Harriet Gordon | President, British Society of Gastroenterology (BSG), London, UK
Citation: EMJ Gastroenterol. 2026; https://doi.org/10.33590/emjgastroenterol/N711VVWR
Gastroenterology is facing growing demand alongside advances in diagnosis, treatment, and technology. What do you see as the biggest opportunities for the specialty over the next few years?
Gastroenterology has changed hugely over the course of my career, and it’s still changing. We can now risk-stratify patients using non-invasive diagnostics. We can detect diseases earlier. We’ve seen the development of therapeutic endoscopy, and we’ve developed targeted therapies.
This means that we have the opportunity to personalise treatment. So, it’s a very exciting time for us and our patients. Importantly, we can change how gastrointestinal disease is diagnosed and managed, and redesign traditional pathways.
A lot of our work is around possible cancer diagnosis, so the ability to do this less invasively is very exciting. Equally, we’ve got a large cohort of patients with chronic lifelong conditions, liver problems, or inflammatory bowel disease (IBD), for example. In IBD specifically, treatment has been revolutionised in recent years with biological therapies, so patients’ expectations are now different, in a very positive way.
But I think in all of this, our greatest asset is our workforce, which is now multidisciplinary. Without them, none of this is possible. We need to provide the conditions that enable them to flourish and contribute meaningfully. This will help create a prosperous future for gastroenterology, fostering innovation and development that can ultimately be translated into improved patient care.
The updated guidelines from the British Society of Gastroenterology (BSG) on IBD and coeliac disease reflect a rapidly changing evidence base. How can guidelines best support clinicians in translating new evidence into everyday practice?
I think the test for any guideline is whether it supports an improved environment for patient care.
IBD and coeliac guidelines had multidisciplinary development. They’ve had patient input and rigorous assessment, so they can help a gastroenterologist provide better care.
Given that the guidelines are probably the most accessed part of our website, we really understand how valuable they are. They’re available to everyone across the UK and abroad, and the information and recommendations are designed so they can be used in all hospital settings in the UK and further afield, but the real test is whether they’re used. We know that the IBD guidelines were the most downloaded last year, so they are clearly used and valued by many.
Where do you see the biggest gaps between what the evidence tells us and what patients currently experience in gastroenterology services?
Patients can have inconsistent experiences, and difficulty then arises because, naturally, everyone wants the best. Unfortunately, by definition, that’s not possible; care comes in a spectrum. You can have inconsistent experiences across the UK, within the same region, or even within the same trust.
So, we have multidisciplinary team meetings to try and bring a consistent experience to the patients we serve. This is particularly important in more complex cases when we are determining the best way to deliver personalised cancer care for an individual, utilising information we have gathered from our investigations. As a result, what applies to one person shouldn’t necessarily apply to the next.
The biggest difference has likely come from the number of gastroenterologists not increasing at the same rate as demand, as the population has become older. So, the biggest gap in experiences is timely accessibility. Unfortunately, we sometimes don’t see patients in the time that we would like to see them. It’s as frustrating for us as it is for them.
I think a patient can be reasonably frustrated by needing several different visits for several different tests. Given that many hospitals have merged, including my own, it can become difficult and confusing for patients to understand what is provided in which hospital. Improving the patient experience in this regard will require timely access to state-of-the-art technology, and communication of its availability to patients when the need arises.
Would you say this is primarily a capacity issue, with the number of gastroenterologists and available resources not keeping pace with increasing demand, or is the bottleneck elsewhere in the pathway?
I think the most frequent bottleneck we encounter is the workforce and having someone available to see you and talk to you. It’s probably for lots of really good reasons.
We try to make things faster by going straight to the test so that patients don’t necessarily need to wait to see someone first. But someone still has to carry out the test, look at the results, and translate that information for the patient.
Going straight to a test without first understanding why someone is concerned, what they’re worried about, and what they’re hoping to find out isn’t necessarily the best possible experience. The best experience is often to meet someone, understand what the problem is and what matters to them, and then make sure the investigation is considered in that context. Therefore, the workforce is the real bottleneck.
You have worked extensively across training, workforce, and professional wellbeing. What would a genuinely sustainable career in gastroenterology look like for the next generation?
A career in gastroenterology is well over 30 years, and during that time there will be changes in gastroenterology management and service requirements, as well as changes in yourself and your personal circumstances. The next generation has articulated a desire to work more flexibly, and we know this enhances professional wellbeing. So, a career needs to have flexible opportunities.
Gastroenterology has many subspecialties. Therefore, a job plan that defines what you do in a week should evolve over a career, and not only reflect the changing possibilities in gastroenterology, but also the changing needs of patients. Working in a team also opens the possibility of complementary training.
What you want to do in the early part of your career is very, very different from what you want to do towards the end of your career. They should be complementary experiences. Alongside subspecialising, there are also opportunities for a portfolio career with research, education, and management. This enriches your professional wellbeing and experience, and we know from surveys that these are the parts of professional life that are most valued.
That should be factored into any job planning, which you should do as a group. The BSG has also published updated job planning guidance, which gives some help and support for people trying to develop their roles and consider how they evolve.
One size doesn’t fit all, so we can do things differently for different people. Within a team, you can work out how different roles and responsibilities fit together while also creating training opportunities. You might have particular aspects of endoscopy that you want to develop alongside clinical responsibilities that work better on different days or at different times.
It’s about understanding what works for different people and tailoring roles to their circumstances while also considering what patients might need. You need a whole range of professionals in a department, as different people want different things.
How can the specialty better support clinicians at different stages of their careers, from training through to senior practice and retirement?
Much of what we’ve said applies here, but the BSG provides professional support right from when you’re considering a career in gastroenterology, before you’ve even begun, all the way through to retirement. There’s education, mentoring, and much, much more.
During COVID-19, it was a tough time for lots of people and for gastroenterology, and afterwards, very reasonably, lots of people were fed up. Project 90, which was brought in specifically to give extra support at a difficult time, created a number of different workstreams.
This was to recognise that the real tension points arise during transitions in your career, whether that is taking on a new professional role, returning to work after a period away, or planning for retirement. It’s to try and give extra support to improve career satisfaction.
The part I like the most is that we have special fellowships. There’s an opportunity to spend 2 weeks at centres of excellence, in the UK or abroad, to gain an insight into something new and exciting and then bring that experience back to your trust, thereby sharing new ideas more widely and invigorating your career.
As gastroenterology becomes increasingly multidisciplinary and technologically advanced, how do you see the role of the gastroenterologist changing?
I think keeping up to date is always important. You always worry that you don’t know what you don’t know. We have a fantastic conference every year that brings the latest expertise to delegates, and it remains clearly valued, with this year’s conference having sold out and requiring a larger venue.
One of the great opportunities of working in teams is that you can draw on the expertise of colleagues. Someone may be working in a particular area and know that there is a new development that we should be considering, or they may recognise that something sounds promising but has not yet found its place in clinical practice and may be better considered as a research tool for the time being.
Technology gives us lots of opportunities, and our patients are increasingly aware of that. They read about developments online and have expectations as well. What they need most is someone who can help them understand what is appropriate for them, whether that means pursuing something further or explaining why not.
The role of the clinician is ever more important, particularly in being able to communicate and apply what you know to each individual patient. You can risk stratify, but if you tell someone they have an 80% chance of something, they’re going to ask what happens if they’re in the 20%.
It’s really important to interpret their symptoms, personalise their investigations, and coordinate what’s going on in a multidisciplinary team. That’s where I see the role of the gastroenterologist in the future. They may not personally be doing every part of the process, but they will bring in the right people at the right time.
As you begin your presidency, what is the change you most want the BSG to deliver for gastroenterologists and, ultimately, patients by 2028?
It might be cheesy, but we want to give the best care to our patients.
I want the BSG to be the professional home for gastroenterologists and to be a strong voice in determining the future of gastroenterology. If we can provide the inspiration and support that enables our workforce to have interesting and exciting careers within the many different branches and facets of gastroenterology and hepatology, then we can support that valuable resource.
If they can have professionally satisfying careers, and we can provide the clinical scaffolding to deliver them, then undoubtedly our patients will have the best experience.
