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I realise that my time as President of the Society is rapidly coming to an end as I start dictating my last President’s column.

I calculate that I have regaled you with about 36,000 words. Somehow (unlike some of my predecessors!) I have always, to the great and pleased surprise of the sub-editor, filed copy for my column on time, although only just, sometimes with minutes to spare!

My senior moment
I first have to admit to my most embarrassing moment as President; a gaffe which certainly can be classed as a ‘senior moment’. The 24th June 2006 had been pencilled in red on my diary since 2005. Red ink means that this date must not be changed under any circumstances. In this instance I had agreed to speak at the National Trainee’s weekend, giving a firm commitment to Sally Briggs. As it happened, the day coincided with a start of a week’s holiday, so on the 23rd, work had been fraught. In fact I had arrived home to a dinner party we had arranged, after the guests had arrived! In my rush I had left without the folder containing the details of the meeting. The following day I left early to attend the West Midlands Show in Shrewsbury; delayed on the way back, I dropped my wife off and shot off to the meeting, convinced it was in Mottram Hall. Arriving with a few minutes to spare, imagine my dismay when the hotel told me that there was no medical meeting at their hotel that evening. I calculate that I have given over 500 postgraduate lectures in my career and never before have I gone to the wrong venue. To make matters worse, I had no contact telephone numbers to ring. Fortunately, my wife was able to pull off an email and was able to make contact with Sally Briggs. Mottram Hall is at the south end of the Manchester conurbation, the meeting was in Worsley, which is at the north end. After a frantic dash up the motorway I made it in time for the first course of the meal and what was to be a pre-dinner address, became an after-dinner address.

I felt that things worked out well as my late and dramatic arrival established an informal atmosphere and we had a very worthwhile discussion about the future of the specialty and problems which trainees face, stretching into the early hours, in the best tradition of the BGS. I would like to compliment Drs Sandy Thompson, Sally Briggs, Jessica Bevan and Emily Fielding, firstly for putting me at my ease, but more importantly, for their enthusiasm and drive. The meeting was highly successful. Unfortunately only a small proportion of the trainees nationally were able to attend. It is evident that one of the problems we have to tackle seriously is the parochialness of postgraduate education, with trainees expected to receive most of their training within their own Deanery and inadequate provision for external training. The networking and exchange of ideas as we had at the Worsley meeting is essential for our specialty to survive and thrive. We are making available more Fellowships and grants for trainees to attend our meetings when they are presenting papers, but I think the trainees should themselves give priority to attending and participating in national meetings.

Young Turks
One of the most important things on my agenda when I became President was to encourage the younger generation to participate. I have tried to do this by increasing representation on committees and I have also floated the idea of a ‘Young Consultants Group’, which might address the question of the future of geriatrics. I am sure if the young consultants put forward a proposal to form a Special Interest Group it would be supported by the Society and would enable the great energy and drive that I saw at the trainees meeting to be transferred in the early stages of a consultant‘s career.

The Society needs young Turks; every generation has to re-write the specialty. I am aware that throughout the country there are excellent young trainees and young consultants who are making a terrific contribution and have great careers ahead of them, but they all need to consider participating with the British Geriatrics Society and the Colleges, so that they can have input to the strategic development of medicine.

Richard Lynham was instrumental in getting Prince Charles to be our Patron and I know that Alex remains a firm believer in the value of this association, particularly as Prince Charles also has connections with a number of other major charities concerned with ageing. I confess to being very sceptical about the value of patronage and have been personally unconvinced about the tangible benefits it brings to the Society. Nevertheless as a result of this patronage I had an extremely pleasant day on the 11th July, when the Society was asked for four couples to attend the Garden Party at Buckingham Palace. Myself, Peter Crome, Jackie Morris and David Walker and our spouses were to attend, but unfortunately Jackie was ill on the day. We were part of a crowd of 8,000 people, Liz and I were lucky to bump into Peter and Ilana but we did not catch sight of David and his wife.

The BGS abroad
August is thankfully free of most meetings, although I attended the EUGMS in Geneva. Another of my prime aims on becoming President was to try and develop an international outlook and I think our participation in the EUGMS is an important part of this strategy. As you know, the BGS now acts as the secretariat to this organisation, which not only brings in small amount of revenue to the Society but also cements our place in European geriatrics. We have also become more active in the IAG with Peter Crome ably representing us on their International Committee. We have important initiatives in Malaysia and Taiwan. Peter Crome and I are representing the Society at the Sri Lankan College of Physicians Meeting at the end of September and for the first time they will be covering geriatrics in their most important meeting. I am glad we are developing a momentum in this direction.

...and at home
With the lack of meetings in August I am getting back to reading. I was delighted to receive a biography of Bim Bhowmick, and was very touched by his personal inscription. I have always said that Bim’s life should be made into a film and this is confirmed by reading what is a marvellous biography. I had to wait until my wife Liz read it first. She was totally gripped by the story. At a time when there are, in my view, unethical restrictions on overseas doctors in the UK, the story made me pause for thought how impoverished our specialty would have been if it were not for the contribution of so many overseas graduates, who often, like Bim, have to overcome great difficulties to thrive and demonstrate their ability within our specialty.
I have also been reading the Allyson M Pollack, Alison Talbort-Smith book, The New NHS – A Guide. Allyson Pollack is a particular medical hero of mine. She has taken a number of principled stands; she has been a constructive critic of the changes which we are undergoing in the NHS. Her other book NHS PLC focuses on the effect of privatisation of care of the elderly. This book makes the point that the NHS is being radically transformed from a tax funded, centrally planned, publicly owned and accountable service to a market that brings with it much more uncertainty and where decision making, funding and continuity of services becomes more problematic. Geriatric medicine at its height has been a product of the old NHS, but there is now a tremendous challenge for our specialty to adapt to the ever-changing rules. There is a certain brutality about the changes. I have received many letters from people who have lost their rehabilitation wards without discussion or have had major changes foisted on them without any consultation. Although the medical profession as a whole cannot turn this tide, even if it wanted to, we will have to be robust and learn to make the most of opportunities as well as defend against the threats. I think over the last few years the Society has become much more effective in contributing to policy. The transformations that Cameron and Bob brought in, allowing the four nations an independent structure to negotiate with politicians in their own countries was extremely wise. My rain check is that Scotland is managing very well and has strong political links and is able to generate clear input. Equally, the progress made by Wales has been very impressive, aided by a number of very able and politically astute geriatricians. Northern Ireland health service faces a major problem as the so-called reforms are cutting deeply into existing services.

In England, the English Council is being very effective and well led, and the formation of a multidisciplinary forum, at the instigation of Ian Philp, has greatly strengthened those with specialised expertise in managing people from all disciplines (medicine, rehabilitation and nursing), enabling us to come together and advocate quality services and to analyse the effects of change of policy on our patient group. For the future, geriatricians are going to have to be very bold. The move is out of hospitals and into the community and we must therefore find our place within the community. I am very intrigued by the model developed in Leeds by Graham Mulley and his colleagues, where they spend half their time in the community and half in hospital. We will see many more such initiatives in the years to come.

The Presidential Election was won by a narrow margin by Graham Mulley. I offer my congratulations and I am delighted that such a great geriatrician should be heading this Society in the future. Graham’s contribution is immense. One only needed to hear his FE Williams Lecture at the Royal College in June, to realise that this is a man of great vision and intellect who has a passion and moral drive for the specialty. I have been lucky to have Graham as a friend for many years; I think we share a very similar vision for the future of our specialty. He will be a most excellent President.

A word of commiseration for another great friend of mine, Doug MacMahon, who has missed out so narrowly on two occasions. Doug is without doubt one of the outstanding geriatricians of his generation. He has a zest for life and energy that puts most people to shame. He has been a great success wherever he has directed his attention. For the Society, he was an outstanding Chairman of the Policy Committee. He was also one of the founders of the Parkinson’s disease section and gave it great leadership in its early days. The establishment of the Parkinson’s Academy is rightly a widely acclaimed achievement. He has reached the international stage in Parkinson’s disease and I am sure will continue to be an outstanding contributor to the work of the Society.

Broadening our membership
One of the other important aims I had was to try to make the Society more multidisciplinary. I am delighted that we now have a thriving Nurse Consultant Group and I am also delighted with the other news in this newsletter, that we have obtained a grant for £400,000 to support professions allied to medicine in care of the elderly. I hope, by setting up Fellowships, we can increasingly incorporate all the disciplines looking after older people, and make our Society more reflective of the way we work. We already have some very firm initiatives in place. I have already mentioned the Department of Health Forum for Older People and I would also like to mention the role of special interest groups in promoting multidisciplinary working. This year marked the 10th Anniversary of what we in the Parkinson’s disease Section call the ‘Dorothy Meeting’. Dorothy Robertson has organised this meeting at the Royal College of Physicians, which is geared for a multidisciplinary audience. The meeting has gone from strength to strength.

Acknowledgments
I hope the next section is not going to sound too much like the Oscars, but I have to thank many people for what has been a very fulfilling and exciting four years for me, two as President Elect and two as President. The Society is extremely lucky with its permanent staff. I think Marjory Warren House is an extremely pleasant place to visit and my many calls to Marjory Warren House are always met in a most pleasant way. Both Sarah and Jo, since joining the Society have made an enormous contribution. Susan keeps the finances of the society in order and it is no co-incidence we are at our best financial state ever. Alex has been a constant source of support to me. We have phone discussions most Fridays and I count myself lucky to work with such a pleasant and sound man who contributes a lot to the Society. It has been difficult doing a full time job on the new contract (I think it is 12 PA’s!) due to the amount of work that is involved in leading this Society. I have been extremely fortunate with my NHS colleagues, particularly my brilliant clinical director, Nadine Carroll, who has made sure that I have been able to get the time off to attend meetings, as have the Chief Executive and Chairman of my Trust. A special word to a few of my colleagues, firstly Emer Ahern, as I dictate this letter, is leaving Liverpool to return to Ireland. I owe her countless nights on-call, but more than that she has been a great moral support. I would also like to mention Lisa Fook who has been an outstanding and courageous colleague. Sadly, she is ill at the moment and I would like to wish her well. Shankar, Geoff, Neil, Alison and Glyn have all also been fantastically supportive and great colleagues.

Taking on the role of President is like taking on two full-time jobs and this has affected the people around me tremendously. I would like to express sincerest thanks to my secretary Chris Harrison. Any of you who have rung me up will know how great she is as a PA. I am not naturally organised and Chris has kept me on an even keel throughout the last two years. I generate a large workload from my clinical practice and the last thing Chris could have done with was all the extra work that I have generated. Liz my wife has had to put up with me working evenings, weekends, being away a lot and has always been extremely supportive. As you may know she has been ever present at the BGS national meetings and we have made what has been an arduous period good fun and a period with many happy memories.

More than anything I have enjoyed tremendous good will and support from members of the Society. I have worked with the most talented and dedicated officers and chairmen of committees who, without exception, have given me great support and loyalty. These are people you would be happy to go to war with! I hope I have been able to voice the concerns of the ordinary geriatrician (each one of you extraordinary in your own way!). I have been extremely lucky to have Peter as President Elect. He is a man of great intellectual distinction with a rising international reputation in academic medicine, but more than anything, has a passion for the specialty. He will work very hard for its future and I wish him the very best of luck.

I am getting nearer my patients, being 60 in December and have made the decision that I will be quitting the NHS at the end of the financial year. I have no intention of being idle and have firm plans for writing, lecturing, consultancy and charity work. I am very much looking forward to the Harrogate meeting and hope as many of you as possible can attend. It should be a very memorable meeting.

Jeremy Playfer