NHS too specialised for demands of ageing population, CMO warns

Doctors and NHS services are becoming too specialised to meet the needs of a rapidly ageing population, the chief medical officer (CMO) has warned in his annual report.

Much of the medical profession is organised around single diseases or organ systems ‘in a way that is ill-suited to a future of increasing multimorbidity’ where people accumulate chronic conditions, Professor Chris Whitty said.

It is essential that doctors maintain generalist skills in order to best care for older populations. NHS services and research bodies also need to adapt to the rise of multiple conditions, he added.

Currently older people are ‘shunted around multiple unrelated clinics often with great difficulty to them and their families’, he said, which is ‘bad medicine and bad organisation’.

The 2023 report Health in An Ageing Society, stressed that the focus should be on improving quality of life rather than longevity.

Sometimes this means less medicine not more in older adults where over-treatment can be as inappropriate as under treatment, Professor Whitty noted.

Ill health and disability in old age is not inevitable, he said, but there are stark inequalities associated with deprivation. The NHS needs to focus more on primary and secondary prevention to delay disease, the report concluded.

In addition, successive governments and professional bodies have also not recognised the degree to which the population living in older age is skewed outside urban areas.

Some rural and coastal areas where rates of older people are growing fastest are underserved by health and other services, he said, and struggle to attract GPs.

In one example of Norfolk and Waveney he predicted that with current trends the demand for GP appointments is likely to increase by more than 1,000 a day over the next five years.

Older people also have less accessible transport links and insufficient infrastructure designed for them, including housing.

Providing suitable services and environments in these areas should be an absolute priority to maximise the period all older citizens have in independence, the report said.

Professor Whitty said older people can and should be served better.

‘We need to recognise and reflect in policy and medical practice where older people are concentrated geographically, increase clinicians’ generalist skills, improve mental health provisions and make it unacceptable to exclude older adults from research because of older age or common comorbidities.’

Professor Kamila Hawthorne, RCGP chair said while it was a testament to advances in medicine that patients are living for longer, they are often living with multiple, chronic health conditions.

‘This is something that GPs and our teams are highly trained to manage and treat, and we are pleased this is recognised in the latest CMO’s report.’ 

She said GPs were experts at treating the whole person rather than individual conditions.

‘Older patients also really value the continuity of care having your own family doctor can provide – being cared for by a doctor who knows you is a precious commodity.’ 

The report highlights the ‘utmost importance in resourcing general practice appropriately for the future’, she added.

‘As the report suggests, demand on general practice is only going to intensify – so decisive measures must be taken now to ensure GPs and our teams can deliver the care our ageing patients need now and in the future.’

Greg Fell, president of the Association of Directors of Public Health, said: ‘Only by ensuring that people have access to the things that support us to thrive – like good housing, good work and green spaces – can we ensure that people will continue to enjoy good health and wellbeing as they get older.’

Dr Sarah Clarke, president of the Royal College of Physicians, said: ‘With an increasing number of people with multiple long-term conditions, generalist skills are key, as are close working links with primary, community care and the voluntary sector.’