Monday, 21 March 2016

A British vision of family medicine for 2022

The British Royal College of General Practitioners has published a major document about their vision on the medical profession for the next 6 years. Remember that, just over two years ago, the Royal College of Physicians came forward with a report regarding the future of hospitals. As I documented at the time, the matter was not without controversy, because family doctors complained that the forecast was too focused on the hospital itself; and maybe that's why we are now seeing another document on the future from the perspective of primary care. Therefore, we welcome the controversy.

The new report from the General Practitioners (GP) is very comprehensive and we should pay attention to it, therefore here are some hints to encourage reading it in its entirety:

Why should we prioritize primary care over the specialist care?

The two boxes on the left of the figure below serve to highlight the efficiency of primary care and we can conclude that we can do a lot with little. To calculate the blue square, it has been estimated that the cost per year of membership to a GP is 80 pounds, which, with British figures becomes 10% of the cost of a hospital stay.

But what I was more interested in are the two boxes on the right. Notice the one stating that for every GP, per 10,000 inhabitants, the population mortality is reduced by 6%. In the same sense, Elliot Fisher, an associate of John Wennberg, wrote about Shannon Brownlee’s book "Overtreated", that in the studies "The Dartmouth Atlas" in the US, it was noticed that in areas with more family physicians and fewer specialists, the health outcomes were better.

The action plan as foreseen by the RCGP for 2022

Without pretending to summarize such a vast and as nuanced document, I’ll just outline the action plan that foresees 6 trajectories: promoting clinical practice value (1), which includes the concept of devoting more professional time to the important things; promoting patient-centered care (2), producing more materials for supporting shared clinical decision; developing doctors’ skills so they can address the real needs of the population (3); placing family doctors at the  centre when complex clinical problems involve several specialists (4) and if this is not possible, at least involving them in all specialists’ decisions regarding their patients; knowing how to support the deployment of community services (5); and promoting community academic activities in order to improve the effectiveness, research and quality of care (6).

The document that I present in this post is written from the perspective of the profession of family doctor in the UK, trying to deal with improving the clinical effectiveness in times of increased multichronic diseases and geriatric frailty. The other report, the one regarding the hospital of the future aims to provide new organizational models, more adapted to the new times. In short, there are different ways of looking beyond the quagmire of this crisis.

Jordi Varela 


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