Following the wide discussion and debate on the "Challenge of Geriatric Medicine" document produced by the England Council earlier this year, a simple statement of recommendations has now been published on the England website as formal policy.

This is also reprinted in the newsletter. We hope that members will find it useful when they debate these issues locally with their Trusts and PCTs.

James Barrett has been undertaking a survey of the effect of reimbursement and preliminary results were discussed at the latest council meeting. There was some good experience of local health and social care communities using the funds in an innovative way to improve discharge planning rather than simply making it a "fining" exercise. On the other hand, many had noticed that their rehabilitation and intermediate care beds were much more likely to be filled with patients who were "not moving". These were patients not covered by reimbursement. There is strong support for the suggestion that reimbursement should cover patients in all settings to prevent game playing.

Chronic Disease Management
The Council continues to consider the implications of the chronic disease management programme set out by the Government in the summer in the latest version of the NHS Improvement Plan. I met John Hutton, the Health Minister, with Prof Carol Black in early November, to argue that chronic disease management is best achieved by having much better integration of primary and secondary care to ensure that patients have access to specialist input at the right time. We saw the way forward as local clinical directorates bringing together primary and secondary care clinicians, together with the new PCT based matrons and GPs with a specialist interest. We were also arguing that the policy of payment by results (PBR) seemed to go in a completely different direction to effective chronic disease management.

The discussion was timely as it seemed to build on work which was already going on in the Department of Health (DoH). We have now been invited to join a DoH project on 'Leadership Development of Complex Care Teams', with particular reference to "emerging thinking about the establishment of clinical directorates which span hospital and community healthcare". This is being led by Ian Philp and we have two meetings scheduled early in the new year. This is certainly to be welcomed, but John Hutton did not accept the point that PBR went against good chronic disease management. We nevertheless were able to use examples of poor care that occurred when fund holding was in place, for him to consider.

National Service Framework
The England Council is now represented on the Health Care Commission Expert Advisory Group looking at the review of implementation of the NSF. Tim Hendra is representing the council together with Alex Mair. Although this has the potential to be a very important piece of work, the England Council continues to have some reservations about the methodology in terms of the depth of detail and the number of sites being covered by the review. On a more positive note they are linking with Jonathan Potter's national audit work at the Royal College of Physicians (London) CEEU using hard data, including the Sentinel audit of stroke data.

Staff and Associate Grades
SAS doctors form an important group within our specialty and one perhaps, which we have not paid enough attention to in the past, particularly with regard to their educational needs. With both appraisal and revalidation starting for all doctors, together with the possible implications of PMETB, we should be doing more for this particular group. As part of our approach to this, the England Council will be looking to appoint an SAS doctor representative. They will not just be there to be a representative. We will be looking for someone to take a lead in increasing BGS active membership among SAS doctors, as well as improving how we communicate with them and what we do educationally.

Under new management
Finally I am delighted to report that Dr James Barrett has been appointed the next Chair of the England Council with Dr Duncan Forsyth having been elected as the next Vice Chair, both taking up their role in April 2005.

David Black
Chairman, England Council