With the drumbeat of the coming General Election becoming louder, health issues are never far from the news.

The government is flexing its muscles to demonstrate that it is increasing investment in the Health Service and delivering better care. The politicians’ posturing offers both threats and opportunities for geriatric medicine. The issues are of course, different for different nations in the United Kingdom, and the reformed structure of the BGS is proving of value, allowing improved communication relating to the different political agendae in each country. I would like to draw attention to two political initiatives from the English perspective, to illustrate how the specialty might be shaped by those politicians who might seek to be seen as innovative and reforming.

Patient choice
Firstly, an initiative called ‘Choose and Book’. This is aligned to the theme of patient choice. Basically, patients will have the right to choose the time and place of their first appointment, and this will be booked electronically without any clinical screening. This initiative has had little input from either patients or clinicians, and it is now hastily being put in place. If we take our own specialty, widespread use of this system is likely to result in inappropriate and ineffective referrals. As geriatric medicine becomes more specialised with different clinicians taking leads on falls, stroke, Parkinson’s disease, continence etc, what could be more disastrous than electronic appointment booking determined by the day of the week on which the patient wishes to be seen at a particular hospital. One can imagine that the results will be chaotic. There will be a loss of ability to refer to specific clinicians, and the continuity of care will be threatened. In the complex conditions presented by the patients that we see, it would be unthinkable that the screening of referral letters to ensure appropriate referral will be a thing of the past. Nobody can argue against the concept of patient-choice, but will this system really give them that? Many of the patients geriatricians see are particularly vulnerable with very complex needs. Anything that weakens the referral process is likely to increase inefficiency and undermine the quality of service patients receive. The Royal College of Physicians (London) has taken up this issue and I have written to them on behalf of the Society, supporting their constructive criticisms.

Payment by results
The second issue on this theme is payment by results. Undoubtedly this is seen as a tool for reshaping services. On the surface there appear to be some opportunities for geriatric medicine. There will be increased payment for people living alone, which could have a significant earning power for our specialty. On the other hand, it is recognised that outpatient appointments for geriatricians are longer and more complicated, and so will cost more. As an illustration, a patient with Parkinson’s disease sent to a neurologist will attract a payment of half that for a patient sent to a geriatrician. The problem of course, is that the payment is a form of commissioning, and one could see that valuable services built up over many years, providing a full range of services to such vulnerable patients, will disappear as PCT’s encourage referrals to ‘cheaper’ neurological clinics. The specialty will have to watch these developments very carefully and will need to consider how to monitor the effects of the so-called reforms.

In facing the effects of political initiatives the specialty is not alone and it is vital that we have forums where we can communicate with other specialties. In January, I attended a Medical Specialties evening at the Royal College of Physicians (London), hosted by the Federation of the Royal Colleges of the United Kingdom. Prof Carol Black, President of the RCP (London), chaired the meeting, with Prof Neil Douglas, President of the RCP (Edinburgh) and Prof Graham Teesdale, President of the RCPS (Glasgow), joining the discussion. The main item on the agenda was How to maximise the relationship between the specialties within the framework of the Federation of the Royal Colleges of the United Kingdom. A lengthy discussion took place on how specialist societies interact with the Colleges. It is recognised that there is an added value from having links with the Colleges. The political access and influence of the Colleges is still probably larger than any of the individual specialties. There needs to be joint work on generic issues, particularly training, general medical education and public health issues. There is the ever-present problem of duplication and the need for clarification between the differences of the work of the Colleges and specialist societies. It seems likely that the Federation of Colleges will develop a medical specialties board/forum. I think this will be a vital development for our speciality and one in which we must play the fullest part.

Following this discussion, Dr Fiona Adshead, Deputy CMO, discussed the public health White Paper, Choosing Health. Dr Adshead emphasised that the White Paper had produced an unprecedented response and has the full commitment of the government. Choosing Health emphasises prevention, much of which is highly relevant to the ageing population. One important effect of the White Paper is that the principle of health needs to be considered in every piece of legislation that is developed. Sitting next to Dr Adshead at the dinner after the meeting, I was encouraged by her awareness of the importance of older people within this initiative. She was certainly aware of the pioneering work of Prof Marion McMurdo on exercise in older people, and sees it as a good example of clinical leadership leading to the improvement of health.

A little reverse-marketing
Following the UKMC meeting of the 20th January, we held a reception for our pharmaceutical sponsors (reversed marketing!). This proved a very pleasant occasion and I was very grateful for the full turnout of office staff and many members of the UKMC. The feedback has been very positive. The Society’s meetings are seen to be friendly and worth supporting, and in giving something back with the reception, we will help maintain sponsorship for our scientific meetings. We scored a PR success!

United in Care II
I am delighted that we have reached an agreement with Medical Education Partnership to run a second United in Care Multidisciplinary Meeting in December this year. Peter Crome has kindly agreed to take the lead and it is hoped that a programme will be evolved by May, with full involvement of all the disciplines. It has also been agreed that the Society, together with the RCP (London), will mount a day conference on Medicine for an Ageing Population in February 2006. This will be a great opportunity to showcase geriatrics, highlighting the challenges and achievements of the speciality.

Finally, I would urge geriatricians of all grades to respond to the “Why geriatrics” survey enclosed with the printed version of the Newsletter. While I know we are all regularly pestered with questionnaires, it is very important for the Society to be able to collect accurate data to support our arguments.

Jeremy Playfer