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www.agmconference.co.uk / Issue 15 / Autumn 2016
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Acute & General Medicine
12 CPD PO ACCREDITINTS BY THE RO ED COLLEGE YAL PHYSICIA OF NS
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How to prevent readmission of the patient with Parkinson’s disease
Latest Cross-specialty training programme
Page 3
We must streamline upper and lower GI bleeds into one single pathway to improve patient outcomes
Pages 4-5
Tackling Sepsis in the NHS requires a culture change
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Less is more in the diagnosis and early management of venous thromboembolism
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Venous thromboembolism (VTE) is the second most common cause of cardiovascular death so it is essential that clinicians working in acute and emergency medicine understand the risk/benefit balance of acute VTE care.
Dr Ron Daniels, Consultant in Critical Care at Heart of England NHS Foundation Trust and CEO of Global Sepsis Alliance NHS England, will provide an update to our delegates on the early identification and management of Sepsis.
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When planning a career, doctors should have a framework for deciding the way forward – in much the same way as they would make a clinical decision, according to Caroline Elton.
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Daniels commented: "Amenable to strategies targeting prevention, early recognition and immediate intervention One of the world's leading experts on with basic care elements, sepsis is one of Sepsis is speaking at Acute & General the biggest causes of preventable death Medicine 2016. Dr Ron Daniels, CEO of in the developed world. the Sepsis Trust and the Global Sepsis Alliance, and Clinical Adviser (Sepsis) to f CONTINUED ON PAGE 2
Career planning: hold a mirror up to yourself then make a plan 16
The talk comes as high profile, new guidance is released by the National Institute for Health and Care Excellence on Sepsis, which all health professionals involved in hospital medicine need to be aware of.
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Sepsis is one of the biggest causes of preventable death in the developed world. With 150,000 cases a year in the NHS and 44,000 deaths, sepsis has to be a critical safety issue for all NHS providers.
This is the view of Dr Dan Horner, Consultant in Emergency and Intensive Care Medicine, Salford Royal NHS Foundation Trust, who will be giving a talk at the Acute & General Medicine conference explaining the harms that can be done through indiscriminate investigations and over diagnosis of small inconsequential thrombi versus the index of suspicion needed to pick up severe disease.
Dr Caroline Elton, Founder, Career Planning for Doctors
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7 ASSESSING AND MANAGING SODIUM BALANCE
He will explain when to investigate how to investigate, when to manage aggressively and how to avoid healthcare associated harm.
8-9 HANDS-ON TRAINING SPECIAL 10 STREAMLINING UPPER AND LOWER GI BLEEDS 11 RED FLAGS AND FALLS: HOW TO SPOT SERIOUS ILLNESS IN FRAIL OLDER PEOPLE 12 TYPE 2 DIABETES MELLITUS IS THE FASTEST GROWING HEALTH THREAT OF OUR TIMES
Delegate bookings:
Martin Houlihan 0207 348 1845 07773 020179 training@closerstillmedia.com
Editorial team:
Francesca Robinson Freelance Journalist
Dr Horner says he will give delegates a modern evidence-based strategy for diagnosing and managing VTE with the patient as a central focus. He will cover current advances in acute diagnostics, anticoagulant options and rapid assessment for ambulatory care. ‘I will be focusing on the concept that less is more and on the importance of using the appropriate diagnostic strategies to try and exclude pulmonary embolism in the acute stage. I will then go on to talk about initial management strategies - what types
j TACKLING SEPSIS IN THE NHS REQUIRES A CULTURE CHANGE "2016 has seen the release of the first NICE Clinical Guideline on Sepsis (CG51), supported at release by a suite of clinical tool its produced by the UK Sepsis Trust to cover the entire spectrum of healthcare."
Contact us: 14 Exhibition House Addison Bridge Place Kensington W14 8XP
Daniels explained that his talk at AGM Conference is an important part of a wider strategy to change the culture around sepsis in the NHS and beyond.
If you're interested in exhibiting:
He said: "To fully embed this across our
Yemi Ibidunni 0207 348 4907 yemi.ibidunni@closerstillmedia.com Organised by:
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Dr Horner co-chairs the VTE committee at Salford and has recently been involved in drafting a new British Thoracic Society guideline on ambulatory management of pulmonary embolism and will be giving delegates an understanding of the recommendations that will be forthcoming in that guideline. Dr Horner says his talk is relevant for all grades of doctor: ‘It is absolutely imperative given the consequences of VTE that all disciplines and grades of doctor have an awareness of the diagnostic and management process of this disease because it is often missed or is not thought about until it is too late or has reached a very severe stage,’ he says.
Dr Dan Horner, Consultant in Emergency and Intensive Care Medicine, Salford Royal NHS Foundation
To hear from Dr Dan Horner at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT after 7th October.
CONTINUED FROM PAGE 1
Mike Broad HospitalDr Editor www.hospitaldr.co.uk
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of clots need treating, what we can use to treat them and how long to treat for. Finally I will talk about the importance of shared decision-making with patients and of articulating the risks and benefits of treatment in a sensible way.’
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Contents
j LESS IS MORE IN THE DIAGNOSIS AND EARLY MANAGEMENT OF VENOUS THROMBOEMBOLISM
www.agmconference.co.uk / Issue 15 / September 2016
Book your pass using discount code BMJ2 via www.agmconference.co.uk/bmjnews and pay £249+VAT before the 7th October
SPONSORSHIP STATEMENT AGM is for healthcare professionals only. The seminars at AGM have been brought to you by Closer2Medical in association with our partners and sponsors. The views and opinions of the speakers are not necessarily those of Closer2Medical or of our partners and sponsors. AGM’s association partners have helped develop the programme. Sponsors have not had any input into the programme except where an individual session states it is sponsored. The session topic and speaker.
healthcare system, we need a cultural change such that health professionals 'think sepsis', coupled with heightened public awareness such that the public ask 'could this be sepsis?' in the context of deterioration in a likely infective illness.
"We urgently need better data to demonstrate and understand outcome improvements, and in particular to track longitudinal progress in recovery to identify the true fiscal burden of disease. We need a Sepsis Registry."
www.agmconference.co.uk / Issue 15 / September 2016
3
How to prevent readmission of the patient with Parkinson’s disease ER
One talk will focus on managing the acutely unwell older patient with Parkinson’s who can present with many challenging complex conditions such as recurrent chest infections, recurrent aspiration pneumonia, confusion or falls.
Dr Thaw Oo will be highlighting the ‘Get it on Time’ approach to medicines management in the Parkinson’s patient which stresses the importance of patients getting the right dose of their medication on time, as soon as they are admitted to hospital, to prevent symptoms such as stiffness or choking.
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Acute & General Medicine conference delegates will be able to attend two important updates on the treatment and management of Parkinson’s disease presented by Dr Moe Thaw Oo, Consultant Physician and Geriatrician in the integrated Parkinson’s disease service at the Sandwell and West Birmingham Hospitals NHS Trust and Honorary Senior Clinical Lecturer at the University of Birmingham.
The second will cover the importance of the integrated care approach for these patients.
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Older people with Parkinson’s disease have higher rates of emergency admission, longer hospital stays and suffer higher inpatient mortality so it is imperative that acute and emergency care physicians can confidently and effectively manage these patients.
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Dr Thaw Oo says it is also important to check whether the patient can take their medication orally and to consider alternative forms of delivering medication such as the patch. He will also discuss how to treat common symptoms of nausea and vomiting, delirium and constipation and which medications are contraindicated. In his second talk on the importance of integrated care for the Parkinson’s patient, Dr Thaw Oo will discuss the need for a multidisciplinary team approach to prevent recurring readmissions and the importance of putting in place integrated long-term care plans based on patients’ before health and social needs discharging patients from the hospital. ‘This talk will be interactive and I will be using case studies to help everyone who is
Dr Moe Thaw Oo, Consultant Physician, Sandwell and West Birmingham Hospitals NHS involved in managing older people in hospital to better understand this condition. This topic is important because Parkinson's disease is a very common condition in older people,’ says Dr Thaw Oo.
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To hear from Dr Moe Thaw Oo at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT.
A 13-year-old patient has an aggressive brain tumour. The majority of doctors in the multi-disciplinary team treating him believe that further aggressive treatment is futile and would cause unnecessary distress and they want to begin palliative care. His parents, who have no other children, are distraught and question whether the hospital is giving up on their son.
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PROGRAMME • TUESDAY 22ND NOVEMBER TIME
THEATRE 1
THEATRE 2
Headaches - send home or admit?
Alcohol in the ED Dr Zul Mirza, Consultant in Emergency
Medicine, Chelsea and Westminster 09:00 Dr Pooja Dassan, Consultant Neurologist, Imperial College Healthcare Hospital NHS Foundation Trust 09:35 NHS Trust and London North West
THEATRE 3 Tricky thyroids Dr Francesca Swords, Consultant in Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust
Healthcare NHS Trust; Honorary Clinical Lecturer at Imperial College
Acute heart failure at the front door
The unconscious patient
Dr David Howell, Consultant in Critical 09:45 Dr Resham Baruah, Heart Failure, Care and Acute Medicine and Clinical 10:20 Cardiomyopathy and Imaging SpR, Royal Lead, AMU, UCL Hospitals Brompton Hospital
GI emergencies
11:00 11:40
Headaches - send home or admit?
Dr Sean Preston, Clinical Lead for Endoscopy and Consultant Gastroenterologist, Barts and the London NHS Trust
Dr Pooja Dassan, Consultant Neurologist, Imperial College Healthcare NHS Trust and London North West Healthcare NHS Trust; Honorary Clinical Lecturer at Imperial College
Session details coming soon
Cancer associated thrombosis
Endocrine emergencies Francesca Swords, Consultant in 13:30 Dr Endocrinology, Norfolk and Norwich 14:05 University Hospitals Foundation Trust
Managing epilepsy
14:15 14:50
Diagnosing and managing IBD Dr Jeremy Sanderson, Consultant Gastroenterologist and Clinical Lead for Gastroenterology, St. Thomas’ Hospital, London
Acute heart failure at the
front door Dr Suzanne O’Sullivan, Consultant in Clinical Neurophysiology and Neurology, Dr Resham Baruah, Heart Failure, Cardiomyopathy and Imaging SpR, Royal UCL Hospitals Foundation Trust Brompton Hospital
Latest advances on acute treatment of stroke
GI emergencies
15:15 Dr Kayvan Khadjooi, Consultant ‘in’ 15:50 Stroke Physician, Cambridge University
Dr Sean Preston, Clinical Lead for Endoscopy and Consultant Gastroenterologist, Barts and the London NHS Trust
Practical guidance on prescribing NOACs to your AF patients in the 16:00 era of reversibility 16:40
Session details coming soon
Hospitals
ECG masterclass 17:05 17:40
Dr Simon Fynn, Consultant Cardiologist and Clinical Director for Cardiology, Papworth Hospital, Cambridge
Understanding arrhythmias Mark O’Neill, Consultant 17:50 Dr Cardiologist and Professor of Cardiac 18:30 Electrophysiology, Guy’s and St Thomas’s NHS Foundation Trust
Melanocortin peptides: Another option for patients with acute gout and multiple comorbidities Dr Dimitrios Daoussis, Asst. Professor of Internal Medicine/Rheumatology, University of Patras Medical School, Greece, Mallinckrodt Specialty Pharmaceuticals Ireland Ltd.
Acute oncology in ED and AMU
Venous thromboembolism – diagnosis and early management
Dr Thomas Newsom-Davis, Consultant Medical Oncologist, Chelsea and Westminster Hospital
Diagnosing and managing IBD
Crime and medicine Dr Philip Zack, Medico-legal adviser, The Medical Defence Union
Alcohol in the ED Dr Zul Mirza, Consultant in Emergency Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
The unconscious patient
Dr David Howell, Consultant in Critical Dr Daniel Horner, Consultant in Care and Acute Medicine and Clinical Emergency and Intensive Care Medicine, Lead of AMU, University College London Salford Royal NHS Foundation Trust Hospitals
Timely, convenient and sensitive: Is point of care troponin testing the future? Professor Rick Body, Professor and Consultant in Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust
Understanding arrhythmias Dr Mark O’Neill, Consultant Cardiologist and Professor of Cardiac Electrophysiology, Guy’s and St Thomas’s NHS Foundation Trust
New therapeutics in diabetes Dr Rupa Ahluwalia, Consultant Endocrinologist, Norfolk and Norwich University Hospitals NHS Foundation Trust
Red flags in geriatrics acute care
Acute oncology in ED and AMU
Dr Suzanne O’Sullivan, Consultant in Dr Jeremy Sanderson, Consultant Clinical Neurophysiology and Neurology, Gastroenterologist and Clinical Lead UCL Hospitals Foundation Trust for Gastroenterology, St. Thomas’ Hospital, London
Dr Thomas Newsom-Davis, Consultant Medical Oncologist, Chelsea & Westminster Hospital
12:40
*Programme accurate at time of print
*Programme accurate at time of print
Professor Simon Noble, Clinical Reader in Palliative Medicine, Cardiff University, 12:00 Honorary Consultant, Royal Gwent Hospital
Managing epilepsy
A 1 RO CCR 2 CP YA ED D P PH L C ITED OIN YS OL B TS ICI LEG Y T AN E HE THEATRE 4 S OF
Stroke prevention in
BOOK BEFORE BOOK BEFORE 7TH OCTOBER 10TH OCTOBERFOR FOR £249+VAT USING £99+VAT USING CODE CODEMDUDM BMJ2 An integrated care approach to the Parkinson’s patient Dr Moe Thaw Oo, Consultant Physician, Sandwell and West Birmingham Hospitals NHS
Anaphylaxis and drug allergies Dr Sophie Farooque, Clinical Lead in Allergy, St Mary’s Hospital, Paddington
New therapeutics in diabetes
atrial fibrillation Dr Jim George, Consultant Physician in Geriatric Medicine, Cumberland Infirmary Dr Kayvan Khadjooi, Consultant in Stroke Medicine, Cambridge University Hospitals
Dr Rupa Ahluwalia, Consultant Endocrinologist, Norfolk and Norwich University Hospitals NHS Foundation Trust
Managing the acutely unwell older Anaphylaxis and drug allergies patient with Parkinson’s disease Dr Sophie Farooque, Clinical Lead in
Venous thromboembolism – diagnosis and early management
Dr Moe Thaw Oo, Consultant Physician, Sandwell and West Birmingham Hospitals NHS
Allergy, St Mary’s Hospital, Paddington
Dr Daniel Horner, Consultant in Emergency and Intensive Care Medicine, Salford Royal NHS Foundation Trust
TIME
THEATRE 1
THEATRE 2
COPD update
THEATRE 3
Transient loss of consciousness
Dr Yee-Ean Ong, Consultant Respiratory Dr Jacob de Wolff MRCP (Acute), Physician, St George’s University Consultant Acute Physician, London 09:00 Hospitals NHS Foundation Trust North West Healthcare NHS Trust
09:35
Early identification of sepsis Dr Ron Daniels, Consultant in Critical Care, Heart of England NHS Foundation 09:45 Trust and CEO at Global Sepsis Alliance
10:20
The deteriorating patient identification and management
THEATRE 4
The deteriorating patient identification and management
The hot joint - how to not get burnt
Toxicology and the post-take ward round
Cross-sectional radiology for Physicians
Dr Spencer Ellis, Consultant Rheumatologist and General Physician, East and North Hertfordshire NHS Trust
Dr Stephen Waring, Consultant Physician, York Teaching Hospitals NHS Foundation Trust
Dr Tristan Barrett, University Lecturer and Honorary NHS Consultant Radiologist, Addenbrooke’s Hospital, University of Cambridge
Delirium – identification, management and prevention
Session details coming soon
Quick guide to assessing and managing the main disorders of potassium and sodium balance
Dr Richard Breeze, Consultant Intensivist Dr Chris Thom, Consultant General and Elderly Care Physician, Maidstone and Tunbridge Wells NHS Trust NHS Trust
Session details coming soon
Acute respiratory presentations
Session details coming soon 14:15 14:50
Professor Sunil Bhandari, Consultant Nephrologist/Honorary Clinical Professor, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School
Making a difference in clinical leadership
Early identification of sepsis
Dr Darren A Kilroy, Deputy Medical Director, East Cheshire NHS Trust
12:00 12:40
Dr Omar Usmani, Clinical Senior Lecturer and Consultant Physician, National 13:30 Heart and Lung Institute, Imperial 14:05 College London & Royal Brompton Hospital
Dr Stephen Waring, Consultant
CXR interpretation tips for Clinicians
Dr James Edwards, Acute Medicine Consultant, Norfolk and Norwich University Hospitals NHS Foundation Trust
Dr Tristan Barrett, University Lecturer and Honorary NHS Consultant Radiologist, Addenbrooke’s Hospital, University of Cambridge
Session details coming soon
Echo at the front door interesting cases
CKD: managing complications in the breathless patient
Dr Sarb Clare, Clinical Lead Acute Medicine, Consultant Acute Medicine, SWBH NHS Trust
Dr Mark Thomas, Consultant Physician and Nephrologist, Heart of England NHS Foundation Trust
Quick guide to assessing and managing the main disorders of potassium and sodium balance
Transient loss of consciousness
Session details coming soon
Acute respiratory presentations
Professor, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School
The patient with chest pain 16:30
CKD: managing complications in the breathless patient
Dr Jacob de Wolff MRCP(Acute), Consultant Acute Physician, London North West Healthcare NHS Trust
Dr Omar Usmani, Clinical Senior Lecturer and Consultant Physician, National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital
15:15 Physician, York Teaching Hospitals NHS Professor Sunil Bhandari, Consultant Nephrologist/Honorary Clinical 15:50 Foundation Trust
Dr Sarb Clare, Clinical Lead Acute Medicine, Consultant Acute Medicine, 15:55 SWBH NHS Trust
Dr Ron Daniels, Consultant in Critical Care, Heart of England NHS Foundation Trust and CEO at Global Sepsis Alliance
Adult safeguarding - what are my reponsibilities?
BOOK BEFORE 7TH OCTOBER FOR £249+VAT USING CODE BMJ2 Toxicology and the post-take ward round
Delirium – identification, management and prevention
Dr Richard Breeze, Consultant Intensivist Dr Chris Thom, Consultant General and and Anaesthetist, Clinical Director of Elderly Care Physician, Maidstone and Critical Care, Lewisham and Greenwich Tunbridge Wells NHS Trust NHS Trust
11:00 and Anaesthetist, Clinical Director of 11:40 Critical Care, Lewisham and Greenwich
Session sponsored by Pfizer
R E DE S EA REA N J R INC SIO BM ICE TEN PR EX
PROGRAMME • WEDNESDAY 23RD NOVEMBER
The hot joint - how to not get burnt
MCA/DOLS - when and how?
Dr Mark Thomas, Consultant Physician Dr Spencer Ellis, Consultant and Nephrologist, Heart of England NHS Rheumatologist and General Physician, Foundation Trust, and chair of NICE’s East and North Hertfordshire NHS Trust AKI Guideline Development Group
Dr James Edwards, Acute Medicine Consultant, Norfolk and Norwich University Hospitals NHS Foundation Trust *Programme accurate at time of print
MIX AND MATCH STREAMS TO CREATE YOUR TAILOR-MADE CLINICAL PROGRAMME: CARDIOLOGY DIABETES & ENDOCRINOLOGY
RESPIRATORY MEDICINE CRITICAL CARE
EMERGENCY MEDICINE
HOT TOPICS
RHEUMATOLOGY
CAREER DEVELOPMENT
NEUROLOGY
NEPHROLOGY
ACUTE MEDICINE
GASTROENTEROLOGY
ELDERLY MEDICINE
MMEDICAL ESSENTIALS PROGRAMME Junior and foundation year doctors and senior clinical nurses can benefit from a dedicated programme: TIME
TUESDAY 22ND NOVEMBER
TIME
WEDNESDAY 23RD NOVEMBER
EXTRA TRAINING FOR TRAINING FOR FINAL YEAR FINAL YEAR STUDENTS AND STUDENTS AND FOUNDATION FOUNDATION DOCTORS DOCTORS
Interpretation and management of arterial blood gas 09:45 Dr Yee Ean Ong, Consultant Respiratory Physician, St George’s 10:20 University Hospitals NHS Foundation Trust
09:00 Diabetes - what you need to know on-call Dr Rupa Ahluwalia, Consultant Endocrinologist, Norfolk and Norwich 09:35 University Hospitals NHS Foundation Trust
Planning your future career in medicine 13:30 Dr Caroline Elton, Founder, CPD (Career Planning for Doctors/Dentists) 14:05
09:45 The neurological examination Dr Indira Natarajan, Consultant Stroke Physician and Clinical Director 10:20 Neurosciences, University Hospitals of North Midlands NHS Trust
Falls and ‘off legs’ - where do you start? 14:15 Dr Jim George, Consultant Physician in Geriatric Medicine, Cumberland 14:50 Infirmary
11:00 What to do if you’re involved in an SUI Dr Sally Old, Medico-legal adviser, 11:35 The Medical Defence Union
ECGs - a beginners guide 16:00 Dr Simon Fynn, Consultant Cardiologist and Clinical Director for 16:40 Cardiology, Papworth Hospital, Cambridge
13:30 Getting to grips with emergency medicine Dr Darren A Kilroy, Deputy Medical Director, East Cheshire NHS Trust 14:05
Advanced communication skills 17:05 Dr Mike Roddis, Former Consultant Pathologist and Director, 17:40 MJ Roddis Associates
14:15 Understanding fluid balance Dr Richard Breeze, Consultant Intensivist and Anaesthetist, Clinical 14:50 Director of Critical Care, Lewisham and Greenwich NHS Trust
BOOKBEFORE BEFORE10TH 7TH OCTOBER BOOK OCTOBER FOR £99+VAT USING CODE MDUDM FOR £249+VAT USING CODE BMJ2
STREAM KEY
CARDIOLOGY CRITICAL CARE
15:55 Improving your consultation skills Dr Kishan Rees, Clinical Teaching Fellow and Reading for a Masters in 16:30 Medical Education, The University of Nottingham
RESPIRATORY MEDICINE CAREER DEVELOPMENT
EMERGENCY MEDICINE DIABETES & ENDOCRINOLOGY NEUROLOGY ELDERLY MEDICINE
FULL CAREER DEVELOPMENT PROGRAMME TO BE LAUNCHED IN THE AUTUMN! FEATURING: TIME
TUESDAY 22ND NOVEMBER
Management and governance in acute hospital care: 12:45 structures and performance Professor Ian Kirkpatrick, Monash Warwick Professor of Healthcare 13:05 Improvement & Implementation Science, Warwick Business School
TIME
WEDNESDAY 23RD NOVEMBER
Digital health: rethinking health services 13:10 Professor Eivor Oborn, Professor of Healthcare Management, 13:30 Warwick Business School
PATIENT FIRST HIGHLIGHTS Acute & General Medicine delegates have complete access to the UK’s leading patient safety conference, Patient First, with dedicated theatres covering everything from strategy to leadership with case-study led workshops. These are just some of the sessions from Patient First: TIME
TUESDAY 22ND NOVEMBER
Leadership, teamwork,communication: Foundation of Safety 11:15 Programme Akerele, Director of Programmes, Change & Performance Management, 11:55 Ronke Imperial College Health Partners 13:30 14:10
Session delivered by Jim Mackey, Chief Executive, NHS Improvement
New care models: what they mean for safety 14:20 Samantha Jones, Director, New Care Models programme, Five Year Forward View 15:20 Malte Gerhold, Interim Executive Director of Strategy & Intelligence, Care Quality Commission
Effectiveness of antibiotics in treating sepsis: 14:30 research update Ron Daniels, CEO, UK Sepsis Trust and Global Sepsis Alliance an Clinical 15:05 Dr Adviser, NHS England
TIME
Patient First is located alongside Acute & General Medicine and is free for all delegates to attend
WEDNESDAY 23RD NOVEMBER
CQC inspection: Protecting patients and encouraging improvement 09:55 Professor Sir Mike Richards, Chief Inspector of Hospitals, CQC 10:40 11:15 11:45
Discharge, transfers and transitions of care: work of the PSC cluster Cheryl Crocker, Regional Lead EMAHSN PSC; Honorary Associate Professor, University Of Nottingham, East Midlands Academic Health Science Network
Learning from fatal claims 15:30 Helen Vernon, Chief Executive, NHS Litigation Authority and 16:30 The Chief Investigator, Healthcare Safety Investigation Branch (to be appointed)
VIEW THE FULL PATIENT FIRST PROGRAMME VIA WWW.PATIENTFIRSTUK.COM
www.agmconference.co.uk / Issue 15 / September 2016
7
What can be confusing for junior doctors is that there is still some controversy over how to manage hyponatraemia. American guidelines differ from European guidelines
Professor Bhandari, who will be giving a talk at the Acute & General Medicine conference on assessing and managing sodium balance, says the topic is important because disorders of sodium balance are common, representing about 7% of all hospital admissions. ‘Also it is clear from the literature that there is an association between low blood sodium and morbidity and mortality,’ he says. ‘I will aim to demystify delegates’ understanding of what causes hyponatraemia and give them a simple algorithm for how to diagnose it. I will then cover what options are available to monitor and then to treat it,’ says Professor Bhandari. ‘The first thing I want delegates to take home is that disorders of salt balance are really disorders of water balance – that is critical to know. When you see a patient the first thing you need to do is make an assessment of their hydration status. ‘Are they
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‘When I was a junior doctor it was one of the most feared things to treat because you could do a lot of damage if you didn't do it right.’
and sometimes the disorder is treated differently by different specialties.
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Hyponatraemia must be recognised quickly and treated appropriately in hospital otherwise it can cause devastating problems such as irreversible brain damage, says Sunil Bhandari, consultant nephrologist at Hull and East Yorkshire Hospitals NHS Trust and an honorary Clinical Professor at the Hull York Medical School.
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Assessing and managing sodium balance: the importance of getting it right dehydrated because they have got lowsodium or because they are losing both salt and water for example when they have diarrhoea? Or are they over hydrated so there is water overload and they may have heart or kidney failure which is treated very differently from dehydration? ‘The most complex patients to treat are those in the uvolemic group - they appear to have fluid balance yet their salt is low. I will talk about how we investigate this group because that is the one that most people get wrong,’ says Professor Bhandari.
Dr Sunil Bhandari, Consultant Nephrologist/Honorary Clinical Professor, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School
To hear from Dr Sunil Bhandari at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT after 7th October.
MORE THAN DEFENCE
j CAREER PLANNING: HOLD A MIRROR UP TO YOURSELF THEN MAKE A PLAN CONTINUED FROM PAGE 1
A career coach and psychologist, Dr Elton says sometimes doctors fail to do this and end up in jobs that they either don’t find interesting or to which they are not particularly well suited. “What I often say to doctors is that when you have to make a clinical decision you have a process – you start with a history, then examine the patient, if necessary carry out some tests or investigations, and only then make a diagnosis and come up with a treatment plan. “In a similar way when you're facing a career decision you need to think about it in a structured way. You need to hold a mirror up to yourself and do some really thorough self-assessment, next you need to look at your options, then you make a decision then finally you get round to implementing your career. This latter stages consists of building your CV, filling out application forms and preparing for interviews. Dr Elton says the doctors who come to her for career support, often do the equivalent of the treatment plan backwards; whilst they typically spend a lot of time worrying about their CV or interview preparation
they often don’t spend enough time thinking about themselves or thoroughly investigating what the different career options might be like. Dr Elton who set up the Careers Unit at London Deanery and who founded CPD – Career Planning for Doctors in 2014, will be giving a talk at Acute & General Medicine which will include a detailed breakdown of the four stages that doctors need to review, when faced with a career decision. “Sometimes the career mistakes doctors make can be extraordinary - I often think of client who in psychometric tests could not rotate visual images yet ended up in radiology or the client who chose paediatrics, despite it being the only specialty she had failed at medical school. Similarly, many doctors choose general practice because of its flexibility but they don’t adequately consider whether they are well suited to core features of the work such as short appointment times or having to have a working knowledge of all bodily systems. Dr Elton says people come to her at all stages in their careers (from medical school through to post-CCT) and she says it is never too late for doctors who are unhappy in their jobs to undergo a thorough assessment and then work out how they can make changes that will enhance their satisfaction at work.
To receive career guidance directly from Caroline Elton at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT after 7th October.
PRACTISE WITH CONFIDENCE WE’RE ON YOUR SIDE We understand you’re working in an increasingly challenging and high-risk environment, with greater workloads and regulatory pressures. Medical Protection is here to help you practise with confidence – knowing that even with all the responsibilities you carry and the decisions you have to make, you have world-class protection behind you. This means doing much more than robustly defending you, should your reputation ever be called into question. Because we believe prevention is always better than cure, we’re here to offer more advice on how to anticipate and avoid complaints or claims occurring in the first place. And we also provide an unrivalled range of support for your professional development.
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www.agmconference.co.uk / Issue 15 / September 2016
SPECIAL FEATURE: Optimise your learning opportunities with hands-on training at Acute & General Medicine.
Delegates attending Acute & General Medicine 2016 can combine both seminarbased learning with an extended hands-on training programme, across a range of practical workshops – providing a unique learning experience. Whether you’re experienced or need to brush-up on your knowledge, the handson training workshops will be the perfect way to practice your skills and you will come away from the conference with fact-based and practical new skills you can implement straight way. Non-Invasive Ventilation, Ultrasound and ECG skills training is available to all delegates as part of their conference package.
NON-INVASIVE VENTILATION TRAINING Experience hands on application of NIV for respiratory failure. Sessions in the Non-Invasive Ventilation workshop area will consider presenting issues in Type I and Type II Respiratory Failure and the requirements for setting up NIV for each of these scenarios. Set up will include interface (mask) type and application followed by the setting of appropriate pressures and support levels from the equipment, with a short presentation before the practical element begins. Considerations will include: 1. Contraindications 2. Troubleshooting 3. Assessment of efficiency of the NIV and weaning Delegates should expect to have an increased awareness of the setting and troubleshooting of NIV following the sessions as well as an appreciation of the pressures and back up settings required for different patient groups and the Phillips team will be on hand to answer any questions to maximise the learning experience. Training sponsored by:
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www.agmconference.co.uk / Issue 15 / September 2016
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INTERACTIVE WORKSHOPS ULTRASOUND TRAINING The Ultrasound Skills Training area will be presented by experienced Consultant Emergency Physicians who are highly skilled in bedside ultrasound of the acutely ill. You'll be guided through seven demonstration stations, covering predominantly critical care and emergency medicine scenarios where you'll learn new techniques that can be put to use immediately back on the wards. You will be given the supervision and guidance while performing the following scans:
✔ Internal Jugular & basilica vein identification and lung scan ✔ Aortic scan ✔ Practical session for intravenous catheterisation ✔ Echocardiography ✔ IVC scan and diameter measurement ✔ TIA scans ✔ DVT Vascular scans ✔ Basic Cardiac Echo scans
ECG TRAINING Training will be run by Dr Simon Fynn, Consultant Cardiologist and Clinical Director for Cardiology, Papworth Hospital, Cambridge and will involve beginner, intermediate and expert sessions on interpreting ECGs as well as refining hands-on skills on taking an ECG. Nihon Kohden will be demonstrating synEci 18, a new technology to derive the waveforms of the right chest leads (V3R, V4R, V5R) and back leads (V7, V8, V9) from the standard 12-lead ECG measurement procedure.
Time to improve the ECG training offered to juniors Junior doctors are not receiving sufficient formal training in ECG interpretation, warns the Clinic Director of Cardiology at Papworth Hospital.
Training sponsored by:
Nihon Kohden is Japan’s largest medical device company renowned the world over for innovation, reliability and engineering quality. We have been manufacturing medical devices for more than 60 years and supplying hospitals around the world with advanced medical equipment. Our product range focuses on, cardiology (ECG equipment and defibrillators), patient monitoring and neurology (EEG, EMG and EP). Nihon Kohden Uk Ltd 0208 391 6800 Trident Court 118, 1 Oakcroft Road, Chessington, Surrey, KT9 1BD Email: info@nihonkohden.co.uk Website: www.nihonkohden.net
Dr Simon Fynn, Consultant Cardiologist, calls on training programmes to improve their approach to ECGs, with too many junior doctors learning about ECGs informally, on-the-job. Fynn said: “The electrocardiogram has stood the test of time as an important diagnostic test for patients. This is the case not only for patients presenting with cardiac symptoms but a wide range of other types of conditions. “Given this, and I am sure to much surprise, it remains the case that junior doctors do not undergo any formal training in ECG interpretation during their training.” He says that the importance of correct ECG interpretation can be life-saving. Similarly, he explains, in less 'urgent' situations, it can mean the difference between an accurate diagnosis and the correct treatment or inappropriate hospital admission and unnecessary investigations.
Training sponsored by:
Modern ECG machines offer interpretation as well as measurement. But Fynn warns that while there have been improvements, the computer-generated interpretation at the top of the ECG still cannot be exclusively relied upon. Furthermore, faxing it to the local cardiology department can result in unwanted delay. Areas of essential training Dr Fynn would like to see introduced include interpretation of ‘normal variants’, 24-hour ECG recordings and how to spot artefact. When training juniors, Dr Fynn also covers rhythm abnormalities in detail. Starting with the recognition of AF, broad and narrow complex tachycardias and heart block.
Sm mooth h transsitions to en nhanc h e patiient i t care a Because a every breath matters and each h one is different, patie ents need a ventila ator that always fol o lows their breatthing patte ern, whatever theiir acuity. With adv vanced breath delivery livery technol nology and algorithms designed to maximize perforrmance in a leak prone environment, our V60 ven v tilator adapts to each of your o patients’ ventilation l needs.
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Dr Fynn will be speaking at Acute & General Medicine 2016 on ECG Interpretation, and running workshops. He said: “The aim of the sessions I run on ECG interpretation is to give junior doctors - and sometimes consultants - more confidence when approaching the ECG, whilst hopefully making it interesting and fun at the same time!”
To hear from Dr Simon Fynn at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjn ews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT.
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www.agmconference.co.uk / Issue 15 / September 2016
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We must streamline upper and lower GI bleeds into one single pathway to improve patient outcomes A report by NCEPOD has set new standards for looking after people with gastrointestinal (GI) bleeding. The report, called Gastrointestinal Haemorrhage: Time to Get Control?, found that there are still significant opportunities to improve the care of patients with gastrointestinal bleeding. The most striking findings of this study were that the organisation of GI bleeding services remain patchy and lacks co-ordination. Many hospitals do not have the facilities or staffing to deliver comprehensive care both during and out-of-hours. As a result, many patients received inappropriate treatment whilst waiting for definitive control of bleeding.
The NCEPOD report identified 31,412 patients who had experienced a gastrointestinal bleed during a 4-month period in 2013. It looked at a group of patients with more severe bleeding and found that 15% of patients received 4 or more units of blood. From these, a random sample of over 1,000 patients were reviewed. The report suggests 9% of patients were given medical treatment that our reviewers felt was unnecessary and 25% were given blood products that could have been avoided. The influential report recommends that the artificial separation of upper and lower gastrointestinal bleeding should be stopped. And, to achieve this, each hospital should appoint a Lead Clinician for GI bleeds to take responsibility for the management of patients with upper and lower GI bleeding.
It also calls on clinicians to develop pathways for patients with GI bleeds that identify patients early who require specialist input from GI bleed experts ensuring timely early investigation and treatment of bleeding. This service should include 24/7 access to a specialist, GI bleed service, endoscopy, IR and surgery. Sean Preston, Consultant Dr Gastroenterologist and Director of Endoscopy at Barts and the London NHS Trust is speaking at Acute & General Medicine 2016 on the topic of GI bleeds. He commented: “The NCEPOD report highlights deficiencies in the diagnosis and treatment of GI haemorrhage, particularly out of hours. It is imperative that the necessary resources are provided to allow patients access to 24/7 high quality endoscopy.
Sean Preston “The streamlining of upper and lower GI bleeds into one single pathway will undoubtedly lead to faster diagnosis and treatment, with improved patient outcomes.” Where deficiencies exist hospitals should develop joint networks with neighbouring hospitals, the report concludes.
To hear from Dr Sean Preston at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT after 7th October.
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T. +44(0)1908 357900 W. www.interactmedical.co.uk E. info@interactmedical.co.uk
Interact Medical, an award winning recruitment agency specialising in the placement of Locum Doctors, AHPs and Agency Nurses across the NHS and Private Sectors, are proud to exhibit at this year’s AGM conference. Interact Medical guarantees to offer you flexible contracts in a variety of roles in support of your career on a full time, part time or adhoc basis. Come and meet us at stand E55, to discuss how you can benefit from access to over 1 million jobs annually from a market leading recruitment company. Specialist recruiters will be on hand at the AGM to guide you through the process of registration ahead of placement opportunities across all national framework agreements.
Visit our website and register with us!
www.interactmedical.co.uk Or contact us for more details: +44(0)1908 357900
Best practice in heart failure Acute heart failure is the number one cause of hospitalisation in the over 65's; one in 10 patients will decease within 30 days after hospitalisation and 30% will decease in a year. ‘This is a big health issue so it is really important that people receive the correct treatment for their underlying problem once the initial panic has subsided in the emergency department,’ says Dr Resham Baruah, Heart Failure, Cardiomyopathy and Imaging Specialist Registrar, Royal Brompton Hospital. Dr Baruah will be giving a talk at the Acute & General Medicine conference on the
Come and meet Interact Medical at this year’s Acute & General Medicine Conference 22-23 November 2016 - ExCeL London
Stand
E55
presentation and management of acute heart failure. ‘The key to changing things for these people long-term is correct management once they've left the emergency department and are in the general or acute medical ward or ideally a specialist dedicated acute heart failure unit,’ she says. Heart failure is a chronic progressive condition which usually presents in people in their late seventies who have had a previous heart attack. Although there is no cure there is plenty of medication that if given early on can stop the disease progressing and extend people’s lives by up to a third. ‘People can live with heart failure and have a good quality of life. About one third of patients will recover completely, one third stay the same and one third will deteriorate,’ says Dr Baruah. In addition to talking about the diagnosis and management of the common cases of heart failure Dr Baruah will talk about some of the more extreme cases. She will explain some of the advanced heart failure therapies that can be used such as mechanical ventricular assist devices, ECMO (Extracorporeal membrane oxygenation) and transplantation. She will also talk about rarer cases of heart failure in younger people. ‘It is hard to diagnose heart failure in a young person. However the stakes are very high because if it is picked up early it is possible these patients will make a full recovery,’ says Baruah.
To hear from Dr Resham Baruah at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT after 7th October.
Book before 7th October for just £249+VAT using discount code BMJ2 before the rate increases to £299+VAT
www.agmconference.co.uk / Issue 15 / September 2016
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Are GPs Paying Too Much For Indemnity Insurance? Tawhid Juneja, MD Primary Care People. Primary Care People are passionate about the NHS and healthcare in the UK. We believe we have one of the best healthcare systems in the world and by working with GPs for the past 3 yearss our respect and admiration for them knows no bounds. At Primary Care People we talk to GPs every day, which gives us the most up to date information on what is happening and how GPs are feeling. There are a number of reasons why there is a severe shortage of GPs in the NHS, including overwhelming workloads, a shortage of doctors wanting to become GPs, underfunded Primary Care services and the indemnity cost to a GP for just being able to practice. Some GPs have been quoted as much as £30,000pa to include out of hours cover and many incur a yearly increase of 25% in
their policies. It has been reported that indemnity costs in Scotland are one third of what it would cost in England so many GPs who live in the northern UK border regions are practicing in Scotland instead. A GP at the LMC Conference said that on moving from Scotland to England his indemnity fees rose by 500% for the same level of cover. While the MDDUS claim that their fees are competitive, they defend rising costs by stating that GPs in England are 3 times more likely to have claims against them, with higher value claims in England than in Scotland. Operating as not for profit organisations, MDOs justify their increasing subscription fees by having to pay out larger compensation claims. With fewer GPs available for out of hours cover inevitably hospital A&E departments are crammed with non urgent cases, creating long waiting times and urgent cases not getting the immediate attention that they need. While the NHS is trying various schemes to solve the indemnity
insurance problem, out of hours cover remains in crisis. One GP, who only works out of hours and who has not had any formal proceedings against her has seen the cost of her indemnity insurance rise from £8,000 to 4 times as much in just 2 years. All GPs are affected by prohibitive insurance policy costs, not just the much smaller percentage who have to make a claim. There have also been assertions by unnamed GPs that just calling an MDO helpline for advice without even making a claim has seen the cost of their next policy soar.
Tawhid Juneja, MD Primary Care People indemnity insurance. For more information about this extraordinary new development, visit www.primarycarepeople.co.uk/insurance MEET WITH PRIMARY CARE PEOPLE ON STAND F80 AT ACUTE & GENERAL MEDICINE
Primary Care People has researched and studied the market for two years and has now resourced a unique indemnity insurance policy, covering in hours and out of hours care, which is available totally free of charge to all of its GP candidates. We have ensured that the policy has the same level of cover that GPs have in their current
Red flags and falls: how to spot serious illness in frail older people
‘These elderly patients are frail and this makes them more vulnerable and a relatively minor illness can tip the balance. But if doctors can pick up that illness then you can make a big difference to get them back to normal ‘Without a doubt junior doctors on call often miss these symptoms and there is a lot of evidence that these older patients wait longer for diagnostic tests such as ECGs and treatment. However the results of treatment
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Frequently missed diagnoses are syncope, delirium, sepsis, depression and acute kidney injury. Red flags include falls, confusion, weight loss and loss of mobility.
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The problem is frail older people often present to medical admission units with nonspecific symptoms such as falls, becoming confused, becoming less mobile and just being generally unwell. So Dr George will be giving a talk at the Acute & General Medicine conference on red flags in geriatric acute care and why these symptoms should be taken seriously.
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Clinical indicators of serious illness in frail older people presenting to medical admission units can be easily overlooked by the busy acute physician, according to Dr Jim George, Consultant Physician in Geriatric Medicine, Cumberland Infirmary, Carlisle.
Dr Jim George, Consultant Physician in Geriatric Medicine, Cumberland Infirmary, Carlisle of older people can often be just as good if not better than in younger people. ‘So it's about being able to identify serious illness and the red flags in older people which might be a fall or just becoming a bit more confused or not being able to walk quite so well,’ says Dr George. He will also be giving a second talk called ‘Falls and off legs, where do you start?’. Frail elderly patients present to hospital in atypical ways. A common presentation is a fall or ‘off legs’ with non-specific decline. One study found that around 40% of frail elderly patients (mean age 80 years) presented to acute medical services in this way and these patients had worse outcomes. In this talk Dr George will describe a simple clinical approach to tackling these common presentations in the elderly in order not to miss serious underlying acute illness.
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FujiFilm SonoSite Back in the days when ultrasound machines weighed hundreds of pounds, and were neither easy to use nor readily available outside of radiology departments, a few intrepid physicians frustrated by their desire to get the earliest diagnosis and treatment to their patients, began to break down the barriers. Clearly, the refrigerator-sized machines they were using weren’t the solution. They needed an ultrasound device they could actually take to the patient. They understood that if more physicians could gain access to this device, more patients would receive better care. When no other manufacturer gave this group of maverick clinicians a chance, SonoSite stepped up. In 1996, and still a part of ATL Ultrasound, a team secured funding from DARPA (Defense Advanced Research Projects Agency) to develop a digital machine from the ground up, specifically for frontline physicians. From the beginning, SonoSite’s greatest source of inspiration has been the doctors, clinicians and healthcare providers who constantly seek better patient care. This collaborative process underpins everything we do, and has yielded the most extraordinary technological innovations.
For experienced clinicians and for first time users, this is ultrasound technology evolving the way it’s needed: a fast learning curve, no hindrance to diagnosis, no distraction from patient care. Giving clinicians the educational resources to use ultrasound with the highest degree of confidence is a key principle for us. As communications and connectivity broaden, so too does access to the knowledge base between SonoSite and clinical educators worldwide. Webinars and online data interface with each medical speciality; hands-on programs and workshops bring EDUCATION on site. And the SonoAccess app opens direct support to each user, pointing the way to an ever widening dissemination of ultrasound’s best practices. TODAY, SONOSITE LEADS THE MARKET… Our machines have come from a collaboration between us and the people who use them. The way they work in every clinical setting – the emergency room, the first response, the bedside diagnosis – it’s the way users want them to work, the way patients need them to work.
www.agmconference.co.uk / Issue 15 / September 2016
Type 2 Diabetes Mellitus is the fastest growing health threat of our times Nearly 3.5 million people have been diagnosed with diabetes in the UK. Approximately 6 million people are at high risk of developing T2DM, with as many as 11.9 million at increased risk. To tackle the challenge there has been a significant growth in the therapeutics available. Beyond the tried and tested metformin and thiazides, inhaled insulins were introduced and then withdrawn amid concerns over respiratory toxicity.
We call them our pillars, the foundations underpinning everything we do to get the best ultrasound machines in your hands, today, tomorrow and onwards.
Then a new class of drugs were launched – called the thiazolidinediones – and lauded as insulin sensitizers. But reports of bladder cancer, increased mortality and fluid retention seriously reduced their utility. Glucosidase inhibitors also seemed to promise great things but their GI side effects were so severe that they have yet to find a place in routine use.
Simon Collinge UK Marketing Manager
More recently, there has been a plethora of new agents targeting the incretin pathway.
DURABILITY, RELIABILITY, EASE OF USE, EDUCATION –
VISIT FUJIFILM SONOSITE ON STAND H35 AT ACUTE & GENERAL MEDICINE 2016
Enticingly, the oral gliptins (DPP4 inhibitors) and injectable ‘tides’ (incretin mimetics) both offer the promise of weight control, though concerns remain about possible pancreatic toxicity. Similarly, the gliplozins (SGLT2 inhibitors) promise increased urinary excretion of the glucose we eat, but with concerns around renal damage and increased urinary infections. Dr Rupa Ahluwalia, consultant endocrinologist at the Norfolk and Norwich Foundation Trust, and speaker at AGM Conference 2016, commented: “The landscape of type 2 diabetes is changing and we now have a rapidly evolving armamentarium of drugs to choose from. “However, use of these drugs warrants caution as well as careful selection for personalised therapy. As physicians, we all are bound to look after patients with T2DM, more so than ever. Therefore, it’s extremely important for all doctors to be familiar with the ‘do’s and don’ts’ around newer agents in T2DM.”
To hear from Dr Ahluwalia at Acute & General Medicine, claim your discounted conference pass at www.agmconference.co.uk/bmjnews and use discount code BMJ2 to pay just £249+VAT before the rate increases to £299+VAT.
Our first mission was to create an ultrasound machine so tough and so efficient that it could be carried into battle. From the beginning, DURABILITY has been a central demand in all of our designs. The concept was simple: get life-saving treatment to trauma victims within the first 60 minutes of injury. The solution? An ultrasound system that clinicians could easily use for time-critical diagnosis under the most grueling conditions. The early breakthroughs in portability and imaging established a key driver in the development of every SonoSite system: RELIABILITY. With an overriding need to get the right answers and the right diagnostic data whenever needed, SonoSite machines have always been designed to work in the most extreme conditions. Day in, day out. As each new generation of SonoSite devices comes to the mainstream, every machine holds to a basic requirement: fast, simple controls to get the right information easily. While functionality and the sophistication of diagnostic data constantly increases, the user interface stays intuitive.
The Warwick Executive MBA with Healthcare Specialism Are you looking to gain the skills and confidence you need to become a leader in the increasingly challenging healthcare industry? Whether you’re a clinician on the frontline under pressure to deliver effective results for patients, or a manager required to provide efficient services under tight budgets, our Executive MBA with Healthcare Specialism will help you develop your general leadership capabilities and your sector-specific knowledge.
The programme
Complete flexibility
You will initially study eight required modules, giving you the foundations to become an effective business leader, followed by three specialist healthcare modules designed to tailor your knowledge to your personal career needs and the demands of your industry. You can also undertake a consultancy project with a healthcare focus, supervised by an appropriate member of our experienced faculty, to fully consolidate your learning.
We understand the rigours of balancing work, family and further study into your lifestyle. That’s why we offer a truly flexible approach. You can complete our Executive MBA at the University of Warwick campus in 3 years, or take just 2 years to complete the programme at WBS London, The Shard. You can also choose to spread out your studies over a period of up to five years if that works for you.
Funding
Meet us
Get up to 50% off the total programme fee with our Healthcare Scholarship, awarded to exceptional candidates.
Hear from leading WBS academics specialising in healthcare research, Professor Eivor Oborn and Professor Ian Kirkpatrick, at the Acute and General Medicine conference from 22–23 November 2016 at ExCel London.
T +44 (0)24 7652 4100
E warwickmba@wbs.ac.uk
W wbs.ac.uk/go/AGM2016
EASE OF USE dictates the entire user experience.
Book before 7th October for just £249+VAT using discount code BMJ2 before the rate increases to £299+VAT