General practice 2016

Remote consultations, fully-functioning consortia and a whole new way of working: Dr Charles Alessi imagines a GP's working day five years in the future

This short paper is meant to describe what the world of health and social care will look like in five years' time. It is thus a visionary paper although it uses as its foundations the emerging landscape at the start of 2011. It describes a fictional doctor in practice.

Dr Moore was in a hurry that afternoon. She was rushing to get to the urgent care centre where she had a few patients to see. She had spent the morning in front of her monitor at home, which was handy as she had her one and a half year old baby to look after.

It had been a busy morning. She had seen 18 patients that morning via her telemedicine port and had managed the consultations well. She felt her technique had improved dramatically after she had attended two teleport training modules which were delivered to her directly at her home.

Six of the patients had warranted an examination, hence her asking them to attend the local urgent care centre at a place close to their home for clinical examination.

Life was very much easier now than it had been in 2010. Patients tended to consult online as the norm, and she also had direct contact with specialist doctors for those instances where she felt she needed further input. Once the hospital doctors had moved into the community they became much more accessible and contact was easy since they also mainly consulted remotely.

She had spoken to Mr Jivani that lunchtime as she had concerns about a patient who had just had a major operative post traumatic revision of her hip and she needed some information on the amount of mobilisation the patient required. Normally this was all dealt with by the new health and social care teams that had now started to work far better together after they started to work in partnership around 2011. However this patient had such a complex medical history that she was asked to get involved.

Dr Moore had another task that afternoon. After seeing the patients at the centre and also acting as a senior clinician in the local urgent care centre for a couple of hours, she then had a face-to-face meeting with colleagues within the consortium to decide on their roles for the next year.

The consortium had developed into a truly democratic and representative body and was really trying to deliver a population health perspective, working very closely with the local authority and public health. All the old GP practices were represented and with time the divisions between practices had started to blur. This had worried her in the beginning but then stopped being of concern as she liked the fact that she could now rely on everyone within the consortium to deliver the same standards of care and follow the same protocols.

Nursing had changed beyond all recognition too. The old divisions between district and practice nurses were a thing of the past and community services were now part of the consortium. In addition, there was now a whole cadre of health and social care professionals who looked after the population and whose roles were becoming more interchangeable.

Many of the patients still wanted to have their doctor and this was not something the consortium tried to interfere with, as it was viewed by all to be a good thing. Having someone you could trust and who you could see when you felt you needed to was acknowledged as an integral part of caring and healing. The nature of seeing people had changed over the years, from face-to-face being the normal means of communication to port-aided health consultations that took place remotely over the internet. These communications were secure, maximised the time of professionals and were liked by patients as they did not have to travel to see their doctor. They were no substitute for all consultations but managed more than 60% of interactions satisfactorily.

Dr Moore managed to get to the urgent care centre on time at 1.30pm and saw her patients, had some discussions with the pharmacists who were managing long-term conditions and sorted out a particularly difficult case in the centre by 4.30pm. She now had the consortium meeting.

The consortium had been set up over the past few years. The Executive Team interacted constantly over the secure link but still all met regularly and today was one of the face-to-face meetings where they spent an hour exchanging experiences and debating 'hot issues' with the Accountable Officer.

The meetings were open and attended by other clinicians within the consortium. The executive rotated every four years to ensure everyone within the consortium had the opportunity to put their name forward should they chose to. In the early years, most people preferred clinical work but the world was changing. There were now far more people who were interested.

Over the past year, Dr Moore had been the clinical owner of orthopaedics and managed the relationships with the local acute orthopaedic centre. She had been very successful, with the help of her manager who performed most of the associated operational tasks, at getting the centre to think much more of the community. She felt that she had succeeded in ensuring the orthopaedic centre had a population perspective as well as a patient one.

It had not been easy, as various new treatments had been deployed which in the past would have meant significant overspends. But for the first time this was accompanied by them accepting that they had to stop doing other things. The programme budgeting approach advocated by the Public Health Director, who also gave her expected prevalence within the population she served, had helped, as it proved the consortium was utilising too many resources in certain areas, without a corresponding improvement in outcomes.

She was contemplating taking on new responsibilities as she wished to widen her experience. She would miss being the clinical owner of orthopaedics but she felt she had to move and learn more skills as she was still planning to take over as the Accountable Officer in three years' time and she needed to understand the care of old people with dementia much better before she felt confident enough to take the job.

She was pleased to be back home by 6pm, just in time to see her husband and her other children who had just come back from school. Work in the new world was better than it was in 2010 she thought. Not everything was perfect - but at least people seemed to be working together to deliver care for patients and were not spending most of their time at cross-purposes.

Dr Charles Alessi is an executive member of the NAPC and a GP in Kingston-upon-Thames