Modelling the benefits of American Mink Mustela vison management options for terns in west Scotland

American Mink Mustela vison is a semi-aquatic predator that has invaded the west coast of Scotland and many of its associated islands. We developed a GIS model of their potential range based on their dispersal abilities and habitat use, which revealed that most islands in west Scotland are accessible to Mink, and that these host a large proportion of the region's Common Sterna hirundo and Arctic Terns S. paradisaea . Mink are predators on tern eggs and chicks, and statistical modelling of long-term productivity data demonstrated that unprotected sites within their range have an average productivity of 0.33 chicks per pair, whereas that at sites where Mink were trapped was 253% higher. We assessed the benefits of current Mink control projects for terns in the Western Isles and the remainder of west Scotland using a population modelling approach. This showed that both projects delivered considerable benefits for Common Terns, because a large proportion of their numbers were within the area of the control programmes and in sites that would be accessible to Mink if no control were in operation. For Arctic Terns, the benefits were less clear, as a larger proportion of their numbers were outside the control areas, and many of these were in sites isolated from, or unsuitable for, Mink. We discuss the implications of these findings for future strategic planning of Mink management in west Scotland.     

The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin.

OBJECTIVE: To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia. DESIGN: Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study. SUBJECTS: Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study. MAIN OUTCOME: Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained. RESULTS: If 10,000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of 20m Pounds over 5 years. These benefits imply an undiscounted gain of 2,460 years of life, and thus 8121 Pounds per life year gained, or 20,375 Pounds per life year gained if benefits are discounted. Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (5601 Pounds per life year gained (undiscounted) and 13,995 Pounds per life year gained (discounted)). CONCLUSIONS: In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.     

Changing patterns of teenage pregnancy: population based study of small areas

ObjectivesTo measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time.Design Population study using routine data from hospital records, aggregated for small areas.Subjects Female teenagers resident in Scotland who were treated for pregnancy in an NHS hospital in either 1981-5 (62 338 teenagers) or 1991-5 (48 514) and who were aged 13-19 at the time of conception.Results From the 1980s to the 1990s pregnancy rates increased differentially according to levels of local deprivation, as measured by the Carstairs index. Among teenagers aged less than 18 the annual pregnancy rate increased in the most deprived areas (from 7.0 to 12.5 pregnancies per 1000 13-15 year olds and from 67.6 to 84.6 per 1000 16-17 year olds), but there was no change, on average, among teenagers in the most affluent areas (3.8 per 1000 13-15 year olds and 28.9 per 1000 16-17 year olds). Among 18-19 year olds the pregnancy rate decreased in the most affluent areas (from 60.0 to 46.3 per 1000) and increased in the most deprived areas (from 112.4 to 116.0 per 1000). The amount of local variation explained by deprivation more than doubled from the 1980s to the 1990s. The proportion of pregnancies resulting in a maternity was positively associated with level of deprivation, but the effect remained similar over time.Conclusion From the 1980s to the 1990s the difference in rates of teenage pregnancy between more affluent and more deprived areas widened. This has implications for allocating resources to achieve government targets and points to important social processes behind the general increase in the number of teenage pregnancies in Scotland.

What is already known on this topic

Rates of teenage pregnancy are considerably higher in the United Kingdom than in other western European countriesIn the United Kingdom rates of teenage pregnancy are known to be higher in areas of greater socioeconomic deprivation, although local variation may also reflect differential access to family planning services

What this study adds

From 1981-5 to 1991-5 rates of teenage pregnancy in Scotland increased more rapidly in areas of greater socioeconomic deprivationIn the 1990s socioeconomic deprivation explained more than 50% of local variation in rates of teenage pregnancy, more than double the amount explained by it in the 1980s     

Cutaneous malignant melanoma in Scotland: incidence,survival, and mortality, 1979-94. The Scottish Melanoma Group.

OBJECTIVE: To determine the changing incidence of and mortality from cutaneous malignant melanoma in Scotland from 1979 to 1994. DESIGN: Detailed registration of clinical and pathological features, surgical and other treatment, and follow up of all cases of cutaneous malignant melanoma diagnosed from 1979 to 1994 and registered with specialist database for Scotland. SETTING: Scotland. SUBJECTS: 6288 patients with invasive primary cutaneous malignant melanoma diagnosed between 1 January 1979 and 31 December 1994. RESULTS: The annual age standardised incidence of cutaneous malignant melanoma rose significantly from 3.5 to 7.8 per 100,000 per year in men and from 6.8 to 12.3 per 100,000 per year in women (P < 0.001 for both). World standardised rates increased from 2.7 to 6.0 per 100,000 per year in men and 4.6 to 8.50 per 100,000 in women. The incidence of melanoma continued to increase significantly in men of all ages during the study, but the rate stabilised in women after 1986. Mortality from cutaneous malignant melanoma was 1.3 per million per annum in men in 1979, rising to 2.3 per million per annum in 1994 (P < 0.01); it was 2.4 per million per annum in women in 1979, falling to 1.9 per million per annum in 1994 (P = 0.09). The underlying mortality trends showed a continuing rise for men but a downward trend for women that was not significant (P = 0.09). In men, melanoma free survival was 69% at 5 years and 61% at 10 years; in women the corresponding rates were 82% and 75%. Younger patients had higher survival rates, which were not entirely explained by thinner tumours. Over the 15 year period, survival rates improved by 12% overall, only partly owing to thinner tumours. CONCLUSIONS: In Scotland the incidence of melanoma in women has stabilised, while mortality associated with melanoma in women shows a downward trend.     

Sectarianism: myth or social reality? Inter-sectarian partnerships in Scotland,evidence from the Scottish Longitudinal Study

This article explores the contested issue of whether sectarianism divides Catholics and Protestants in Scotland. The conclusions are based on an analysis of 111,627 couples from the 2001 Census. The proportions with no religious upbringing and currently belonging to no religion decrease steeply with year of birth for the members of couples. This is largely due to a decline in the Protestant group, while the proportion of Catholics remains fairly stable with year of birth. For the oldest cohort those with a Catholic upbringing are disadvantaged compared to Protestants, in terms of educational qualifications and membership of the professional classes, but this difference has eroded so that there are few differences at the youngest ages. Those with no religious upbringing are disadvantaged on these measures at all ages. Catholics are more likely than Protestants to form couples outside their religious group, and this is not simply a consequence of their minority status, which would restrict the number of available partners. The trend towards secularism could be influenced by inter-sectarian coupling because those in mixed relationships are less likely to practise their religion of upbringing. The high proportion of inter-sectarian marriages may give rise to many Protestants in Scotland having practising Catholics among their extended families, and this should contribute to undermining sectarian divisions.     

Oral cancer in Scotland: changing incidence and mortality.

OBJECTIVES--To determine the incidence of oral cancer in Scotland between 1960 and 1989 and oral cancer mortality from 1911 to 1989. SETTING--Data were obtained on oral cancer incidence from the information and statistics division of the Common Services Agency of the Scottish Health Service and mortality data from the office of the registrar general for Scotland. RESULTS--Mortality from intraoral cancers in Scotland substantially declined throughout this century until the mid-1970s. This trend, however, was then reversed, and fourfold increases in incidence were observed in younger age groups after 1960. Death rates in these younger age groups increased to levels previously recorded in the 1940s. These increases seemed to be cohort based and may therefore continue into the future. CONCLUSIONS--Reasons for increasing rates among younger age groups are speculative and rely on combining knowledge about risk factors and available ecological data. Though increases in incidence at younger ages do not result in a large change in the number of cases diagnosed, possible similar increases continuing into older ages, when oral cancer is more common, will correspond to a much larger increase in the actual number of cases. Given that such a large attributable risk is associated with tobacco and alcohol, however, these increases may be preventable.     

The flock-to-flock force of infection for scrapie in Britain

A postal survey of British sheep farmers provided information on the proportion of farms that experienced their first case of scrapie in each year between 1962 and 1998. We found no evidence of a large increase in the proportion of scrapie-affected farms prior to, during or following the epidemic of BSE in British cattle. After correcting for between-farm heterogeneity in the probability of acquiring scrapie, we estimated the yearly between-flock force of infection since 1962. The current force of infection is estimated at approximately 0.0045 per farm per year and combined with a simple model of scrapie spread provides an estimate of the average duration of a scrapie outbreak on an individual farm. Considering all farms, the average outbreak lasts for five years, but if only those farms that have cases in animals born on the farm are considered, it lasts 15 years. We use these parameter estimates to compare the proportion of farms with scrapie in time periods of different lengths. In the survey, 2.7% of farms had a case in 1998. The 5.3% of farms reporting having a case between 1993 and 1997 is consistent with the hypothesis that the scrapie force of infection remained constant over this period.     

Inter‐annual variation in primary production of a semi‐arid grassland related to previous‐year production

Mean annual precipitation accounts for a large proportion of the variation in mean above‐ground net primary production (ANPP) of grasslands worldwide. However, the inter‐annual variation in production in any grassland site is only loosely correlated with precipitation. The longest record of variation in production and precipitation for a site corresponds to a shortgrass steppe in Colorado, USA. A previous study of this record showed that current‐year precipitation accounted for 39% of the inter‐annual variation in ANPP. In this note, we show that ca. one third of the unexplained variation is related to previous‐year ANPP: ANPP per mm of precipitation was higher in years preceded by wet, more productive years than in years preceded by average years; similarly, ANPP per mm of precipitation was lower in years preceded by dry, less productive years than in years preceded by average years. Since previous‐year ANPP was, in turn, associated with precipitation of a year before, current‐year ANPP was also explained by precipitation of two previous years. Our finding not only increases our predictive ability, but it also changes our understanding of how ANPP responds to fluctuations in precipitation. If ANPP is thought to vary according to current‐year precipitation only, it will simply track annual precipitation in time. According to this new result, however, ANPP fluctuations are buffered if wet, more productive years alternate with dry, less productive years, and they are amplified if wet or dry sequences of several years take place.     

A functional assessment of the response of grassland vegetation to reduced grazing and abandonment

Question: Predicting the impact of land‐use change on vegetation is vital to understanding how biodiversity and ecosystem function may respond. Is it correct to assume that abandonment is an extreme form of grazing reduction? Location: Borders and central Scotland. Methods: The analysis used data sets from two identical experiments where the impacts of two unfertilized, extensively grazed treatments and one unfertilized abandoned treatment were compared against the species dynamics of a pasture subject to normal, productive grazing management over a 16‐year period. Initial multivariate analysis using Principal Response Curves was used to assess if particular traits were associated with either extensive or abandoned treatments, and was checked using univariate tests of individual traits. RLQ analysis followed by clustering into response groups was used to assess if species behaved in a similar manner between sites. Results: For many traits/attributes the shift in value or proportion was approximately linear across the extensification treatments as grazing was removed. However, certain traits showed step changes and quadratic responses. Leaf dry matter content, an important effect trait, was in the latter group. Most traits/attributes and species behaved similarly at the two sites. However, traits such as regenerative strategy, seed length, longevity and mass and seed bank type behaved differently, indicating that they are not predictable response traits. Conclusion: The results indicate that responses to grazing removal during extensification are largely straightforward and largely independent of species pool. However, there are discrepancies that suggest that simple analyses of the impacts of land‐use changes such as grazing reduction may hide more complex responses.     

Melanoma in people aged 65 and over in Scotland, 1979-89.

OBJECTIVE--Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN--Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland in the 11 years 1979-89 with similar data for patients aged under 65. SETTING--Data were obtained from the Scottish Melanoma Group''s database, established in 1979, which aims to record detailed clinical, pathological, and surgical follow up details of all primary cutaneous melanomas registered in Scotland. PATIENTS--1430 patients (954 women, 476 men) aged 65 and over; comprising over a third of the 3903 patients with primary melanoma recorded for all age groups in Scotland during this period. RESULTS--The overall incidence of melanoma in patients aged 65 and over increased from 12.2/100,000 in 1979 to 20.7/100,000 in 1989, with the greatest increase seen in older men, from 7.8/100,000 in 1979 to 18.0/100,000 in 1989. The site most commonly affected was the face in both men and women (33% of all tumours). The most common histogenetic type was superficial spreading melanoma. 526 patients (37%) had melanomas with a tumour thickness of 3.5 mm or greater in the older age group, compared with 453 patients (18%) in those aged under 65. The highest proportion of thick tumours was seen in older men. Five year survival figures for 616 patients diagnosed between 1979 and 1984 were 88%, 66%, and 47% for thin, intermediate, and thick tumours respectively. Overall five year survival for the older age group was 64% compared with 78% for the younger age group. CONCLUSION--The increase in melanoma in the elderly and the high proportion of thick tumours, especially in men, require a specific educational programme for both primary and secondary prevention directed towards the older population.     

The effects of control on the biomass, carbohydrate content and bud reserves of bracken (Pteridium aquilinum (L.) Kuhn), and an evaluation of a bracken growth model

This paper examines the initial effects of bracken control on frond numbers and biomass, and the biomass, carbohydrate reserves and bud densities of bracken stands cut once per year, twice per year, subject to a single application of asulam or left untreated. The seasonal dynamics of these parameters are displayed; carbohydrate and biomass are both removed from the rhizome system to produce frond tissue, and are replenished at the end of the growing season. Asulam application reduced densities of both active and dormant buds, and both frond biomass and density. It did not significantly reduce rhizome biomass or carbohydrate reserves in the two years after treatment. Cutting, either once or twice per year reduced both rhizome biomass and rhizome carbohydrate reserves, as well as bud densities, though the latter were reduced in proportion to biomass. Cutting twice a year reduced the production of fronds, both in numbers and biomass. The collected data were used to evaluate a model of bracken growth, and subsequently to improve estimates of some of the model parameters. The model simulations of control treatments were compared to field data. The effects of cutting once per year and spraying with asulam were predicted accurately, but the bracken stand was more resilient to cutting twice per year than would be expected from model predictions. The combination of cutting and spraying is discussed as a potential tool in land management and the deficiencies of the model are discussed in relation to the need for future research into the biology of bracken.     

Potential Benefits,Limitations and Target Product-Profiles of Odor-Baited Mosquito Traps for Malaria Control in Africa

Background

Traps baited with synthetic human odors have been proposed as suitable technologies for controlling malaria and other mosquito-borne diseases. We investigated the potential benefits of such traps for preventing malaria transmission in Africa and the essential characteristics that they should possess so as to be effective.

Methods and Principal Findings

An existing mathematical model was reformulated to distinguish availability of hosts for attack by mosquitoes from availability of blood per se. This adaptation allowed the effects of pseudo-hosts such as odor-baited mosquito traps, which do not yield blood but which can nonetheless be attacked by the mosquitoes, to be simulated considering communities consisting of users and non-users of insecticide-treated nets (ITNs), currently the primary malaria prevention method. We determined that malaria transmission declines as trap coverage (proportion of total availability of all hosts and pseudo hosts that traps constitute) increases. If the traps are more attractive than humans and are located in areas where mosquitoes are most abundant, 20–130 traps per 1000 people would be sufficient to match the impact of 50% community-wide ITN coverage. If such traps are used to complement ITNs, malaria transmission can be reduced by 99% or more in most scenarios representative of Africa. However, to match cost-effectiveness of ITNs, the traps delivery, operation and maintenance would have to cost a maximum of US$4.25 to 27.61 per unit per year.

Conclusions and Significance

Odor-baited mosquito traps might potentially be effective and affordable tools for malaria control in Africa, particularly if they are used to complement, rather than replace, existing methods. We recommend that developers should focus on super-attractive baits and cheaper traps to enhance cost-effectiveness, and that the most appropriate way to deploy such technologies is through vertical delivery mechanisms.     

The status of the freshwater pearl mussel <Emphasis Type="Italic">Margaritifera margaritifera</Emphasis> in Scotland: extent of change since 1990s,threats and management implications

All known rivers in Scotland with recent records of freshwater pearl mussels Margaritifera margaritifera were surveyed in 2013–2015 using a standard methodology. Freshwater pearl mussel populations were classed as: (i) apparently extinct in 11 rivers, (ii) not successfully recruiting in 44 rivers, and (iii) evidence of recent successful recruitment in 71 rivers. On a regional basis, a high proportion of extant populations were located in North and West Scotland. In all regions extant populations were characterised by low pearl mussel densities, with 97 of 115 extant Scottish populations defined as ‘rare’ (0.1–0.9 mussels per 1 m ²) or ‘scarce’ (1.0–9.9 mussels per 1 m ²). Only 18 Scottish rivers now hold pearl mussel populations in densities that are considered to be ‘common’ (10–19.9 mussels per 1 m ²) or ‘abundant’ (>20 mussels per 1 m ²). Based on survey evidence, the number of apparently extinct pearl mussel populations in Scottish rivers is now 73. The decline is particularly pronounced in the West Highlands and Western Isles strongholds. The key threats are: (i) pearl fishing, (ii) low host fish densities, (iii) pollution/water quality, (iv) climate change and habitat loss, (v) hydrological management/river engineering and (vi) ‘other factors’, such as non-native invasive species. Over the last 100 years this endangered species has been lost from much of its former Holarctic range. Scotland’s extant M. margaritifera populations continue to be of international importance, but their continued decline since the first national survey in 1998 is of great concern.     

Timing and fidelity of breeding for Siskins Carduelis spinus in Scottish conifer plantations

The timing of breeding for Siskins in plantations in south-west Scotland was determined by reference to the incubation patch in trapped females. Breeding began earlier in years with good cone crops. Over a six-year period, individual birds returned to breed in the same area for several successive seasons. The proportion of first-time breeders in spring was apparently lower following a good cone year.     

Food vs. fuel: the use of land for lignocellulosic ‘next generation’ energy crops that minimize competition with primary food production

This review addresses the main issues concerning anticipated demands for the use of land for food and for bioenergy. It should be possible to meet increasing demands for food using existing and new technologies although this may not be easily or cheaply accomplished. The alleviation of hunger depends on food accessibility as well as food availability. Modern civilizations also require energy. This article presents the vision for bioenergy in terms of four major gains for society: a reduction in C emissions from the substitution of fossil fuels with appropriate energy crops; a significant contribution to energy security by reductions in fossil fuel dependence, for example, to meet government targets; new options that stimulate rural and urban economic development, and reduced dependence of global agriculture on fossil fuels. This vision is likely to be best fulfilled by the use of dedicated perennial bioenergy crops. We outline a number of factors that need to be taken into account in estimating the land area available for bioenergy. In terms of provisioning services, the value of biofuels is estimated at $54.7?$330 bn per year at a crude oil price of $100 per barrel. In terms of regulatory services, the value of carbon emissions saved is estimated at $56?$218 bn at a carbon price of $40 per tonne. Although global government subsidies for biofuels have been estimated at $20 bn (IEA, 2010b), these are dwarfed by subsidies for fossil fuel consumption ($312 bn; IEA, 2010b) and by total agricultural support for food and commodity crops ($383.7 bn in 2009; OECD, 2010).     

Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.     

A reappraisal of flight regulation in the green spruce aphid, Elatobium abietinum

Alate formation and its importance in the population dynamics of Elatobium abietinum is examined. It is concluded that alate formation is related to high soluble nitrogen levels in Sitka spruce needles. In N.E. Scotland the proportion of the population developing as alatae was related to aphid density. The apparently differing status of alatae in S. England may be related to differences in the physiology of the host caused by heat input. In Scotland alate formation may cause a decline in spruce aphid populations when densities are very high but, at the densities normally encountered in Scotland and Germany only small proportions of the populations become alate. In these areas the population collapses in late June or early July occur in response to low soluble nitrogen levels in the spruce needles. The role of alate adults in the formation of new colonies following migration to uncolonised hosts is discussed.     

Evolution of the Global Use of Unsafe Medical Injections, 2000–2010

Objective

Since 1999, substantial efforts have been made by the international community to reduce the risks associated with unsafe injections, through ministries of health, international donors, the World Health Organization and the Safe Injection Global Network. The present study attempted to measure the progress, or lack thereof, made over the 2000–2010 decade in reducing unsafe injections in ten regions of the world corresponding to developing and transitional economies.

Methods

Data about the number of injections per person per year and the proportion of re-use of syringes and needles were obtained for 2010, mainly from population surveys, and compared with previous estimates for 2000 which had used various sources of information including injection safety assessments, population surveys and published studies on injection practices.

Results

From 2000 to 2010, in developing countries and transitional economies, the average number of injections per person per year decreased from 3.40 to 2.88, while the proportion of re-use of injection devices dropped from 39.8% to 5.5%. Combining both factors the number of unsafe injections per person per year decreased from 1.35 to 0.16. Even if substantial progress has been made, the Eastern Mediterranean region remains problematic, with 0.57 unsafe injections per person per year. In sub-Saharan Africa and Latin America, people now receive on average only 0.04–0.05 unsafe injections per year.

Conclusion

Substantial progress has been made in reducing the number of unsafe injections in developing countries and transitional economies, essentially through a reduction in the re-use of injection devices. In some regions, elimination of unsafe injections might become a reasonable goal.     

Doctors' retainer scheme in Scotland: time for change?

OBJECTIVES: To describe the present doctors'' retainer scheme in Scotland and ascertain the need for change. DESIGN: Semistructured postal questionnaires to current and past members of the doctors'' retainer scheme and general practitioner employers. SETTING: Scotland, October to December 1994. SUBJECTS: 152/160 current and 104/124 former members responded together with 101/118 general practitioner employers. RESULTS: 93% of members currently working in general practice were either vocationally trained or had previously worked as principals. 84% of current members held postgraduate qualifications. 73% of former members had left the scheme within 4 years and 72% of current members had been with the scheme for 4 years or less. 66% of current members said that the scheme prevented them from leaving medicine. Both members and employers were dissatisfied with the current limit of two working sessions per week, 77% of employers wanting it increased. 61% of current members would not have joined the scheme if suitable part time work had been available and 46% of those would have preferred to work flexibly, up to 5 sessions per week. 52% of members do not receive BMA rates of pay and, of those, 46% work more than 3.5 hours per session. CONCLUSION: The scheme appears to be appreciated and would be more so if inconsistencies in pay and conditions were addressed. An increase in the permitted number of weekly sessions would enable these highly qualified doctors to maintain their skills and confidence.