We
Update on Post-CCT Fellowship
will
The Joint Royal Colleges of Physicians Training
development team to take this forward and as
Board (JRCPTB) is keen to develop accredited
always if BASP members have any suggestions
post-certificate of completion of training (CCT)
for specific features they would like to see incor-
fellowships. The project started in March 2013
porated, please forward to [email protected].
be
identifying
an
appropriate
web-
with the intention that these fellowships would
be available to individuals who have successfully obtained their CCT or in some cases those
Dates for the diary
who are in established consultant posts. Various
European Stroke Conference, 13-15th May
different models have been accepted to take
2015, Vienna
part in a pilot and evaluation process which is
expected to complete in April 2016. Employers,
educational guides and post-CCT fellows are
Northern Ireland Stroke Conference, 20th May
2015, Belfast
expected to contribute to the evaluation pro-
UK Stroke Forum, 1-3rd December 2015, Liver-
cess. The pilot is closed to new applications
pool
now so that all pilot fellowships will have completed by April 2016.
Gavin Young
JRCPTB have received 30 applications to date
for the Pilot, one of which was for a Post-CCT
Fellowship in Stroke. At the BASP AGM in Harrogate concerns were expressed regarding the
difficulties encountered in recruiting individuals
into stroke consultant posts. Post-CCT fellowships may provide another route into Stroke
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Treasurer’s Report Spring 2015
Account balance £ 256 700
The Treasurer’s Year
Direct Debit 1 in August
Companies House Accounts in December
Charity Commission Annual Return in December
Charity Commission Annual Report in December
Charity Commission Accounts in December
Companies House Annual Return in March
Direct Debit 2 in March.
BASP Annual Report and Accounts 2014
This is available on the website.
Charitable activity for 2015
Our financial position is strong enough to support the Warlow and medical student prizes and subsidise BASP members selected to attend the ESO Summer School for the coming year.
March Direct Debit
A small DD run took place in March to accommodate new and returning members. This will complete
the collections for the year to March 2015. The main DD will take place in August 2015. If you notice
from your bank statements that you are paying BASP at any time of year other than March or August,
you should email Trish ([email protected]).
Anthony Pereira
Treasurer, BASP
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TRAINING AND EDUCATION
COMMITTEE UPDATE
The BASP Education & Training Committee
E-Learning Project
have met on 3 occasions, since our last report.
David Collas has been providing Education &
The first day of the UK Stroke Forum this year
Training committee representation upon this
will again be organized by BASP, and the Edu-
Royal College of Physicians working group with
cation & Training Committee are currently com-
the hope that on-line resources will be devel-
piling an exciting programme for you all, encom-
oped for stroke medicine trainees in the near
passing a debate regarding the implementation
future.
of intra-arterial treatment to routine clinical prac-
Other resources
tice in the UK, through to challenging cases, and
post-acute/stroke rehabilitation innovations. We
should be delighted to once again offer the opportunity of voting pads so that audience participation will be encouraged, which will certainly
add great value, particularly with regards to the
in-depth case studies and debate.
E-brain– www.ebrainJNC.com. All BASP
members should have been issued login details,
giving access to over 550 sessions covering a
wide range of clinical neuroscience topics. Ebrain is the largest e-learning programme of its
type. E-brain includes comprehensive modules
on ischaemic and haemorrhagic vascular
disease.
Feedback from Trainees Weekend (20 21/3/15)
UK Forum for Stroke Training – http://ukfst.org/
Stroke Training & Awareness Resources
(STARS) –
Click here to open copy of programme.
http://www.strokecorecompetencies.org/
Feedback from the Trainees meeting was excellent, demonstrating high levels of learning satisfaction, with the venue also scoring highly. Philip Ferdinand, BASP/BGS liaison trainee repre-
David Hargroves
Chair Training and Education Committee
sentative, to organise the 2016 BASP Trainees
Weekend, which will be held in Birmingham
(dates to be confirmed).
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TRAINEES NEWSLETTER
BASP Trainee Weekend
ESO Stroke Summer School 2015
The annual BASP Trainee Weekend took place on
20-21 March 2015 in College Court, Leicester.
The programme was as informative as ever with
an excellent array of internationally recognised
speakers covering the breadth of the stroke curriculum.
Applications are now open for the 2015 ESO
Stroke
Summer School, to be held 24-28 Au-
gust 2015 in Hradec Králové, Czech Republic,
approximately 1 hour south of Prague. The ESO
Summer School is entirely funded by the ESO and
all travel expenses are covered by BASP for successful applicants from the UK. It provides a
ESO / BASP Joint session for young stroke
physicians ESOC 2015
unique opportunity to learn from some of the
greatest stroke minds in Europe at a limited personal financial cost. Speaking from personal ex-
The first conference of the European Stroke Organisation (ESOC) will be held this year in Glasgow, 17-19 April 2015. We are excited to announce a joint session between ESO and BASP,
dedicated to young stroke physicians. The session will be held on Saturday 18th April, 2015
(15:30 – 17:00). Young stroke physicians (<40
years) from across the UK and Europe have submitted abstracts of research protocols or ongoing
perience I cannot recommend attending strongly
enough.
The application deadline is 31 May 2015. Please
see http://mhconsulting.cz/en-kongreskongres_obecne-87.html for further details.
Patricia Fearon,
Trainees Chair
studies. A selected group have been invited to
present their work at this session. Senior experts
in the field of stroke will then comment on the project and invite comments from the audience. We
wish the very best of luck to those who are presenting and would encourage all young stroke
physicians attending the conference to seek out
this session. It is sure to provide some exciting
discussion and offers a fantastic opportunity to
network with other budding stroke physicians from
across Europe.
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SCIENTIFIC COMMITTEE REPORT
First and foremost I would like to thank Cathie
Sudlow, the outgoing chair of the BASP Scien-
Lastly, in case anyone hasn’t seen emails from
tific Committee, for all of her hard work. We al-
the ESO lately, the ESO Conference 2015 is a
so bid farewell to David Werring whose term of
unique opportunity to partake in a top calibre
office ended this year and welcome Nick Ward
scientific programme and discuss various as-
and Mike O’Sullivan to the committee.
pects of the field and profession with leading
internationally renowned specialists. The ESO
Cathie has handed the reins over to me to continue to address the committee’s existing remit:
(1) to lead on stakeholder comments to organi-
is a Pan European society of stroke researchers, national and regional stroke societies committed to scientific excellence by hosting the
sations such as NICE, (2) to contribute on be-
perfect forum for professional collaboration,
half of BASP to the scientific programme for the
networking and sharing of knowledge on the
UK Stroke Forum, and (3) to organise joint
latest research. Further information is available
meetings with other professional groups. If you
here: http://eso.kenes.com/. I hope to see you
have comments about any of these areas then
in Glasgow 17-19 April 2015…
let me know. In view of recent results from the
randomised trials of thrombectomy for acute
ischaemic stroke, I am hopeful that a joint
meeting with BSNR and the College of Emer-
Rustam Al-Shahi Salman
Edinburgh
gency Medicine may arise.
The next year will be an interesting time for the
committee, in view of the reconfiguration of the
Clinical Research Networks. The vision is that
the BASP Scientific Committee will take more
of a role in setting priorities for portfolio development, whilst CRN:stroke will focus on portfolio delivery.
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CLINICAL STANDARDS COMMITTEE
page 8
is a beginning of a new era for hyper-acute care, 20
years after intravenous thrombolysis was first deliv-
Chair: Ajay Bhalla
ered? The implications for the future include identifying
Members: P Gompertz, D Wilson, B Patel, J Barrick, selective patients with large vessel occlusion as quickly
K Harkness, G Subramanian, T Hassan, MR Chowas possible, ensuring there is staffing capacity and exdhury, F Doubal
pertise within specialist centres that can deliver these
Endovascular Therapy
interventions and to ensure that maximum impact can
There has been a ripple of excitement in the stroke
be achieved through centralisation of systems of hypercommunity following the results of MR CLEAN, which
have shown for the first time through a randomised
controlled trial, the benefits of intra-arterial therapy using mechanical thrombectomy over conventional care
with intravenous thrombolysis. However there were
some limitations to this trial and adopting a whole scale
strategy of providing this intervention has a number of
implications around costs, staffing (interventional neuroradiology, vascular technicians, anaesthetists), training and in particular service re-organisation as detailed
in the BASP Endovascular Consensus document. The
clinical standards committee have adopted an approach whereby the results of MR CLEAN should be
acknowledged but not to radically change practice
based on one single trial.
acute care.
The Committee will look towards updating the Endovascular Consensus document in light of the new
emerging trials and BASP has stipulated that patients
should still be encouraged to participate in further randomised controlled trials (i.e. PISTE) to continue to answer uncertainties of benefit and risk, strengthen the
level of evidence, ensure generalisability and estimate
the levels of effect from a health economic perspective.
Data from patients undergoing intra-arterial therapy
should also be entered into recognised national registries i.e. SITS TBY or in the future, SSNAP. For the
moment, patients who have contraindications to intravenous thrombolysis or have failed to respond to intra-
venous thrombolysis then this treatment may be conHowever since the publication of MR CLEAN, two other sidered as long as the service standards described in
randomised controlled studies (EXTEND IA) and
the BASP Endovascular Consensus document are ad(ESCAPE) have recently been published and a further
study (SWIFT PRIME) has reported its findings, although not published yet. The consensus findings from
hered to.
Revalidation for Stroke Physicians
these studies indicate that endovascular therapy leads
The Committee has produced a document setting out a
to early reperfusion, improved functional recovery with
framework of supporting information and resources
no major safety concerns compared with conventional
where applicable to enable stroke physicians meet the
care with intravenous thrombolysis. The studies are
requirement for revalidation. This is currently available
heterogeneous in terms of the imaging modality used
on the BASP website.
(CT angiography, CT and MR perfusion) and there are
still unanswered questions as to what is the most practical strategy deliverable within a modern day health
service. The results of these trials are indeed consistent and are biologically plausible. So what are the
implications and the challenges of implementing this?
Six month Stroke Reviews
The Committee is currently synthesising a consensus
document on this process highlighting the key elements
that need to undertaken to ensure improved national
delivery of this strategy.
Do we have enough evidence and data to suggest this
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Revalidation
The clinical standards group have developed a statement on revalidation which has been published on
the BASP website.
The RCP helpdesk has had fewer requests regarding revalidation which is perhaps expected as the
new process reaches the end of its first cycle. A survey of Responsible officers reported that appraisal
and revalidation is less onerous than had been expected. There have been no specific stroke related
issues which have been asked to comment on.
However a recent report by Plymouth University funded by the Health foundation concluded that the
revalidation process still needed work to ensure consistency in the appraisal process through independent evaluation and more rigorous checks on the evidence used in the appraisal process.
An important area is the use of patient feedback which the RCP revalidation committee is working on
and will be developing support possibly using “Talking pads”.
The Revalidation committee are interested in how we currently assess patient feedback so I would be
interested in your thoughts please e-mail me at [email protected]
Neil Baldwin
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News from Northern Ireland:
1. RQIA report was published late last year and
3.
The N.I. Stroke Conference takes place on
It
the 20th May and an anticipated 250 delegates
commented ‘The review identified some regional
are expected to attend. Details are available on
protocols for service delivery is in place. Howev-
the UK Stroke Forum web-site.
highlighted several areas for improvement.
er, the service could benefit from a greater regional approach and the development of a managed clinical network. At the time of the review,
the recruitment of service improvement leads in
each trust area, offers an opportunity for further
progress in this area’. It also stated ‘Inequality in
access to services was evident in all trusts, between the in-hours and out-of-hours periods.
This related to access to imaging, interpretation
and reporting of images taken, thrombolytic therapy, TIA clinics and AHP therapies’. The report
4.
A meeting involving NIMAST, Prof Tony
Rudd and the N.I. CMO took place in late Nov
outlining the importance of stroke data collection
and ensuring admin support is found to support
this. Prof Rudd outlined the comprehensive data
currently being collected in SSNAP and the fact
that only 1 trust so far in N.I. was contributing. All agreed that all N.I. trusts need support
to contribute to SSNAP.
recommended better and more consistent information gathering which would be helped greatly
Michael Power (NI BASP Exec rep)
by all trusts entering their stroke data onto
SSNAP. The full report is available at
http://www.rqia.org.uk/cms_resources/Review%
20of%20Stroke%20Services%20in%
20Northern%20Ireland%20-%20Report%
20Dec%2014_ISBN.pdf
2.
A regional stroke co-ordinator has been ap-
pointed for an initial period of 2 years and there
has been an initial meeting to discuss how a
stroke network will work in practice. Funding for
‘Stroke improvement’ posts for each trust have
been approved for some trusts with others hopefully to follow. They will report to the regional coordinator. It is anticipated that a steering group
and sub-groups will soon be established to look
at various aspects of the stroke journey.
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Report from England
We have had some wonderful Easter
dependent on FY1s. This will tend to be bigger
weather, but are the storm clouds gather-
teaching trusts, although very few hospitals will
ing?
be entirely immune. Start planning now with
David Cameron has said the NHS will be more
7/7 if his party is elected. On the face of it quite
your Director of Medical Education and Foundation School to lessen the impact.
worrying, but as far as I can gather this applies
We have just appointed our first Physician As-
to those services not already 7/7 and so per-
sistant. These non-medical graduates do a 2
haps we could look out for more laboratory and
year course after their original degree plus or
diagnostics support. Labour promises to spend
minus an independent prescribing course and
more on the NHS and on past form I am sure
with appropriate support they can slot into our
they would.
The Lib-Dems have said some-
understaffed system. Elsewhere, they are al-
thing similar and UKIP would like more-
ready clerking in EDs, so clerking on the hyper-
targeted immigration and have highlighted the
acute stroke unit is already envisaged as is
issue of health tourism.
supporting our Fast Track TIA clinic. Our PA
All of this is unsettling enough, but whatever
happens during the election, there are some
issues we will need to face.
There are not
enough medical staff to deliver a 24/7 service.
In August 2016, the Foundation Schools have
decided that FY1 training needs to be broader.
New rules will be applied to the rotations, such
that two consecutive, acute hospital attach-
has yet to start, so I hope to serialise the experience in my remaining contributions to the
BASP Newsletter.
Considering these two developments together,
it does make me wonder how the next generation of hospital doctors will be trained and I
haven’t even mentioned ‘The Shape of Training’.
ments will not be allowed, they will have to be
But enough about juniors, what about consult-
separated by a community or lab-based disci-
ants? As the ceiling for the total value of pen-
pline. If the books are balanced within FY1 that
sion was dropped once again in the latest
will mean that there will be dramatically fewer
budget, from £1.25m to £1m, expect some ear-
FY1 doctors available on the wards. With a bit
ly retirements to stretch the thin-white line still
of help from your local foundation school you
further. Have a lovely Spring!
could swap community attachments between
Wayne Sunman
FY1 and 2, so that the decrease in FY1 support
will in part be made up by FY2 support. The
Ordinary Member England
impact will be greater in those hospitals more
BASP SPRING NEWSLETTER 2015
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PO Box 259
Wallasey
Merseyside
CH27 9DY
[email protected]
www/basp.ac.uk
The British Association of Stroke Physicians (BASP) was set up in April 1999 to promote better care for people with stroke in the UK. The five objectives of BASP are:
1. Training: Improving and assuring the training of doctors in Stroke Medicine;
2. Research: Promoting and disseminating research in Stroke;
3. Clinical Standards: Leading on clinical standards for Stroke Services and for doctors practising in Stroke Medicine;
4. Policy: Developing and influencing local and national policy for Stroke
Services;
5. Expertise: Providing expert advice to external bodies on all aspects of Stroke
Medicine.
BASP SPRING NEWSLETTER 2015