NORTH STAFFORDSHIRE

LOCAL MEDICAL COMMITTEE

Newsletter October 2010

GP_Commissioning_in_North_Staffordshire

Quality_and_Outcomes_Framework_Achievement_Data_2009/10

Summary_Care_Record

Items_from_GPC_News_October_2010

Contract_negotiations

NHS_White_Paper

QOF_indicator_diabetes_23

QOF_indicators_depression_2_and_3_business_rules

Partnership_agreements

SFE_changes_-_paragraph_7JA.25_learning_disabilities_DES_

Real_time_feedback_to_GPs

Clinical_waste_pre-acceptance_audit

Care_Quality_Commission_registration

Update_on_changes_to_tax_relief_on_pensions

British_Heart_Foundation_2010_National_Audit_for_Cardiac_Rehabilation

Items_from_GPC_News_September_2010

GP_earnings_and_expenses_report

Negotiations

NHS White Paper

NHS_White_Paper_–_GPC_guidance

Revised_tax_guide_following_the_emergency_budget

Summary Care Record

NHS_Appraisal_Toolkit

Patient_Group_Directions

DWP_DBD36,_DS1500_forms_and_GP_factual_reports

Cleanliness_guidance

New_vetting_and_barring_scheme

NHS_general_practice_workforce_census

Occupational_health_advice_lines

NHS_Litigation_Authority

BMA_2011_research_grants

GP Commissioning in North Staffordshire

At the last meeting of the LMC we were instructed by the committee to write to you conveying advice as to how the committee would recommend we ultimately configure ourselves to deliver GP Commissioning as described in the White Paper ‘Equity and Excellence”

Clearly this view is provided by the LMC at an early stage in our understanding of GP Commissioning as the consultations process is not complete and neither has the legislation gone through Parliament.

We recognize that the decision on configuration needs to be made by grassroots GPs. We also recognize that there will currently be many differing views amongst colleagues. However we feel it appropriate to offer an opinion as to what configuration we believe will best serve our patients and ourselves as we understand the situation at this stage.

In North Staffordshire PCT we currently have a PBC board, a group has also begun work to look at how we manage the transition period. In Stoke it has been decided to hold an election/selection process to appoint GP’s to a single Shadow GP commissioning consortium for Stoke. It is anticipated this may be in place by March 2011. Clearly these organisations will not be ultimately accountable as the PCTs legal retain responsibility until April 2013

We take the view that there is advantage to gain in an early understanding of how we will look in April 2013. Some early clarity will help reduce the loss of skilled people from the local PCT. In addition, to understand our final shape will help us work in the transition period and a way that will facilitate the future of GP commissioning.

We believe that we should have a single GP Commissioning Consortium for the whole of North Staffordshire including both of the current PCT areas of NHS Stoke and NHS North Staffordshire.

We base this recommendation on the following:-

The committee hopes this advice is helpful, we will endeavour to continue to work with you GPs, PCT’s and PBC’ers to move this agenda forward. As we glean further understanding we will keep you informed. This is interim advice and the landscape may change.

Quality and Outcomes Framework Achievement Data 2009/10

The QOF achievement data for 2009/10 has been published.  A summary of the results plus spreadsheets can be found at www.ic.nhs.uk/qof

Summary Care Record

A review of the Summary Care Record commissioned by the DoH has been published. The main recommendations of the report are:

It is recommended that the Summary Care Record should contain only a core set of essential information: a patient’s demographic details, medications, allergies and adverse reactions.

Where a patient and their doctor wish to add additional information to the patient’s Summary Care Record, this should only be added with the explicit consent of the patient.

We should only consider expanding the content of the Summary Care Record when we have built trust in the system and when patients request that we do so. We therefore recommend that new governance be established, for the content of the Summary Care Record.

As a principle, any change to the scope of the Record must be driven by citizens and patients, with appropriate advice from professional bodies and tempered by the Information Technology capability

A copy of the report can be found here.

A copy of Guidance from NHS Connecting for Health (CfH) to PCTs/SHAs can be found here. This will have implications to GP practices that have created SCRs containing more than the core clinical information of medication, allergies and adverse reactions. Further guidance will follow from NHS Connecting for Health for the practices concerned. In addition, constructive discussions are taking place around the practicalities of implementing the SCR Review recommendations and further communications/guidance will follow in due course. Until this guidance is forthcoming, we would advise LMCs and practices to continue dialogue with PCTs but practices should not feel pressured to create SCRs.

Items from GPC News October 2010

Contract negotiations

 Negotiations with NHS Employers on contractual changes for 2011/12 are ongoing. We will let you know the outcome of these discussions as soon as we can.

NHS White Paper

Equity and excellence: Liberating the NHS

 On 1 October, the BMA published its response to the NHS White Paper consultation ‘Equity and excellence: Liberating the NHS’ and the four supporting consultation documents. These are a very thorough and considered set of documents, and we would urge LMCs and practices to read them. The main response is on the BMA website and the responses to the supporting consultations can also be found on the BMA website.

The consultation deadline has now passed, and we are expecting that the government will publish a draft Health Bill in early December. We hope they will take account of the concerns that we have raised, and continue to raise in the many meetings at which the GPC is represented where the White Paper is discussed.

As you are aware, the GPC has produced a series of guidance notes to advise and inform practices and LMCs as to what the new proposals may mean for them, and what they should think about as they consider how they would be implemented. We encourage you to read these documents to gain understanding of how general practice may change. The GPC guidance on the White Paper is available on the BMA website.

The GPC has published a report of a round-table meeting, hosted by the GPC and attended by a range of national health organisations and local commissioning groups, to discuss the White Paper commissioning proposals. This report is also available on the BMA website.

The GPC, with its subcommittees, continues to work hard in trying to understand what the White Paper proposals, and in particular, the commissioning proposals, will mean. We intend to publish further guidance on a number of areas in the coming weeks, including more detail on electing and appointing officers in the embryonic shadow consortia and some of the human resources implications.

Next steps on commissioning

Andrew Lansley has written a letter to all GPs as part of the ongoing engagement with the profession on the White Paper proposals and to set out the next steps on commissioning. The letter discusses the responsibilities of GPs with respect to the commissioning proposals, the support GPs will receive and the organisational and governance arrangement of commissioning consortia. There has been no decision on the value of the management allowance, while the letter reiterates that the size of consortia will not be determined centrally, and there is no pressure to form new arrangements at this stage. The letter is available on the BMA website.

QOF indicator diabetes 23

Following on from an article published by GP Notebook on 30 September titled ‘Targeting Type 2 diabetes’, NHS Employers and the GPC would like to clarify that there have been no changes to the HbA1c targets for diabetes in 2010/2011.

NICE published their menu of recommended changes on 3 August 2010 which included a recommendation to increase to the HbA1c target for DM23 from 7, as it is currently, to 7.5. In line with the new QOF process, this menu of recommendations is now subject to agreement through formal negotiations between NHS Employers and GPC on changes to QOF across the UK.

Once negotiations have concluded, any changes to the QOF will be published by NHSE and the BMA and the QOF guidance will be updated and published on the relevant websites ahead of the new QOF year.

QOF indicators depression 2 and 3 business rules

In response to a number of queries regarding the business rules for depression indicators 2 and 3, NHS Employers has published a clarification which is available online.

Partnership agreements

We strongly recommend that GPs in partnership enter into a written partnership agreement and seek legal and accountancy advice in doing so. Partnership agreements reduce both financial and non- financial risk and provide a detailed framework on which the ongoing management and administration of the partnership can be based.

The BMA offers a partnership agreement drafting service exclusively for general practitioners. The service is provided by Neal Hooper, a BMA lawyer, offering high-quality legal advice and drafting, and can be accessed by calling 020 7383 6128 or emailing info.pds@bma.org.uk. To take advantage of the service at least one of the partners in your practice must be a BMA member. BMA members are entitled to the service at a competitive price of £1,500 plus VAT. Members can also take advantage of a fee of just £25 per annum plus VAT for the BMA to hold and store a final signed version of their agreement on behalf of their practice.

SFE changes - paragraph 7JA.25 learning disabilities DES

The latest SFE amendment incorporates a minor feescale correction relating to the learning disabilities DES (changing the fee from £50.87 to £51.08). This will have virtually no implications for GPs as it should only apply where the contractor:

In addition this paragraph 7JA.25 payment is an aspiration type payment that is fully recovered when the annual payment is calculated at year end (it is a cash flow issue). We are informed by the DH that PCTs should have no difficulty in identifying these merged practices. This change will take effect from 1 October 2010. Please go to the Department of Health website.

Real time feedback to GPs – Report of a pilot from DH

 The Department was interested in finding out whether real-time patient feedback could help GP practices to better understand patients’ views on services, identify opportunities for improvement and evaluate whether changes made in response are effective. To investigate this, a six month pilot study was undertaken into the use of real time feedback in 22 GP practices in England between October 2009 and March 2010. The pilot’s objectives were to understand how effectively real-time feedback could help to drive performance improvement in GP practice settings, and to identify the key learning from the GP practices that took part. A mixture of three devices for collecting patient feedback (tablet PC, kiosk, desktop device) was piloted across 22 GP practices. The GP practices who volunteered to take part varied in size, patient list, staffing levels, geography and demography.

The project's objectives were:

Six key findings from the pilot study identified that real-time patient feedback:

These points are set out in the Best Practice Guide to using Real time Patient Feedback, which shows, using case studies, that it has had a positive impact on practices’ performance and patient engagement where it has been piloted.

The Best Practice Guide can be accessed online.

Clinical waste pre-acceptance audit

There has been some confusion over the requirements for GP practices to fill in clinical waste pre-acceptance audits. We contacted the Environment Agency (EA) for clarification and the confusion appears to have stemmed from the fact that there are two main disposal routes for clinical waste - incineration and treatment (disinfection), and the deadline of 1 October only referred to those using treatment facilities rather than incineration.

However, the EA has been in further discussions with the waste collection trade associations and initially decided that an interim additional six month period for undertaking pre-acceptance audits for general practices would be put in place to enable their discussions with the industry to continue. These discussions are still ongoing, but the EA has now published an updated briefing note (replacing that published in October 2009) with a revised timescale for implementation of pre-acceptance audits which will be 1 July 2011 for both incinerators and alternative treatment facilities.

The Environment Agency Pre-acceptance Producer Update - October 2010 is available online.

The EA has also temporarily withdrawn their guidance document EPR 5.07: Clinical Waste which will be republished by the end of 2010. The GPC is liaising with the Environment Agency in producing a self-audit pre-acceptance tool for practices to use and we are also drafting further guidance on this issue.

Care Quality Commission registration

We have had reports of some PCTs telling NHS GP practices that they must comply with Care Quality Commission standards. We would like to make clear that NHS GP practices do not yet need to do so. The registration window for CQC will open from October 2011 and NHS GP practices will need to be registered from1 April 2012. Monitoring of compliance with the CQC standards will not commence until 1 April 2012.

However, it is worth noting that PCTMS practices should be registered with CQC because PCTs needed to be registered from 1 April 2010. Also organisations that provide some NHS primary medical services but whose main purpose is to provide other services, such as private healthcare, social care or NHS acute services need to have been registered for all of their services from 1 October 2010.

If your PCT requests that a practice in your area complies with CQC standards then please email William Jones at wjones@bma.org.uk. We will share any information we receive with CQC so that they can investigate.

The GPC will be producing ‘CQC for GPs’ guidance that will explain registration and act as a ‘how to’ guide on compliance with the CQC standards. It is intended for this guidance to include template documents that could be used to reduce the burden and bureaucracy for practices. We aim to publish this document in the first quarter of 2011.

Update on changes to tax relief on pensions

Following the publication in July of the discussion document entitled "Restriction of pensions tax relief: a discussion document on the alternative approach", the government has now announced the changes that will take place for restricting pensions tax relief. The main points are:

  1. Annual allowance reduced from £255,000 to £50,000 from April 2011.
  2.  Lifetime allowance (LTA) reduced from £1.8 million to £1.5 million from April 2012.
  3.  Deemed contributions to defined benefit schemes calculated using a simple “flat factor” method set at 16.
  4.  Proposal that unused allowance from up to three previous years will be carried forward to offset against the excess contribution.

Further details on how the annual allowance test would apply on cases of ill-health have not been fully concluded yet, but it has been confirmed that exemptions will not be granted in cases of redundancy.

The government has also announced that it will consult on options to give individuals and schemes more flexibility over the payment of these charges in November 2010, for cases where the tax charges incurred are unmanageable from current income.

The Treasury’s paper, which includes a summary of the responses to the previous discussion document can be read online.

The BMA is named in the list of respondents in Annex D.1 of the paper. We are pleased to note that the original proposals have been toned down considerably and that relief has been granted to members who receive 'spikes' in pay. As suggested in the BMA response, unused annual allowance will now be able to be carried forward for up to three tax years which would mean that a specialist registrar, on qualifying as a consultant, would in the vast majority of cases no longer face a tax charge of up to £25,000.

Even the highest earners in the NHS Pension Scheme are likely to avoid tax charges. The document confirms that the valuation factor for annual increases to pension against the annual allowance will be 16:1. This means that as long as an individual's pension accrual does not increase by more than £3,125 (£50,000 divided by 16) in a single tax year then they would not face a tax charge.

The BMA will continue to monitor developments in this area and notify members accordingly.

British Heart Foundation executive summary on the 2010 National Audit for Cardiac Rehabilitation

Cardiac rehabilitation is a structured program of care, consisting of exercise and information sessions, which helps patients to manage their condition and improve their health and quality of life after a heart event. The British Heart Foundation (BHF) has just published the fourth National Audit of Cardiac Rehabilitation, and it shows that only 41% of heart patients from the target groups (heart attack, bypass surgery and angioplasty) took part during 2008–2009.

The recently published NICE guideline on chronic heart failure (August 2010) recommends cardiac rehabilitation for many of the heart patients that live with heart failure. Disappointingly, there has been no improvement in the numbers of patients with heart failure attending cardiac rehabilitation. The BHF are also concerned that women are under-represented in the programme – they made up only 26% of participants.

The Department of Health in England has worked with patients, the NHS and other partners in the field to develop a pack to help the NHS commission high quality cardiac rehabilitation services for those who are eligible, including people with heart failure. This will be published on the Department of Health website and will be available to view later this month.

We are calling on those that commission local services to use this vital tool to improve their cardiac rehabilitation services for the benefit of local heart patients.

For more information on our campaign please go to the British Heart Foundation website.

Items from GPC News September 2010

GP earnings and expenses report

The Provisional EEQ for 2008/09 and the Investment in General Practice to 2009/10 reports were published this week. The EEQ confirms that GP income has reduced and expenses increased for the third successive year. These falls in income happened while GPs were taking on more work in the form of changes to QOF and extended hours. Clearly, it is essential that we continue to do our utmost to ensure that key players and the media fully understand the significance of these income reductions.

Negotiations

Our QOF plenary subgroup has now begun to discuss NICE’s recommendations for new indicators, indicator replacements and indicator retirements.

The committee debated the GPC’s negotiating position for the 2011/12 contract. The negotiators now have a clear steer for ongoing discussions with NHS Employers.

NHS White Paper

Following the publication of the NHS White Paper, Equity and Excellence – Liberating the NHS, the Department of Health (DH) published three further consultations, titled Transparency in outcomes - a framework for the NHS, Increasing democratic legitimacy in health and Commissioning for patients. Each of the consultations and the White Paper can be accessed and responded to via the Department of Health website. Over the summer the GPC has made a significant contribution to the BMA’s response to the White Paper which is due to be finalised by early next month.

The BMA has produced summaries of the NHS White Paper and all the accompanying consultations that have been published to date. These are available along with other related information on the BMA website.

We are still within the consultation process for the White Paper and the majority of the proposals are lacking in detail and the situation is very fluid. Consequently, we strongly urge GPs to resist forming any firm agreements at present. However, we would very much encourage LMCs to open dialogue with their local PCTs, existing consortia and GP commissioners, acute trusts (medical and management) and even local authorities, so that they are fully aware of any local developments and are well placed to play a role in the potential development of commissioning consortia in the future. We would also advise LMCs to consider holding meetings with their local representatives and key stakeholders in the coming weeks and months to discuss commissioning in the local area.

We know that some PCTs are rushing ahead and trying to implement these proposals. We are also aware that a small number of PCTs have attempted to redirect funding from the extended hours DES towards assisting with the establishment of new commissioning structures and incentives. PCTs are not able to manipulate the national contract in this way. Nationally agreed enhanced services can only be altered in negotiation between the GPC and NHS Employers – not on a local basis. Existing national funding must be used as it is directed.

More worryingly, we have heard reports of some PCTs selecting a group of GPs to run a consortium, and forcing all practices in the PCT to join that group. This is unacceptable. The White Paper does not state that PCTs or SHAs will have a role in developing any new structures and LMCs should resist any attempts by them to influence the process of consortium development.

NHS White Paper – GPC guidance

The GPC has begun to publish a series of documents to advise and inform practices and LMCs:

The principles of GP commissioning

This is a statement outlining the principles of GP commissioning in the context of the White Paper. It is intended that these principles should be used to define policy, inform debate and negotiations, and ensure that good medical practice is enshrined within the changes proposed in “Liberating the NHS”.

Legal overview and guidance on the commissioning proposals

This guidance is an introduction to issues that GPs may have to consider in terms of legalities, education and training in preparation for the outcome of the current consultation on the White Paper.

The role of LMCs in supporting the development of GP consortia

This guidance identifies a number of specific actions that the GPC believes LMCs can and should take over the next few months. For ease of reference, these have been grouped into three main areas of: communicate with GPs and practices; support GPs in planning future consortia; and build wider relationships.

GP consortia commissioning: initial observations

This document contains a set of principles and practical observations that GPs and LMCs should consider when beginning to explore how White Paper proposals should be put into practice.

All of these documents can be found on the BMA website.

Revised tax guide following the emergency budget

Following the announcement of the emergency budget on 22 June, specialist accountants have now reviewed the Focus on New Tax Bracket guidance. The previous advice about superannuation has been removed because it is no longer applicable, along with the spreadsheet illustrating how tax could affect income for the year 2009-10 as it is out of date. Otherwise the advice remains the same and we would urge practices to seek advice where necessary from an accountant. The revised guide is available on the BMA website.

Summary Care Record

The GPC has informed Simon Burns, Minister for Health of the motions that were passed at the July GPC meeting, and reiterated our position that all uploads should cease whilst the review of the Summary Care Record took place. We received a response from the Minister confirming that Public Information Programmes (PIPs) had halted. However he maintained the position that the decision whether to proceed with uploads rests with individual GP practices and PCTs. If a GP practice decides to proceed with uploads, smart cards must be used to ensure that the SCR is routinely updated. NHS Connecting for Health has stated that no practice should feel coerced into uploading SCRs and any incidents of GP practices being placed under pressure to upload patient records should be reported to the GPC.

The BMA is playing an active part in a review of the Summary Care Record. The review comprises of two parts; the first focuses on the information sent to patients and the process by which patients record their consent preferences and the second explores the content of the SCR. We will disseminate further information once available.

NHS Appraisal Toolkit

The Department of Health will be allowing their contract with SCHIN, the providers of the NHS Appraisal Toolkit, to expire at the end of October. Following this, they do not intend to hold a contract with one appraisal toolkit provider or fund one particular appraisal system centrally. It is the Department’s intention to promote a situation where the NHS has a choice of tools to support appraisal and eventually revalidation. We have been in correspondence with the Department of Health regarding transitional arrangements, following this development.

In this correspondence, the Department has clarified that up until 31 October 2010, users of the toolkit will be able to download their appraisal documentation from the system in Word (Forms 1-3) and PDF (Form 4) format. Following 31 October 2010, it is our understanding from the Department that users of the toolkit will still be able to request their data from SCHIN, and that SCHIN will not levy a charge for users to receive their data, irrespective of which appraisal system they have adopted. However, we also understand that accessing the data will take longer after 31 October as users will need to prove their identity to access their information. We would therefore advise users of the toolkit to download their appraisal documentation as soon as possible.

Patient Group Directions and Patient Specific Directions in general practice

In response to enquiries on this issue, the GPC has reviewed the complex legislation surrounding the administration of medicines and has clarified the advice on the use of Patient Group Directions (PGDs) in general practice. Please note that this guidance will be updated as and when further issues are raised. Please email info.gpc@bma.org.uk if you have further queries on this issue.

The guidance is available on the BMA website.

DWP DBD36, DS1500 forms and GP factual reports

The Department of Work and Pension’s Pension, Disability and Carers Services (PDCS) have asked the BMA to inform GPs of changes to and information regarding DBD36 forms, GP factual reports and DS1500 forms. Full details can be accessed via the BMA website.

Cleanliness guidance

The National Patient Safety Agency (NPSA) has now published guidance on cleanliness in the NHS for primary care providers, which is aimed at helping primary care providers set up simple, easy-to-follow processes to ensure that their premises are clean and safe.

Using these specifications is not mandatory, but may be a useful guide for providers and may help towards registration with the Care Quality Commission (CQC) from April 2012.

The National specifications for cleanliness: primary medical and dental premises is available on the NPSA website.

New vetting and barring scheme

This guidance explains the steps that GPs need to take individually and as employers to ensure that they comply with the Safeguarding Vulnerable Groups Act 2006. It applies only to GPs in England, Wales and Northern Ireland, with separate guidance being prepared for GPs in Scotland. The guidance is available on the BMA website.

NHS general practice workforce census

Practices and LMCs may be aware of the fact that this annual census is about to take place. The GPC generally supports this as a means of getting accurate information negotiators on both sides, to support negotiations in the coming year. This census (as at 30 September each year) is one of three which together deliver statistics on the total NHS workforce. The other two censuses relate to hospital and community health service staff in medical, and non-medical, roles.

General practice workforce statistics in England are compiled from data supplied by or on behalf of around 8,200 GP practices. The NHS Information Centre for health and social care liaises with these organisations and their agents to encourage complete data submission, and to minimise inaccuracies and the effect of missing and invalid data.

The general practice census aims to gather information on all practices and practice staff in England, including GPs. It delivers a detailed view of the workforce including staff type, headcount, full-time equivalence, age, gender, and country of qualification (in the case of GPs). It also delivers information on practice size (in terms of number of GPs, and list size). It has historically been published at the level of SHA and PCT. You can view recent census publications online. The collection of information is rigorously vetted and controlled by the Review of Central Returns process which demands ministerial approval for any collection and specifically seeks to reduce the burden imposed on the service.

The majority of the information for the census is obtained automatically from the Connecting for Health / NHAIS / 'Exeter' GP practice re-imbursement system, the aim being to reduce the burden imposed on practices. The census has a number of uses, including:

The NHS Information Centre will be distributing templates to PCTs shortly and PCTs will then contact practices to ask for this information. We would encourage practices to participate, particularly this year as it is important that accurate and complete information is available to inform the discussions on the implementation of the NHS White Paper and particularly GP led commissioning. LMCs are therefore asked to ensure practices are aware of the background to this census and the GPC's support for it.

Occupational health advice lines

The Department of Work and Pensions has set up two new types of occupational health advice line for GPs and small businesses in England, Scotland and Wales. One provides guidance to GPs on health and work issues affecting individual patients. The other provides support to small businesses on all occupational health issues, including those raised by the new Statement of Fitness for Work. Both services are staffed by qualified occupational health nurses. The two types of advice line in England, Scotland and Wales have different contact numbers which can be seen below.

The phone numbers for the occupational health advice line for GPs in England, Scotland and Wales are:

England: 0800 022 4233

Scotland: 0800 019 2211

Wales: 0800 107 0900

The phone numbers for the occupational health advice line for small businesses in England, Scotland and Wales are:

England: 0800 077 8844

Scotland: 0800 019 2211

Wales: 0800 107 0900

For further information please go to the relevant website England, Scotland and Wales.

NHS Litigation Authority – Family Health Services Appeal Unit

The Family Health Services Appeal Unit, responsible for determining contractual disputes between GPs and their PCT, now has a new address and contact details. These are:

1 Trevelyan Square

Boar Lane

Leeds

LS1 6AE

Telephone: 0113 86 65500

Fax: 0207 821 0029

DX: 26416 Leeds Park Square

BMA 2011 research grants

The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around 12 research grants are administered under the auspices of the Board of Science, all funded by past bequests to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research.

The 2011 research grants will be available to apply for online on the BMA website from mid-December this year. The application deadline is 11 March 2011.

Subject specifications for each grant vary. For example, in 2011, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to asthma, social determinants of health and neurological disorders. For more information on the grants on offer in 2011 and details of how to apply, please go to the BMA website.

Also find attached (appendix 1) is a copy of the BMA Research Grants leaflet for circulation.

If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Evelyn Simpson at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.