Introduction

Single organ therapy for medical specialties, general medicine and its subspecialties, has increasingly failed a number of groups of people over the last 200 years or so. The largest group were elderly people who were summarily dismissed from the Infirmaries from the days of their building as ‘vagabond beggars, incurables and elderly’.The vagabonds at least were welcomed after 1948, when the NHS diverted attention from people's cheque books and on to their illnesses. However, other groups have continued to suffer from the tyranny of single organ care, notably the ‘incurables’, young chronically sick people and those who were not capable of ‘getting better’ immediately. The lack of good, consistent mycocardial infection advice, despite excellent research findings, and a lack of rapid admission and full rehabilitation services for stroke victims remain a matter for concern in general medicine. How will new changes in the NHS, especially the development of Primary Care Groups (PCGs) and Trusts affect geriatrics?