The last few weeks have been a period of intensive activity for me. In a two-week period I had meetings at the Royal Colleges in Edinburgh, Glasgow and London.
My programme included five major presentations, all on different subjects. My junior staff and family have seen even less of me than usual!
On the 8 November, the Chief Medical Officer, Liam Donaldson, invited me to a briefing and dinner, regarding the influenza pandemic. I had rather naively expected it to be a large affair and was quite surprised to be one of only twenty guests, most of whom appeared to be ennobled in one way or another. It is gratifying that the British Geriatrics Society are making it to the top table! The briefing was honest and professionally done. Sir Liam Donaldson led a discussion over dinner, which was very open, and it was clear that he was happy to take ideas. I was able to flag up my concern about loss of geriatric beds and hence the loss of capacity that there would be in the hospital system, should such a pandemic occur. I sat next to Liam Donnellson at the dinner and found that he had actually done some of his research on disability, and briefly considered a career in academic geriatric medicine. He clearly had a good grasp of the issues around an ageing population and appreciation of the contribution our specialty makes in delivering care.
Modernising medical careers
On the 22 November, an important meeting took place at the Royal College of Physicians in Edinburgh, between the Federation of the Royal Colleges of Physicians of the United Kingdom and Specialist Societies. As the largest specialty of medicine, it is nice to see that we are playing a full part in all the Colleges in the UK. Alex Elder is Registrar of the Edinburgh College and Paul Knight has similarly taken office in the Glasgow College. Ian Starke has the important role of Director of CPD and Chairman of the SAC in General Medicine in the London College. The meeting on the 22 November, centred on a number of important issues. Dr Mary Armitage gave a review of general practitioners with special interest and then Dame Carol Black led a discussion on how care in the community affects the specialties. Dr Chris Clough gave a progress report on maximising relationships between the specialities and the Federation of the Royal Colleges of the United Kingdom, led a discussion on training and the impact of Modernising Medical Careers and Postgraduate Medical Education and Training Board (PMETB). The forum of Presidents of most of the specialist societies led to a lively and informed debate. There is still a great deal of uncertainty about the precise details of Modernising Medical Careers, particularly the numbers that are attached to each box in the ever-changing diagram!
The discussion proved valuable to me in preparing for the lecture I would give the following week at the Royal College of Physicians and Surgeons in Glasgow, in our joint meeting of the SAC and BGS, co-chaired by Prof Tim Hendra, Chair of the SAC in Geriatric Medicine and Dr Oliver Corrado, Chair of our Education and Training Committee.
Both these committees have provided an outstanding lead to the specialty in the difficult problems of training. The meeting was a success with between 60-70 committed geriatricians participating in the discussions. There were outstanding presentations on the present organisation of training and curriculum by Nicki Colledge, the MMC and changes in specialist training by Prof Ken Cochrane; and the acute specialty of medicine by Dr Ian Starke. A lively and insightful view of trainees was given by Dr Sally Briggs and a truly inspiring presentation by Prof Paul Baker on the North West Regional Training Programme and MSc Course, showing that the marriage between professional educational expertise and geriatrics is a very happy one. John Gladman gave a typically original view on the use of academic sessions. Prof Steve Allen outlined developing assessments of knowledge and competence (an area where we are one of five lead specialties). Tash Masud’s sharing the experience of 360-degree feedback and Tim Hendra’s session on sub-specialty training were of great value. I ended the meeting by trying to look to the future. The importance of the meeting was that it allowed the Society to think about what is one of the most important issues that faces us. I cannot help thinking that we should do a lot more of these in-depth strategic meetings.
Talking to the Lords
I was very grateful to Dame Carol Black, who in my view, has been a superb President of the Royal College of Physicians in London and a great friend of geriatric medicine, for inviting me to talk at the luncheon held for members of the House of Lords on 7 December in the College of Physicians in London. I think it is again recognition of the importance of our specialty that I should be chosen to be the speaker on this occasion. I had just ten minutes to ‘advertise’ our specialty. It was a very good time to be speaking to our policy makers because in the same week the pension crisis and the funding problems of the Health Service were front page news. I chose to talk about frailty to demonstrate how this was a driver of these problems and how geriatric expertise was critically important for the success of the Health Service. The talk was very well received and I fielded numerous questions. I had several contacts from members of the House of Lords, subsequent to the lecture. The Briefing Note supplied to the members of the House of Lords is published left. Although what I said on the occasion was perhaps a bit more amusing, I hope you can see where I put the emphasis, particularly in the need for more academic geriatric medicine. This was done because I sensed that a significant proportion of those attending had links with academia. The House of Lords remains an important forum where fundamental issues about health are discussed and government legislation is scrutinised. I hope that raising the specialty’s profile with this group will have future benefits.
| Extract from the Briefing Note - RCP Lords Luncheon
We live in a unique era; the combination of demographic shift and rapidly increasing longevity has resulted in the highest proportion of elderly in the population ever. In parallel with this historic change there has been a health transition and the work of doctors is now dominated by chronic disabling illnesses, many of which are age related. The impact of illness is greater in older people and their vulnerability is related to the degree of mental and physical frailty from which they may suffer. Geriatric medicine has very deep historical roots. In its modern form it was developed in the United Kingdom initially by Marjory Warren, who introduced principles of rehabilitation and management of chronic illness. Geriatric medicine is the largest specialty of general medicine and we are the acknowledged leading country in developing clinical services in geriatric medicine. The core activity of any health service in advanced countries is the management of the frail elderly person. Frailty is a deceptively simple concept but in truth we have little understanding of the fundamental changes in body composition and function that occur with ageing. Many of these processes are not inevitable. Geriatric medicine by its nature is anticipatory, preventative and restorative. The work of the geriatrician ranges from predominantly managing acute care in hospitals, to full time work in a community setting. Geriatricians have sub-specialised and have been at the forefront of developing and improving care for stroke, Parkinson's disease, recurrent fallers, ortho-geriatric patients and patients with memory disturbance. For generations to continue to flourish, there needs to be a much greater understanding within the general population, of the importance of elderly care. Current changes in the Health Service offer both opportunities and threats to the development of the specialty. The management of frailty requires not only social care but also expert medical interventions at the correct time and skilled management of acute illness occurring in the context of advanced age and multiple pathology. There is strong evidence that we are living longer and healthier lives and that medical interventions contribute to the compression of morbidity in old age. Policy makers need to support further development of geriatric services and, particularly in the UK; there is a mismatch between excellent service provision and a poor output in research. In the last twenty five years, the UK contribution world wide to research in ageing and geriatric medicine has fallen from 40% of the published output to less than 8%. Unless academic foundations of the specialty are better supported by the University system, the Health Service's ability to cope with elderly patients will be compromised. |
Challenging times ahead
Coming to the end of the year, I am very aware that all of us in the specialty face many challenges. The next year is going to be harder because of financial constraints, which always affect services for older people disproportionately. The move to a patient centred programme for the NHS with payment by results, choose and book and other manifestations, will mean that the specialty will need to continue to adapt and be prepared for change. At the Glasgow meeting, I alluded to the American Geriatrics Society’s document on the future of geriatric medicine. I think it is about time that our society take leaf out of the book of some of the other societies, particularly the Renal Society, in having a very hard look at the implications of modernising medical careers, new patterns of purchasing, new patterns of provision and community care for our specialty. Already the National Councils and the Policy Committee grapple with these issues. I would like to see a far-reaching debate going to the grass roots of our society, with as many contributors as possible studying what we need to do in the future. I would particularly like the next generation of geriatricians, be they trainees or newly appointed consultants, to have a disproportionate say in this. I will be having discussions with officers of the society and UKMC in the New Year to see if we can move forward on this issue.
Public relations
Our PR campaign has been a little faltering but I am glad to report that Lynne Trenery from Setpoint, a public relations group in Oxford, visited Liverpool to interview me and has set up a number of interviews for profiles, the first of which I did recently in London with Marion Curtis, the features Editor of Hospital Medicine. Onyx, another public relations group we have formed links with, have given us some suggestions as to how we can get our message across in the media more successfully, and the BGS PR sub-group will be having a telephone conference before the end of the year, so hopefully in my next column we will have some progress on this front.
We end the year in a stronger position, I think, than we began it. I am particularly pleased that we have taken the first positive step to having an interdisciplinary society with the formation of a Consultant Nurses Special Interest Group. May I wish Dave Jones, its newly elected Chairman, and the group every success and we look forward to you being full participants within the Society in the coming year.
By the time you read this newsletter, turkey will have been consumed and the new slippers worn in. Can I hope that everybody has had an excellent and well-deserved rest over the Christmas period and wish you all a very happy and prosperous New Year.
Jeremy Playfer