I am fortunate enough to be married to a general practitioner. This is one possible strategic approach to intra-professional partnership! However we need a more broadly applicable professional and organisational strategy, and I am happy to report on progress being made jointly by the BGS and the Royal College of General Practitioners.

It is self-evident that older people especially (though not, of course, exclusively) bring primary care needs into the secondary care context and equally, carry with them continuing secondary care needs when leaving hospitals. General practice colleagues are only too aware of this, perhaps to an increasing degree.

Our speciality at its best has an excellent record of collaboration with primary care to bridge this transition. When this happens, everyone benefits. The key to success in the past has invariably been the delivery of a responsive service together with well-organised mechanisms to support free inter-communication and agreement between clinicians, on the preferred course of action for each patient. This has not changed, but both disciplines have changed and developed, and there are substantial contemporary opportunities.

This summer I was joined by Drs Chandi Vellodi, Jackie Morris and Paul Knight to meet with representatives of the RCGP at the College. Our discussions were against the background of two recent joint Department of Health-RCGP guideline documents - (1) on General Practitioners with Special Interests (GPSI) and (2) on GPSI Appointment in Intermediate and Continuing Care for Older People[1]. BGS members not already au fait with these documents should obtain them and become familiar with the innovative GPSI concept the College envisages. Our meeting set out broadly to explore ways (assuming the availability of some funding for posts) in which we could encourage and support GP’s to take up or continue GPSI opportunities in thisu field, as positive personal development and career choices.

It would be hard to exaggerate the importance of our specialty working closely with general practice. From the point of view of our patients, everything possible should be done to achieve continuity of service and standards between primary and secondary healthcare.

The avenues to develop closer working relationships include:

• Collaboration in clinical practice and service delivery
  Consultants and hospital-based departments should do all they can to encourage the establishment (particularly by teaching Primary Care Trusts or Joint Care Trusts) of GPSI posts reflecting RCGP/DOH guidelines, and in due course to forge links with appointees. Many of us already know outstanding and experienced GP colleagues with particular interest and experience in this field, eminently eligible to take up the challenge (some perhaps at present keeping their heads below the parapet). The current NHS plan in-corporates a number of initiatives to promote such appointments.
  
  
• Collaboration in training and continuing personal development
  The RCGP has an extensive programme of accredited CPD. At the time of our meeting the outcome of its negotiations with the Department of Health on the resources for accreditation of GPSI were pending. For the BGS, the analogy of the relationship of specialist societies with the Joint Committees on Higher Medi-cal and General Professional Training of the Royal Colleges of Physicians is a useful one. It is likely that if the resources for accreditation are realised, the RCGP would welcome representative involvement and support from the BGS in its accreditation procedures for this speciality, and in its development of more contemporary training programmes, career-tracks and CPD programmes for GPSI. We should embrace this opportunity with enthusiasm.
  
  
• Collaboration at national organisational level and in research.
  A number of GP’s (but too few) are highly valued members of this society. The RCGP has set up its own special interest section on the care of older people. Equally the BGS has a developing SIG in Community and Continuing Care and Health Promotion. The logic of forging relationships between these groupings is inescapable. It is proposed that there should be joint “badging” of a workshop already planned by the RCGP for November this year. This is to be an exploratory workshop (max 60 delegates) focusing on four topics - care home issues, collaboration and organisational interfaces, rehabilitation, and single assessment. The BGS now hopes to support this by fielding a number of delegates (through the SIG) as well as a plenary speaker. There is also the possibility of a jointly badged national conference on ageing and the health care needs of older people.

These and similar interchanges should inevitably uncover the many unanswered research questions about the prevention, early detection and best shared management of the health problems of late life. There is already significant research collaboration within our ranks, but the key to its growth is in organised joint pursuit of both the ideas and the funding.

I very much hope the current initiatives will be highly successful.

[1]see below for website urls where these documents are available

Cameron Swift
President

Guidance on General Practitioner (GP) Specialists

Dept of Health/Royal College of GPs - Implementing a scheme for general practitioners with Special Interests (published April 2002). Provides information on the issues that need to be considered when commissioning and appointing a GP with a special interest, including how the scheme will operate nationally and locally. The document identifies care of the elderly as a priority area, although it is for

Primary Care Trusts to determine local need for the scheme.

Guidelines for the ap-pointment of GPs with Special Interests in the Delivery of Clinical Services – Intermediate and Continuing Care for Older People (published May 2002). This document provides information on the core activities, competencies and clinical governance of GP specialists in intermediate and continuing care. The document is explicit about integration with departments of geriatric medicine. Reference is made to BGS compendium documents on intermediate care (D4), rehabilitative care (A4) and Clinical Governance (May 2000).
Both documents and further information is available at www.doh.gov.uk/pricare/gp-special interests/index.htm
In November 2001, prior to the publication of the DoH and RCGP guidelines, the BGS produced recommendations on the core activities and competencies of GP Specialists for older people. This is available at www.bgs.org.uk/ publications/publications.htmv