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I was delighted to have been elected as President-elect of the BGS and wish to thank all those who voted for me and for the many kind and encouraging letters that I have received.

I would like to compliment Doug MacMahon, the other candidate for the post, on being so noble and gracious in defeat – the result was very close indeed and I am grateful to him for being such a good opponent.

The post is for two years: time to learn how things work, who does what, what needs to be done and how to make the most effective use of time and skills in improving the medical care of older people. As an apprentice, I do not wish at this early stage to be too prescriptive but it might be useful to share some preliminary thoughts and observations with you.

Fun runs and a day at leisure
I have spoken to colleagues in other disciplines about how they organise their specialist societies. Some have a single annual meeting in a major centre. One has a free day in the middle of the week so that delegates can explore the city. The rheumatologists begin the week with a fun run. I like the idea of including many more colleagues from nursing, therapy and other professions in our national meetings. Smaller “state of the art” seminars seem to work well. The idea of regional presidents is one to consider. I would be interested to hear from geriatricians who are also members of other specialist societies and invite them to write to me with their thoughts on which initiatives we might develop.

Our profile
An area which merits serious attention is how to improve the profile of our specialty. People outside our field are astonished to learn that we are the second biggest specialty (after anaesthetics) and the largest specialty group in the Royal Colleges of Physicians. The rise of elderly medicine in the UK has been truly remarkable and old people now receive a standard of care that would have been inconceivable a few years ago. We have many highly talented people in our ranks who are providing excellent services, teaching with verve and doing useful research – as well as doing managerial work and advising policy-makers. Yet we seem to be punching below our weight. The government has not always been ready to listen to front line clinical staff, perhaps perceiving us to be reactionary and negative about initiatives in care. The virtual exclusion of clinicians from designing policy initiatives is, of course, not confined to our specialty. We already have close links with the RCN. A strategy that harnessed other professional and charitable organisations would be more likely to succeed than a medical group working in isolation.

I have been hugely impressed with the team at the BGS head office, who are energetic, keenly committed and highly professional. I am equally taken by the many geriatricians who contribute to the Society’s committees, do important work at the Royal College, produce our fine journal and do much else besides. People have told me that some regions seem to be less active. This is a shame – the Society exists for its members and the centre can only be effective if it has close contact from colleagues throughout the country. The Policy Committee devotes time at the beginning of their meetings for “blue sky” thinking (I must be careful not to slip into management jargon!) and this may be a model for regional meetings. We have perhaps become re-active to the welter of changes and not given time and energy to original thinking on how to improve elderly care. Both Peter Crome and I would be delighted to attend BGS regional meetings. Individual regions could also learn from each other. The idea of large regional BGS-sponsored meetings for hospital and community staff which address key themes in elderly care is something which has worked well in some parts of the country and which might be considered elsewhere.

Turn ‘change’ to ‘progress’
The medical landscape is changing rapidly and will do so at an increasing pace. In the near future, there will be a small number of high-tech specialty hospitals. More elderly care will be in intermediate care beds, in patients’ homes or in other settings such as independent treatment centres. We must ensure that policy makers are aware of the evidence for effectiveness or otherwise for these schemes. We must agitate for research (as well as doing more ourselves) to inform future plans. And we must ensure that the many hard-won gains in British geriatrics are not lost. There is no doubt that much more elderly care will be away from hospitals. As a specialty, we must be involved in this inexorable change and help ensure that old patients get timely access to investigations and are not deprived of a comprehensive geriatric assessment. Equally, we must be flexible in our styles of working – there are enormous opportunities for developing high quality care in the community. This is a theme that I will return to in future letters.

Graham Mulley