Community geriatricians

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6955.668a (Published 10 September 1994) Cite this as: BMJ 1994;309:668
  1. G Greveson
  1. Department of Medicine for the Elderly, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE.

    EDITOR, - As one of the few consultant community physicians in geriatric medicine, I wish to comment on correspondents' criticisms of Jackie Morris's suggestion that posts for consultant geriatricians with a community orientation should be created.1,2 Morris's suggestion was not at odds with the recommendation by the British Geriatrics Society that one or more consultants in a hospital department should take a lead role in developing community initiatives. Geriatrics is a broad based specialty. Many geriatricians have commitments to acute medicine or an interest in a subspecialty such as neurological or orthopaedic rehabilitation, which may prevent them spending much time on community activities. Surely it is legitimate for some geriatricians to concentrate on developing community initiatives as a special interest. I agree that such specialists should be full members of the department of geriatrics, undertaking all aspects of hospital based work as well as community activities.

    I understand David Black's concern that posts for community geriatricians may be created with the underlying aim of restricting acute hospital care for frail elderly people.1 This is unlikely to happen if posts are created as described above. Indeed, in Newcastle our experience is just the opposite. In our work with social services, providing specialist input into community care assessments, we see people who would not normally present to the geriatric service (for various reasons), and our involvement ensures that more, not fewer, frail old people gain access to specialist acute or rehabilitation facilities. With the current emphasis on community care and the shift to primary care services I am sure that this aspect of our work will be increasingly important.

    I do not share Black's fear that it will be difficult to find applicants of suitable calibre to fill these posts. As with any new development, there will be a lag phase while sufficient interested people receive appropriate training, but the framework for training is already available,3 and it should not be difficult to ensure that trainees receive the requisite experience. Increasingly, trainees express an interest in my post, which they see as a natural development in the context of today's health service.

    Of course, community geriatricians should not duplicate or supplant primary care services but should complement and enhance them. General practitioners seem to welcome the extra support I provide. I believe that we are working in partnership to ensure the highest quality service for all elderly people under our care. It would be unfortunate if unnecessary division was created between professionals because of misunderstandings or suspicion about the post of community geriatrician.


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