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President's Column

It’s been a busy three months since I took office as BGS president. Thanks to the efforts of the secretariat and officers already in post before the new officers stepped up, our membership has continued its upward trajectory and reached an all time high at over three thousand.

Our social media “footprint” has gone from strength to strength with an increasingly lively blog and twitter following. Indeed, the Brighton Scientific meeting attracted nearly 8 million twitter hits in total. Under the editorship of David Stott, Age and Ageing continues to grow its impact and a number of our Sections and Special Interest groups are very lively. We continue to respond to and influence many guideline groups, national audits and policy consultations. We have also produced our own priorities for the General Election (thanks to Patricia Conboy in particular). 

I am also personally delighted that the paper I co-authored for the King’s Fund, Making health and care systems fit for an ageing population has ended up being the Fund’s most downloaded report this year  – showing just how much interest there now is in improving care for older people and therefore in the work of geriatricians and their colleagues delivering innovations in local services. The Health Service Journal Commission on the care of frail older people in hospital also received a great deal of profile and the website carries links to several good service models as well as the Animation  Mrs Andrews revisited in which I discuss the pathway of care for an 84 year old lady with falls and declining mobility and what could have worked better. 

For those interested in learning more about the BGS’s activities, we have an updated narrative slide set outlining the range of activities, some of which may be less visible to the membership than our scientific meetings or publications but which have equal importance.

Beyond all this ‘feel good’ factor, one or two specific things merit a mention.  

The National Audit of Intermediate Care Round 3  was launched at a conference in Birmingham in November. Its findings are highly relevant to the work of geriatricians and our members Duncan Forsyth, John Gladman and John Young have been key members of the steering group from the outset. The audit is a large and incredibly detailed look at the capacity, responsiveness, cost and effectiveness of intermediate care services (median age of users 82) both bed-based and home-based, both “step-up” (pre-hospital) or “step-down” (from hospital). It’s just about the most useful resource I have seen in striving to understand integrated care pathways for older people with acute and subacute illness. Please read it, please show it to your local colleagues, please subscribe to participate. 

RCP London Poll on Physician Assisted Dying
The findings were published in November and I wrote a BGS blog summarising them. In essence, only 30 per cent of the 8,000 RCPL members polled favoured a change in the law and fewer still would want to play an active part in assisting – even if it were legalised. Many of those polled were geriatricians. Presently, we therefore have no mandate for changing the BGS’s current position of opposition. If a law were to be passed, we would of course have to engage constructively with getting the regulations and safeguards right but we aren’t there yet. 

The BGS’s meetings with Andrea  Sutcliffe – Chief Inspector of Social Care at the CQC
Colin Nee, Eileen Burns and I have now had two very constructive meetings with Andrea – someone we respect, trust and want to work closely with.  She has set out her plans for the new care home inspection system. We in turn have highlighted the crucial importance of adequate assessment and rehabilitation before people enter care homes, and of adequate healthcare for residents – as set out in our BGS Care Home Commissioning Guidance . We are now in discussions about how our members might help with the training of inspectors (volunteers please); whether we could provide some geriatricians or other BGS members to go on inspection visits and whether we could make better use of the “soft intelligence” of our membership about any local care homes which might be causing concern. We look forward to a good ongoing relationship. 

BGS work with the RCP London and Future Hospitals Commission
Talking of people we can do business with, several BGS officers enjoyed a very constructive meeting with Prof Jane Dacre, the new College president. As the biggest GiM speciality within the college, this needs to be a mutually beneficial relationship. The College has just launched its Five Year Strategic Plan and a copy of this will have been mailed out to all College members and fellows by the time you read this. When we met Jane she was keen to know more about the work of the BGS, our workforce issues and our own view on the proposals in the Shape of Training, as well as the drive to revive General Medicine. She was also pleased at the progress we were making as a speciality in supporting flexible training.  

Professor Dacre is particularly interested in ensuring that female trainees are encouraged to stay in acute hospital specialities and also in ensuring that black and minority ethnic doctors are supported to take on more clinical leadership roles; also in ensuring that the RCPL is seen as being “out and about” and supporting physicians in the frontline. All of this is music to our ears.  

Talking of the RCPL, I wrote a letter in December’s Clinical Medicine responding to John Firth’s article  on the Future of General Medicine. My central point was this. When it comes to dealing with the overwhelming and increasing demand on acute hospital beds, with rising ED attendances, admission rates, delayed transfers of care and readmissions, with insufficient community alternatives and a growing focus on integration, it is Emergency Medicine, Geriatric Medicine and Acute Medicine which now constitute the engine room of adult secondary care. Services would fall over without our skills and insight which hold the key to solving many of the system’s problems. Whilst Firth talked about single organ medicine being seen as traditionally more prestigious, he also admitted that it was often intellectually less demanding than treating people with frailty or complex co-morbidities. Surely we need to go beyond getting a few extra “ology” trainees on the registrar rota and start sending out the clear message from undergraduate training onwards that there is no more important role in modern services than that of the “expert generalist”.  

Allied to this, funding has now been secured from NHS England and Monitor for an Acute Frailty Clinical Network, with ten hospitals in England participating and geriatricians from all involved. This should prove a great vehicle for peer support, quality improvement and disseminating good practice.  

Finally, I want to mention the BGS’s ongoing efforts to diversify our membership. Most of us work closely in our day jobs with nurses, GPs, mental and allied health professionals as well as doctors who have not yet chosen their higher speciality. We have been in discussion with our GP, nursing and therapies members, with the RCN and RCGP and with Health Education England. Wednesday sessions at our last three scientific meetings have all focused on interdisciplinary community care models and attracted a new audience. We had a stand at the Intermediate Care Audit Conference and the King’s Fund Conference on “Empowering Allied Health Professionals”. We are in discussions about offering new CPD and accreditation in geriatrics for General Practitioners with a special interest. The recent Geriatrics for Juniors conference was a great success and hopefully has sparked an interest for some young doctors in becoming geriatricians. Finally, we have a joint conference with the RCN in March at which we hope to attract some more nurses to join us as well as enjoy some good joint education. We work together in multidisciplinary teams so its good sometimes, to learn together. 

David Oliver

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