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As the NHS moves out of winter and away from noro-virus no doubt we are all now being asked to focus on cost improvement initiatives to help keep the good ship NHS af loat! One answer might be for our specialty to be ever more engaged in community and front-door care of older people. Whilst the evidence base for admissions avoidance is weak compared to that for early supported discharge schemes, the key to reducing either admissions or length of stay must lie within comprehensive geriatric assessment and so our services must be able to deliver this with a degree of urgency. It seems I may be in danger of suggesting that in order to save money some investment in geriatric services might be necessary! There is perhaps no better time than one of financial constraint to review your service and seek to ensure it can deliver proactive rather reactive care. Dont wait for the frail and vulnerableto be referred to you go out and find them you know where they are!

Once again I have tried to cover the breadth and multidisciplinary nature of geriatric medicine. This volume includes: a comprehensive review of biliary tract disease; the perplexities of unexplained fever; a multidisciplinary approach to the diabetic foot; Charles Bonnet Syndrome; more educational top tips; and an excellent article by two of my therapy colleagues on dysphagia.

As always, I welcome feedback from you as to whether the journal is helping you to fulfil your CME needs. Those of you who are members of any BGS SIG should consider sharing your sub-specialty expertise by contributing to this journal. If you do truly have knowledge, why keep it to yourself?

Duncan Forsyth