The British Geriatrics Society (BGS) welcomes the opportunity to comment on your report Good Doctors, Safer Patients. This response has been formulated by our Policy Committee and approved by our executive body the UK Management Committee.

The BGS is a joint signatory with other specialist societies to the Royal College of Physicians of London’s (RCP) combined response to recommendations about specialist re-certification (recommendations 17, 26 and 31). We strongly support the RCP and specialist societies having a key role in this part of medical regulation.

The BGS strongly supports the move to involve selected and trained members of the public (recommendations 5 and 10). As a Society we have strong links with patient groups and the voluntary sector e.g. Age Concern and Help the Aged.

In the late 1990s, our Society developed an approach to clinical governance which included the use of agreed standards of care e.g. the documentation of comprehensive geriatric assessment in patients moving from hospital to institutional care. We are reviewing our specialty guidance on clinical governance and this will complete by the end of 2006. We will be setting standards of care covering “the geriatric giants” - incontinence, immobility, impaired intellect and instability.

The BGS believes consultant and junior doctor appraisal (recommendation 18) will provide a key opportunity to check achievements against specialty standards e.g. aspects of good medical care such as mortality review (important where acute hospital mortality of frail older people varies according to case mix, e.g. the better community / primary care the sicker older people tend to be by the time hospital admission is necessary and hence mortality rates tend to be higher) or systematic learning from complaints.

The BGS has recently highlighted the need to raise the profile of caring for older people in undergraduate training 1. The BGS believes that whoever leads on regulation of medical education (recommendation 19) be it the General Medical Council or The Postgraduate Medical Education and Training Board (PMETB) that they should take this into account. This resonates with the marked demographic shift in the population with there being more people over 50 years of age than less, and the need to have doctors capable of managing chronic and complex disease and co-morbidities.

One concern, the BGS have over re-certification (recommendations 26 and 31) is that many of our members work in both acute medicine and our specialty. We hope that geriatricians who often provide “the backbone” to District General Hospitals acute take arrangements will not have to satisfy too many different masters.

The BGS has a track record of delivering on clinical audit (recommendation 33) and welcomes this move to re-energise audit. Our society is moving towards audit themes which are nationally agreed, based around the geriatric giants and which will be necessary for specialty re-certification. Examples of existing good practice such as the Sentinel Stroke Audit and RCP audit on continence already exist. We have strong links with the RCP Clinical Effectiveness and Evaluation Unit. As a Society, we have had recent success in developing clinical guidelines e.g. for the assessment and treatment of delirium 2.

In summary our Society is supportive of many of the recommendations in Good Doctors and Safer Patients. We hope these comments will be considered in your response to the consultation. If you would like to consult us further on this matter or want any clarification, please contact myself or Dr Peter Belfield, Deputy Chair of our Policy Committee.

Professor Peter Crome MD, PHD, MRCP, FFPM
President of the British Geriatric Society

10 November 2006

References
1. Survey of training in geriatric medicine in UK undergraduate medical schools. L Bartram, P Crome, A McGrath, O Corrado, S Allen, I Crome
Age Ageing 2006 35: 533-535;

2. Guidelines for the prevention, diagnosis and management of delirium in older people in hospital