Mohammed T. Abou-Saleh

COMMUNITY CARE: THE BACKGROUND 675psychiatry and general practice (Figure 2), and there is pairingwith medical and surgical firms. The department is embedded inthe local medical community, and particularly values its links withthe parent disciplines of medicine and psychiatry and its closenessto primary care. All referrals to the psychiatric side of thedepartment are initially seen at home by a senior psychiatrist,usually together with a medical student, and any other teammembers or community staff who are involved and able to bepresent, and if possible the family doctor is present too. Inpractice, most visits are by psychiatrist and medical student. Onthe medical side of the department a home assessment service isfreely available, but the majority of patients are seen in the clinic,or admitted as emergencies. Community nurses, working outwardsfrom the hospital, are part of both the medical andpsychiatric services.EDUCATION AND RESEARCHAll Nottingham medical students spend a month full-time in thedepartment. Teaching is a joint effort between all staff, ofwhatever specialty, medical and non-medical. The coursecomprises: a clinical clerkship, inside and outside the hospital; aplanned course of teaching; and a personal project undersupervision. With about 150 students a year, there is a heavyteaching load. The course is well received and many students comeback as postgraduate trainees. Rotating trainees come to acquirebetter skills (and, we hope, greater job satisfaction) in dealing withold people in whatever field they decide eventually to work. Onlythe senior registrars are being trained to become specialists in oldage.Research thrives on collaboration and transcends boundaries ofdepartments: we have long been collaborating with otherdepartments, and within a mixed department research collaborationcomes easily. Major projects include longitudinal studies ofwell-being of old people at home—the Activity and AgeingStudy—and participation in the Medical Research Council studyof Cognitive Function and Ageing (CFAS). Most projects haveinvolved staff from both of the main branches of the department.CONCLUSIONWhat has been called ‘‘the Nottingham Model’’ works well, and isa satisfying way in which to work. There have naturally been dayto-dayproblems, some general, others parochial, but none thathave divided the department along specialty lines. Above all,patients do not fall between stools and bucks do not get passed.REFERENCES1. Arie T. Combined Geriatrics and Psychogeriatrics: a new model.Geriatr Med 20th Anniversary Issue, April 1990: 24–7 (on which thisSpecial Article is based, with permission).2. Arie T. Education in the care of the elderly. Bull NY Acad Med 1985;61(6): 492–500.3. Bendall MJ. The interface between geriatrics and psychogeriatrics.Curr Med Lit Geriat 1988; 1(1): 2–7.