The latest meeting of the England Council took place on 1st April. As usual, full minutes of the meeting are available on the England Council website.

The two major agenda items were the Single Assessment Process (SAP) and discussion on the challenges faced by consultant geriatricians in England.

SAP
Implementation of the SAP is one of the major challenges of the Older People’s NSF. At the previous meeting, Ray Wharburton from the Department of Health updated the Council on progress. On this occasion Beverly Castleton came to update the England Council. She is currently seconded part-time to the Department of Health team trying to deliver the National Programme for IT. She presented an overview of the detailed work that has gone on nationally and the huge push behind the programme to actually deliver on time. Prof Aiden Halligan, the Deputy Chief Medical Officer, is now heading up the project jointly with Mr Stephen Grainger, to ensure that the IT input is balanced by clinical input. The data set for the Single Assessment Process is now well advanced and work is progressing on developing data sets for stroke, falls, continence and confusion. A plea to the council was for clinical involvement at every level. If you are offered the opportunity to join a local ‘group cluster’, do not miss the chance! Also, Beverly is looking for clinicians (whether IT literate or not) to advise and help support her programme. If you are at all interested, please email her on beverly.castleton@nsurreypct.nhs.uk. She promises there will not be a lot of meetings, mainly e-mail discussions and debate.

Challenges
The main debate at the council was based on the results of the questionnaire sent out to consultants and SpR’s in England in January. Currently, 223 consultants and 84 SpR’s in geriatric medicine completed the questionnaire, enough to get a reasonable picture of current views. The England Council has now agreed the final version of the document, “The Challenge of Consultant Geriatric Medicine in England”. The core of the thinking is encapsulated in the recommendations:

• Older people who need it, should have access to specialist geriatric input in a way and setting that suits their needs.
• The primary focus of every Department of Geriatric Medicine should be the management of frail older people and assisting in the delivery of high quality care to this vulnerable group wherever they might be.
• Geriatric departments need a balance between the acute management of older people in the first 24 hours and other aspects of a comprehensive service including rehabilitation. This needs to be reflected in the job plans of consultants in the specialty which should (a) take account of the other core aspects of geriatric practice in the community and (b) recognise the value of the sub-specialties of geriatric medicine and their role in the care of older people in both primary and secondary care.
• Specialist geriatric input is central to the work of A&E departments and in particular, in the growing importance of Medical Assessment Units. The daily input into post take ward rounds by either consultant geriatricians or specialist nurses from the medicine for elderly team should be an objective for all acute Trusts.
• Geriatricians in the role of Acute Physician or Physician to the Medical Assessment Unit require a significant geriatric medicine component in the rest of their job plan. The Royal College of Physicians (London) should insist that all other doctors training for, or applying for, such posts should receive a minimum of 6 months training in geriatric medicine, and be capable of demonstrating ability in core competencies once complete.
• It would be helpful if the Royal College of Physicians (London) were to discourage the continuing trend of filling acute physician posts with geriatricians.
• While a small proportion of CCST holders will take up posts with a significant community content for their first post, the British Geriatrics Society and the Royal College of Physicians should actively encourage Trusts and individuals to consider a career progression for geriatricians, allowing them to spend a greater proportion of their time in specialist services or community activities in the later part of their careers.
• The importance of comprehensive geriatric assessment and the management of the frail older person in the community and Intermediate Care should be constantly emphasised. This will require a greater emphasis on implementation of the new training curriculum.

This document will now be going to the BGS/RCP Joint Geriatrics Committee and will hopefully be used to influence thinking within the Royal College of Physicians. It is also hoped that it will be useful for individuals in their own Trust, in either helping to manage external demands or in allowing opportunities for career change.

And next..
The next piece of work for the England Council will be to look at how reimbursement is being implemented six months into the new system. James Barrett will be leading on this work for the Council.

David Black
Chairman, England Council