August is a month with mercifully few meetings to attend so I find myself in reflective mode, particularly as I have a number of important presentations to give in the Autumn.

My reflections were greatly helped by the arrival of the newly retired and sprightly Mahendra Gonsalkorale, armed with his video camera. Mahendra has produced a marvellous DVD, recording John Brocklehurst’s historical perspectives on the development of geriatric medicine. He very kindly asked me to preface the DVD, which he hopes to launch at the Autumn meeting of the British Geriatrics Society. John Brocklehurst rather startlingly recognises the origin of our speciality from the time of Henry VIII’s divorce! You will have to buy the DVD to discover the full story (a bargain at £10 plus postage and packaging). John of course, was an inspirational leader of the specialty, and I think it is now impossible for anybody to span the spectrum of academic research, scholarship, education and service development that John was able to achieve in his career. It is very evident from the DVD that the development of the speciality arose as a result of the drive and vision of exceptional individuals who radically changed the provision of healthcare for older people. I realised that I knew most of these pioneers personally, but for the up and coming generation, they will only be known as historical figures. It is very important that the specialty remains in touch with its roots and rich tradition.

Golden age
Following John’s narrative, it occurred to me, that the specialty, for all its faults close to, is probably in its golden age. Most of the ambitions of John and the other pioneers, Exton Smith, Ferguson Anderson, Bernard Isaacs and Jimmy Williamson, have really been achieved. The specialty is now the largest branch of general medicine. Acute assessment is routinely and expertly carried out in all NHS acute hospitals. Academic geriatrics is established (although wilting at the moment). We have universal excellent training schemes. In addition, we have the development of specialist care with geriatricians taking the lead in areas such as stroke, Parkinson’s disease and falls, etc. Nevertheless the picture is changing. There is a clear reaction against the medical model of caring for older people and politicians by and large do not look to geriatricians for solutions, but to nurses running managed care, privatisation of long stay care and a radical shift from the medical model to the social model.

In twenty or so years time, a future Mahendra will look on our current era with equal admiration and find much original and pioneering work. However, John Brocklehurst made it quite clear that geriatrics thrived in the United Kingdom because the political framework allowed individual innovation. I believe, in the present climate, this is going to be increasingly difficult. Many of us are struck by the ineptitude and illiteracy of local commissioning with regard to elderly care. To be successful, geriatricians of the future will need to be part of integrated care networks, of the sort that have been pioneered in Scotland by Ann Hendry. Ann gave a fantastic presentation of this at the Council Study Day in Edinburgh on 14 June. It was a pity so few people were there to hear, but I am sure this is the future of our specialty. Following the meeting that Jackie Morris set up with Dave Black and myself with the Chief Executive of the National Health Service Confederation, on 14 September, the BGS is having a joint conference on vertical integration within the Health Service. The run up to this meeting has not been smooth and is perhaps symptomatic of the blind spot that strategic thinkers in the health service have for our specialty. I do hope that the meeting will open dialogue whereby we can take the responsibility of trying to educate future planners of the Health Service of the importance of retaining a high level of geriatric expertise.

On June 16, I was able to present a view of geriatric medicine to the Medical Specialties Board of the RCP London. I am very encouraged that all three colleges are now recognising the centrality of our specialty. My feeling is that the London College lags behind the Scottish Colleges in the integration of geriatrics within its programme. We will be rethinking our connections with the London College over the next few weeks and will be discussing it at the Joint Geriatrics RCP meeting in September.

Science to Practice
Since the last newsletter, the tragic events of 7 July occurred, on a day in which we were due to hold the UKMC meeting. Out of 23 people due to attend only the intrepid Dr Beaumont and myself arrived, both of us having started our journey in the very early hours. David arrived at Kings Cross while I came in at Euston within minutes of the outrage, and both of us walked past the bus which blew up outside the BMA House. Alex, our Chief Executive didn’t make it into the office because he was on the train immediately behind that which carried one of the bombs. We were extremely well looked after by the staff at Marjory Warren House. Rather ironically I got home from London much earlier than I normally would have, getting the first train to Liverpool out of Euston Station and being the first person on board! I hope that the uncertainty of future attacks will not inhibit people from attending meetings at the BGS Headquarters. I made it back on 11 July so that I could attend the multidisciplinary PD Meeting, Science to Practice. This meeting - a joint venture between the Parkinson’s disease section and MEP, organised by Dorothy Robertson, was over subscribed. It was a hugely successful multidisciplinary meeting, which does our Society great credit.

Consultant nurses
The consultant nurses in elderly care group met at the Foresight Centre in Liverpool and I once again had the pleasure of addressing them, on the invitation of David Jones, a valued colleague of mine. There are now over 60 consultant nurses in the group and it is hoped that as many of them will become members of the BGS, and that a special interest group in nursing in the elderly can be formed. This will be a major step to our becoming a truly multidisciplinary society and we look forward to the nurses actively participating in the Society in the future.

Public Relations
Alex and I have been busy pushing the public relations agenda and have forged a link with Onyx Health, who have put together suggestions as to how we might organise and pursue a public relations offensive to raise the profile of geriatric medicine and our Society. I hope to be able to debate this at the UK Management Meeting in September and then disseminate more widely what I hope will be fairly ambitious plans.

I hope everyone has had a jolly good summer holiday with the great weather. Please remember the Autumn meeting in Harrogate in October, which looks like being a very successful event. Judging by last year it would pay to book early.

Jerry Playfer