PEM is the product of a unique partnership between the DSRU and thousands of GPs in England, to whom we are most grateful. The DSRU thanks the PPA for providing exposure data for PEM and for their continuous support.

I am most grateful to Professor Ron Mann, the previous director of the DSRU and Emeritus Professor at Southampton University, for providing me with material without which it would not have been possible to write this chapter. My thanks also go to Gill Pearce, Georgina Spragg and Lesley Flowers.

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