28 September 2023

I start this month’s message with some sad news: Katy Amberley, who has been with the BSH for 16 years and Chief Executive Officer since 2017, will leave us at the end of 2023.

Katy has steered the BSH through difficult times and has been instrumental in turning around the Annual Scientific Meeting and the Society more widely. Her loyalty, integrity and consistent attention to detail have been without parallel. Whilst understanding her reasons for moving on, the Society owes her a great debt of gratitude, and we will be very sorry to see her go.

In the final few months of her tenure, Katy has the Herculean task of pulling together the wide range of ideas and topics discussed at the recent BSH Board retreat into our next three-year strategy.

For those of you who haven’t had the pleasure of a BSH retreat, it involves substantially less yoga and many more biscuits than you’d imagine. It was an enjoyable two days, which made me proud to be part of the BSH and a member of the current Board of Trustees.

The new strategy will represent an evolution of the current one. The core work of guidelines and education will be coupled with efforts to widen membership across the haematology team and to encourage new people into our specialty.

The development of a broader range of strategic partnerships will enable an extension of our ability to advocate across a range of issues affecting the profession.

We have been successful in growing the Society over recent years and have the ambition to expand the scope of work along with the correct BSH staffing infrastructure to match.

Needless to say, we are only as good as our volunteers; around 300 of you at the last count. A key part of the strategy will be to recognise and support your commitment. We will formally launch the strategy in early 2024.

For those interested in educational matters, vacancies are coming up on the BSH Education Committee. It is a diverse group and one of the most active and imaginative in the BSH portfolio. From our recent volunteer survey, it is very clear that volunteering with such groups, rather than representing yet more work and demand on your time, is stimulating, interesting and fun.

I was disappointed to read the British Medical Association’s (BMA) position statement on physician associates (PAs) published this month. They state, without evidence, that this professional group (and the intended regulation by the General Medical Council) will devalue the medical profession, impair medical training, and that the term ‘physician associate’ will cause confusion among patients.

So let me get this off my chest:

  • The NHS Long Term Workforce Plan does suggest that PAs will be an increasing part of our workforce, much as they have been in North America for decades (where I see no evidence of a weakened medical profession). The plan also looks to a marked increase in medical student and doctor numbers. As for the remainder of the workforce plan, who knows what will happen with a general election looming and sudden policy U-turns, as we have recently seen on net zero plans.
  • There is no doubt that there is some confusion amongst patients about the changing roles of all sorts of medical personnel. Surely, this is an issue of communication rather than regulation. How have the BMA responded to the continued number of patients who maintain they have seen a nurse when confronted by a female medic? I’m not sure I’ve seen their position statement on that one. Increasingly, jobs which would have been medical have passed into the hands of other professionals; across the country, our clinical services are delivered by specialist nurses, advanced nurse practitioners, pharmacists, as well as physician associates. I wonder if the BMA intends to issue negative statements on these other groups as well.
  • I don’t see PAs as a threat to medical training; on the contrary, my experience is that they facilitate it by freeing up trainee time.
  • Have the BMA leaders not seen the workforce/workload projections for the next decade or so? At this point, PAs are our only growth workforce.

Whilst I would support the BMA’s stance on the salary inequity for newly qualified doctors and their calls for quality assurance of training programmes, the rest seems ill-timed and misguided.

Please also see the formal BSH statement.

I include this item to highlight my support for the growing number of PAs in the haematology team.

Finally, courtesy of JAMA, another reminder of why, as haematologists, we must continue to reduce unnecessary blood transfusions. This fascinating large-scale cohort study suggests the possibility of transmission via transfusion of an unidentified agent, which may increase the risk of cerebral amyloid angiopathy and spontaneous intracerebral haemorrhage (ICH). NHSBT exclude potential donors with a history of ICH, which will further reduce risk. The main point is that this study identifies another potential risk of a therapy where the clinical decision process does not always get the attention it deserves.