Clinical medical officers could provide service

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6947.128a (Published 09 July 1994) Cite this as: BMJ 1994;309:128
  1. Sukhdev Saharan Sharma
  1. Consultant in communicable disease control Department of Health Gain and Strategy, Ealing, Hammersmith and Hounslow Health Authority, Southall, Middlesex UB2 4SA.

    EDITOR,—Jackie Morris proposes that the gap between community and hospital services for elderly people should be bridged by a new subspecialty of community geriatric medicine.1 Since the formation of trusts and the implementation of community care, consultants in medicine of old age have been more involved in hospital work. The role of community geriatrician as specified by Morris seems the same as the role of a consultant geriatrician used to be when the specialty of geriatric medicine came into force. The role has changed along with the attitudes of physicians, who prefer not to be called geriatricians; as a result of amalgamation of this specialty with general medicine, the sharing of the medical intake and out of hours duty rota makes it difficult to continue to fulfil the traditional role of providing care in the community. My concern is that the same would happen with community geriatricians in the future.

    Morris is unaware that the gap between community and hospital services is filled in certain districts by clinical medical officers or senior clinical medical officers. Their involvement in acute care, rehabilitation, and continuing care varies across districts. The number of doctors is small but requires a review, as happened with the child health service.2 The joint working party on non-child health community services is working on producing guidelines.3 Clinical medical officers and senior clinical medical officers have provided these services for years, and their experience should be recognised. Appointment as a community geriatrician should be an option for senior clinical medical officers with higher qualifications. If an employer considered that a senior medical officer had the relevant skill to undertake consultant work it could seek dispensation from the requirement to advertise. Senior clinical medical officers should be given other options, such as training or being allowed to retain their posts. Similarly, clinical medical officers should be offered appropriate options. It is of paramount importance that senior registrars training for this subspecialty should have acquired experience in community geriatric medicine before being accredited; in this the Royal College of Physicians should work closely with the Faculty of Community Health.

    It is time for us to create such posts to make community care successful. Those who are involved in this aspect of care must continue to influence purchasers. Funding jointly by health and social services would be appropriate for these posts.


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