Acute & General Medicine Issue 5

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AGM moves to a new home

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Registration for the best value medical training event is now open

The findings are published in a report called Hospital Workforce: Fit for the Future? which warns that the workload of the medical registrar is now at crisis point.

The number of patients requiring general medicine skills is increasing with the ageing population but in 2011 it was not possible to fill 50% of consultant posts advertised in geriatric medicine. Teaching hospitals fared better than district general hospitals (DGH).

Hospital doctors from across the country, from all grades and specialties are welcomed back to the second year of the cost-effective Acute & General Medicine conference.

Acute & General Medicine conference will offer up to the minute expert clinical training across even more specialty areas, bringing delegates more essential practical training to help meet revalidation requirements.

The RCP says with medical registrars being the backbone of any hospital delivering acute care, urgent action is needed.

More than a third (37%) of trainee physicians described the workload of the medical registrar as ‘unmanageable’ and 59% described it as ‘heavy’.

One registrar said: ‘I had 30 patients to review. It was a ridiculous number. I was unsafe….’ Another said: ‘We are already working 200% of our capacity; we haven’t got enough flexibility. The biggest problem is massive workload.’

In addition the report claims that the training of registrars in general medicine is highly variable and is too often compromised by the heavy workload.

Only 38% of registrars felt that their training in general medicine was good or excellent compared to 75% in their main specialty.

These problems are compounded by an uneven distribution of senior specialist doctors across the country, with London having almost double the number of consultants per head of population compared to the East Midlands.

Dr John Firth Sarah Logan, medical registrar and report author, said: ‘Medical registrars are struggling up and down the country to provide good care to patients. Instead of facilitating this, too often the system makes this difficult to achieve. Changes within hospitals, such as improved staffing deployment would help. Crucially, the out-of-hours workload in particular must be better shared across the wider clinical team.’

Dr John Firth, consultant nephrologist and deputy medical director at Addenbrooke’s Hospital, Cambridge, who is speaking at the Acute and General Medicine conference, said: ‘There are issues about the way hospitals work out of hours that we need to change. For a whole raft of reasons, the pressure is increasingly focussed on the medical registrar, who – despite working incredibly hard – can feel that they are blamed for all the system’s deficiencies (and actually are blamed by some ignoramuses).

Continued on page 9

Acute & General Medicine 2013 provides hospital doctors from all grades and specialties, high quality, easy to access training, essential to their everyday practices for only £99+VAT. Call the delegate team now to secure your early bird ticket on 0207 348 4906.

Clinicians need more training to recognise confusion and acute delirium Confusion and acute delirium is a common presenting symptom in older patients with serious illness in hospital but despite being more common than taking an overdose, having a seizure, fits or a GI bleed, it is often poorly managed or missed entirely.

This was one of the findings of the first inquiry by Robert Francis QC into care provided by Mid Staffordshire NHS Trust.

He found that some clinicians did not understand the diagnosis

of acute confusional state and its importance and in some instances treated it as ‘bad behaviour’ rather than as a valid medical condition.

The condition was also in the news recently when the journalist and commentator David Aaronovitch wrote vividly about it in The Times after he suffered from intensive care delirium when complications set in after a routine operation.

Continued on page 2

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Medical registrars are struggling under such heavy workloads that patient care is at risk, reveals a survey by the Royal College of Physicians (RCP).

It recommends that a greater proportion of doctors are trained in the skills of emergency, general, acute and geriatric medicine; the hospital workforce must be reorganised to meet the need of frail elderly patients; and, the role of the medical registrar must be reassessed with their skills used more efficiently to better meet patients’ needs, particularly in DGHs.

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Main Sponsor:

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Book now for the early bird price of £99 +VAT for two days of accredited education and practical skills training delivered by expert speakers.

See page 3 for the most up-to-date conference programme and speaker details.

New for 2013!

The AGM speaker programme has been developed to include even more clinical streams including: nn Gastroenterology nn Rheumatology nn Nephrology nn Haematology NEW! nn Cardiology nn Medical Essentials NEW! nn Hot Topics nn Respiratory Medicine nn Elderly Medicine NEW! nn Neurology nn Diabetes & Endocrinology Visit www.agmconference.co.uk or call the delegate team on 0207 348 4906 to book your early bird ticket today.

Follow us on Twitter: @AGMConfUK Like us on Facebook: facebook.com/AGMConference

Join us on LinkedIn: linkedin.com/groups?gid=4867623

AGM is moving to a brand new location at London’s Excel where delegates will experience a better equipped conference with new and improved features. See page 5 more details.

Page 2 Main sponsor

AGM is organised by Closer2 Medical Ltd, part of the CloserStill family.

Unit 17, Exhibition House, Addison Bridge Place, London W14 8XP www.agmconference.co.uk Tel: 0207 348 5250

Mitchell Ingram – Business Development m.ingram@closerstillmedia.com

Michael Seaman - Group Event Director m.seaman@closerstillmedia.com

Delegate team training@closerstillmedia.com

Daniel Harding - Event Executive d.harding@closerstillmedia.com

Sophie Holt - Group Marketing Manager s.holt@closerstillmedia.com

Mike Broad – Programme director m.broad@closerstillmedia.com

Sarah Bray – Marketing Assistant s.bray@closerstillmedia.com

Liz Sanders – Business development manager l.sanders@closerstillmedia.com

Julia Danmeri - Head of operations j.danmeri@closerstillmedia.com

Yemi Ibidunni - Business Development y.ibidunni@closerstillmedia.com

Kate Jackson – Conference and speaker manager kate.jackson@closerstillmedia.com

Clinicians need more training to recognise confusion and acute delirium Continued from Page 1

This publicity which is raising awareness of the condition is welcomed by Dr Jim George, consultant physician in elderly care medicine at North Cumbria University Hospitals NHS Trust, who is giving a talk on confusion and acute delirium at the Acute and General Medicine conference.

The first Francis report recommended that doctors and nurses should be given more training to enable them to recognise confusion and delirium. The more recent Francis report also shone a spotlight on the care given to frail older people and the need for compassionate person-centred care.

‘Two thirds of people in acute hospitals are over 65 and around two thirds of those patients have a mental health disorder as a well as a physical disorder which might be delirium depression or dementia. It’s a growing problem with more and more older people,’ says Dr George.

‘Junior doctors and nurses don’t always recognise the condition.

But it’s not just to do with them not having enough training and education, it’s also about the complete separation of psychiatric illness from medical illness while they are training. So doctors and nurses go into one specialty or the other and never the twain meet whereas in older people you tend to get medical and mental illness both together.

‘So if somebody becomes agitated, a bit aggressive, difficult to engage with and may be having visual hallucinations or paranoid delusions, the immediate thought for junior doctors is they must have a psychiatric illness. But actually these are the symptoms you can get when physical illness affects the patient cognitively.’

NICE guidance, a care pathway and early warning scores are, says Dr George, beginning to make a difference to the diagnosis and management of confusion and acute delirium. His talk at AGM on 28th November at 12.25 will provide an insight into how to treat the underlying causes of this condition and how to provide supportive management.

Dr Jim George will speak at AGM on the 28th November at 12.25

Dr. Jim George

Sponsorship statement AGM is for healthcare professionals only. The seminars at AGM have been brought to you by Closer2 Medical in association with our partners and sponsors. The views and opinions of the speakers are not necessarily those of Closer2 Medical 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 have been developed by each sponsoring company.

Page 3

Conference programme

Speakers

Wednesday 27th November Strand 1

Strand 2

Strand 3

Strand 4

Registration Sponsored Breakfast Symposium Neurology Dr Rob Simister Strokes

Gastroenterology Dr Lotte Dinesen Upper GI bleed

Cardiology Prof Adam Timmis Acute Coronary Syndrome

Diabetes & Endocrinology Dr Fancesca Swords Endocrine emergencies

Neurology Dr Fayyaz Ahmed Epilepsy

Gastroenterology Dr Sean Preston IBD

Cardiology Dr Suzanna Hardman Atrial Fibrillation

Diabetes & Endocrinology Dr Jeremy Turner Diabetic emergencies

Neurology seminar sponsored by Bayer

Gastroenterology Seminar sponsored by Abbott Diarrhoea in children

Cardiology Seminar sponsored by Menarini Atrial Fibrillation

Diabetes Session sponsored by Bayer

Cardiology Prof Adam Timmis Acute Coronary Syndrome

Gastroenterology Dr William Bernal Cirrhosis and ICU

Neurology Dr Paul Davies Acute headaches

Hot Topics Dr Stephen Waring Poisoning and overdose

Cardiology Prof Andrew Clark Acute Heart Failure

Hot Topics Dr Kevin Jones Admissions avoidance through AC

Hot Topics Dr Ross Welch Managing the pregnant patient

Haematology New anticoagulants

Hot Topics Dr Victoria Johnston Fever in the returning patient

Diabetes & Endocrinology Dr Fancesca Swords Endocrine emergencies

Neurology Dr Fayyaz Ahmed Epilepsy

Gastroenterology Dr Lotte Dinesen Upper GI Bleed

Cardiology Dr Suzanna Hardman Atrial Fibrillation

Diabetes & Endocrinology Dr Jeremy Turner Diabetic emergencies

Neurology Dr Rob Simister Strokes

Gastroenterology Dr Sean Preston IBD

Cardiology Seminar sponsored by Bayer

Sponsored Session

Sponsored Session

Accredited session

Neurology Dr Paul Davies Acute Headaches

Hot Topics Dr Stephen Waring Poisoning and overdose

Cardiology Prof Andrew Clark Acute Heart Failure

Gastroenterology Dr William Bernal Cirrhosis and ICU

Hot Topics Dr Ross Welch Managing the pregnant patient

Hot Topics Dr Victoria Johnston Fever in the returning patient

Haematology Prof Mike Laffan New anticoagulants

Hot topics Dr Kevin Jones Admissions avoidance through AC

Dr Fayyaz Ahmed

Dr Paul Davies

Dr Ross Welch

Dr Stephen Waring

Prof Andrew Clark

Prof Adam Timmis

Dr Suzanna Hardman

Dr Sean Preston

Prof Mike Laffan

Dr Fancesca Swords

Dr Jim George

Dr Helen May

Dr Catherine Urch

Dr Simon Flynn

Prof Emma Baker

Dr Andrew Menzies-Gow

Dr Sam Janes

Dr John Firth

Dr Mark Thomas

Dr Peter Topham

Prof John Isaacs

Morning Break

Lunch Break

Afternoon Break

Close

Thursday 28th November Strand 1

Strand 2

Strand 3

Strand 4

Registration Sponsored Breakfast Symposium Elderly Medicine Dr Catherine Urch End of life care

Respiratory Dr Andrew Menzies-Gow Acute severe asthma

Medical Essentials Dr Fayyaz Ahmed Neurological examination

Rheumatology Prof Raashid Luqmani Managing the hot joint

Elderly Medicine Dr Helen May Off legs

Respiratory Dr Sam Janes The breathless patient

Medical Essentials Dr Simon Fynn Demystifying difficult ECGs

Nephrology Dr John Firth Accelerated/malignant hypertension

Sponsored Session

Respiratory Seminar sponsored by Chiesi

Medical Essentials Seminar sponsored by Bayer

Accredited session

Respiratory Prof Emma Baker COPD

Nephrology Dr Mark Thomas Acute Kidney Injury

Elderly Medicine Dr Helen May Off legs

Rheumatology Prof John Isaacs Update on RA

Respiratory Dr Andrew Menzies-Gow Acute severe asthma

Nephrology Dr Peter Topham Sodium & potassium disorders

Elderly Medicine Dr Jim George Confusion and acute deliriums

Medical Essentials Dr Paras Dalal Chest X-rays

Medical Essentials Dr Fayyaz Ahmed Neurological examination

Medical Essentials Dr Paras Dalal Chest X-rays

Medical Essentials Dr Simon Fynn Demystifying difficult ECGs

Nephrology Dr Peter Topham Sodium & potassium disorders

Respiratory Dr Sam Janes The breathless patient

Rheumatology Prof Raashid Luqmani Managing the hot joint

Elderly Medicine Dr Catherine Urch End of life care

Nephrology Dr John Firth Accelerated/malignant hypertension

Sponsored Session

Sponsored Session

Neurology Seminar sponsored by Bayer

Accredited session

Respiratory Prof Emma Baker COPD

Nephrology Dr Mark Thomas Acute Kidney Injury

Morning Break

Lunch Break

Afternoon Break Elderly Medicine Dr Jim George Confusion and acute delirium

Rheumatology Prof John Isaacs Update on RA Close

Acute & General Medicine 2013 Highlights NEW for 2013! The AGM Bookshop

Simulation Lab

Delegates will receive excellent deals on the latest medical publications at the new AGM Bookshop. Purchase pioneering publications at exclusive discounts from the leading medical publishers.

The popular Simulation Lab is returning to AGM this year but promises to be bigger and better. AGM’s relocation to Excel will accommodate for a larger area for more delegates to take part in key life-saving skills training provided by the Advanced Life Support Group.

New for 2013! Masterclass: Use of non-invasive ventilation for acute respiratory disease Integral tools training for acute physicians in non-invasive ventilation (NIV) procedures. Hands-on practical sessions will cover everything there is to know about NIV including management of the machines, modes, circuits and interfaces; when to initiate NIV, dealing with complications and weaning patients off NIV - all from a doctor’s perspective.

Hospital Directions AGM delegates have complimentary entry to Hospital Directions conference with exclusive access to the expert speaker programme including key sessions on clinical leadership and important updates on structural reforms in the NHS.

AGM provides delegates with a onestop-shop for all of their medical training needs. Book your place now to take advantage of the limited early bird rate of £99+VAT and receive regular updates on the speaker programme and special events at the conference.

Call the delegate team now on 0207 348 4906 or book online at www.agmconference.co.uk

Page 4 Main sponsor

New best practice tariff announced for rheumatoid arthritis A new best practice tariff for early inflammatory arthritis, including rheumatoid arthritis, is being introduced to incentivise hospitals to provide early, intense treatment for thousands of people with the disease.

Experts have welcomed the tariff which could help rheumatologists to prevent permanent pain and disability for sufferers.

From April people who develop inflammatory arthritis should expect to be seen by a rheumatologist within three weeks of a GP referral, receive their diagnosis and start treatment within six weeks of a GP referral and have regular review appointments with their specialist until their arthritis is adequately controlled.

British Society for Rheumatology President Dr Chris Deighton said: ‘This is an exciting opportunity to further embed the principles of improving clinical outcomes within the

recommended timeframes for treatments including diseasemodifying anti-rheumatic drug (DMARD) therapy and biologics.

There is existing wide variation in treatment and outcomes, for example the National Audit 2009 found only 10% of patients are put onto DMARDs within three months of symptom onset in spite of NICE guidelines.’

John Isaacs, Professor of Clinical Rheumatology at Newcastle University, and consultant rheumatologist at the Freeman Hospital, who will be giving a talk at the Acute and General Medicine conference on 28th November at 11.50 on the latest treatments for rheumatoid arthritis, said: ‘The tariff should make a difference. It’s aimed at hospital trusts to ensure they have the right infrastructure in place with sufficient resource to enable rheumatoid arthritis patients to be seen quickly and expediently, and managed well. This provides the patients with the optimal chance of achieving disease remission, thereby preventing joint damage and disability.’

Prof John Isaacs

Leading expert to deliver update on rheumatoid arthritis

Control fluid, control diarrhoea Hidrasec specifically targets the uncontrolled secretory processes that underlie acute diarrhoea, reducing stool output and diarrhoea duration. And because it’s licensed in infants older than 3 months, Hidrasec, together with oral rehydration solution, provides rapid control for even your smallest patients.1-5

An update on the latest developments in diagnosis and treatments for rheumatoid arthritis (RA) will be the subject of talk at the Acute and General Medicine conference by Professor John Isaacs, a leading expert on the disease.

Professor of Clinical Rheumatology and Director of the Wilson Horne Immunotherapy Centre at Newcastle University, and consultant rheumatologist at the Freeman Hospital, John Isaacs has for the last 20 years focused his research on the potential of novel immunotherapies to treat RA. He has performed several pioneering translational studies in patients with inflammatory disease, challenging existing dogma and informing the design of subsequent generations of therapeutic agents.

His talk will bring attendees up to date on the new biological treatments which include the TNF-alpha inhibitors (etanercept, infliximab, adalimumab, certolizumab, rituximab, abatacept and tocilizumab) and the latest diagnostic tests.

Professor Isaacs says: ‘There is little disagreement that these drugs are effective - they are more potent than existing therapies, and so general physicians need to understand how they work, what their side effects are and what they need to watch out for when they encounter a patient who is taking one of these drugs.

Presentations: Hidrasec Infants 10 mg granules for oral suspension: Each sachet contains 10 mg of racecadotril.

Hidrasec Children 30 mg granules for oral suspension: Each sachet contains 30 mg of racecadotril.

Hidrasec 100 mg hard capsules: Each capsule contains 100 mg of racecadotril.

Indication: Sachets: Complementary symptomatic treatment of acute diarrhoea in infants (older than 3 months) and in children together with oral rehydration and the usual support measures, when these measures alone are insufficient to control the clinical condition, and when causal treatment is not possible. If causal treatment is possible, racecadotril can be administered as complementary treatment.

Capsules: Hidrasec is indicated for the symptomatic treatment of acute diarrhoea in adults when causal treatment is not possible. If causal treatment is possible, racecadotril can be administered as a complementary treatment.

Dosage and Administration: Paediatrics (from 3 months): Hidrasec granules are administered via the oral route, together with oral rehydration.

The recommended dose is determined according to body weight: 1.5 mg/kg per administration, three times daily. Infant less than 9kg: one 10 mg sachet 3 times daily. In infants from 9 kg to 13 kg: two 10 mg sachets 3 times daily. In children from 13 kg to 27 kg: one 30mg sachet 3 times daily. In children of more than 27 kg: two 30mg sachet 3 times daily. The duration of treatment in the clinical trials with children was 5 days. Treatment should be continued until two normal stools are recorded. Treatment duration should not exceed 7 days. Hidrasec should not be used in patients younger than 3 months of age as there is no data available.

Adults: One capsule initially, regardless of the time of day.

Then one capsule three times daily preferably before the main meals. Treatment duration should not exceed 7 days.

Contraindications: Hypersensitivity to racecadotril, or to any of the excipients.

Due to the presence of sucrose, Hidrasec Infants and Hidrasec Children are contraindicated in patients with fructose intolerance, glucose malabsorption syndrome, and saccharaseisomaltase deficiency.

Precautions and Warnings: The administration of Hidrasec does not modify the usual rehydration regimens. It is essential for the child to drink abundant liquids.

The presence of bloody, or purulent stools, and fever may indicate the presence of invasive bacteria as a reason for diarrhoea, or the presence of other severe disease. Also racecadotril has not been tested in antibiotic-associated diarrhoea and should therefore, not be administered under these conditions.

Chronic diarrhoea has not been sufficiently studied with Hidrasec. In patients with diabetes, it should be taken into account that each sachet of Hidrasec Infants contains 0.966 g of sucrose and each sachet of Hidrasec Children contains 2.899g of sucrose. The product must not be administered to children with renal or liver impairment, whatever the degree of severity, due to a lack of information on these patient populations and caution should be shown in adult patients due to limited data.

Do not administer in cases of prolonged or uncontrolled vomiting due to the possible reduced bioavailability.

Hidrasec hard capsules contain lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption should not take Hidrasec capsules.

Interactions: No interactions with other active substances have been described in humans to date. In humans, joint treatment with racecadotril and loperamide, or nifuroxazide does not modify the kinetics of racecadotril.

Side-effects: Headache (100mg capsules only), erythema multiforme, tongue oedema, face oedema, lip oedema, urticaria, tonsillitis, papular rash, prurigo, pruritus, eyelid oedema, angioedema, erythema nodosum and toxic skin eruption. In paediatric patients the nature of the safety profile is similar to that seen in adults.

Prescribers should consult the summary of product characteristics for further information on side effects.

Pregnancy and lactation: Due to a lack of clinical data, racecadotril should not be administered to pregnant or breastfeeding women.

Legal category: POM Marketing Authorisation Holder: Bioprojet Europe Ltd. 29 Earlsfort Terrace, Dublin 2, Ireland.

Marketing Authorisation numbers/presentations: Hidrasec Infants 10mg granules for oral suspension (each box contains 20 sachets) PL 39418/0001 Cost: £8.42.

Hidrasec Children 30mg granules for oral suspension (each box contains 20 sachets) PL 39418/0002 Cost: £8.42.

Hidrasec 100mg Hard Capsules (each box contains 20 capsules) PL 39418/0003 Cost: £8.42.

Further information is available from Abbott Healthcare Products Ltd, Mansbridge Road, West End, Southampton, SO18 3JD. Date of revision of PI: January 2013 PI/Hidrasec/006 1.

2.

3.

4.

5.

Hodges K. Gut Microbes 2010;1:4-21.

Cezard JP et al. Gastroenterology 2001;120:799-805.

Hidrasec UK SmPC 10mg (January 2013).

Hidrasec UK SmPC 30mg (January 2013).

Hidrasec UK SmPC 100mg (January 2013).

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.

Adverse events should also be reported to Abbott by phone: 0800 121 8267.

AHHID120460e. Date of preparation: February 2013.

HGFX0069.AHHID120460e Abbott Advert Hidrasec.indd 1

22/2/13 17:03:01

‘I will also talk about rheumatoid arthritis in general because it’s a disease where people can now live a normal life. Rheumatology is not taught well in medical school so some clinicians have a distorted view of the RA patient as somebody who is wheelchair bound with a poor quality of life. It’s very, very different now.’

Professor Isaacs says his talk will be aimed at general physicians but will be relevant for almost any secondary care clinicians. RA affects 1 in 100 people and he says clinicians will sometimes see new arthritis patients in the acute hospital setting; it is essential for them to recognise the disease so that it can be referred and treated early. Early identification and intensive treatment are the keys to remission induction and prevention of joint damage and disability.

To watch Professor Isaacs seminar at AGM for the early bird price of £99+VAT, visit www.agmconference.co.uk or call 0207 348 4906.

Page 5

Acute & General Medicine relocates Laughter is the to a new world class venue best medicine

Excel hosted the 2012 London Olympics The success of the inaugural Acute & General Medicine conference in 2012 has prompted its relocation to London Excel for 2013.

Over 4000 hospital doctors and NHS managers are expected to attend the 2013 event. Excel will provide the additional space and facilities to create a first-class delegate experience, whilst keeping the event on a single floor for ease of movement.

First class delegate experience The new layout will provide more theatre capacity, improved acoustics and additional networking and catering areas. The popular simulation lab has also been expanded to allow more delegates to take advantage of the hands-on training in key life-saving techniques provided by the Advanced Life Support Group (ALSG).

A new location creates opportunities for the conference to develop and will provide the platform for a new addition to the conference – Private Practice (see page 12 for more details).

There will also be more opportunity for shared networking, with healthcare leadership content to challenge and inspire clinicians and NHS managers alike.

Group event director Mike Seaman says: “Feedback from the 2012 launch event told us that delegates found the programme content hugely valuable, but that we could do more to improve

Excel London’s buzzing boulevard their experience at the event. The new venue allows us to put a number of initiatives in place that will ensure that nothing detracts from the learning and networking opportunities available for the doctors and hospital managers who attend.”

World class venue Delegates will be familiar with Excel from its role in the 2012 Olympics and other high profile events such as Sports Personality of the Year. In addition to world-class conference facilities, the venue is surrounded by ample leisure facilities including Europe’s largest indoor shopping village and plenty of nearby restaurants and hotels.

If the content and venue wasn’t impressive enough, the diverse ways to travel makes Acute & General Medicine’s new home even more attractive. Delegates are invited to fly in on the Emirates Air Line Cable Car, catch a high speed Thames Clipper, the revamped Jubilee line, or take advantage of the new Javelin rail service from Kings Cross.

Delegates who prefer to travel by car are also well catered for with parking for over 3000 cars and easy access from the M23 and M11.

Book your early bird to ticket to AGM at its brand new location by visiting www.agmconference.co.uk or call 0207 348 4906.

The new oral anticoagulants - Dabigatran, Rivaroxaban and Apixaban - are licensed to replace warfarin for stroke prevention in atrial fibrillation (AF) and Rivaroxaban has a license for the treatment and management of Deep Vein Thrombosis and Pulmonary Embolism. But are they safe and effective?

But some of the drawbacks are that they are more dependent on renal function for elimination, there is no reliable way of reversing their effect and they have a relatively short half-life and these vary between the medications. They are also more expensive than warfarin based on drug acquisition costs.

In the first two years after these novel drugs were licensed for use in America, patients in 25 per cent of consultations for AF were switched from warfarin to a novel agent. However Professor Laffan says their uptake in the UK is likely to be slower. He predicts that their use for AF will creep in gradually but will become prevalent in time.

A chest physician and lead consultant in acute medicine at the Royal Bolton Hospital, Dr Jones, who has been described by critics as ‘one of the wittiest after dinner speakers in the UK today’, has been practising what he describes as his ‘lucrative hobby’ for 30 years.

He gives talks at over 70 dinners a year, many within the corporate world, captivating his audiences with humorous tales and one-liners about the dark side of medicine as seen through the eyes of a hospital consultant.

He qualified in medicine from Liverpool University in 1977 and during his career has worked on the heartlung transplant team at Papworth Hospital and at St Bartholomew’s Hospital. His experience provides him with a fund of stories about acute medicine, transplantation and dealing with death, illness and dying.

‘What I loved about this guy was that while he was in the middle of a song he just started to slowly pitch forward and as he fell he banged his head on my table. Later, when he had recovered, I said to him: ‘Did you realise that at that point you were dying – what were your last thoughts?’

Instead of screaming for help or for his Maker – he told me that his last thought was, ‘What’s going on here then?’

Michael Laffan, Professor of Haemostasis and Thrombosis at Imperial College London, will be answering this question in a talk on this novel class of drugs at Acute and General Medicine 2013.

The main common indication for these novel medications is for stroke prevention in AF. The benefits are that they are easy to use, are predictable, do not require INR monitoring and have much less interaction with other drugs and the patient’s diet.

Dr Kevin Jones’ talk on admissions avoidance through ambulatory care will, he promises, be peppered with humour and anecdotes, something that comes naturally to him as a highly successful after dinner speaker.

The funniest incident he says he is famous for is the true story about the night he gave life-saving resuscitation to jazz singer Roy Crawford who keeled over and had a cardiac arrest in front of him while he was having a drink in a pub.

The new oral anticoagulants: will they replace warfarin?

Professor Laffan is director of the Hammersmith Hospital Haemophilia centre, a member of The British Committee for Standards in Haematology and has sat on some of the NICE panels which have scrutinised the cost effectiveness of these drugs.

Dr Kevin Jones

‘I thought what a marvellous thing to be thinking as you die – it’s completely taken away my fear of death. That episode made me very famous in Bolton for a short while.’

Prof Michael Laffan The novel oral anticoagulants are also likely to become a preferred choice for people who have had venous thrombosis because they avoid the need for initiation with heparin and the subsequent transition to warfarin. However there is little evidence yet that they will be effective for some other indications such as prophylaxis after heart attacks or for use in people with heart valves.

Professor Laffan says: ‘My talk will be aimed at cardiologists, haematologists and GPs who currently use warfarin and are wondering whether their patients would be better off on the novel oral anticoagulants. It’s very important people understand the properties of these drugs and all their pros and cons so they can make those decisions.’

Professor Michael Laffan wil speak at AGM on the 27th November at 17.10.

Dr Jones admits that being a consultant is many times more stressful than doing a stand-up comedy routine.

‘Although you’re nervous before you get up it’s only for a few minutes until you get into your stride. They say there are two things people are frightened of – death and public speaking and I talk about both.’

Dr Jones promises that there will be humour in his talk about reversing the unsustainable rise in hospital admissions with effective ambulatory care, a subject which he is passionate about.

‘It will be all-singing all-dancing multimedia extravaganza of a talk’, he says - with his tongue firmly in his cheek.

Dr Kevin Jones will be speaking at AGM on 27th November at 12.30.

Page 6 Main sponsor

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AGM delegates have access to Hospital Directions conference at no extra cost!

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APPRAISAL & REVALIDATION LIVE

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Exhibition Floorplan

CATERING

Look at who’ll be exhibiting at Acute & General Medicine and Hospital Directions 2013

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RIS Esaote Products UK

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• Specialists in Elderly Care • Intensivists

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AGM & Hospital Directions is relocating to Excel London with improved facilities, see page 5 for more details

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Plan not to scale and subject to change.

Correct at the time of print.

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Contact us now for bookings call Dan Harding on 02

Acute & General Medicine is home to the biggest secondary care event in the UK, sitting alongside Hospital Directions, it will deliver two days of clinical training to senior hospital doctors and managers looking to network with key suppliers to the NHS. New to 2013, Private Practice is the national event for clinicians looking to grow their private practice.

Page 7

2013 FLOORPLAN me: £329pm2 and Space: £319pm2*

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ENTRANCE 14

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= Available stands *plus VAT

Do you sell to hospitals? Interested in exhibiting at Acute & General Medicine or Hospital Directions?

2476Stand 719682 or email HD@closerstillmedia.com / AGM@closerstillmedia.com space is limited but still available, contact the sales team to reserve a prime location, discuss extra marketing activities we can provide and find out how you can meet thousands of potential end users.

For more information please contact a member of the team on 0207 348 4907 or email agm@closerstillmedia.com

Page 8 Main sponsor

Francis report: All doctors working in acute medicine should make safe and compassionate care a priority

Doctors working in acute medicine should carefully read the report of the inquiry into failings at Mid Staffordshire NHS Trust because its recommendations have direct relevance to their work.

deanery systems of quality management and failed to consider patient safety standards. When concerns were raised about inappropriate pressure or bullying by staff towards trainees these were not followed up or investigated.

This is the advice of the Society for Acute Medicine which says acute medical units play a key role in providing high quality, safe and compassionate care for patients admitted to hospital in an emergency.

The report sets out a raft of recommendations for ensuring that medical education and training systems in future enhance patient safety. It says students and trainees should not be placed in hospitals which do not comply with patient safety standards.

‘All staff working in acute medicine must continue to make this their priority. This report highlights the need for all health care practitioners to examine their practice to ensure that lessons are learned and changes are made so that these failings are never repeated,’ said a spokesman.

Another of the 290 recommendations directly impacting on doctors is a requirement for all healthcare provider organisations to develop and publish real time information on the performance of their consultants and specialist teams in relation to mortality, morbidity, outcome and patient satisfaction, and on the performance of each team and their services against a set of fundamental standards.

The report, by Robert Francis QC, blamed an ‘insidious negative culture’ for years of poor care between 2005 and 2009. It recommends new laws requiring doctors and other health professionals to be open and truthful when mistakes have occurred. It calls for a ‘duty of candour’ to be imposed on doctors to report incidents that have caused ‘death or serious injury’ as soon as possible.

It also recommends that it should become a criminal offence for a doctor to mislead a patient or relative about any harm that has been caused, lie to a regulator or a commissioner or obstruct anyone else from raising concerns.

Francis says too many consultants at Mid Staffs kept their heads down instead of speaking out when things went wrong and failed to take a lead in promoting change.

The report scrutinises the system of regulation and oversight of medical training and education in place between 2005 and 2009 which failed to detect any concerns about the trust.

The former Postgraduate Medical Education and Training Board, GMC and deanery wide reviews focused only on

Following publication of the report NHS medical director Sir Bruce Keogh NHS medical director has launched a review of 14 acute trusts which have recorded higher than expected mortality rates for two successive years. A new Chief Inspector of Hospitals is expected to be appointed by the Care Quality Commission later this year to check whether hospitals are clean, safe and caring.

The GMC has investigated 42 doctors from Mid-Staffs; 22 doctors have received formal letters advising them about their future conduct, one has accepted restrictions on their practice, and a further 8 are subject to ongoing active investigation, 4 of whom are due to appear shortly before a public hearing. If they are found guilty, there will be sanctions including the possible loss of their registration.

In a statement Francis said: ‘We need a patient centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership and caring, compassionate nursing, and useful and accurate information about services.’

The profession’s response: Professor Paul Knight, President, British Geriatrics Society: ‘Many of the failings in care described in the report affected old and vulnerable patients. Policy, regulatory, organisational, funding and professional lessons must be learnt. There must be an immediate focus on what we know will improve quality. Central to this is the need for health professionals to demonstrate clinical leadership. They should be advocating for patients and their carers, challenging poor practice and embodying good practice. No doctor or nurse should assume that failings in basic care, safety or dignity are someone else’s problem and all should speak out when they see neglect or poor care. This extends to clinicians in senior leadership roles in hospitals who should have a clear focus on the care delivered on wards and experienced by patients and their families.’

Sir Richard Thompson, President, Royal College of Physicians: ‘Patientsafetyandqualityimprovementisasharedresponsibility between healthcare professionals, managers and others working across the system. The RCP is committed to continuing our leadership role in ensuring doctors take responsibility for holistic care, not just diagnosis and treatment, and all care must be compassionate.’

Dr Neil Dewhurst, President, Royal College of Physicians of Edinburgh: ‘Let us be under no illusion that the problems encountered in Mid Staffordshire were a localised, or isolated, happening.

Page 9

Hospital doctors need more training in emergency and general medicine to improve patient care Continued from Page 1

We need to think which routine jobs really need to be done by doctors out of hours, and which can be done by other members of staff. We need to think how we can best integrate medical registrars (and CMTs and FYs, and consultants) with specialist outreach nurses from ICU’s to best manage deteriorating patients.

‘At Addenbrooke’s as in many other hospitals we are reviewing our arrangements. Even if we wanted to stand still – which we don’t – we couldn’t because with reductions in the number of trainees expected in the years ahead it will not be possible to continue with existing rotas.’

Connect with delegates at Acute and General Medicine Join Connect to access 2012 conference presentations and ample networking opportunities.

The Acute & General Medicine Connect platform provides delegates with all the education content from the 2012 conference, including clinical training and hot topics from our expert speakers to help doctors with revalidation needs.

The useful networking platform proved itself invaluable with 2012 delegates, allowing them to set their own agenda as well as connect with colleagues and fellow delegates from across the country.

Receive all the medical training from the 2012 conference whilst creating your own bespoke 2013 programme and arrange meetings with like-minded colleagues.

Book now to get instant access to presentations and book your free lunch at AGM 2013.

Find out more at www.agmconference.co.uk

Dr Ben Molyneux chair of the BMA’s junior doctors committee warned that if hospitals weren’t redesigned to ensure that frontline service delivery did not fall disproportionately on registrars the next generation of consultants would avoid careers in the acute medical specialties.

But Dean Royles, chief executive of the NHS Employers organisation, said the report ignored the debate that was needed over seven day working by consultants. ‘If consultant level doctors in all medical fields embraced out-of-hours shifts, it would go a long way towards ensuring there are enough experienced doctors available at all times, and that registrars were being well trained and supervised,’ he said.

The contributing circumstances have the potential for this to occur in any hospital under pressure, and leave no room for complacency. The lessons learned here are too important to ignore, must be acted upon and result in cultural change to avoid repetition.’

The Academy of Medical Royal Colleges: ‘We believe that poor care is not everywhere in the NHS but has the potential to happen anywhere. Many doctors will have had experience of aspects of what happened at Mid Staffordshire.

Within organisations which in overall terms provide a good standard of care there can be departments, wards or teams where standards fall below what is acceptable.’

Laura will help you land the job you want.

After almost a decade with us, Laura will jump at the chance to find you roles as fulfilling as hers. Share your ambitions with her and she’ll know how to help you reach those new heights.

Or to simply make sure you get more out of doing what you do best. At HCL Doctors, every member of our recruitment team is as focused as Laura on keeping your career flying high. So get in touch. You’ll only land the jobs you want with us.

Professor Norman Williams, President , Royal College of Surgeons: ‘We are now preparing for the publication of surgeons’ results later this year and welcome the report’s commitment to the publication of proper outcome data which is publicly funded.

The surgical profession believes this will help reduce mortality rates through greater scrutiny, drive down poor performance and ultimately empower patients. But there is still a long way to go. We are still concerned about a zealous pursuit of targets in some trusts to the detriment of quality of care, particularly around the focus on elective procedures in preference to urgent or emergency work.’

The Royal College of Anaesthetists: ‘The Francis report offers an opportunity for all involved in the training and development of healthcare professionals to examine how their standards and guidelines protect patients, how their outreach services and quality assurance frameworks can be enhanced to detect failing services and how they can work more closely with clinicians, patients, employers and regulators to correct and prevent poor healthcare delivery.’

Laura Howson Operations Manager

Dr Mark Porter, Chair BMA Council: ‘Despite all the regulations and guidance to help staff raise concerns, a climate of fear, bullying and harassment can stop clinicians from speaking out. Unless and until medical staff and management jointly promote the ethos that raising concerns is notonlyacceptablebutapositivething,theshadowofMidStaffs will put us all into darkness. Doctors, along with other clinical staff, have a professional responsibility to show leadership in helping to change this culture. We must no longer accept the attitude that it is someone else’s job to worry about.’

Call 08450 613 613 or Visit www.hcldoctors.com

Page 10 Main sponsor

Nine out of 10 palliative care experts would choose Liverpool Care Pathway for themselves The controversial Liverpool Care Pathway (LCP) represents best practice for the care of dying patients, according to 90 per cent of UK palliative medicine consultants.

The same proportion of consultants, who responded to a recent online survey, said they would choose it for themselves if they were dying and over 97 per cent of consultants thought that the pathway allows patients to die with dignity when used correctly.

The survey was commissioned by Channel 4 and published by the British Medical Journal for a programme investigating accounts of the withdrawal of foods and fluids from dying patients and the use of financial incentives to encourage NHS hospitals to put patients on to the LCP. The LCP controversy will be explored at the Acute and General Medicine conference by Dr Catherine Urch, lead consultant for palliative care and chief of service for oncology at Imperial College London, who is giving a talk on end of life care.

Dr Urch says the LCP is a useful pathway which gives nurses a series of jobs to do and most doctors like it because it prompts questions and when completed properly asks doctors to reflect and check that they have not missed anything.

The problem arises in how it is being used. ‘The valuable point

of the media frenzy is that unfortunately communicating information that a patient is dying is difficult. Most doctors find it a classically difficult conversation to have and may use the LCP as a euphemism for dying.

‘So instead of having an open and honest communication about dying and giving the relatives a chance to challenge them doctors just use the LCP. Any euphemism used at this stage is terrible because it blocks communication and relatives and patients quite rightly feel they have just been ignored and left on their own and the medics feel irritated because they thought they had communicated with the patients and their family.’

An independent review of the LCP ordered by the Department Of Health and chaired by Baroness Julia Neuberger is currently underway. Dr Urch predicts that when it reports, later this summer, it will recommend that the LCP will continue in some format, possibly with a change of name, because the nursing section of the pathway is very good. What needs more thought, she says, is giving nurses and doctors the skills and confidence to say a patient is deteriorating and they are dying – it all comes down to diagnosis and communication.

‘The worse thing that will happen, and we are already seeing it happening, is that people will say they don’t want to go on the pathway and end of life care will go back 20 years. People need to

Dr Catherine Urch start thinking what are real problems with it rather than chucking the baby out with the bathwater. We need to start addressing the real nub of it which is communicating with patients and relatives.’

To watch Dr Catherine Urch’s seminar at AGM on the 28th November, register now at www.agmcongerence.co.uk or call 0207 348 4906

Hospitals should only treat acutely ill patients Reserving inpatient care in hospitals for people with lifethreatening conditions or those needing complex surgery could be more clinically effective and make better use of NHS resources, argues a report by the NHS Confederation.

It says that only a system-wide change which sees new commissioners and service providers collaborating for the benefit of the local health economy will help the NHS meet the significant challenges it faces.

This should go hand-in-hand with the development of more health services delivered in the community and in people’s own homes, it says.

The report claims there is an emerging consensus that limiting larger hospitals’ care to specialist treatment for the acutely ill could significantly improve both patient experience and clinical

outcomes, as well as make the NHS more efficient.

It demonstrates a number of examples where providers of community services are already transforming care delivery and says they should be allowed to go even further.

Jo Webber, interim director of policy at the NHS Confederation, said: ‘For too long, the default setting when we think about health care or support is to think of a hospital. But in reality, acute hospitals - whether major teaching sites or local district generals - are rarely the best place for someone who needs ongoing health or treatment.

‘It is time we started thinking differently right across the country, and making sure investment supports innovative service delivery that supports patients’ independence and recovery.’

Admissions avoidance through ambulatory care An innovative approach to ambulatory care where acute physicians liaise with GPs about the treatment of acutely ill patients is helping to reduce hospital admissions in Bolton.

Dr Kevin Jones, lead consultant in acute medicine at the Royal Bolton Hospital, will be describing in a talk at the Acute and General Medicine conference how potential admissions from GPs can be effectively diverted into an ambulatory care pathway.

In Bolton the acute physician carries a bleep which enables GPs wanting to admit a patient during working hours to discuss the problem first with a consultant. The bleep takes an average of 13 calls a day, of which 4-6 potential admissions can be deflected away from the hospital.

unnecessary admissions then you have got more time to look after the really sick people.’

Dr Jones says admissions to hospital are increasing at an unsustainable 12 per cent a year and this has become one of the most pressing issues that needs to be dealt with by the NHS. ‘The people coming to my talk will learn about the philosophy and the culture change that is needed to prevent emergency admissions - you have to almost get into the mindset that almost every admission is a failure,’ he says.

Dr Kevin Jones will be speaking at AGM on 27th November at 12.30.

This is achieved either by the consultant giving advice to the GP to which may enable them to manage the patient themselves or by referring the patient the same day to a rapid assessment clinic where they can be seen by a senior doctor and given the most appropriate treatment.

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Dr Jones will talk about the way the ambulatory care system successfully works in Bolton and he will also discuss a range of conditions which can be safely treated without having to admit the patient.

‘Young registrars are fantastically good at looking after desperately ill patients but they may not have the skills of recognising which patients don’t need to come in at all. That’s a very important skill to have because if you can reduce your

Jo Webber

Dr Kevin Jones

Page 11

Brush up on hypertensive emergencies Accelerated or malignant hypertension is a relatively rare condition that most junior doctors will have heard of but would not feel confident treating on their own.

However most doctors on take could expect to come across a patient in the next year who has been admitted with the condition as an emergency.

Those doctors who need to brush up their knowledge in this area will be able to attend a talk about this illness being given at the Acute and General Medicine conference by Dr John Firth, a consultant nephrologist at Addenbrooke’s Hospital, Cambridge.

The condition got its name malignant hypertension from the days before modern drugs were available because it caused widespread damage to the blood vessels leading to strokes and other serious problems. Eight in ten patients would die within a year of developing the condition.

Now it can be kept under control with the right medication,

however doctors need to recognise the risks.

Dr Firth says: ‘If doctors are not familiar with malignant hypertension it can be a worrying condition because controlling very high and unstable blood pressure is not straightforward as it can be unpredictable. You can’t just give the standard treatment to somebody and know that it will work you have to treat and assess responses and then judge as you go along.

‘If you don’t get the blood pressure under control quickly enough patients can end up having strokes but also if you treat it so that the blood pressure falls too rapidly that too can cause strokes and other serious problems.

‘The intention of my talk will be to give people more confidence in knowing how to deal with the problem if it arises.’

Dr John Firth will be speaking at AGM on 28th November at 9.55.

Dr John Firth

Doctors are key to boosting NHS productivity Top 5 reasons to book AGM 2013 today: 1. Get two days of essential medical training for only £99+VAT – a massive saving of £200 2. AGM is the only cross-specialty event to take place in the UK 3. Delegates will receive up to 12 hours of accredited educational content 4. All of the AGM 2012 educational content available from the moment you register 5. AGM provides the biggest sourcing and networking floor in secondary care www.agmconference.co.uk Tel: 0207 348 4906

Western Australia Health Department The Department of Health Western Australia coordinates a world class health system for the people of Western Australia (WA). This includes tertiary and secondary hospitals and community services in the capital Perth, as well as hospitals and health services in regional and remote settings throughout this vast state.

The UK Recruitment Office in London has been established to assist health professionals interested in working in our beautiful state. We can provide information and advice about potential roles within the WA Health service and opportunities for visa sponsorship.

We are looking for qualified doctors, particularly GPs, Medical and Paediatric registrars and consultants in Obs/ Gynae, Geriatrics, Paediatrics, Neonatology, Anaesthetics, Emergency Medicine, Neurology, General Medicine and General Surgery.

Hospitals with larger proportions of doctors and other medically trained professionals achieve higher labour productivity despite the greater expense of employing them, an analysis of NHS spending reveals.

Hospitals in the South of England, with the exception of London, have higher labour productivity than those in the North, while hospitals in the East of England and South West have better labour productivity compared to England as a whole.

Larger NHS and foundation trusts tend to have lower labour productivity indicating that managers and policy-makers should carefully review the impact of potential trust mergers on staff productivity, warns the review, conducted by the Nuffield Trust.

Competition appears to have a small but significant negative effect on labour productivity, with trusts which come closer to monopoly, performing slightly better says the report, ‘The anatomy of health spending 2011/12’.

Overall however the data shows there appears to have been very little improvement in labour productivity across the

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hospital sector in recent years. Funding for community health services has increased rapidly in line with Government policy yet despite efforts to move care closer to patients. Spending on hospital care has also grown rapidly at an average of 5.2 per cent over the last five years while spending on GP services has seen a real terms decline.

Anita Charlesworth, report co-author and Nuffield Trust chief economist, said the success of hospital workforces with more medically qualified staff indicated ways that the pattern of ‘stubbornly stagnant’ hospital labour productivity and the variation among regions could be broken.

Dr Mark Porter, chair of BMA Council, said: ‘Doctors are crucial to innovation in the NHS, and their work not only improves quality, but also frequently saves their employers money.’

Dr Andrew Goddard, the Royal College of Physicians director of medical workforce, said: ‘This report demonstrates the interconnectivity of funding in the NHS and planning of the medical workforce. A key action for Health Education England, the new national body responsible for workforce

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Page 12 Main sponsor

Private Practice - the national event for clinicians launches CloserStill Media, the team behind Acute and General Medicine and Hospital Directions, have announced the launch of Private Practice 2013 - a new event for clinicians looking to launch or expand their private practice.

Times are tough for NHS consultants - who haven’t had a pay rise in three years. With flat funding and rising waiting lists in the NHS, many want to start a private practice and offer a higher quality service.

According to Show Director Mike Seaman, the launch of this new event in clinical practice “provides a national forum to demonstrate and disseminate best practice in the delivery of private practice – with 83% of the clinicians we surveyed reporting that they would be interested in attending a conference covering the topics of Private Practice.”

Topics covered will include investment planning, marketing strategies, outsourcing and procurement, quality management and financial growth strategies.

Private Practice has a dedicated and interactive exhibition and is designed to allow delegates face-time with the sponsors and exhibitors, as well as times to focus on their own individual needs, network and discuss the latest hot topics and issues with each other.

For more information please contact: Mike Seaman, Group Event Director m.seaman@closerstillmedia.com 0207 348 5760

But it is a big step to run a business, in addition to keeping upto-date clinically. And that is where Private Practice Conference comes in - offering expert advice on finance, regulatory compliance and business development.

The event will appeal to consultant surgeons and physicians, radiologists, ophthalmologists, urologists, gynaecologists and anaesthetists who practice privately outside of the NHS, or are looking to do so. Day one will cater for those doctors who have recently set up, or intend to set up a private practice, or for more established clinicians who want to refresh the basics or plug a knowledge gap. Day two will involve masterclass sessions for those who have already established a successful practice and want to develop it further. It will also appeal to those looking to fast track their knowledge by combining the two days for a complete. grounding.

Private Practice will run at London’s Excel conference centre on the 27th and 28th November 2013. By hosting the event alongside the popular Acute and General Medicine conference and secondary care management event Hospital Directions, CloserStill has created a family of events that will allow delegates from diverse disciplines in secondary care to network and learn together.

For delegates too, the co-location of the shows allows practitioners to top up their clinical CPD if they wish, by upgrading their tickets to include sessions at Acute and General Medicine. This will act as a great value way to ensure they gain general medical knowledge needed to support their revalidation appraisals.

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The modern compact units fit really into small areas (60cmx35cm) So that routine measurements can be conveniently and quickly taken.

With more than 500 monitors situated in GP surgeries across the country and over a dozen in various hospitals locations, now is the time to investigate this time and money saving device which also reduces ‘white coat syndrome`.

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Main sponsor:

Book Acute & General Medicine for only £99+VAT by visiting www.agmconference.co.uk or call 0207 348 4906