Rheumatology Nursing: A Journey of Discovery - The British Society ...

Rheumatology Nursing:
A Journey of Discovery
Jackie Hill
Presenter Disclosure Information:
Declaration of interest
This speaker has no conflicts of interest

1970’s
• In the 1970’s hospitals had rheumatology
wards’ & rheumatologists
• Rheumatology Nursing was not recognised
as a specialty in the UK, classed with
‘geriatric’ nursing

1980’s – The Journey Begins in the UK!

RCN Rheumatology Nursing Forum
• Forum started in 1981
• 1 st meeting in Manchester elected:
Chair - Sally Chesson
Secretary - Vickie Stephenson
Treasurer - Joan Ball
• Hold 2 x 1.5 day conferences each year
• Set up course for rheumatology nurses
• Newsletter

1985
• Vickie Stephenson realised that rheumatology
care was multidisciplinary
• Went on to establish a multi-professional
organisation – BHPR and became its first
President
• These two organisations heralded the
emergence of rheumatology as a truly
recognised MDT specialty

New Roles
Bed bath
anybody?
• Interesting to note that the RCN RNF did
not really accept the concept of
rheumatology nurse working from out
patient departments
• Real rheumatology nurses worked at the
bed side!!!

1980’s - New Roles
• Too many patients and not enough
rheumatologists
• In Leeds nurses employed to work in out
patient departments to take clinical
measurements in clinical drugs trials

The Leeds Experience
• Began to take on responsibility for disease
management and PE
• Patients began to request nursing
consultations - Our first nurse-led clinics
• 1985 - ‘Nursing clinics for arthritis’
• 1986 – ‘Patient evaluation of a rheumatology
nursing clinic’

By the End of 1980’s
• Rheumatology Nursing Clinics began to
appear in the UK
• ENB 983 Advanced Course in
Rheumatology & Rehabilitation
• One month certificated course

1989 Standards of Care – Rheumatic
Disease Nursing, Scutari Press

1990’s – A Time of Consolidation
• Many more NLC appeared, nurses began publishing
papers describing the work they did
• 1994 - Val Arthur
Nursing care of people with rheumatoid arthritis. BJN
• 1996 – Sarah Ryan
Defining the role of the specialist nurse. Nurs Stand
• 1999 – Anne Sutcliffe
A regional nurse led osteoporosis clinic. Nurs Stand

An evaluation of the effectiveness, safety and
acceptability of a nurse practitioner in a rheumatology
outpatient clinic
• 70 RA patients random allocation CR or NS
(n=35)
• Seen on 6 occasions over a 12 month period
• Battery of outcome measures &
questionnaires
Hill J, Bird HA, Harmer R, Wright V, Lawton C (1994) Br J Rheumatol, 33:283-
288.

Assessment CR Clinic CNS Clinic
Biochemical PV ** **
CRP = =
Clinical Articular Index * ****
Morning stiffness = *
Pain = **
Physical Function = =
Psychological Anxiety = ***
Depression = **
Overall status = ***
Knowledge Overall = ****
Pat Satisfaction Overall = ****
= no change *improvement significant 5% level, ** improvement significant 1% level
***improvement significant 0.1% level
****improvement significant 0.01% level

1990’s - Consolidation
• Nurses taking on new responsibilities
• Needed to access to new knowledge and skills
• 1995 – IAI course began Cannock Chase
Hospital
• 1999 - Sarah Ryan and Andy Hassell produced
the Rheumatology Nursing Masters course at
Keele University

Computerisation
Kind permission from ‘Little Dog Laughed’

Please!

2000 – New millennium, new leaps
forward and few retrograde steps!

2000’s – Leaps Forward
• 1997 AR UK set up AHP Working Party
• Undertook workshops and national survey
• 203 nurses responded
• Published findings in 2001

Defining the Extended Clinical Role for
Nurses in Rheumatology in the UK
Functions
% of Nurses who
Routinely Perform
these Functions
Give information and advice to patients 82
Read/record blood results 73
Give information and advice to relatives 71
Refer to other health professionals 58
Provide counselling to patients 54
Run drug monitor clinics 53
Order clinical investigations 52
Carr et al 2001

2000’s
• 20% of nurses had significantly extended roles
• Joint injections
• Reading x-rays
• Running specialist clinics
• Recommending treatment changes to
rheumatologists and GPs
• Research
• Teaching

2001 2003 & 2009 2004
Telephone
Advice 2006

The Nurse Consultant Role –
Another Leap Forward
Brought about by:
• Limitations in career structure
• Experienced nurses leaving the profession
• Lack of expert clinical leadership

The Rheumatology Nurse Consultant
• In 1999 aim was for 1000 Nurse Consultants by
2004
• In 2000 Sarah Ryan became the first RNC in the
UK
• >10 at the present time

What Does the Role Involve?
Defined criteria for the role
• 50% in direct clinical care
• Education
• Research
• Leadership

An Evaluation of Nurse Consultant Roles
• In depth interviews and questionnaire survey
• 528 Nurse Consultants identified 419(79%) response
• 53% worked in a clinically based specialty area (A&E
or care of the elderly)
• 23% mental health
• 11% condition based specialty
• 8% midwifery
• 5% community/primary care
Guest et al 2004. An evaluation of the impact of nurse, midwife and health visitor
consultants. Kings College, London

An Evaluation of Nurse Consultant Roles
• Broad target of spending 50% directly with patients
• 43% were attaining this
• 48% claimed a high impact on the standards of care
patients’ received
• 40% improved follow up care

2000 Retrograde Steps -
Justifying the Role of the CNS
• 2006 funding deficit within the NHS – Trusts were
required by Government to balance their books!
• Simultaneously, job evaluations and pay awards
resulting from Agenda for Change were
implemented
• CNS posts identified as potential areas for cost
saving
• Reductions in wage bill and help with the black hole
in pensions funds

2000 - Justifying the Role of the CNS
• Posts were lost in rheumatology but not known
how many
• Lack of cost effectiveness evidence for the CNS
role in rheumatology from the UK
• Research had gained impetus during the 1990’s
& this decade

A randomized comparison of care provided by a clinical nurse
specialist, an in-patient team, and a day patient team in RA
• RCT into 3 groups
• 210 RA patients difficulty with function
• Clinical assessments recorded 0, 6, 12, 26 and 52
weeks
• Satisfaction VAS at week 6 all patients and at week
12 for CNS patients
Tijhuis et al AC&R 2002;47:525-31

Outcome Measures
• Health Assessment Questionnaire*
• McMaster Toronto Arthritis Patient Preference Disability
Questionnaire*
Secondary measures
• RAND 36
• RAQoL
• Health Utility Rating Scale
• DAS
• VAS
(QoL)
(QoL)
(Health Utility)
(Disease Activity)
(Patient Satisfaction)
*Primary Outcome Measures

Results From all 3 Studies
• All 3 groups improved FS, QoL, Health Utility
• Care from the CNS has similar clinical outcome in
comparison with inpatient and day patient team care
• The results of from the 52 week study remained
stable until 104 weeks
• Total cost per patient 2 years:
CNS: €11,572 Day Care: €16,896 In pat: €22,449

Outcomes for Patients with RA: A Rheumatology Nurse
Practitioner Clinic Compared to Standard Outpatient Care
80 patients from Consultant clinic
RNP clinic
39 RA patients
JHD clinic
41 RA patients
Weeks 0, 2, 12, 24, 36, 48
Hill et al Musculoskeletal Care 2003;1:5-20

RA Cohort
RNS (n=41)
JHD (n=36)
Fatigue p

Impact of a rheumatology expert nurse on the well
being of patients attending a drug monitoring clinic
• Single blind RCT
• 71 RA patients
• Starting a new DMARD
• Randomised to a CNS (n=36) clinic or an
outpatient nurse (n=35)
• Visits at 0, 3, 7, 12 months
Ryan et al J Adv Nurs 2006;53:277-86

End Point Results
• RAI change score improved 1.8 in CNS group
and deteriorated 0.3 in the CG (NS)
• DAS scores improved significantly CNS but no
change CG, difference significant (p

Do OA Patients Gain Additional Benefit from Care
from a Clinical Nurse Specialist? – An RCT
100 Patients from Consultant Clinic
RNS clinic
51 OA patients
JHD clinic
49 OA patients
Weeks 0, 16, 32, 48
Hill et al 2009 Rheumatology;48:664

Results - Osteoarthritis Study
• Better outcomes for pain, morning stiffness,
physical function and self-efficacy RNS group
• Patient knowledge and satisfaction favoured
the RNS (p>0.05)
• Patients gained additional benefit as they were
better informed about their disease and
significantly more satisfied with their care

2010 and onwards……

The effectiveness of nurse-led care in people
with RA : A systematic review
Ndosi et al. Int J Nurs Stud 2011: 48:642-654
• Only found 7 articles describing 4 RCTs
• Meta analysis on 431 patients
• Most effect sizes inconclusive
• AI, QoL, Patient Knowledge (p

Who Responded?
• 274 rheumatology nurses
• 262 (96%) female
• Average age was 48 yrs (26 – 71)
• 113 (41%) were 50 yrs or older
• Nurses qualified 24 yrs (2 – 48 yrs)

Number of nurses
Nursing Qualifications
140
47%
47%
120
100
80
60
40
20
0
36%
33%
26%
22%
Diploma Undergrad Masters PhD Teaching Prescribing
Qualifications Obtained

% Nurses
Hours Allocated for Telephone
Helpline
35
30
25
20
15
10
5
0
0.5 - 2 >2 - 4 >4 - 6 >6 - 37.5
Hours per Week

Percent
Non Clinical Activities
70
60
50
40
30
20
10
0
Essential sp clinical
admin
Essential non-sp
clinical admin
Non-essential non
clinical admin
Team/PD

Pandora (software workload modelling tool)– Susan
Oliver & Alison Leary
BJN: 2012:2(1):32-37

Pandora study
• Nationwide study
• 99 nurses who recorded their activities
• 3324 intervention events representing 101
nursing days
• 2,227 clinical intervention

Top 5 Outcomes
• 21% alleviation of suffering - Physical assessment and
specialist symptom management
• 19% assessing and meeting information needs
• 14% rescue work particularly in drug therapy
• 11% alleviation of psychological suffering
• 11% access to key contact / knowledgeable
professional or brokering rapid access to other
professionals

AR UK Project Grant
Started February 2008 last patient completed March 2011

Clinical outcomes
• DAS28 – Primary outcome
• Pain, fatigue and stiffness
• Quality of life (RAQoL)
• Functional ability (HAQ)
• Self-efficacy (ASES)
Economic Evaluation
• EQ5D – Quality adjusted
life Years (QALYs)
• Cost - NHS costs,
Healthcare costs, Society
costs
• Psychological well-being
(HADS)
• Satisfaction with care (LSQ)

622 Invited
371 - No response
29 - Not eligible
41 - Declined
181 Randomly assigned
91 randomised to NLC
- 9 protocol deviations
90 randomised to RLC
-14 protocol deviations
82 PP analysis
91 ITT analysis
76 PP analysis
90 ITT analysis

Results
• Mean change in average DAS 28 significantly
greater NLC than the RLC group
• NLC higher patient satisfaction
• Lower health care costs
• QALYs favoured RLC
• Uncertainty over cost-effectiveness

Geriatric Nurses
Became Organised RCN RF / BHPR
Conferences Papers and Text Books
Psychological Support
Referrals
Courses to MSc Level
Teach Self Management
Telephone Advice Lines
Practice Development
Physical Examination Order / Interpret Investigations
Disease Management
Nurse Consultants
Admitting to Wards
Clinical Nurse Specialists
Intra Articular Injections
Teaching Leadership Mentoring
Prescribing High Quality Research
Nurse - Led Services

What About the Future?
• Going to be difficult times ahead, no idea
how the new NHS will pan out
• Could adversely effect rheumatology
• Need to be vigilant
• Number educational courses may decline
• Change brings opportunities

What About the Future?
• Need more research to produce the
evidence for rheumatology nursing
• Need to use mixed methodology
• Statistical model such as the Structural
Equation Model (SEM) could be of use

Direct effects on Quality of Life in OA
Anxiety
0.57
Pain
0.34
Quality of Life
0.81
Function
Number of comorbidities
Duration of
disease
0.22
Kind permission Dr Anne-Maree Keenan
Age

Physical and Psychosocial Effects on QoL in OA
Keenan et al, 2008
0.48
Anxiety
0.57
Pain
0.39
0.45
0.34
Quality of Life
0.81
Function
0.33
Number of comorbidities
0.17
0.18
Duration of
disease
0.22
0.22
0.18
0.15
Age
Kind permission Dr Anne-Maree Keenan

Making a Difference

• Dr Jill Firth
• Consultant Nurse in
Rheumatology
• Senior Research
Fellow
• Seminal research on
foot ulceration – 1/10
RA will acquire a foot
ulcer

• Professor Sarah Hewlett
• 1 st Professor
Rheumatology & Nursing
• Consultant Nurse
• Fatigue
• Ensuring patients are
involved in the research
process
• Helping patients cope with
arthritis

• Professor Candy McCabe
• 2 nd Nursing Professor
• Consultant Nurse
• Work on regional pain
syndrome
• Chronic Unexplained Pain

• Dr Mwidimi Ndosi
• Researcher & practitioner
in Rheumatology
• Outcomes from nurse led
clinics
• Economic evaluation
• Educational Needs
Assessment Tool

• Susan Oliver
• Nurse Consultant
• Past Chair of RCN RF
• Leadership many of the
guidelines produced
• Prolific author
• Very politically aware!

• Dr Sarah Ryan
• 1 st Nurse Consultant
• Editor Musculoskeletal
Care
• MSc course leader
• Prolific author

“Change comes from small initiatives
which work, initiatives which imitated,
become the fashion. We cannot wait for
great visions from great people, for they
are in short supply at the end of history.
It is up to us to light our own small fires in
the darkness”
Charles Handy (1994) Irish author and philosopher

Welcome to
The 2012
DROITWICH LECTURE

LIFETIME ACHIEVEMENT
Dr Jackie Hill:
For outstanding service
to rheumatology and
allied health
professional working
AWARDED BY THE BHPR

Presentation on behalf of
EULAR Nursing Task Force

2012
Prizes and Awards
Recognising and celebrating
achievements and innovations
that change the face of
rheumatology

Chris Moran poster prize

The winner of the Chris Moran Poster Prize
2012 is:

BHPR/Arthritis Research UK
research silver medal

BHPR/Arthritis Research UK
research UK silver medal
research prize
Miss Victoria Manning,
King's College London, London
Physical inactivity among UK adults with rheumatic
diseases: an evaluation of physical activity
participation, recommendation and preferences

Physical inactivity among UK
adults with rheumatic diseases:
an evaluation of physical activity
participation, recommendation
and preferences
Victoria Manning

Physical Activity Audit
UK physical activity guidelines (2011)
2008, 2009 NICE guidelines
508 patients with rheumatic conditions
Inner city UK hospital
2-page questionnaire (IPAQ)
61% met the 2011 PA guidelines
27% entirely inactive
48% had never discussed physical activity
with a healthcare professional
50% would welcome advice

Thank you!
• All participants
• Dr. Lindsay Bearne, King’s College London
• Prof. Mike Hurley, St. George’s University of London
• Prof. David Scott, King’s College London
• Rheumatology Team, King’s College Hospital
• Physiotherapy Research Foundation, Chartered
Society of Physiotherapy

Arthritis Research UK Awards

Arthritis Research UK
Physiotherapy Silver Medal Prize
Dr Jonathan Hill,
Keele University, Stoke on Trent
Comparison of stratified primary
care management for low back
pain with current best practice
(STarT Back): a randomised
controlled trial

Arthritis Research UK Podiatry
Silver Medal Prize
Dr Michael Backhouse,
Division of Musculoskeletal Disease,
University of Leeds, Leeds
Factors predicting the outcome of
foot and ankle surgery in patients
with rheumatoid arthritis

Factors predicting the outcome of
foot and ankle surgery in patients
with rheumatoid arthritis
M.R. Backhouse
Division of Rheumatic and Musculoskeletal Disease,
University of Leeds,
Leeds Institute of Molecular Medicine

Background
Epidemiology
of foot and
ankle surgery
in RA
Generation of Candidate
Factors
Background
Perception of outcome from
patient perspective
Rheumatoid arthritis has a profound impact on foot and
Validation of Activity Monitors
ankle (Michelson et al 1994, Grondal et al 2008, Helliwell 2005, Williams 2007)
Longitudinal
evaluation of
candidate factors
ability to predict
surgical outcome
Study Type:
Registry data
Leeds Institute of Molecular Medicine
Foot and Ankle surgery accounts for 1/3 of lower limb
surgery in RA (Weiss et al 2006)
Modified Delphi Process
Surgical outcomes vary considerably and are often
Qualitative Interviews
suboptimal (Hamalainen et al 1997)
Validation Study
Aim
Prospective
cohort study

Methods
• Prospective
cohort
• Baseline
assessment of
candidate factors
Methods
• 12 month follow
up
• Exploratory
analysis of
candidate factors
conducted using
CART analysis
Leeds Institute of Molecular Medicine

Results
CART analysis produced decision trees for
different aspects of outcome
Although predictor variables varied, three
key constructs emerged:
– Patients with higher baseline pain showed
more improvement than those with lower
pain
– Patients with the severest deformity failed
to improve as much as patients with less
extensive foot deformity
– Patients with tighter disease control
showed greater improvement than those
with less well controlled disease
Requires validating in external cohort
Leeds Institute of Molecular Medicine

Acknowledgements
Dr Anthony C. Redmond
Dr Anne-Maree Keenan
Dr Philip S. Helliwell
Dr Elizabeth M.A. Hensor
Dr A. Isdale
Dr A. Gough
A. Emmerson
A. Gill
C. Bennett
B. Starss
P. Briggs
A. Budgen
C. Chebil
C. Mann
Dr D. Walker
P. Heslop
J. Madden
D. Lavallette
Dr L. Hordon
Dr M. Green
N. Harris
M. Peat
J. Pickard
R. Monkhouse
T. Nazzar
Dr Z. Karim
Leeds Institute of Molecular Medicine

Arthritis Research UK
Occupational Therapy Silver
Medal Prize
Ms Kate Hackett,
Newcastle University, Newcastle
Functional impairment and
primary Sjogren’s syndrome: a
case for occupational therapy?

Functional impairment and primary Sjögren’s
syndrome: A case for occupational therapy?
Kate Hackett
• pSS second most common autoimmune
rheumatic disease
• Affects secretary glands e.g. eyes and
mouth
• Fatigue, autonomic dysfunction, pain,
sleep disturbance, depression,
cognitive impairment
• Impact on self care, productivity and
leisure
-work, eating, sexual function,
functional mobility, concentration,
engaging in social activities
• Associated costs e.g. reduction in
employment
Hackett et al. Occupational therapy: A potentially valuable intervention for people with primary
Sjogren's syndrome, British Journal of Occupational Therapy (in press)

Study
• Measured impact of pSS symptoms on functional ability
(Improved HAQ) and relationships between functional ability,
systemic disease activity and patient reported symptoms
• Responses received from 69 well characterised patients
• Data compared with 69 age and sex matched healthy controls
• pSS patients had a reduced capacity in carrying out a wide
range of everyday activities compared with controls
• Reduced function correlated strongly with fatigue, depression,
pain, disease activity and impaired HR-QoL
Hackett KL et al Functional impairment in primary Sjogren's syndrome. Arthritis Care
and Research (in press)

A Case for Occupational Therapy
• Effective at improving function in other
conditions e.g. RA (Steultjens et al 2004)
• Addresses specific areas of functional
impairment
• Sleep, pain, fatigue, low mood, daily activity
management
• Many pSS patients do not have routine
access to OT
• OT could facilitate improvement in function,
quality of life and costs associated with the
disease

Arthritis Research UK Nursing
Silver Medal Prize
Mrs Patricia Cornell, Rheumatology Dept,
Poole Hospital NHS Foundation Trust, Poole
Don’t forget to clean your teeth - does
informing patients about the link between
dental hygiene and Rheumatoid Arthritis
encourage better dental care?

BHPR Prizes and Awards 2013
BHPR/Arthritis Research UK silver medal
research prize
BHPR /ALGEOS clinical prize
BHPR student prize

BHPR ANNUAL GENERAL MEETING
1 May 2012 , 1pm

APOLOGIES
Andrea Graham
Michael Backhouse
Vicky Cameron-Fiddes
Kanta Kumar
Elizabeth Ssendi
Alison Blake
Cathy Ball
Carol McCrum

AGENDA ITEM 2
AGM 2011 MINUTES
• CORRECTIONS
• APPROVAL
• MATTERS ARISING

AGENDA ITEM 3
PRESIDENT’S REPORT
- Lindsey Hawley

BHPR Goals
• To ensure that the key role of the MDT is
understood and reflected in policy and
service planning.
• To provide members of the MDT with
knowledge, skills and tools needed to deliver
best practice and quality care.
• That members of the MDT have a voice through
an effective, sustainable
organisation.

MEMBERSHIP
700
BHPR membership Trend Line
Mar 2009 to date
600
500
400
300
No of Mems
200
100
0

Education Update
• Plans underway to conduct BHPR courses
jointly with BSR
• Endorsements of external courses up and
running
• First training survey conducted
• Education Bursaries awarded end of 2011:
- Sharon Gieve (Royal National Hospital for Rheumatic Diseases)
- Helen McKeenan (Belfast City Hospital)
• Potential for e-learning opportunities

COMMUNICATIONS
• Resources
• Conference
• Links to external organisations
• Website: Events page, Notice Board/Your
page
• New communication areas: Social media
channels

Special Interest Groups
• Rheumatoid Arthritis (Janet Cushnaghan)
• Osteoporosis (Rachel Lewis)
• Connective Tissue Disease (Sue Brown)
• And a new Musculoskeletal Physiotherapy group
- Rheumatology Physiotherapy (Jenny Ratcliffe)

PRIZES
BHPR
• Chris Moran Poster Prizes
BHPR/Arthritis Research UK
• Arthritis Research UK Silver Medal Research Prize
Victoria Manning
• Arthritis Research UK Physiotherapy Silver Medal Prize
Jonathan Hill
• Arthritis Research UK/PRCA Podiatry Silver Medal Prize
Michael Backhouse
• Arthritis Research UK Occupational Therapy Silver Medal Prize
Kate Hackett
• Arthritis Research UK Nursing Silver Medal Prize
Patricia Cornell
All prize applications are online

DROITWICH LECTURE
• 2013 Lecturer - Dr Philip Helliwell
- nominations will open in the autumn for the 2014
lecturer

AGENDA ITEM 4
TREASURER’S REPORT
-Trish Cornell

• Annual Report and Accounts 2011
circulated with AGM papers
• Appointment of independent examiners
– The trustees have decided to re-appoint Paul
Furrer & Co as the independent examiner of
accounts

Treasurers report - 2012
THE FUNDS OF THE CHARITY
Endowment funds: 2011 2010
Droitwich Medical Trust
Lecture permanent endowment fund 60,000 60,000
Restricted income funds:
Special Interest Groups fund - 77
Droitwich Medical Trust Lecture income fund 11,300 12,504
Unrestricted income funds:
General fund 25,827 30,773
TOTAL CHARITY FUNDS £97,127 £103,354

2013 subs
Direct Debit
Cheque
Ordinary members £30 £35
Associate Overseas members £35
Associate UK
and Student members £21 £26

BHPR admin support
• 2006
– Commenced paying for admin support .5 day per week
£5,000 +VAT PA
• 2007
– Council agreed an increase to 1 day per week £10,000 +
VAT PA
• 2008 Recession
– Reduced interest rate
– Loss of members
• 2010 BHPR 25 th anniversary
– Pharma support for dinner

AGENDA ITEM 5
CLOSER WORKING
ARRANGEMENTS
WITH BSR

The Story So Far
2003 BSR & BHPR: A Plan for Closer Collaboration
• Increased cross representation
• Joint conference planning
• Joint education courses
• Joint guidelines
2011-2012: Review of Original Plan
• Regular meetings of CEOs and Presidents of BSR & BHPR
• Initial thoughts to membership at both AGMs 2011
• Working group established
– Meetings with ARHP (Association of Rheumatology Health
Professionals) to discuss the structure within ACR
– Outline proposals drafted
– Discussed at BHPR Council and BSR Executive and Council
– Proposals approved in principle

The Bottom Line
BHPR is not financially sustainable
– BHPR needs reserves of 9 months running
costs (£17,400)
– Reserves January 2012: £25,827
– Budgeted reserves December 2012: £17,957
– Estimated reserves December 2013: £10,087
– Estimated reserves December 2014: £2217

AHPR/ACR model
• ARHP is a division of ACR
– has its own executive and standing committees
– budget, staff, and tax status are all part of the ACR
• ARHP sets its own policies, projects and budget
– consistent with the policies and procedures of the ACR
– approved by the ACR Board of Directors
– the approved budget and projects are managed by ARHP (under
the ACR Board of Directors supervision).
• ARHP president serves as a voting representative on the
ACR Board of Directors
– ARHP president-elect attends as an invited guest
• One or more ARHP members serve on all ACR committees.

GOVERNANCE
• Constitutional changes required
• All changes need to comply with legal
requirements
– Charity Commission
– BWB charity lawyers
• A formal resolution will be put to the
membership (BSR and BHPR) once legal
advice has been sought

Outline Proposal To Be Agreed
• That work continues to establish an integrated
organisation whereby BHPR retains its discrete
identity as a division of BSR.
• This will include the following :
– BHPR retains its own council and president
– BHPR president to be a voting member of BSR
Executive Committee
– Increased AHP representation on BSR committees
– Strengthening of financial relationship
– AHP category of membership within BSR

Item 6
ELECTIONS RESULT AND
COUNCIL UPDATE

ELECTIONS
• Ms Mel Holden has been elected
unopposed as Honorary Treasurer
• The Trustees have agreed to co-opt
Lindsey Hooper for one year to AGM
2013 as Deputy Communications officer

Thank you and Goodbye to the following
representatives to BHPR Council:
Victoria Chamberlain – RCN RF
Richard Rees - BSR

Thank you and
goodbye to:
Andrea Graham
Honorary Secretary

Thank you and
Goodbye to:
Trish Cornell
Honorary Treasurer

Welcome to:
Robert Field
President
2012 - 2014

And Thank you
to:
Lindsey Hawley
President
2010 – 2012

COUNCIL UPDATE
Trustees are:
• Robert Field
President
• Jill Firth
Honorary Secretary
• Mel Holden
Honorary Treasurer
• Lindsay Bearne
Research Officer
• Sue Gurden
Communications Officer
• Michael Backhouse
Education Officer
• Lindsey Hawley
Past President
Links & Representatives are:
• Colin Beevor & Jo White – RCN
• Cathy Ball – COTSSR
• Jenny Ratcliffe – CSP
Co-opted members to 2013:
Jo Adams
Research and Education Officer
Lindsey Hooper
Deputy Communications Officer

ANY OTHER BUSINESS
-None received
AND FINALLY…

Thanks to all the staff of BSR
• With special
thanks to BHPR’s
Chief Executive
and BSR’s
Director of
Operations and
Resources, Sue
Murray-Johnson
who has now left
the organisation.

..and to all
of you!

Prize draw
See you all
there!

Networking session
Rheumatology Physio (SIG) RA (SIG) Connective Tissue Disease (SIG) Osteoporosis (SIG)
BHPR General & communication Podiatry Occupational Therapy