BRITISH SOCIETY FOR RHEUMATOLOGY Minutes of the Council of the British Society for Rheumatology held at the St Brides Institute, London, EC4Y 8EQ on 17th October 2006, at 10:30-13:00 hours Committee Members Present: Dr A Bamji, President Dr J Dixey, Honorary Secretary Dr J Halsey, Honorary Treasurer Prof. Hill Gaston, Chair Heberden Committee Dr K Morley, Chair Clinical Affairs Committee Dr S Bowman, Council Member Dr M Bukhari, Council Member Dr D Haskard, Council Member Dr S Edmonds, Council Member Dr J Isaacs, Council Member Dr K Gaffney, Council Member Dr C Gorman, Council Member, Trainee Dr D Walker, Council Member Dr C Kelly, Council Member Dr J Hill, Co-opted: BHPR Representative Dr D Bax, Co-opted: JCHMT SAC Representative Others in attendance: Ms S Peters, Chief Executive, BSR Ms D Smith, Head of External Relations, BSR Mrs J Kermode, Head of Education and Events, BSR Mrs S Murray Johnson, Deputy CEO, BSR Miss K Jepson, Policy & Project Administrator Miss K Chandaria, Policy Officer Mr B Freeman, ARMA Director Dr R Butler, Honorary Website Editor Dr D L Scott, Honorary Heberden Librarian 1. WELCOME AND APOLOGIES Apologies were received from Dr A Crisp, Chair Education and Training Committee; Dr R Hughes, Chair External Relations Committee; Dr R Watts, Honorary Editor Rheumatology; Dr S Fraser, Council Member; Dr R Armstrong, Council Member; Dr P Thompson, Council 1 Member; Dr J Davidson, Co-opted BSPAR Representative; and Mr M Hogg, Clinical Projects Manager – BSR Biologics Register. 2. MINUTES OF THE PREVIOUS MEETING The minutes of the previous meeting held on 17th July 2006 were agreed as a true and accurate record with the following amendment: 2.1. Minute 1. Welcome and Apologies Dr K Morley’s apologies were received prior to the meeting. 3. MATTERS ARISING FROM THE MINUTES 3.1. Minute 3.3. British Medical Associations Central Consultants and Specialists Committee (BMA CCSC) representative Ms S Peters reported that Prof. Kuntal Chakravarty had been asked to take on the role of BMA CCSC representative on the External Relations Committee (ERC). 3.2. Minute 6. The Musculoskeletal Services Framework (MSF) Ms D Smith reported that following the endorsement of the MSF by the British Society for Rheumatology (BSR) an email briefing had been emailed out to all BSR members. A number of responses had been received by both the External Relations Department and Arthritis and Musculoskeletal Alliance (ARMA). 3.3. Minute 7. Advance Planning Ms S Peters reported that feedback had been received regarding the 2007-2010 BSR work plan following the last Council meeting and this process had now ended. Any resulting changes to service delivery will be discussed later on in the work plan implementation. 3.4. Minute 9.2. Clinical Affairs Committee (CAC) Dr C Kelly reported that he and Dr David Walsh were meeting shortly to confirm the final draft of the BSR’s response to the implementation of the 18 week target. The President noted that the BSR would like to thank Dr C Kelly and Dr D Walsh for the work they have done. ITEMS FOR DECISION 4. NEW MEMBERS, RESIGNATIONS, RETIREMENTS AND DEATHS Dr J Dixey introduced a membership report which had been distributed to Council members with an additional paper tabled at the meeting. The following new members were approved by the Council: Dr Sumaira Farman, Dr Anjandeep Nijjar, Dr Sandeep Bawa, Mrs Sandra Bowden, Dr Penelope Wong, Dr Gwenan Huws, Dr Lubna Aslam, Dr Lisa Davies, Dr Luke Gompels, Dr Chetan Narshi, Dr Jamal Teir, Dr Debbie Hazlewood, Dr Claire Crabtree, Dr Claire Artmitage, Dr Alexander Clarke, Dr Louise Hamilton, Dr Mark Wood, Dr Su-Yin Tan, and Miss Lauren Whyte. The Council also noted the following resignations: Dr Nick Hall and Dr Matthew Brown. 2 5. APPOINTMENTS TO BSR COMMITTEES The following changes to BSR Clinical Affairs Committee were approved by Council: The appointment of Ian Rowe, for three years as co-opted Peer Review representative up to the 2009 Annual General Meeting 2009. The following changes to Rheumatology were approved by Council: The appointment of Dirk Elewaut (Belgian) as a new Associate Editor; and Dr Hani El-Gabalawy (Canadian) as a new editorial board member, The appointment of the following recruitment panel for new Honorary Editor (President, Past President, Chief Executive, Honorary Treasurer, and an Associate Editor). The following nomination for the co-option of a Non Clinical Scientist to Council was approved by Council: Professor Tim Cawston. The following changes to BSR Website Working Group were approved by Council: The approval of the term of office of Dr Marwan Bukhari and Dr Zoe Paskins as ordinary members of the Committee for three years to the Annual General Meeting 2009. Ms S Peters asked Council to note the increased international make up of the Rheumatology Journal Editorial board. 6. APPROVAL OF BSR GUIDELINES – VASCULITIS Ms D Smith introduced the Vasculitis guidelines, which had been circulated with the papers for this meeting. The committee queried the wording relating to azathioprine monitoring and Thiopurine S-Methyltransferase (TPMT) pre-treatment assessment, (1st sentence of 1st paragraph, page 22). It was decided that the sentence should read. ‘Pre-treatment assessment should include full blood count (FBC), renal function and liver function tests (LFTs)’. It was also noted that as the guidelines would be reviewed in 2009-2010 as this would be an appropriate time to assess any changes in pre-treatment assessment. The Council approved the Vasculitis guidelines subject to agreed changes to page 22. Dr A Bamji noted that the Council would like to congratulate the Vasculitis working group on a superb document. Action Points Ms D Smith to contact the Vasculitis guidelines working group convenor, Dr R Watts with the Council’s changes. ITEMS FOR DISCUSSION 7. MUSCULOSKELETAL SERVICE FRAMEWORK (MSF) Ms D Smith and Mr B Freeman gave a presentation on the newly available MSF document. Ms D Smith noted that the BSR along with ARMA endorsed the principles of the MSF and it is due to have its official launch on 31st October. The document is available via the Department of Health and BSR website. Ms D Smith commented that members should contact the Department of Health’s publications department if they would like a hard copy but she agreed to arrange for a bulk deliver for the BSR’s use. 3 Mr B Freeman noted that ARMA are working towards getting the MSF implemented across the country, raising the level of awareness amongst the health and social care sector. Neil Betteridge, Chief Executive Arthritis Care, and Andy Burnham MP, Minister of State (Delivery and Quality), Department of Health will also be speaking at the launch on the 31st October. Mr B Freeman noted that he was concerned that their was currently no senior civil servant responsible for the implementation the MSF and that he would be asking for this to happen. ARMA are putting together an implementation strategy group and are planning an event to promote good implementation in 2007 with the Department of Health. Ms D Smith commented that an email had been sent to BSR members providing members with details of the MSF and highlighting the role ARMA Local Networks would have in its implementation. This had resulted in a high response rate regarding ARMA Local Networks. Action Points Ms D Smith to arrange for a bulk delivery of hard copies of the MSF for the BSR’s use once it has been launched 8. NATIONAL INSTITUTE OF HEALTH AND CLINICAL EXCELLENCE (NICE) GUIDELINES Miss K Chandaria outlined the BSR’s current and future involvement in NICE guidelines. BSR are currently involved in six appraisals and two clinical guidelines. The new Single Technology Appraisals (STA) has reduced the opportunities for BSR involvement in the process with appraisals taking eight months instead of 18 months to complete. The BSR now have two opportunities to submit written comments and this process is more structured. Miss K Chandaria gave the following updates on current appraisals and guidelines: 8.1. Multiple Technology Appraisals Adalimumab, etanercept and infliximab for Ankylosing Spondylitis Dr Andrew Keat and Prof Roger Sturrock are BSR representatives at appraisal committee. Appraisal Committee requested additional analysis of the cost effectiveness of the anti-TNF therapies, which we are in the process of responding. The second appraisal committee meeting will now take place on the 22nd November 2006. Adalimumab, etanercept and infliximab for Rheumatoid Arthritis The Rheumatoid Arthritis (RA) reappraisal was suspended in March while data on switchers was obtained from the BSR Biologics Register (BSRBR). This data along with extra analysis from NICE itself was completed at the beginning of September and the documents sent out for consultation. The comments on these documents were used to inform a further appraisal committee meeting which took place on the 3rd of October and which Dr Chris Deighton and Dr Frank McKenna attended on behalf of ARMA. We now expect that a Final Assessment Document will be issued in November. Osteoporosis primary and secondary prevention Strontium ranelate was included in this appraisal of technologies instead of being appraised on its own as initially indicated. The first appraisal committee meet 1st November 2005 at which the committee decided that a reanalysis of the evidence was needed, additional analysis was produced and the work completed in July. Following this a further Appraisal Consultation Document (ACD) was released. BSR 4 have been in regular contact with the National Osteoporosis Society and are supporting their responses. 8.2. Single Technology Appraisals Rituximab for refractory Rheumatoid Arthritis The final scope for this appraisal has been published and Prof D Isenberg has been put forward as the BSR’s nominated clinical expert. The deadline for submitting our statement is the 21st of November. Adalimumab for Psoriatic Arthritis The final scope for this appraisal has been published and Dr Phillip Helliwell and Prof. Ian Bruce have been put forward as our nominated clinical experts. Certolizumab pegol for Rheumatoid Arthritis The draft scope for this appraisal has been published and comments were provided by Prof. Rob Moots and Prof. Paul Emery. A scoping workshop took place on the 30th of August and a draft scope is likely to be issued once Phase 3 clinical trials are complete and it has gained a licence for RA. Abatacept for refractory Rheumatoid Arthritis The draft scope for this appraisal has been published and comments were provided by Dr Chris Deighton. The final scope is likely to be issued in January 2007. Leflunomide for Psoriatic Arthritis The draft scope for this appraisal was published and comments provided by Dr Neil McHugh and Dr Phillip Helliwell. 8.3. Clinical Guidelines Osteoarthritis The guideline group has met several times since April and BSR is well represented on the Guideline Working Group. Rheumatoid Arthritis The consultation for this guideline has yet to begin but it is anticipated for November. Osteoporosis Work on this guideline has been suspended pending the outcome of the ACD and the Appraisal Committee Meeting. Miss K Chandaria noted that the BSR needed to be aware that NICE will require input that is increasingly robust, with strong clinical data and a greater focus on Health Economics, and this should be worked into Society responses from now on. Dr A Bamji thanked Miss K Chandaria, the BSR Secretariat and BSR members for their hard work in these processes. ITEMS FOR INFORMATION 9. REPORTS FROM OFFICERS 9.1. President’s Report Dr A Bamji reported on the following items: The Health Care Commission had been in contact with the BSR as they are interested in the work carried out by the BSR regarding Peer Review, Audit and clinical activities, Channel 4’s Dispatch programme on postcode prescribing will now be aired in November, 5 A poor response to the submitted key word selection for the Choose and Book system. The key words chosen do not reflect the document submitted by Dr A Bamji and therefore the specialism’s views. This issue will be a matter for future discussion, The RCP are producing an official response to the recently published Donaldson report but they are encouraging specialties to produce their own responses. Dr A Bamji will draft the BSR’s response within the next two weeks, BSR had received the ILAR constitutional draft but was currently concerned by issues relating to its funding. Dr A Bamji asked Council members to inform him if they had any comments, The success of the joint Irish Society for Rheumatology and BSR meeting held on 14th -16th September in Dublin. Dr A Bamji felt that it was a fantastic meeting with excellent educational content, Meetings are arranged for the coming months with a range of partner organisations to discuss future relationship and matters of interest. As an additional item to the President’s report Dr J Halsey tabled and introduced a document on the Introduction of Independent Sector (IS) Provided Capture, Assess, Treat and Support (CATS) in Cumbrian and Lancashire. Dr J Halsey drew the Council’s attention to concerns surrounding the introduction of ISCATS as the preferred mode of delivery for many musculoskeletal services in the North West. Particularly the process by which Netcare was awarded preferred bidder statue for the Cumbria and Lancashire ISCATS Scheme by the North West Strategic Health Authority (SHA). Dr J Halsey noted that he had communicated with fellow colleagues in the North West SHA and a meeting had been arranged to discuss the issue further. The ARMA Local Network had also been contacted. Prof. H Gaston enquired as to whether the local Rheumatology consultants could have submitted a local bid. Dr J Halsey noted that in the North West SHA only bids from the independent sector were asked for and that as Netcare had already been agreed as the preferred bidder by the SHA, they were now receiving an income from the Department of Health. Ms S Peters commented that this message should be taken to Ministers once Dr J Halsey was happy that he had a clear understanding of the whole situation. Discussions of this subject at the MSF launch should be viewed with caution so as not to detract from the MSF document. Ms D Smith noted that this issue would be of interest to the national press. Dr J Halsey stated that his next steps were as follows: To communicate a vote of no confidence in the pathway choice, To send a letter regarding the situation and concerns to the Primary Care Trust Chief Executive, To send a letter to the Strategic Health Authority, To send a letter to the Health Care Commission. Dr J Halsey noted that a whole musculoskeletal community response was needed to gain the most impact. Dr A Bamji agreed to enquire with other organisations regarding this issue. Ms S Peters agreed that the BSR would be ready to escalate the issue to the national press and ministers once the process noted by Dr J Halsey had taken place. Dr J Halsey agreed to keep the BSR updated on any local press coverage he received. Ms S Peters also asked all Council members to update Ms D Smith with any information about ICATS in other areas. 6 Dr J Halsey on behalf of the North West Rheumatology community and Dr A Bamji on behalf of the BSR agreed to contact Dr D G I Scott regarding questions about the training of Specialist Registrars (SpRs) in the independent sector. Dr J Halsey noted that he was very grateful for any help the BSR would be able to give. Action Points Dr A Bamji to draft a BSR response to the Donaldson report within the next 2 weeks, Dr A Bamji to enquire with other organisations regarding their concerns about ISCATS, Dr J Halsey to update Ms D Smith with any local press coverage received, Dr J Halsey and Dr A Bamji to contact Dr D G I Scott regarding questions about the training of SpRs in the independent sector, Ms S Peters and Ms D Smith to escalate the issue to the national press and Ministers once the process noted by Dr J Halsey had taken place, Council members to update Ms D Smith with any information about ISCATS in other areas. 9.2. Chief Executive’s Report Ms S Peters introduced her written report which had been circulated with the meeting papers, and this was duly noted. 9.3. Treasurer’s Report Dr J Halsey gave a verbal report noting the following points: The BSR will have a small surplus at the end of 2006, Planning for the 2007 budget is underway, Discussions are currently underway with the Oxford University Press regarding the Journal price over the coming years. The present issue being that if the Journal increases in size (number of pages) but the publication price remains the same the revenue made will be reduced, Plans are underway to claim gift aid on past and future memberships. 9.4. Honorary Secretary’s Report Dr J Dixey had no further points to raise following on from the President’s report. 9.5. Honorary Heberden Librarian’s Report Dr D L Scott noted that he had met with the Head of Heritage Collections at the Royal College of Physicians (RCP) and a further meeting was arranged for the New Year to discuss future plans. There were no further issues to be raised. 9.6. Honorary Editor’s Report Dr R Watts had given his apologies for this meeting, therefore no report was given. 7 9.7. Honorary Website Editor’s Report Dr R Butler gave a verbal report noting the following points: Hits on the website were at a steady monthly rate of around 14,000, No comments on the website had been received recently but it was noted that it would be good to get some feedback, A newsfeed from the National Library for Health’s Musculoskeletal News forum has been added to the BSR website. It will provide up to date and relevant news to members visiting the site. 10. REPORTS FROM BSR STANDING COMMITTEES 10.1. External Relations Committee Dr R Hughes had given his apologies for their meeting. Ms D Smith presented the minutes from the meeting on 15th June 2006 which had been circulated with the papers for this meeting, and these were duly noted. Ms D Smith gave a verbal report from the 7th September 2006 meeting noting the following points: A deal has been negotiated with Target Medicine for a full-page advertisement on rheumatology as a career. Dr Nidhi Sofat had written a case study which would be displayed on the http://doctorjob.com/medicine website after the rheumatology advertisement had been published, A regionalisation paper had been finalised and this would be going to the Executive Committee in December 2006 for discussion. 10.2. Clinical Affairs Committee Dr K Morley presented the minutes of the meeting on 14th June 2006 which had been circulated with the papers for this meeting, and these were duly noted. He gave a verbal report from the 8th September 2006 meeting noting the following points: Peer Review Dr Ian Rowe and his team had revised the Peer Review documentation and it is now complete and would be available in November. The documents will be available to download via the website and an email would be sent out to all members. In response to a question from Dr C Kelly on whether or not completed Peer Reviews should be available to the wider community. Dr K Morley clarified that documentation would be owned locally and any decisions would be based on their discretion. New to follow up ratios Dr E George is putting together a statement to be put to Council on new to follow up ratios. It will include data from a questionnaire to send to all Primary Care Trusts to get a picture of the broader situations. Standards, Guidelines and Audit Working Group (SGAWG) Following issues with the revised disease-modifying anti-rheumatic drugs (DMARDS) guideline these guidelines are in the process of being carefully reviewed by Dr Tom Kennedy, Dr Tom Puller and Susan Oliver. Dr K Morley would like to note that there are no concerns regarding Rheumatology and its publication process. 8 Ms S Peters drew to the Councils attention that the original document had been signed off by Council and the SGWAG and that the current issues highlight the importance of careful proof reading before approval is given. Dr T Kennedy will be standing down as chair of SGAWG at the 2007 AGM and an advertisement for the election of his replacement will appear in the November BSR Newsletter. 18 weeks As mentioned in minute 3.4 Dr C Kelly and Dr D Walsh are working on the BSR’s response. The Journal of the American Medical Association (JAMA) Paper on anti TNF and infections Prof. Alan Silman had written a letter in response to the JAMA paper. 10.3. Heberden Committee Prof. H Gaston presented the minutes from the Heberden Committee meeting on the 14th June 2006 which had been circulated with the papers for this meeting, and these were duly noted. Prof H Gaston gave a verbal report from the 8th September 2006 meeting noting the following points: 2007 State of the Art Lecture at the Annual meeting will be given by Niall Dixon, Chief Executive of The King’s Fund, The Meet the Experts sessions have been scheduled to take place on the first morning, The Tuesday Evening Plenary session will take the format of an interactive quiz for the whole audience with Chris Deighton as quizmaster, It has been agreed that the entry mechanism for the Michael Mason prize should be a submission of three to five published papers on a similar theme with a 500-750 word comprehensive introduction. The prize will be open to those with a clinical background only and the age limit will be worded as ‘applicants will normally be expected to be under forty. Prof. H Gaston noted that it was important for everyone to generate interest in these prices, Future Annual Meeting strategies are being discussed, with the possibility of moving to a three day meeting up for discussion. Mrs. J Kermode noted that no decisions had so far been made and members would be polled on their views in December. 10.4. Education & Training Committee Dr A Crisp had given his apologies for this meeting, Mrs J Kermode presented the minutes from the Education and Training committee on 15th June 2006 which had been circulated with the papers for this meeting, and these were duly noted. Mrs J Kermode gave a verbal report from the 7th September 2006 meeting noting the following points: Prof. Sandhu had given the Committee a useful presentation on the changes to career structure for trainees, 2007 Education courses had been agreed. 11. REPORTS FROM OTHER COMMITTEES 11.1. BSRBR Steering Committee 9 Mr M Hogg had given his apologies for this meeting, Ms S Peters presented the minutes from the BSRBR Steering Committee on 11th July 2006 which had been circulated with the papers for this meeting, and these were duly noted. Ms S Peters gave a verbal update on the following points: BSRBR contracts with the all participating pharmaceutical companies had been revised and were currently with the companies awaiting sign off, Discussions were currently underway with Roche regarding their joining of the biologics register, Mr M Hogg, Ms S Peters and Prof. D Isenberg are due to meet with Arthritis Research Campaign’s Epidemiology Unit (arc EU) on 8th November to discuss ongoing relationships after Prof. A Silman’s change in job role. 11.2. Website Working Group Ms D Smith presented the minute of the meeting on 4th May 2006 which were duly noted. She had nothing further to report. 12. REPORTS FROM COUNCIL REPRESENTATIVES TO EXTERNAL BODIES 12.1. Royal College of Physicians (RCP), Joint Speciality Committee Dr A Bamji had reported the majority of issues raised at the Joint Speciality Committee in his earlier report. He noted that the RCP were currently trying to developing a more robust relationship with NICE and that the decision to withdraw Co-proxamol was unlikely to be reverted. 12.2. British Medical Association, CCSC Medical Committee There was no report. 12.3. Arthritis and Musculoskeletal Alliance (ARMA), Members’ Forum Ms D Smith had reported the issues discussed at the ARMA Members’ Forum in the MSF presentation. 12.4. Arthritis Care, Medical Advisory Committee Dr J Dixey was present at this meeting and had nothing to report. 12.5. UEMS Section of Rheumatology/ European Board of Rheumatology (EBR) Dr D Bax was present at this meeting and had nothing to report; she noted that the next meeting would take place in December. 13. REPORTS FROM COUNCIL REPRESENTATIVES CO-OPTED FROM EXTERNAL BODIES 10 13.1. Rheumatologist at Training (RATS) Dr C Gorman reported that there were currently concerns regarding the changes in training and the potential impact on future consultant jobs. Dr C Gorman asked the Council if any members would be willing to speak at their forthcoming AGM about this issue. Dr A Bamji, Dr D Bax, Ms D Smith and Dr M Bukhari all said they would be available to attend. Dr A Bamji noted that the BSR shared Dr C Gorman’s concerns. The trainee survey has been completed and they had an 80% response rate. Data was currently being analyses and results would be communicated at the next Council meeting. Dr C Gorman also noted if members or trainees wanted to find out about job share opportunities they should contact Dr Lisa Dunkley. Action Points Dr C Gorman to contact Dr A Bamji, Dr D Bax, Ms D Smith and Dr M Bukhari with details of the forthcoming Annual General Meeting. 13.2. Joint Council for Higher Medical Training (JCHMT), Specialist Advisory Committee (SAC) Dr D Bax reported that the SAC rheumatology curriculum has now been written within the Postgraduate Medical Education and Training Board (PMETB) framework and it will be presented at a meeting with PMETB on November 13th. The SAC now needed to blueprint the knowledge based assessments to the curriculum. These knowledge based assessments will be based on the Neurology and Dermatology pilots. Dr D Bax was in the process of putting together a small working group to do this. Dr D Bax outlined the new procedures for applications to specialist posts. Foundation (F) 2 students need to apply via The Medical Training Application Service (MTAS) in December for August 2007 posts. They can apply to two specialities and in two geographical areas or if applying for General Medicine they can apply in four geographical areas. They can then register as Specialist Training (ST)1 , from ST3 onwards they will be able to do sub-specialist training. Trainees will need to have Membership of the Royal College of Physicians (MRCP) prior to Certificate of Completion of Training (CCT) date. The Council raised concerns over the reduction of Rheumatology Senior House Officer (SHO) posts in light of these changes and the likely impact on limited exposure of trainees to Rheumatology. 13.3. British Health Professionals in Rheumatology (BHPR) Dr J Hill reported the following: BHPR awards had been awarded to: BHPR silver medal for research to Mrs Naomi Reay for her work entitled: ‘A Study of Levels of Fatigue in Diffuse and Limited Systemic Sclerosis’. BHPR Newly Qualified prize to Lisa Henderson, a recently qualified podiatrist for her work entitled: ‘The Development of an integrated Care pathway for the Management of a Patient with Rheumatoid Arthritis from a Podiatric Perspective’. 11 There were no applicants for the arc Physiotherapy prize. We are looking at ways to advertise this more widely. 2007 Spring Conference in Birmingham Dr Sarah Hewlett has agreed to present the 2007 Droitwich Lecture. The BHPR/BSR/arc collaboration ‘Meet the Academics Workshop’ will be repeated at the 2007 conference following on from the success of the 2006 workshop. The 4 academics will be; Alison Hammond, Sarah Hewlett, Krysia Dziedzic and Tony Redmond. Other matters BHPR has been accepted as a full member of the European League Against Rheumatism (EULAR). The Swiss Allied Health Professional (AHP) association, Health Professionals in Rheumatology Switzerland also applied to EULAR and was accepted. BHPR Council now has a new logo following as decision to rebrand. 13.4. British Society for Paediatric and Adolescent Rheumatology, (BSPAR) Dr J Davidson had sent her apologies. 14. ANY OTHER BUSINESS 14.1. 2007 Meeting cycle Ms S Peters reported that the 2007 meeting cycle will shortly be circulated and any issues should be raised with her. There were also plans being implemented to allow meetings to be run more smoothly which may result in a few changes to the structure and preparation for meetings Action Points Ms S Peters to circulate the new 2007 meeting cycle dates to all Council members. 15. DATE OF NEXT MEETING The dates for the next meeting of the BSR Council are still to be confirmed Minutes drafted by: Miss K Jepson, Policy & Project Administrator, BSR Minutes signed by Chair: 12