agm newspaper summer

5
There is a pressing need to improve the way we care for older people in an emergency Dr Simon Conroy will tell AGM 2012. This is because current services are too fragmented and poor communication between different clinical settings and professionals is affecting the quality of care older people receive, says Dr Conroy, a senior lecturer and geriatrician at the University of Leicester. In his talk Dr Conroy will be outlining how care can be improved using the Silver Book, a new toolkit which defines key standards for the emergency care of older people. Launched in June by a multidisciplinary group of stakeholders, the Silver Book recommends ways in which emergency admissions of older people can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses for each service including: primary care, ambulance services; emergency departments; urgent care units, acute medical units and community hospitals. Continued on page 2 Latest programme Page 3 Exhibitor guide: Page 6-7 Conference floorplan: Pages 4-5 Issue 1 | www.agmconference.co.uk Book now for only £99 Visit www.agmconference.co.uk Follow us on Twitter: for the latest news: @AGMConference UK Seven-day acute medicine service is improving patient outcomes Toolkit set to raise the bar on the urgent care needs of older people Acute medicine is one of the youngest and fastest growing medical specialities which is playing an increasingly important role in improving patient outcomes. Hospitals began appointing specialists in acute medicine from the late 1990s to cope with a progressive increase in emergency medical admissions, a requirement to reduce junior doctors’ hours and to meet patient expectations for consultant-led care. It was also realised that a new breed of specialist acute medicine physician was needed to fill the gap left by hospital consultants becoming more specialised and spending less time on general medicine. The Society for Acute Medicine (SAM) was formed in 1999 to provide support for these new specialists and acute medicine has now been approved as a specialty in its own right. SAM was launched by a handful of consultants and now has a membership of over 450. The number of acute medical units (AMUs) across the UK has grown to 225. Specialist acute physicians are driving forward changes in the management of patients on the AMU, and several hundred specialist registrars are now training on the newly approved Curriculum in Acute Internal Medicine. A landmark document called Quality Standards for Acute Medical Units, was launched in June to help trusts achieve consistency in the quality and standards of care for patients admitted as an emergency. Dr Chris Roseveare, president of SAM and an acute medicine consultant at University Hospitals Southampton Foundation Trust, says: ‘We are providing a framework to ensure consistent standards of care in AMUs across the UK. This will enable AMUs to benchmark against other units and will reassure patients that the quality of care they are getting in their local hospital is as high as in any other part of the country.’ The standards emphasise the key role of specialists. The document stipulates that a consultant should be present on the AMU for at least 12 hours a day 7 days a week. Many units meet or exceed this but others struggle to achieve that target because they don’t have adequate numbers of consultants to provide that level of care. Dr Roseveare says that providing a 7-day consultant-led service is likely to improve outcomes for patients. ‘SAM is committed to promoting a consistent level of consultant care, 7 days a week; this will require reorganisation of services and more consultants. However the increased costs may be offset by better outcomes and shorter hospital stays resulting from earlier consultant involvement in a patient’s care’ The standards stipulate that a patient should be seen by a competent clinician within four hours and by a consultant within 14 hours of arrival at the unit. Many hospitals are already achieving that figure. Preliminary data suggest that over 80% of patients are being seen in that time and in some hospitals the figure is as high as 95%. ‘We are moving in the right direction, which is very encouraging,’ says Dr Roseveare. ‘The speciality has grown considerably since 1999 which is crucial for patient care. When patients first come in to hospital they are now more likely to see a consultant, more likely to get an appropriate diagnosis and more likely to get the right treatment.’ But Dr Roseveare says there is still a lot to do. The acute medicine workforce would need to expand considerably to achieve a 12-hour, 7-day consultant presence on AMUs across the country. At present consultants dually accredited in general internal medicine (GIM) and another speciality provide much of the weekend and out-of-hours care in many hospitals across the UK. This is crucial and will need to continue for the foreseeable future, even though the numbers of trained acute physicians is slowly rising. The specialty also needs more junior doctors to specialise in acute medicine. SAM is currently working closely with the Royal College of Physicians to develop sustainable models of consultant working practice to encourage more doctors to consider the specialty as a career option. The nature of the shift pattern may also lend itself to ‘family friendly’ working arrangements for those who plan to work on a less than full- time basis as a consultant. Dr Roseveare says the specialty needs to continue to develop at the rapid pace seen over the past decade. ‘In the future I believe that the acute medicine specialist should play a key role in the ongoing management of general medicine patients beyond the AMU. Acute medicine consultants, dually accredited with GIM, are ideally placed to provide this ongoing care for patients whose problem does not fall into the remit of any clear cut specialist category.’ Looking for an event focussing solely on acute medicine? SAM runs a dedicated annual event, for registration and further information please visit www.acutemedicine.org.uk Quality Standards for Acute Medical Units is at: http://www.acutemedicine.org.uk/images/stories/pdf/the%20 coordinator%20role%20in%20am.pdf BOOK NOW FOR ONLY £99 Dr Chris Roseveare Dr Simon Conroy In association with: AGM Newspaper 8pp A3 11 (NEW JULY).indd 1 02/08/2012 12:42

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The latest news from secondary care and the Acute and General Medicine Confernece

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Page 1: AGM Newspaper Summer

There is a pressing need to improve the way we care for older people in an emergency Dr Simon Conroy will tell AGM 2012.

This is because current services are too fragmented and poor communication between different clinical settings and professionals is affecting the quality of care older people receive, says Dr Conroy, a senior lecturer and geriatrician at the University of Leicester.

In his talk Dr Conroy will be outlining how care can be improved using the Silver Book, a new toolkit which defines key standards for the emergency care of older people.

Launched in June by a multidisciplinary group of stakeholders, the Silver Book recommends ways in which emergency admissions of older people can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses for each service including: primary care, ambulance services; emergency departments; urgent care units, acute medical units and community hospitals.

Continued on page 2

Latest programme Page 3 Exhibitor guide: Page 6-7Conference floorplan: Pages 4-5

Issue 1 | www.agmconference.co.uk

Book now for only £99Visit www.agmconference.co.uk

Follow us on Twitter:for the latest news: @AGMConference UK

Seven-day acute medicine service is improving patient outcomes

Toolkit set to raise the bar on the urgent care needs of older people

Acute medicine is one of the youngest and fastest growing medical specialities which is playing an increasingly important role in improving patient outcomes.

Hospitals began appointing specialists in acute medicine from the late 1990s to cope with a progressive increase in emergency medical admissions, a requirement to reduce junior doctors’ hours and to meet patient expectations for consultant-led care.

It was also realised that a new breed of specialist acute medicine physician was needed to fill the gap left by hospital consultants becoming more specialised and spending less time on general medicine.

The Society for Acute Medicine (SAM) was formed in 1999 to provide support for these new specialists and acute medicine has now been approved as a specialty in its own right. SAM was launched by a handful of consultants and now has a membership of over 450. The number of acute medical units (AMUs) across the UK has grown to 225.

Specialist acute physicians are driving forward changes in the management of patients on the AMU, and several hundred specialist registrars are now training on the newly approved Curriculum in Acute Internal Medicine.

A landmark document called Quality Standards for Acute Medical Units, was launched in June to help trusts achieve consistency in the quality and standards of care for patients admitted as an emergency.

Dr Chris Roseveare, president of SAM and an acute medicine consultant at University Hospitals Southampton Foundation Trust, says: ‘We are providing a framework to ensure consistent standards of care in AMUs across the UK. This will enable AMUs to benchmark against other units and will reassure patients that the quality of care they are getting in their local hospital is as high as in any other part of the country.’

The standards emphasise the key role of specialists. The document stipulates that a consultant should be present on the AMU for at least 12 hours a day 7 days a week. Many units meet or exceed this but others struggle to achieve that target because they don’t have adequate numbers of consultants to provide that level of care.

Dr Roseveare says that providing a 7-day consultant-led service is likely to improve outcomes for patients. ‘SAM is committed to promoting a consistent level of consultant care, 7 days a week; this will require reorganisation of services and more consultants. However the increased costs may be offset by better outcomes and shorter hospital stays resulting from earlier consultant involvement in a patient’s care’

The standards stipulate that a patient should be seen by a competent clinician within four hours and by a consultant within 14 hours of arrival at the unit. Many hospitals are already achieving that figure. Preliminary data suggest that over 80% of patients are being seen in that time and in some hospitals the figure is as high as 95%.

‘We are moving in the right direction, which is very encouraging,’ says Dr Roseveare. ‘The speciality has grown considerably since 1999 which is crucial for patient care. When patients first come in to hospital they are now more likely to see a consultant, more likely to get an appropriate diagnosis and more likely to get the right treatment.’

But Dr Roseveare says there is still a lot to do. The acute medicine workforce would need to expand considerably to achieve a 12-hour, 7-day consultant presence on AMUs across the country. At present consultants dually accredited in general internal medicine (GIM) and another speciality provide much of the weekend and out-of-hours care in many hospitals across the UK. This is crucial and will need to continue for the foreseeable future, even though the numbers of trained acute physicians is slowly rising.

The specialty also needs more junior doctors to specialise in acute medicine. SAM is currently working closely with the Royal College of Physicians to develop sustainable models of consultant working practice to encourage more doctors to consider the specialty as a career option. The nature of the shift pattern may also lend itself to ‘family friendly’ working arrangements for those who plan to work on a less than full-time basis as a consultant.

Dr Roseveare says the specialty needs to continue to develop at the rapid pace seen over the past decade. ‘In the future I believe that the acute medicine specialist should play a key role in the ongoing management of general medicine patients beyond the AMU. Acute medicine consultants, dually accredited with GIM, are ideally placed to provide this ongoing care for patients whose problem does not fall into the remit of any clear cut specialist category.’

Looking for an event focussing solely on acute medicine? SAM runs a dedicated annual event, for registration and further information please visit www.acutemedicine.org.uk

Quality Standards for Acute Medical Units is at: http://www.acutemedicine.org.uk/images/stories/pdf/the%20coordinator%20role%20in%20am.pdf

BooK now For onLy £99

Dr Chris roseveare

Dr Simon Conroy

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AGM Newspaper 8pp A3 11 (NEW JULY).indd 1 02/08/2012 12:42

Page 2: AGM Newspaper Summer

Conference programme

21 november 2012

Theatre 1 Theatre 2 Theatre 3 Theatre 4

8.00 Registration Registration

8.15 Breakfast symposiaCardiology

Prof Adam Timmis Acute Coronary Syndrome

Neurology Dr Fayyaz Ahmed

Epilepsy

9.15Gastroenterology Dr Kieran Moriarty

Abdominal pain: medical or surgical?

Endocrinology Dr Francesca Swords

Endocrine emergencies

Cardiology Prof Richard Schilling

Life threatening arrhythmias

Neurology Prof Neil Scolding

When is a “stroke” a stroke?

9.55Gastroenterology Prof Terence Wardle

Upper GI Bleed

Diabetes Dr Mark Savage

Diabetic emergencies

Cardiology workshopin association with Bayer

Neurology workshop

10.35Gastroenterology

Dr Will Bernal Acute liver failure

Diabetes workshop Morning Break

11.15 Morning Break

Cardiology Prof Andrew Clark

Advanced heart failure — all the tricks of the trade

Neurology Dr Paul Davies

Acute headaches

11.45Gastroenterology Dr Chris Roseveare

Managing acute diarrhoea

Diabetes Dr Jeremy Turner

New therapeutics T2DM

Cardiology Dr Suzanna Hardman

Hospital admissions for heart failure — kill or cure?

Neurology Dr Richard Davenport Acute leg weakness

12.25Gastroenterology workshop

Sponsored by Abbott

Endocrinology Dr Maralyn Druce

Challenging thyroidsLunch

13.05 LunchNeurology

Dr Fayyaz Ahmed Epilepsy

Endocrinology Dr Maralyn Druce

Challenging thyroids

14.05Gastroenterology Prof Terence Wardle

Upper GI bleed

Cardiology Prof Richard Schilling

Life threatening arrhythmias

Neurology Prof Neil Scolding

When is a “stroke” a stroke

Diabetes Dr Jeremy Turner

New therapeutics T2DM

14.45Gastroenterology

Dr Will Bernal Acute liver failure

Cardiology Prof Adam Timmis

Acute Coronary Syndrome

Neurology workshopin association with Bayer

Diabetes workshop

15.25Gastroenterology session

Sponsored by NorgineCardiology workshop

sponsored by MenariniAfternoon break

16.05 Afternoon breakNeurology

Dr Paul Davies Acute headaches

Endocrinology Dr Francesca Swords

Endocrine emergencies

16.35Gastroenterology Dr Kieran Moriarty

Abdominal pain: medical or surgical?

Cardiology Prof Andrew Clark

Advanced heart failure — all the tricks of the trade

Neurology Dr Richard Davenport Acute leg weakness

Diabetes Dr Mark Savage

Diabetic emergencies

17.15 Gastroenterology

Dr Chris Roseveare Managing acute diarrhoea

Cardiology Dr Suzanna Hardman

Hospital admissions for heart failure — kill or cure?

Close

17.55 Close

AGM Invited lecture : Professor Peter Rubin, Chair of the GMC: Revalidation – raising clinical standards

22 november 2012

Theatre 1 Theatre 2 Theatre 3 Theatre 4

8.00 Registration Registration

8.15 Sponsored breakfast symposiaRespiratory Medicine

Prof David LomasUnderstanding COPD

Nephrology Dr Mark Thomas

Acute kidney injury

9.15Rheumatology Prof John Isaacs

Update on rheumatoid arthritis

Hot topics Dr Sarah Burnett

Chest X-rays — radiology for the general physician

Respiratory Medicine Dr Sam Janes

Pulmonary embolus

Nephrology Dr John Firth

Preserving function in CKD

9.55Rheumatology

Prof Raashid LuqmaniVasculitis and inflammation diseases

Hot topics Dr Simon Fynn

Demystifying difficult ECGs

Respiratory medicine workshopin association with Bayer

Nephrology workshop

10.35 Rheumatology workshop General workshop Morning Break

11.15 Morning BreakRespiratory Medicine Dr Andrew Menzies-Gow

Acute severe asthma

Nephrology Prof Sunil BhandariPotassium disorders

11.45Hot topics

Dr Simon Conroy & Dr Jay BanerjeeEmergency care for older people

Hot topics Dr Stephen Waring

Poisoning and overdose

Respiratory Medicine Dr Nick Maskell

Pleural effusions — pneumothorax

Rheumatology Prof John Isaacs

Update on rheumatoid arthritis

12.25Hot topics

Dr Simon Conroy & Dr Jay BanerjeeEmergency care for older people

Hot topics Dr Richard Beale

SepsisLunch

13.05 LunchHot topics

Dr Stephen WaringPoisoning and overdose

Hot topics Dr Simon Conroy & Dr Jay Banerjee

Emergency care for older people

14.05Nephrology

Dr Mark ThomasAcute kidney injury

Respiratory Medicine Dr Andrew Menzies-Gow

Acute severe asthma

Hot topics Dr Richard Beale

Sepsis

Hot topics Dr Simon Conroy & Dr Jay Banerjee

Emergency care for older people

14.45Nephrology Dr John Firth

Preserving function in CKD

Respiratory Medicine Dr Nick Maskell

Pleural effusions — pneumothoraxGeneral workshop Rheumatology workshop

15.25 Nephrology workshopRespiratory medicine workshop

sponsored by ChiesiAfternoon break

16.05 Afternoon breakHot topics Dr Ross Welch

Managing the pregnant patient

Nephrology Dr Peter TophamSodium disorders

16.35Nephrology

Prof Sunil BhandariPotassium disorders

Respiratory Medicine Dr Sam Janes

Pulmonary embolus

Hot topics Dr Paul Gill

Psychiatry for general physicians

Rheumatology Prof Raashid Luqmani

Vasculitis and inflammation diseases

17.15Nephrology

Dr Peter Topham Sodium disorders

Respiratory Medicine Prof David Lomas

Understanding COPDClose

17.55 Close

wednesday 21st november

Thursday 22nd november

In association with

In association with

- Acute Medicine - General

- Acute Medicine - General

Conference Speakers

Dr Mark Thomas

Dr Fayyaz Ahmed

Dr Mark Savage

Prof Andrew Clark

Prof Richard Schilling

Dr Sam Janes

Dr Peter Topham

Dr Richard Beale

Dr Andrew Menzies-Gow

Dr Paul Gill Dr Simon Conroy

Prof David Lomas

Dr Ross Welch

Prof John Isaacs

Dr Stephen Waring

Dr Nick Maskell

Dr Simon Fynn Prof Neil Scolding

Dr Richard Davenport

Dr John Firth

Dr Jeremy Turner

Prof Sunil Bhandari

Dr Suzanna Hardman

Dr Francesca Swords

Dr Paul Davies

Dr Sarah Burnett

Prof Raashid Luqmani

11 CPD points accredited by the rCP

Book now for only £99Visit www.agmconference.co.uk

Dr Kieran Moriarty Dr Chris Roseveare Dr Will Bernal

Xarelto®: the � rst oral single-drug approach for DVT treatment

© Bayer Healthcare BHP

Xarelto®15 and 20mg � lm-coated tablets (rivaroxaban) Prescribing Information (Refer to full Summary of Product Characteristics (SmPC) before prescribing) Presentation: 15mg/20mg rivaroxaban tablet. Indication(s): Treatment of deep vein thrombosis (DVT) & prevention of recurrent DVT & pulmonary embolism (PE) following an acute DVT in adults. Posology & method of administration: Dosage – 15mg b.i.d. for 3 weeks followed by 20mg o.d. for continued treatment & prevention of recurrent DVT & PE; take with food. Refer to SmPC for information on duration of therapy & converting to/from Vitamin K antagonists (VKA) or parenteral anticoagulants. Renal impairment: mild (creatinine clearance 50-80 ml/min) – no dose adjustment necessary; moderate (creatinine clearance 30-49 ml/min) & severe (creatinine clearance 15-29 ml/min: limited data indicates rivaroxaban plasma concentrations are signi� cantly increased, use with caution) – 15mg b.i.d for 3 weeks, reduce maintenance dose to 15mg o.d; patients with creatinine clearance <15 ml/min – use not recommended. Hepatic impairment: Do not use in patients with hepatic disease associated with coagulopathy & clinically relevant bleeding risk including cirrhotic patients with Child-Pugh B & C. Paediatrics: Not recommended. Contraindications: Hypersensitivity to active substance or any excipient; clinically signi� cant active bleeding; hepatic disease associated with coagulopathy & clinically relevant bleeding risk including cirrhotic patients with Child-Pugh B & C; pregnancy & breastfeeding. Warnings & precautions: Clinical surveillance in line with anticoagulant practice is recommended throughout the treatment period. There is no need for monitoring of coagulation parameters during treatment with rivaroxaban in clinical routine. If clinically indicated, rivaroxaban levels can be measured by calibrated quantitative anti-Factor Xa tests. In studies, mucosal bleedings & anaemia were seen more frequently during long term rivaroxaban treatment compared with VKA treatment – haemoglobin/haematocrit testing may be of value in detecting occult bleeding. The following sub-groups of patients

are at increased risk of bleeding & should be carefully monitored after treatment initiation: Use with caution in patients with severe renal impairment or with renal impairment concomitantly receiving potent inhibitors of CYP3A4 (PK models show increased rivaroxaban concentrations); in patients treated concomitantly with medicines affecting haemostasis; in patients with an increased bleeding risk such as congenital or acquired bleeding disorders, uncontrolled severe arterial hypertension, active ulcerative gastrointestinal disease (consider appropriate prophylactic treatment for at-risk patients), recent gastrointestinal ulcerations, vascular retinopathy, recent intracranial or intracerebral haemorrhage, intraspinal or intracerebral vascular abnormalities, recent brain/spinal /ophthalmological surgery, bronchiectasis or history of pulmonary bleeding. Use is not recommended in patients: with creatinine clearance <15 ml/min; receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors; with prosthetic heart valves; for treatment of acute pulmonary embolism. If invasive procedures or surgical intervention are required, stop Xarelto® use at least 24 hours beforehand. Restart use as soon as possible provided adequate haemostasis has been established. See SmPC for full details. Xarelto® contains lactose. Interactions: Concomitant use with strong inhibitors of both CYP3A4 & P-gp not recommended as increased rivaroxaban plasma concentrations to a clinically relevant degree are observed. Avoid co-administration with dronedarone. Use with caution in patients concomitantly receiving other anticoagulants, NSAIDs or platelet aggregation inhibitors due to the increased bleeding risk. Use with caution in patients concomitantly receiving CYP3A4 inducers as they may reduce rivaroxaban plasma concentrations. Pregnancy & breastfeeding: Contraindicated. Effects on ability to drive and use machines: Adverse reactions like syncope & dizziness are common. Patients experiencing these effects should not drive or use machines. Undesirable effects: Very common: urogenital tract haemorrhage (in women

<55 years in DVT-t trials). Common: anaemia, dizziness, headache, syncope, eye haemorrhage, tachycardia, hypotension, haematoma, epistaxis, GI tract haemorrhage, GI & abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, pain in extremities, urogenital tract haemorrhage, fever, peripheral oedema, decreased general strength & energy, increase in transaminases, post-procedural haemorrhage, contusion, wound secretion. Serious: cf. CI/Warnings and Precautions – in addition: thrombocythaemia, allergic reactions, occult bleeding/haemorrhage from any tissue (e.g. cerebral & intracranial, cutaneous & subcutaneous, muscle), haemoptysis, haemarthrosis which may lead to complications (incl. compartment syndrome, renal failure, fatal outcome), abnormal hepatic function, renal impairment, hyperbilirubinaemia, jaundice, pseudoaneurysm formation following percutaneous intervention. Prescribers should consult SmPC in relation to full side-effect information. Overdose: No speci� c antidote is available. Legal Category: POM. Package Quantities and Basic NHS Costs: 15mg – 28 tablets: £58.80, 42 tablets: £88.20, 100 tablets: £210.00; 20mg – 28 tablets: £58.80, 100 tablets £210.00 MA Number(s): EU/1/08/472/011-21 Further information available from: Bayer plc, Bayer House, Strawberry Hill, Newbury, Berkshire RG14 1JA, U.K. Telephone: 01635 563000. Date of preparation: June 2012. Xarelto® is a trademark of the Bayer Group.

Simple, proven, predictable anticoagulation

UK.PH.GM.XAR.2012.245a June 2012

Treatment of deep vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism (PE) following an acute DVT in adults

Xarelto®

NOW AVAILABLE FOR

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 Bayer plc.

Tel.: 01635 563500, Fax.: 01635 563703, Email: [email protected]

coagulation

complicateda stop to

ant -l

help put

BAY01J11011_DVT_Ad_297x210.indd 1 21/06/2012 11:35

Page 2 Page 3

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

Paul Shelley - Show director [email protected]

Mike Broad – Programme director [email protected]

Liz Sanders – Business development manager [email protected]

yemi Ibidunni - Event executive [email protected]

Alice Andrews - Delegate manager [email protected]

Sophie Holt - Marketing and PR manager [email protected]

Julia Danmeri - Head of operations [email protected]

Vanda Vokes - Conference and speaker manager [email protected]

rebecca royal - Event administrator [email protected]

Andy Center - Chief Executive [email protected]

Michael westcott - Business Development Director [email protected]

Phil nelson - Commercial Director [email protected]

Jonathan wood - Director of Finance [email protected]

Phil Soar – Chairman

Our high profile speakers will offer practical, interactive presentations that will help delegates transfer the latest thinking and practices from the auditorium to the clinic room and ward. With over 80 talks, and a skills lab, medics will be able to tailor their own programme of learning according to their own training needs. After attending our conference, doctors will be ready for anything when on-call or dealing with general medical intakes!

Follow us on Twitter:for the latest news: @AGMConference UK

The toolkit outlines the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people. This includes appropriate communication skills, clinical reasoning and assessment skills in respect of complex co-morbidities, poly-pharmacy and altered physiological response to trauma and illness; and risk management skills surrounding discharge planning with knowledge of community services.

The Silver Book suggests that in acute medical units, greater use of geriatric liaison services should increase the proportion of older people able to be managed in community settings. It also encourages greater use of the voluntary sector.

Dr Conroy says: ‘The document is ambitious but everything in it is evidence based. A lot of it is about using what is already there and making it work differently in a more joined up way.

‘Acute care in general and care of older people is key to the success of the NHS because so many resources are poured in to it. The evidence is there that if we get it right costs will come down, lengths of stay, hospital readmissions and care home use will all come down.’

The Silver Book is at: http://www.bgs.org.uk/campaigns/silverb/silver_book_complete.pdf

Continued from page 1

Toolkit set to raise the bar on the urgent care needs of older people

AGM programme achieves CPD accreditationThe Royal College of Physicians has verified the educational content of the AGM programme for 11 CPD points. This confirms the AGM conference as a great value way for doctors to update their knowledge across the core medical specialties, and demonstrate their professional development at reviews and revalidation meetings.

AGM offers two packed days of training in cardiology, endocrinology, gastroenterology, neurology, geriatric medicine, nephrology and respiratory medicine in both a general and acute setting, allowing both junior medics and consultants to keep up to date with best practice, supporting them during on call time and when dealing with general intakes.

A staggered programme allows doctors to create their own training plan, blending educational sessions with hands-on skills training in the Emergency Simulation Lab, run by the Advanced Life Support Group.

Sponsorship statementThe 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.

11 CPDPOINTS

AGM Newspaper 8pp A3 11 (NEW JULY).indd 2-3 02/08/2012 12:42

Page 3: AGM Newspaper Summer

Page 4

For more information you can visit the PHA UK website www.phassociation.uk.comemail [email protected] or call the PHA UK office on 01709 761450.

Pulmonary Hypertension Diagnosis and Management is an education programme that aims to raise awareness of PH and therefore improve the outcome of patients with this condition.

The programme is an online course funded and developed by the PHA UK in collaboration with Edge Hill University and a panel of specialists in PH.

Completion of the course and associated assessment can lead to 20 credits at degree or Master’s level

A non-academic certified option is also available

Some bursaries are available to help with course fees. Please ask a member of the PHA UK for details.

Visit the PHA UK at stand E45 for a demonstration of the programme and to find out

more information.

PHA UK – Registered Charity No. 1120756

To ensure you get prime choice of stands and sponsorship opportunities, please call Paul Shelley 0207 348 5260 or email [email protected]

Sudden death wrecks more than just one life

Signifi cantly reduces sudden death after MI2

Sudden cardiac death accounts foraround 50% of all CHD-related deaths1

OMACOR 1000 MG CAPSULE, SOFT: PRESCRIBING INFORMATION

Presentation: Capsules containing 1000mg of omega-3-acid ethyl esters 90

comprising 840mg eicosapentaenoic acid ethyl ester (460mg) and docosahexaenoic

acid ethyl ester (380mg). Indications: Adjuvant treatment in secondary prevention

after myocardial infarction. Endogenous hypertriglyceridaemia as a supplement to

diet when dietary measures alone are insuffi cient to produce an adequate response:

Type IV in monotherapy; Type IIb/III in combination with statins, when control of

triglycerides is insuffi cient. Dosage and Administration: Post myocardial infarction:

One capsule daily. Hypertriglyceridaemia: Initially two capsules daily. Increase to four

capsules daily if necessary. May be taken with food. No or limited information of use in

elderly (>70yrs), children, hepatic or renal impairment. Contraindications, Warnings,

Precautions etc: Contraindications: Hypersensitivity to ingredients including soya.

Warnings/Precautions: Due to risk of haemorrhage (with high dose only) monitor

patients on anticoagulant therapy and those at high risk of haemorrhage (e.g. severe

trauma, surgery etc). Not recommended in children. Not indicated in exogenous

hypertriglyceridaemia. There is limited experience in secondary endogenous

hypertriglyceridaemia and no experience of use in combination with fi brates. In

hepatic impairment, regularly monitor ASAT and ALAT. Drug Interactions: Monitor

use with oral anticoagulants. Pregnancy and Lactation: Should not be used in

pregnancy or lactation. Ability to Drive and Operate Machinery: Not relevant. Side

Effects: Common: dyspepsia, nausea. Uncommon: Abdominal pain, GI disorders,

gastritis, gastroenteritis, hypersensitivity, dizziness, dysgeusia. Rare: GI pain,

headache, hyperglycaemia, hepatic disorders, acne, pruritic rash, ill defi ned disorders.

Very rare: Lower GI haemorrhage, hypotension, nasal dryness, urticaria, increased

white blood cell count, increased blood lactate dehydrogenase, moderate elevation of

transaminases in hypertriglyceridaemic patients. Marketing Authorisation Holder:

Pronova BioPharma Norge AS, P.O. Box 420, 1327 Lysaker, Norway. PL: 15905/0001.

Basic NHS price: £14.24 (28 capsules); £50.84 (100 capsules). Legal Category: P.

Further information is available from: Abbott Healthcare Products Ltd, Mansbridge

Road, West End, Southampton, SO18 3JD. Date of Last Review: 20th June 2011

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

References: 1. Myerburg RJ, Junttila MJ. Circulation 2012; 125: 1043-52. 2. GISSI-P Investigators. Lancet 1999; 354: 447-55.

Date of preparation: June 2012.AHOMA120263www.omacor.co.uk

OM237_4_Omacor_262x390_AGM_ad.indd 1 14/06/2012 12:30

Acute and General Medicine 2012 offers a visionary new approach to medical training.Physicians across the UK – from core medical trainees to consultants – have a unique opportunity to get up-to-date with latest practices and thinking in acute and general internal medicine for practically nothing.

Update your knowledge in Cardiology, Respiratory Medicine, Diabetology, Care of the elderly, Neurology, Nephrology, Rheumatology, Gastroenterology and much more…

Up to 11 CPD points accredited by the RCP. Great value with two days of training for just £99 including refreshments and lunch.

register online or call 0207 348 4906

agmconference.co.uk | @AGMConfUK

A full body of knowledge

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Eighty-five percent of NHS trusts use one or more CSC solution, making it the UK’s principal IT provider. And with 13,000 customers in 42 countries, it also ranks among the world’s largest healthcare IT companies.

Its software portfolio is extensive and covers every facet of healthcare delivery and planning. This includes interoperable e-health solutions that build on existing systems to maximise current investments, increase efficiency and transform patient care.

Its MedChart solution supports all aspects of electronic prescribing and medicines administration and is shown to prevent drug-related mistakes. It improves the communication of medicines related information between medical, nursing and clinical pharmacy teams. Advanced drug formulary management, and clinical and workflow based decision support, provides a highly effective tool to help improve safety

BCM Specials is at the forefront of the unlicensed medicines market.

We’ve been manufacturing bespoke unlicensed medicines for over 70 years and we have passion for every single one of our 70,000 formulations.

Based in our state-of-the-art MHRA approved facilities, we manufacture sterile and non-sterile bespoke unlicensed medicines for Community and Retail Pharmacy, Hospital Pharmacy, Doctors, Veterinary practices and Wholesalers. We always provide full supporting documentation with every order.

We also offer a wide range of manufacturing services such as clinical trial supply and contract manufacturing.

Our ethos is about being ethical, improving patient care and exceeding our customer expectations.

To enquire about your specific needs, or if you require more information, just visit us at our stand.

GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care. Our broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and solutions services help our customers to deliver better care to people around the world at a lower cost. In addition, we partner with healthcare leaders, striving to leverage the global policy change necessary to implement a successful shift to sustainable healthcare systems. Our “healthymagination” vision for the future invites the world to join us on our journey as we continuously develop innovations focused on reducing costs, increasing access and improving quality around the world. Headquarters in United Kingdom, GE Healthcare is part of General Electric Company (NYSE: GE). Worldwide, GE Healthcare employees are committed to serving healthcare professionals and their patients to over 100 countries. For more information please visit: www.gehealthcare.com.

Kora Healthcare aims to be to the leading company in the development and supply of quality specialist innovative products to niche hospital and healthcare markets Business Interests Kora Healthcare develops, manufactures and markets own label products and also acts as a distributor for several partners in the areas of:• Infectious disease• Women’s health • Clinical nutrition KoRa Healthcare is the hospital and retail pharmacy distribution division of the Immdal group. Within the Immdal group, KoRa develops and sources niche products for supply to hospitals and pharmacies. Kora outsources its products from GMP audited manufacturing companies for distribution in multiple markets. Kora is licensed to batch release pharmaceuticals and investigational medicinal products into EU markets wholesalingKora has appointed distribution agencies to supply wholesale, hospital and retail customers in Ireland and United Kingdom - Kora is also licensed to distribute prescription medicines in the EU.

Abbott Healthcare Products Ltd is committed to optimising patient care through innovative treatments and education. These include therapies for post myocardial infarction, lipid regulation and hypertension. Towards the end of 2012 Abbott will launch a first in class ‘antisecretory’ for treating acute diarrhoea for all ages from 3 months.

Elsevier is a leading publisher of health science information, helping to advance medicine by delivering superior education and reference information as well as decision support tools for students and health care professional. At this year’s Acute & General Medicine conference, Elsevier is proud to announce the launch of ClinicalKey, the world’s first Clinical Insight Engine. Powered by Elsevier’s comprehensive and trusted content, ClinicalKey provides online access to faster, smarter clinical information at the point of care.

Our team would welcome the opportunity to meet with you to discuss the benefits a ClinicalKey subscription could bring to your institution. Please join us at the Elsevier stand to hear more. SimMom is an advanced full body simulator with accurate

anatomy and functionality to facilitate multiprofessional training with emphasis on obstetrics and birth management.

With this SimMom provides for the realistic practice of multiple delivery positions and manoeuvres, teamwork, leadership and communication skills in a risk-free environment. Different uterus modules add further realism and extend the application of the simulator.Pre-programmed scenarios provide standardised training for consistent quality patient care.Customisable scenarios and real time instructor controls allow for scenario adaptation to accommodate individual student or team needs.

Developed in partnership between Limbs & Things and Laerdal.

Based in Amsterdam, the Netherlands, Norgine is a long-established specialty pharmaceutical company with an extensive presence throughout Europe.

Since its foundation in 1906, Norgine has been committed to the development and marketing of high quality, innovative and ethical products for the benefit of both patients and physicians.

Specialising in the areas of gastroenterology, hepatology

Founded in 2010, Internis is a pharmaceutical company engaged in the development and commercialisation of highly effective and innovative new medicines aimed at the treatment and prevention of a range of common bone disorders, such as osteoporosis and vitamin D3 deficiency.

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Kora HealthcareAbbot Healthcare

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Internis Pharmaceuticals Ltd.

The Pulmonary Hypertension Association (PHA UK) is the only charity in the UK especially for people with pulmonary hypertension (PH). Our main objectives are to advance the education & awareness of the general public and medical professionals whilst helping improve the lives of people with PH, and supporting the PH community in the UK. We do this by funding research into PH, raising awareness of the condition, and helping people in their day-to-day lives.

The PHA UK was started in 2000 with only 6 members. We now have approximately 4000 members and over 10 years’ experience of supporting people affected by PH.

If you would like to know more about PH or the PHA UK, please visit www.phassociation.uk.com or contact the office on 01709 761 450.

Our objective is high quality cost effective care for every person with diabetes or kidney disease. We produce evidence, case studies and guidance to inform local decision-making. Our networks and regional representatives support frontline NHS staff to drive quality and efficiency, tackle health inequalities and improve outcomes for patients.

We know that over half of all deaths take place in hospital, despite the majority of people not wanting this. We also know that the estimated total cost of acute admissions ending in death in 2010-11 was over £520m.

The National End of Life Care Programme has made significant progress working with health and social care staff, providers, commissioners and third sector organisations across England to improve end of life care for adults. We help put into practice the Department of Health’s End of Life Care Strategy (2008) and the NICE quality standard for end of life care for adults (2011).

Our acute hospitals initiative aims to transform end of life care, supporting the implementation of ‘The Route to Success in End of Life Care – Achieving Quality in Acute Hospitals’ (2010). Find out more at www.endoflifecareforadults.nhs.uk or follow us on Twitter @NEoLCP.

The RMBF is the leading UK charity for doctors, medical students and their families. We provide financial support, money advice and information when it is most needed due to illness, age, bereavement or disability.

Each year the RMBF provides support for hundreds of doctors and their dependents through all stages of their career and beyond. Our help ranges from financial assistance in the form of grants and interest-free loans to a telephone befriending scheme for those who may be isolated and in need of support.

The RMBF is committed to leading the way in providing support and advice to members of the medical profession and their families. However our work is only made possible through the kind support we receive from members of the profession. To find out more about our work, or how you can get involved visit www.rmbf.org.

ExHIBITor ProFILE

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Pulmonary Hypertension Association UK

nHS Diabetes and Kidney Care

Transforming end of life care in hospitals

royal Medical Benevolant Fund

Exhibitor profilesand clinical outcomes.

CSC works with its NHS customers to develop solutions that meet a genuine need, deliver real benefits and make a lasting difference to clinical staff and patients alike.

Book now for only £99 - visit www.agmconference.co.uk

Follow us on Twitter:for the latest news: @AGMConference UK

A brand new show for hospital leaders will be sharing the floor with AGM in November. Hospital Directions will bring together directors and function leaders from foundation trusts across the UK, to share ideas and practical solutions. Eschewing blue sky thinking, the conference programme and workshops will focus on practical solutions for managing the changes brought about by the Health and Social Care Bill.

It is a large scale opportunity for all those who shape secondary care to network and gain understanding on key issues. Shared keynotes and networking sessions will provide ample opportunity for informal networking between both delegate groups.

Hospital Directions is not a traditional conference. It’s a dynamic, new event aimed at providing managers in secondary care with the information they need to navigate and succeed in the new look health service.

The speaker programme has been carefully designed to explore the key challenges health managers will face during this period of transition, together with practical guidance on how to deliver high quality care for patients and the public: trail blazing examples of managers who streamlined and restructured to achieve more with less.

To that end, Hospital Directions contains three comprehensive speaker streams – dedicated to Leadership, Quality and Efficiency – jam packed with leading thinkers and successful case studies.

Hospital Directions involves 54 workshops and seminars over two days and offers essential insight for secondary care managers. It’s an inclusive conference offering learning for managers from across NHS trusts including HR, finance, patient services, procurement, strategy, IT and information services, estates and facilities management and senior directors. Hospital Directions already has the support of leading management institutions, including the Institute of Healthcare Management.

Pre-show research also suggests a keen interest from potential delegates. 96% of those surveyed told us they believed Hospital Directions would aid their teams in driving quality and efficiency. And every respondent told us they would be interested in attending the event.

To find out more about sponsorship or speaker opportunities, please contact event director Paul Shelley on 020 7348 5260

All the team together with Hospital Directions

and supportive care, Norgine is dedicated to addressing unmet clinical need, not only for effective treatment of life-threatening conditions, but also, importantly, to improve the quality of life for patients with a range of acute and chronic illnesses.

In recent years, Norgine has focused on expanding its pan-European infrastructure. The company now has affiliates in all major European countries and has centralised and strengthened its research and development activities.Norgine’s success is based not only on its strong portfolio and robust development programme, but also on a long-standing tradition of building strong and meaningful relationships with patients, physicians, employees, partners and other key stakeholders.

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new standards set to improve emergency care for hospital patientsA landmark document designed to establish consistent standards of care for patients admitted to Acute Medical Units (AMUs) across the UK was published in June.

Produced by the West Midlands Quality Review Service in association with the Society for Acute Medicine the document, ‘Quality Standards for Acute Medical Units’ was launched on the first ever Acute Medicine Awareness Day.

The guidance sets out standards to ensure the clinical team

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One-tablet, once-daily Xarelto®: simple stroke prevention in atrial � brillation vs warfarin

© Bayer Healthcare BHP

Xarelto®15 and 20mg � lm-coated tablets (rivaroxaban) Prescribing Information (Refer to full Summary of Product Characteristics (SmPC) before prescribing) Presentation: 15mg/20mg rivaroxaban tablet. Indication(s): Prevention of stroke & systemic embolism in adult patients with non-valvular atrial � brillation with one or more risk factors such as congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischaemic attack. Posology & method of administration: Dosage – 20 mg orally once daily with food. Continue therapy long term provided bene� t of prevention of stroke & systemic embolism outweighs risk of bleeding. Refer to SmPC for information on converting to/from Vitamin K antagonists (VKA) or parenteral anticoagulants. Renal impairment: mild (creatinine clearance 50-80 ml/min) - no dose adjustment necessary; moderate (creatinine clearance 30-49 ml/min) & severe (creatinine clearance 15-29 ml/min; limited data indicates rivaroxaban plasma concentrations are signi� cantly increased, use with caution) – reduce dose to 15mg o.d.; patients with creatinine clearance <15 ml/min – use not recommended. Hepatic impairment: Do not use in patients with hepatic disease associated with coagulopathy & clinically relevant bleeding risk including cirrhotic patients with Child-Pugh B & C. Paediatrics: Not recommended. Contraindications: Hypersensitivity to active substance or any excipient; clinically signi� cant active bleeding; hepatic disease associated with coagulopathy & clinically relevant bleeding risk(including cirrhotic patients with Child- Pugh B & C; pregnancy & breastfeeding. Warnings & precautions: Clinical surveillance in line with anticoagulant practice is recommended throughout the treatment period. There is no need for monitoring of coagulation parameters during treatment with rivaroxaban in clinical routine. If clinically indicated, rivaroxaban levels can be measured by calibrated quantitative anti-Factor Xa tests. In studies, mucosal bleedings & anaemia were seen more frequently during long-term rivaroxaban treatment compared with VKA treatment – haemoglobin/haematocrit testing may be of value in detecting occult bleeding.

The following sub-groups of patients are at increased risk of bleeding & should be carefully monitored after treatment initiation: use with caution in patients with severe renal impairment or with renal impairment concomitantly receiving potent inhibitors of CYP3A4 (PK models show increased rivaroxaban concentrations); in patients treated concomitantly with medicines affecting haemostasis; in patients with an increased bleeding risk such as congenital or acquired bleeding disorders, uncontrolled severe arterial hypertension, active ulcerative gastrointestinal disease (consider appropriate prophylactic treatment for at-risk patients), recent gastrointestinal ulcerations, vascular retinopathy, recent intracranial or intracerebral haemorrhage, intraspinal or intracerebral vascular abnormalities, recent brain/spinal/ophthalmological surgery, bronchiectasis or history of pulmonary bleeding. Use is not recommended in patients: with creatinine clearance <15 ml/min; receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors; with prosthetic heart valves; for treatment of acute pulmonary embolism. If invasive procedures or surgical intervention are required, stop Xarelto® use at least 24 hours beforehand. Restart use as soon as possible provided adequate haemostasis has been established. See SmPC for full details. Xarelto® contains lactose. Interactions: Concomitant use with strong inhibitors of both CYP3A4 & P-gp not recommended as increased rivaroxaban plasma concentrations to a clinically relevant degree are observed. Avoid co-administration with dronedarone. Use with caution in patients concomitantly receiving other anticoagulants, NSAIDs or platelet aggregation inhibitors due to the increased bleeding risk. Use with caution in patients concomitantly receiving CYP3A4 inducers as they may reduce rivaroxaban plasma concentrations. Pregnancy & breastfeeding: Contraindicated. Effects on ability to drive and use machines: Adverse reactions like syncope & dizziness are common. Patients experiencing these effects should not drive or use machines. Undesirable effects: Common: anaemia, dizziness, headache,

syncope, eye haemorrhage, tachycardia, hypotension, haematoma, epistaxis, GI tract haemorrhage, GI & abdominal pains, dyspepsia, nausea, constipation, diarrhoea, vomiting, pruritus, rash, ecchymosis, pain in extremities, urogenital tract haemorrhage, fever, peripheral oedema, decreased general strength & energy, increase in transaminases, post-procedural haemorrhage, contusion, wound secretion Serious: cf. CI/Warnings and Precautions – in addition: thrombocythaemia, allergic reactions, occult bleeding/haemorrhage from any tissue (e.g. cerebral & intracranial, cutaneous & subcutaneous, muscle), haemoptysis, haemarthrosis which may lead to complications (incl. compartment syndrome, renal failure, fatal outcome), abnormal hepatic function, renal impairment, hyperbilirubinaemia, jaundice, pseudoaneurysm formation following percutaneous intervention. Prescribers should consult SmPC in relation to full side-effect information. Overdose: No speci� c antidote is available. Legal Category: POM. Package Quantities and Basic NHS Costs: 15mg – 28 tablets: £58.80, 42 tablets: £88.20, 100 tablets: £210.00; 20mg – 28 tablets: £58.80, 100 tablets: £210.00 MA Number(s): EU/1/08/472/011-21 Further information available from: Bayer plc, Bayer House, Strawberry Hill, Newbury, Berkshire RG14 1JA, U.K. Telephone: 01635 563000. Date of preparation: June 2012.

Xarelto® is a trademark of the Bayer Group.

Simple, proven, predictable anticoagulation

Prevention of stroke and systemic embolism in eligible patients with non-valvular atrial � brillation

UK.PH.GM.XAR.2012.245 June 2012

Xarelto®

NOW AVAILABLE FOR

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 Bayer plc.

Tel.: 01635 563500, Fax.: 01635 563703, Email: [email protected]

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responds quickly to meet patient’s needs. The aim is to help clinicians develop services and provide a framework on which they can benchmark themselves.

The document also emphasises the need for units to provide appropriate information to patients about their condition and the process of care on the AMU. Dr Chris Roseveare, president of the Society for Acute Medicine, said: ‘Improving patients’ understanding of acute

medical care was also a key aim of Acute Medicine Awareness Day; this will help to reduce the anxiety which many will feel during this difficult period.’

Key recommendations for AMUs:• To ensure that a doctor experienced in the care of acutely

unwell patients is immediately available at all times.• To provide a team of healthcare professionals, with the

necessary skills to enable all aspects of acute medical care to be delivered on a daily basis.

• To maintain high quality, safe patient care at all times, with plans in place to deal with unexpected rises in patient numbers, when the capacity of the ward is stretched.

• To ensure that patients are properly informed about their condition, the process of care on the unit and the services which can be provided to support them when they go home.

Professor Matthew Cooke, National Clinical Director Urgent and Emergency Care, said: ‘We know that earlier senior involvement in the emergency care of patients with acute medical problems improves their outcomes. Specialists in acute medicine are a key component in ensuring the best care for people who suffer sudden illness. This document supports this continuing improvement in care for these patients.’

Dr Mark Temple, acute care fellow, Royal College of Physicians London, added: ‘The quality of care delivered on acute medical units is critical to the best outcomes for acutely ill patients. This important document sets out the quality standards for the care of patients with acute medical conditions, throughout the NHS.’

Quality Standards for Acute Medical Units can be downloaded at http://www.acutemedicine.org.uk/

need accommodation in London for AGM?There is plenty do and see in the Kensington area around your time at the conference, including the restaurants of Kensington and Notting Hill, Portobello Market and the world famous Science and Natural History Museums.Delegates for AGM can get preferential rates on local hotels through our accommodation partner, Event Express.

Visit the why Visit page of our website for more information.

www.agmconference.co.uk

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