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President's column

Our Spring Meeting in Liverpool was well-attended with over 600 delegates, most staying for the full three days. The venue was the modern, spacious and welcoming conference centre with hotels a short walk away.

Better still, we could enjoy some glorious spring sunshine on the banks of the Mersey and the beautifully restored docks and waterfront.

For those who made it, there will be lasting good memories and some valuable learning. For those who didn’t, it’s easier than ever to catch up with what you missed. Over 100 abstracts were presented – all available on the BGS website. Most of the 40-plus powerpoint files supporting the platform presentations will also be online once we have gathered all the speakers’ authorisations.  Also, see our comprehensive conference report

 

Even if you don’t like or aren’t on twitter (and I would strongly commend it as a forum for clinicians wanting to know what’s going on), you can follow all the tweets from the conference at #bgsconf. Our friend Dr Bernadette Keeffe @nxtstop1 storified each of the three days for us – a labour of love.

One successful innovation over the past four years has been a full Wednesday event handed over to one or more Sections and Special Interest Groups. These have been well attended, very lively and packed with content. They have also brought in more non-BGS members who may come from other fields, leading to some interesting “cross-fertilisation”.

In Liverpool we had two parallel whole day sessions devoted to Dementia and End of Life Care respectively. These brought in a number of specialist palliative care and mental health clinicians, as well as a range of primary care practitioners. The Gold Standards Framework Team, Association of Palliative Medicine and Royal College of Psychiatrists Faculties of Old Age Psychiatry and Liaison Psychiatry were present, along with charities such as MacMillan and the Alzheimer’s society.

Geriatric Medicine - everybody’s business

To me this illustrated a wider and encouraging point of progress for our society and speciality. We can learn much from experts in these fields, form alliances with other specialist societies, colleges or charities. But better still, other specialities are increasingly seeing the need to improve their own skills and knowledge in the care of older people. With a rapidly ageing population, only around 1,400 consultant geriatricians and not enough nurses, therapists and GPs with a specialist interest and additional training, geriatrics becomes everyone’s business. For the first time in my career, people are really waking up to that.

In recent times, the BGS has hosted two very lively Perioperative Care for Older People undergoing Surgery (POPS) conferences and a conference on cancer in older people. These brought together, surgeons, anaesthetists, oncologists and palliative care specialists.  We also put on a conference with the London RCP on “geriatrics for the non-geriatrician”. Doctors from emergency and acute internal medicine and from palliative care were especially prominent. And our second joint conference with the Royal College of Nursing Older People’s Forum proved a hit with tremendous cross-fertilisation and collaboration.

It goes beyond our own in-house events though. Geriatric medicine has been more prominent in major RCP conference programmes. The Edinburgh college devoted a whole day symposium to Frailty last November. Our members are contributing fulsomely to the ECIP/Acute Frailty Network Conference on June 30th, which will feature contributions from geriatrics, acute and emergency medicine, specialist nurses and therapists. And the King’s fund has hosted a series of conferences and workshops on the care of older people with very diverse delegate lists. 

The message is spreading because people want to hear it and are beginning to realise how useful some skills, training and knowledge of best practice in geriatric medicine will be for them and their patients.

General Practice under pressure

Over 40 per cent of registered doctors in the UK are GPs. As a recent report from the King’s Fund [www.kingsfund.org.uk/publications/pressures-in-general-practice] has shown, General Practice is facing a considerable workforce, funding and demand crisis. Activity has risen exponentially without the additional resources to cope with it. Recruitment into GP training is still difficult, partly because of low morale. There are also major workforce problems in community nursing, yet 90 per cent of NHS consultations happen in primary care, for less than nine per cent of the funding. General practice is a key reason for UK health services being some of the most equitable and efficient in the world.

Just as acute hospital teams realise they need to change the way they work to become more age-attuned, so increasingly, primary care leaders acknowledge that even if funding and staffing improve, General Practice has to evolve to meet the increasingly complex needs of an ageing population. To that end, the BGS is working with the RCGP to produce a joint document on GPs and Geriatricians collaborating across services to improve care. We are looking for case studies, so do send them to .

We are also working with the RCP London to look at the Diploma of Geriatric Medicine exam so that more doctors can formalise competencies. We hope to expand our learning materials and educational resources to provide more support to GP colleagues.

Friends in high places

It is especially welcome that the new national clinical director for older people – Dr Martin Vernon – a longstanding and enthusiastic BGS member has a strong clinical and leadership background working in and with primary and community care. A welcome bonus is that Dr Dawn Moody has been appointed as his deputy and is a GP with a longstanding special interest in the care of older people, a track record in leading and commissioning services for them, and has added greatly to the BGS work and our drive to get more GPs on board.

Amongst all my enthusiastic optimism, it saddens me to say that the National Audit Office report “discharging older patients from hospital” [www.nao.org.uk/report/discharging-older-patients-from-hospital/#] which I put a great deal of advice into behind the scenes, showed a very steep rise in Delayed Transfers of Care in England – 85 per cent of them in people over 65, with social care funding and service cuts biting especially hard and the “real number of delays” exceeding the officially reported ones nearly three fold. I wrote about findings and implications in my BMJ column (www.bmj.com/content/353/bmj.i2948) and kings fund blog (www.kingsfund.org.uk/blog/2016/05/ older-people-leave-hospital). Needless to say, it’s the membership of this society who are bearing the brunt.

Banging the drum

It is important that I, individually, and we, as a Society, don’t stop highlighting the problems caused by underfunding and underprovision of services and by systems that promulgate poor continuity and disintegration. We’ll keep on banging the drum but I am also very interested to publish some blogs from people who have tackled delays within their existing resources or who are starting the journey.

The other side of the coin is patients having poorly planned or supported discharges. This was highlighted last year in HealthWatch “Safely Home” report. During the Liverpool BGS meeting, I did media interviews regarding the Parliamentary and Health Service Ombudsman’s Report of Unsafe Discharges of Older People from Hospital. Clearly, the Ombudsman is dealing with extreme cases - complaints unresolved elsewhere and I hope they aren’t typical. Nonetheless, from the perspective of the complainants, failings included patients (some of whom were still medically unwell) being sent home without without sufficient support and without adequate involvement or communication with either them or their family. 

As a Society and a speciality we have a key role in ensuring such stories are reported in a fair and balanced way, rather than as a scandal. We should also keep showcasing what best practice is and demonstrate how to do discharge planning well on the NHS shop floor. It is after all, an issue over which our speciality has great ownership, even if there aren’t enough of us to look after every patient leaving hospital.  

We have pretty much known what good practice looks like in this field for years now but we aren’t consistently able to apply this. This is a feature of a system under great stress with competing pressures and priorities. It is sometimes due to a lack of knowledge and awareness. So again, I would like to invite good case studies as blogs or maybe abstracts for the next BGS Autumn meeting in Glasgow – on how geriatricians and the teams they work with have got discharge planning right for people. Let’s rebalance and challenge the narrative of gloom.

I will be on the Clyde in November. It’ll be a great gig and I hope to see many of you there.

David Oliver

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