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Presidential Christmas Letter, 2006
Posted by () on Apr 02 2008
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Dear members, colleagues and friends,

The Edinburgh BESS meeting was a great success and our biggest meeting ever with 302 attendees. The sun shone, Edinburgh was buzzing, the scientific content was of high quality, the exhibition bigger than ever, and it was a very sociable meeting being so central, with so many coffee shops spilling onto the streets, and marvellous restaurants for the evenings. The guest speakers, Laurant Lafosse from France and JP Warner from the States were charismatic, controversial, learned and fun. As if all this was not enough the society made a profit of £36,000 that can be ploughed back into fellowships, education and research. Julie McBirnie and Richard Nutton and their team from Edinburgh really did us proud, and we thank them deeply for all their hard work.

The society continues to flourish. Over the last five years membership has risen from 169 (in 2002) to 346 today. However it is interesting to note that although 62% of the members have attended more than 2 meetings in the last five years, we appear to have a small dormant membership, for 19% of our membership have not attended a meeting in the last five years. Although these people may still be enjoying some benefit from the society through the Journal and the website, we need to decide at the next AGM whether we should give these members the offer of leaving the society, for a smaller but active society may flourish better than a larger but less interested grouping. What do you think?

Our yearly Scientific Meeting goes from strength to strength, with 193 participants in 2002, breaking the 200+ barrier in 2003 and this year, despite clashing with the English half term (but not the Scots half term!) and the Nice meeting we broke the 300 participant barrier. Members account for about 45% of participants at all our meetings, and the society is made up of 80% surgeons and 20% Allied Health Professionals. There were 194 abstracts submitted for the Edinburgh meeting and despite increasing the number of podium presentations and posters we still had to reject many excellent studies. We have debated how to accept more papers by increasing the length of day and packing the talks in to our meetings. We have debated increasing the length of meeting from two to three days, but the present view of Council is to maintain our present two-day meetings and to make them as high quality as possible. But how then can we increase the number of podium presentations? The BOA is asking the affiliated societies to be more active at their meetings and perhaps we should make a speciality day at the BOA, starting with an instructional lecture, having a free paper session, then re-presenting the three best papers from our annual meeting, and in the afternoon having a debate with a number of international figures hosted through the participation of industry? What are your views? We ran a pilot of this at the Glasgow BOA, with an instructional meeting on fractures, a free papers session in the morning and one in the afternoon, and then a combined instructional with BOOS on tumours at the shoulder and elbow the following morning, and this was a great success with over a hundred at each session.

As you know the Council has made an executive decision to go ahead with a Shoulder and Elbow Arthroplasty register. Our reasoning is that if we set out to do this it can be kept under our control and will answer the scientific questions that need to be addressed, and that if we do not take a lead then we will be forced into participating in “Big Brothers” register, and believe me you do not want that!! Ro Kulkarni has come up with the magic acronym SEND, a reminder for you to SEND in your data to the Shoulder and Elbow National Database. We are hoping to trial the forms with the Big Beasts, or large volume users starting this December. The form will be on the website and David Selvey and Len Funk are working to get an on-line data entry form working through the website www.bess.org.uk. Eleven of us met at the BOA to push this project forwards, for it is a massive endeavour, it will be expensive ( Ian Bayley is trying to see if the DOH will help with funding, whilst we keep control), and it will require all of us to participate and make it second nature, that when you do a TSR you fill the form in. Please, please, please help.

Professor Carr and Jonny Rees have been working hard to set up a BESS multicentre study through the Research Committee and have managed to acquire funding for this study to the tune of £2.7 million!! The study will involve a comparison of the costs and benefits of open versus arthroscopic rotator cuff repair. If you are interested in participating and have not yet been accosted by Andrew or Jonny please get in touch with them directly through the Nuffield Orthopaedic Centre. This study will be a major landmark for our society and we urge you all to get enthused and join in.

The Education committee is starting to come together. In November we held the first BESS Course on Surgical Approaches to the Shoulder and Elbow in Paris. You well might ask why Paris? The answer is that Professor Gagey offered his lab and as many bodies as we needed, his lab has splendid views from the top floor of the Sorbonne to the Eiffel tower, travel to Paris is quicker and easier from most parts of the UK than going to Brighton or Norfolk, and I can tell you that the coffee, and the opportunity for a two hour lunch at the local street café beats the greasy spoon in Doncaster!! I commend this course to you next year. Make a date! Simon is working with his committee on the modular arthroscopic courses. If I can be cheeky I will just say that I am holding a feast of live surgery in Exeter, March 12 and 13 2007, and Steve Copeland, Angus Wallace, Andrew Wallace, Simon Lambert, Tim Bunker, Peter Brownson and Len Funk will all be demonstrating their signature dishes live to an admiring audience! We hope to make it a UK rival to Annecy!

Now we come to the serious stuff, VAT, Tarriff and Independent practice. Council debated the vexed question of VAT. There is no getting away from Gordon Brown, I am afraid he has stealthed his way into every nook and cranny of our great country and has even got his hands on BESS! We have looked at every opportunity to avoid having to pay VAT on our scientific meetings including becoming a Charity and setting up a shell company to run the Scientific meeting from within the Charity. That was the best option, but incredibly complex and quite scary, and at the end of the day extra accountancy bills meant that we would save very little. So Council have agreed to stay with our present financial structure, meaning that we will have to pay VAT on the profit from our meetings. We will have to ensure that we make very little profit. There is no escape from death or taxes.

Tarriff is another scary phenomenon. A figure plucked from the ether bearing no relation whatsoever to reality. It is a worry to us and to the industry. For us Tarriff means that the NHS will not pay for what we do. Ro Kulkarni was tasked by me to look into the costs of cuff repair and Bankarts and his Fellow approached 40 hospitals to get this data. He got data back from just four of the forty hospitals that we approached and the information was incomplete from two. So no surprises there then!! The study by Adla et al from Leicester showed that arthroscopic cuff repair was £610 more than open surgery so that blows tariff away. Again we need your input on this question.

The new BUPA schedule threw another spanner in the works. At our AGM in Edinburgh the members felt that we needed to get more politicised about this. I wrote to Ian Leslie in his role of President of the BOA to explain the anomalies such as revisions being reimbursed less than primaries, index plus extra operation being recompensed less than index operation alone and ASD being recompensed at the same rate as an arthroscopic meniscectomy of the knee. Well the letter was passed on to BUPA and the good news is that they are listening and have agreed to look into all these anomalies. The bad news is that for most of the anomalies they say they are looking into them and the only actual movement is that they have elected to increase the benefit from ASD plus excision of ACJ from the same as ASD alone, and they have elected to increase benefit for excising the ACJ to £10!!! Wow I say £10 for 30 minutes highly skilled work, less than one fifth of the call out fee for a plumber!! However you never expected insurance companies to roll over and say “take what you want” did you? The way forward is for us to work closely with the Professional Pratice Committee of the BOA (under John Carvell) and with FIPO to address these anomalies. Address them we will but don’t expect this to happen in an instant.

Now back to good news. Charles Neer has graced our society by accepting honorary membership. He is the only overseas surgeon that this has ever been offered to, the UK honoraries being Willie Souter and Steve Copeland. The following were offered BESS Fellowships at the Edinburgh meeting, Campbell Hands (Kessel Prize), David Stanley (Poster Prize), Ford Quereshi (Smith and Nephew Travelling Fellowship), Peter Reilly (Biomet Travelling Fellowship), Ann Wilkes (Donjoy AHP Prize), Alison Armstrong (Mitek Seniors Prize), Cormac Kelly (Research Prize). Next year in addition to these Prizes we will add a BESS Elbow Fellowship to the Mayo Clinic sponsored by Acumed.

Finally we come to next years meeting to be held in Telford on 13th to 15th June. Visit the website for a rolling introduction to the meeting. The Presidential Guest Speaker will be Ralph Hertel from Switzerland and the Organisers Guest Speaker will be Joe DeBeer from South Africa. The meeting will be in the Telford International Conference Centre, the dinners will be at RAF Cosford Air Museum and at Weston Park. You will be assured of a wonderful, educational and congenial time.

I wish you all a happy Christmas and a prosperous new year

Tim Bunker  President BESS

Last changed: Apr 02 2008 at 1:56 PM

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