The instantification of healthcare

How do we safely manage ever increasing demand of patient expectations in a stretched primary healthcare system?

The demands on the NHS and its cash-strapped resources are becoming ever greater, along with the needs of an ageing population becoming more urgent, thus stretching the NHS to breaking point.

We are in a time when society’s health anxiety is on the rise, ably described by Richard Watson in his book ‘Future Files’; Watson predicts that anxiety is one of the top five key trends that will continue to affect society in the next 50 years.

Given the public health campaigns purporting the importance of checking out early vital signs in diseases coupled with the advent of the internet where people can check their symptoms online, this trend of rising demands on healthcare cannot be surprising.

We are living in a fast paced society, working 24/7 in a global world which has been shrink wrapped with technology.

Is our healthcare system in the UK keeping pace?

When patients are trying to access their GP practices for advice they can face a two week wait, or in some cases, longer. If patients are asked ‘when do you want to see a GP?’ the answer is almost always ‘today’..

So how can we develop models of care to be more efficient and ultimately meet the needs of today’s society?

Some of our data from a recent Practice Assist patient survey showed that up to 20 per cent of patients would have either gone to A&E or to their local walk- in centre, had they not received a call from us that day. This proves the rising demand for instant healthcare advice and treatment.

We are seeing the emergence of two main cohorts of patients. Frail older people and those with complex multi-morbidity conditions or serious mental health needs for which continuity of care and seeing the same GP (thus avoiding duplication and providing improved safety outcomes) would be very beneficial.

For other patients, continuity of care is not so important; they may have simple, less threatening concerns that can be addressed by any clinician qualified to give the correct advice, regardless of whether the patient is familiar with them or not.

Our research showed that in a single week, through a data collation exercise, 15 per cent of patients surveyed felt they needed to see the same GP compared with 46 per cent of GPs who felt that continuity mattered for the same episodes of care.

There were some prickled egos but the clinicians accepted these findings.

What does this tell us as health professionals?

It tells us we need to balance access to care with continuity of care sensibly, that we need to listen to what the public is telling us. If we cannot meet the needs of patients in primary care through often stretched GP practices, then they will quite rightly turn elsewhere, as they have no choice.

If we can increase capacity for ‘in hours’ primary care services when the need is greatest and to meet the core demands, then the pressure should in turn reduce on A&E departments, where primary care problems simply do not belong. A&E departments are for "accidents and emergencies" not "anything and everything", after all.

Ultimately the demand will turn up somewhere in the system. So why not tackle patients’ needs at the source? Target at the right time in the right place and design a primary healthcare system to match the demand. Right now, this is one of the greatest challenges for the NHS.

Dr Reggie Sangha. MRCGP
Medical Director - Practice Assist