Proposed merger of the BGS Community Geriatrics SIG and the BGS GeriGPs Group

This draft document sets out a proposal to merge two groups within the BGS to better achieve our goal of improving healthcare for older people. This is by ensuring that BGS members who work in community and primary care have an integrated, dynamic and active group through which to share learning, to network and to influence local, regional and national policy and practice. This document is the third draft and incorporates comments made by the Chairs and other officers of the GeriGPs committee and the Community Geriatrics SIG committee in November 2021.

The BGS has a Community Geriatrics Special Interest Group (SIG) and a GeriGP group. The Community Geriatrics SIG has been in existence for some years, principally working on sessions about community care for BGS national meetings and contributing to consultations on community-based services for older people, particularly in England. The GeriGPs group was established in 2017, providing a forum for GPs with an interest in older people to share experiences and work on issues of importance to the group and to the BGS. Both have contributed significantly to the BGS’s goals and to widening the diversity of professions involved in the BGS and the settings in which care is provided for older people. This has been fundamental to the BGS multidisciplinary ethos and its relevance to the current health and social care landscape.

Both groups share a common agenda around improving the quality of care for older people outside (but linked to) acute settings. This covers a broad spectrum of services and care settings from care homes to primary care networks to emerging models of community care such as Hospital@Home and Urgent Care responses. The majority of interactions older people have in relation to their health take place in primary and community care. In all four countries of the UK, there is an increasingly strong emphasis on care closer to home for older people with the aim of reducing avoidable hospital admission and the associated risk of potential harms such as deconditioning and delayed discharge.

While it is recognised that there are some issues specific to each group, it is also the case that there is a huge overlap of interests between the Community Geriatrics SIG and the GeriGPs group. It is suggested therefore that in terms of purpose and structure, it makes more sense for these to come together while providing protected space for the specific issues relevant to each and ensuring no loss of voice or authority. Indeed there is a compelling case for the BGS to ensure that there is representation from community and primary care on the BGS Trustee Board, and that this should be written into the governing documents.

The Community Geriatrics SIG comprises 1589 members, who are multidisciplinary and work in a variety of community care settings, including community care teams, care homes, community hospitals, intermediate care and integrated services with hospitals. In recent times, individual members have been involved in the design and development of community-based models, such as the three programmes of Ageing Well in England – Urgent Care Response, Enhanced Health in Care Homes and Anticipatory Care - but this has not really involved the wider group. The opportunity to share experience and knowledge and to compare notes has been largely confined to BGS Autumn and Spring meeting sessions, though there has been input to the geriatric medicine training curriculum and a current initiative to profile community care for older people in the next BGS newsletter.

 

The GeriGP group has built up a loyal following of GPs within the BGS, but has now stalled at 175 in terms of membership, not least because the membership fees are comparable with those charged to consultants (£195 a year) and GPs find it hard to attend meetings or use study leave during the working day. Members of the GeriGPs group have tended to be experienced GPs who have been able to carve out local roles with special responsibility for older people, rather than GPs with a mainstream caseload that includes older people. A small number of GeriGP committee members have been closely involved on behalf of the BGS in the development of new responsibilities for Primary Care Networks and the design of programmes such as Enhanced Health in Care Homes, which require a designated GP/care home relationship. They have also provided GP input to policy publications, educational materials and to the Diploma in Geriatric Medicine.

We are incredibly grateful for the leadership of the Chairs and the engagement of the committees of both groups. The involvement of the Chairs in regular Wednesday meetings with England’s National Clinical Director for Older People has been a valuable way to ensure NHSE plans are informed by real experience from the front line and has given the BGS vital access to decision-making during the Covid pandemic. Both groups have given the BGS a credible voice in the increasing focus on care for older people delivered closer to home.

 

With the Community Geriatrics SIG Chair (Shelagh O’Riordan) moving to a crucial advisory role with Ageing Well, and the ending of terms of office for the Co-Chairs of the GeriGPs group (Maggie Keeble and Eva Kalmus), it seems timely to revisit the purpose, structure and operations of both groups.

As has been explained above, there is an obvious policy window for the BGS to influence the quality of care for older people provided outside hospital. This is particularly so in England, with the Ageing Well programme; in addition, the moves to embed Hospital@Home across Health Boards in Scotland and the hoped-for reform of social care across all four countries are also advocacy opportunities.

 

Bringing the two groups together aims to deliver a clearer, more unified statement of the importance and inter-dependence of primary and community care. Renaming the Community Geriatrics SIG will help to underline that it is not just for geriatricians, but for all healthcare professionals working with older people in the community. Bringing the GeriGPs into the mainstream of primary care networks, with a better member offer, will attract more GP members. Combined, the two groups can develop an incisive action plan to influence the availability, quality and reach of primary and community care for older people in the UK and strengthen the voice of its workforce within the work of the BGS across clinical quality, research, education and policy. It will continue to be important to ensure GPs, community geriatricians, nurses and AHPs working across community and primary care are involved in the planning and delivery of sessions at BGS national meetings.

For historic reasons, the Community Geriatrics group has been classified as a SIG, even though it is not really a sub-specialty. Over the last year, we changed its line of accountability from the Clinical Quality Committee (overseen by the Vice President Clinical Quality) to the Policy and Communications Committee (enabling the Chair, Shelagh O’Riordan, to feed into policy planning). Meanwhile the GeriGP group developed as a professional group, akin to but smaller in size than the Nurses and AHPs Council. Although this was originally discussed as a possible eventual option, the group has not as yet been large enough to warrant its own seat on the BGS Board.

 

To maintain the gains made thus far, it is proposed that the merged group, to be named ‘Community and Primary Care Group’ would be co-chaired. One Co-Chair would be a GP, and the other would be either a community geriatrician or another professional working in community care. To provide accountability and oversight within the BGS, it is suggested that the new group would have an elected committee, and report directly to the Board, with one of the Co-chairs co-opted on to the Board. It is suggested this could initially be as a Board member but not a trustee (like the Vice-Presidents, who play a full role in Board discussions, but do not have a vote nor trustee liabilities/responsibilities). After review, this could potentially become a trustee role. It is important to the BGS Board to ensure that its decision-making is not skewed in favour of acute care, and that a community/primary care perspective is represented.

 

The merged Community and Primary Care Group would be open to non-members as well as BGS members, as is the case with other SIGs. This would encourage engagement, with the hope that non-members may be persuaded of the benefits of BGS membership over time. Within the overall group, it is suggested sub-groups could have a specific focus. One sub-group could be for GPs, to enable them to retain a community of practice specific to their professional needs (eg on issues such as revalidation, leadership of PCNs etc). Another could be for care homes. The BGS has given strategic priority to healthcare in care homes over the coming three years, and it will be important to have a community of those working within or providing services to care home residents. Other sub-groups could be established in future.

These proposals represent a structural change and it is important that those involved have the chance to discuss them and suggest amendments. We will email all members of the two groups in mid-November with a link to this document. The GeriGPs have a meeting planned within the BGS Autumn 2021 conference (10-11.30 on the third day of the conference, Friday 26 November) and can thus use the time to discuss these ideas. We are happy to set up further online calls as is felt useful by either group. It is hoped many members of the Community Geriatrics SIG will attend the first day of the Autumn Meeting, which has a community focus.

 

Assuming that there is majority support for the decision to merge the existing groups, we would use the period from December 2021 to March 2022 to plan the transition to the new Community and Primary Care Group, with the assistance of a small working group comprising people from both the SIG and the GeriGPs. We would hold an election of a new committee (existing and new members from both groups being encouraged to stand), confirm the new name, and establish new terms of reference clarifying purpose, objectives, accountability and governance. The group would be supported by two BGS staff members, and a public launch in April 2022 would be accompanied by a refreshed presence on the BGS website and revamped member offer.

 

The BGS Board has been made aware of the idea and supports it. They would be asked to give formal approval at their meeting in January 2022.

This is a third draft and there is still time for members of the two groups to give feedback to help improve the proposition. Please send any written feedback to Jo Gough (j.gough@bgs.org.uk) by 22 November. This third draft will be shared with the full membership of both groups before the Autumn meeting so that the proposal can be discussed in the GeriGPs session (Friday 26th Nov 10-11.30) or in the margins of the community-focused first day (Wed 24th Nov). Following the BGS Autumn Meeting and assuming there is support for the idea, the decision to merge the groups will be put to the BGS Board for approval.

The intention behind this merger proposal is to strengthen the voice, visibility and prominence of older people’s healthcare delivered by professionals working in primary and community care within the BGS, and in turn to have more influence on policy and practice. We look forward to your support for a BGS Community and Primary Care Group and welcome your feedback.

 

Sarah Mistry
CEO, British Geriatrics Society

12/11/21