Acute geriatrics at the front door

Editor – A recent article on acute geriatrics by Conroy and Parker¹ was both clear and relevant.

I was however disappointed (but not surprised) by the first sentence which stated that ‘the emergency department is the main portal of entry to emergency care’. The authors also point out that ‘geriatricians cannot address the population need alone’.

It is a pity that general practice therefore gets but a passing mention. This is not the fault of the authors but results perhaps from a cumulation of political interference, workforce issues and a near complete fission of primary and secondary care.

A few years ago, as a GP, I developed an interest in acute medicine.^2,3 There are now a number of similar initiatives in different areas, the common qualification of the doctors involved being the desire to dispel the myth that hospitals and the community have different agendas. As Conroy and Parker imply, it is rather important that they don’t.

There have been recent discussions between the RCP and RCGP to develop both a skill set and an assessment to accredit such doctors. These discussions have currently been shelved. This is all the more regrettable since, as the authors infer, management should focus on what is appropriate for the individual as opposed to exclusion of the unlikely. This concept lies at the heart of general practice.