In the mid-1970s the Permanent Working Group (PWG) of European Hospital Doctors was formed when it became apparent that junior doctors in different European countries shared many common problems and experiences. The PWG now represents 17 national organisations of junior hospital doctors and is recognised by European institutions such as the European Commission; British doctors are represented by the British Medical Association. The PWG organised a conference in Maastricht in the Netherlands in 1982 bringing together politicians, planners and the medical profession to try to plan the future supply of doctors to match the anticipated demands for services at a time when large-scale unemployment was beginning to appear in a number of western European countries. From this developed a major study of medical manpower in western European countries which formed the core of a conference on ‘Medical Manpower in Europe: from surplus to deficit?’ on 31 October 1991, hosted by the PWG in Florence. Europe in this context was defined as the member states of the EEC and EFTA.

In October 1991 the then Secretary of State for Health, William Waldegrave, appointed Sir Bernard Tomlinson to act as adviser on health services in London. Early on it was agreed that Sir Bernard would also take account of the role of these services in teaching and research. Previous reports have focused on one or other aspect, e.g. the Todd Report (1966) and Flowers Working Party Report (1979) primarily considered teaching and research while the report of the London Health Planning Consortium (1979) mainly addressed provision of services. While the former two reports have been followed by extensive change in the organisation of medical academic activities in London, there has been much less change in health care delivery. For instance, primary care and community care are still seriously deficient in parts of London while high technology hospital based medical practice, sometimes providing a nationwide service, has survived and sometimes continued to develop in an entrepreneurial way. The problem is riven by academic and professional concerns of nationwide relevance and importance.

Since 1979, consultants in psychiatry of old age and geriatric medicine have used the excellent guidelines drawn up by Professor T. Arie and agreed by the Standing Joint Committee of the British Geriatrics Society and the Royal College of Psychiatrists to determine which patients each group should be responsible for. Then, as now, there were concerns that some patients might fall between two stools.