After 10 years working as an ‘acute hospital’ geriatrician, I had the opportunity last year, to spend a six month secondment working with newly developed intermediate care teams in Leeds.

The aim of this secondment was to “scope the job” and identify what support the teams needed to operate safely and efficiently. It led to agreement that there was a clear need for such posts, and the plan for the first of these is currently well developed.

This experience led to an interest in the role of the community geriatrician. Discussion with colleagues locally and nationally revealed a lack of information regarding such roles. So, with the support of the BGS (and the invaluable, practical assistance of Louise who has now left the BGS staff), Peter Belfield and I, with assistance from Sue Harris (a professional market researcher), surveyed lead clinicians in England regarding community geriatrician posts in their area. We asked about the number of posts which had community responsibilities; whether such posts were “full time” in the community or shared across the acute/community divide. We also asked about the content of these posts and we asked colleagues what the stimulus for the development of these posts had been; we asked what the benefits of the introduction of such posts had been and what problems they had created. We asked colleagues who had no community sessions why such posts had not been developed in their area.

Dr Eileen Burns

The results of the survey revealed a fascinating picture across England. We sent out 126 questionnaires and had a response rate of 77%. Only 23% of lead clinicians reported that colleagues within their trust had any community sessions, and of these most were working 2 or fewer community sessions.

The results of this survey clearly indicate a growth in the area of community geriatricians, with 15 of the 95 posts identified new, rather than replacement posts. A further 9 posts were “out to advert” and 10 were reported to be in preparation. The stimulus for development of these posts came from within geriatric medicine in 24 cases, and from PCTs in 10 cases. In 20 cases the community posts were reported to be a development in response to the NSF for older people.

The job content of such posts usually involved working with the local intermediate care team. Many lead clinicians also reported day hospital work, supervision of community hospitals and, in some cases, even home visits as community work, suggesting that some of the work performed in these roles may not represent a change in practice.

Many colleagues recognised potential benefits in such posts and some had attempted to develop them, but lack of support had hindered progress.

Some clinicians reported PCTs were unwilling to fund consultant expansion to meet this role.

However, the aspiration that general practitioners with a special interest may fill this role was not supported by the results of our survey. Although it is possible that there may be some GPs working with older people, who are not known to their local geriatricians, we identified only 8 general practitioners working in this role across the whole of England. There may of course be others who are awaiting the developments of training plans for GPwSIs before showing their hand.

Although most colleagues who responded regarded the development of community posts positively, a small minority of respondents (n=7) regarded the geriatrician’s role as limited to the management of acute medical problems only. This narrow definition of geriatric medicine clearly does not encompass the range of services which the BGS regards as a essential to a complete geriatric service.

Eileen Burns