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Do we care enough?

Do we care enough?

Many GPs are too worn down to drive change in the NHS, says Dr Steven Laitner. But embracing patient leadership and new technologies could be a step in the right direction

At an event I attended a few weeks ago, one of the speakers mentioned the need for a ‘burning platform’ to spread much-needed innovation in the NHS. We couldn’t have more burning platforms!

In Britain today, people are spending a lot of time waiting: waiting on the phone to their GP practice; waiting for an ambulance; waiting in ambulances; waiting in A&E, on trollies, in corridors; waiting longer than they should for treatment; waiting to be discharged from overcrowded hospitals.

And of course, people are going to hospital when primary and community care would be much more suitable, especially during end-of-life care. People are suffering – and the situation is only getting worse. We’ve gone from an annual winter crisis to a year-round emergency, with older and sicker patients cared for by a weary workforce who feel compelled to take industrial action to improve their working conditions. The situation simply is not sustainable.

Collective compassion fatigue

I get a sense from recent health events and speaking to colleagues that we’re too worn down to care enough to create the changes we need. We don’t have the head space to care enough to change.

We’ve lost the onus and impetus to drive change. We’re no longer taking the future of the NHS by the scruff of the neck and driving up standards with an almost single-minded pursuit. We’ve been here too many times before. We’ve heard promises and seen them get broken, almost every time.

By detaching ourselves from the reality and ownership of a worsening health and social care system, we protect ourselves from a perceived impossible task. And that’s why, both in our public discourse and in attempts to define the ‘problem’, we end up blaming not only the Government but also the public and the patient. ‘There’s too much demand,’ we say. ‘Health literacy is the issue.’ And my particular bugbear: ‘We just made access too easy.’

Until we give voice, leadership and power to the public and patients – the ones actually on the burning platform – nothing will change. We are at an inflection point and need to embrace patient leadership, new approaches to care and new technologies to restore our ailing health service.

The public and patients need to be alongside clinicians and managers in driving that change. We all need to feel the heat a little more.

We need new solutions to fix old problems

Covid brought into sharp focus the need for new solutions to fix old problems. Long waiting lists in the NHS are by no means a new issue, but a combination of factors too complex to be explored here has once again seen questions around capacity and staffing levels back in the news this year.

But traditionally we are too slow to embrace new ways of caring for patients. It took the pandemic, and dare I say doctors’ fear for their own safety, for practices to shift to total triage and to embrace phone consultations, text messaging patients and e-consultations.

An international analysis last month found that British patients face the shortest GP appointment lengths. The study, led by the Health Foundation, found that Britain had the shortest appointment times at 10 minutes, along with Germany. Just a decade ago, UK GPs were among the most satisfied of any country in the survey, but now they are the least satisfied, along with GPs in France.

GPs are stressed out and burned out – and many are considering leaving their jobs. Add to this the record dissatisfaction rates with the NHS widely reported, it’s clear we need new solutions and a radical redesign to restore our health service.

This is where we need to focus on targeted prevention. We need supported self-care of acute illnesses, supported self-management of long-term conditions, and proactive, personalised, holistic care for those with complex needs.

Much of this does not need doctors, it needs new ways of working. It needs new roles, and it needs technology – not necessarily always new technology, just the type of technology that other industries have used for decades!

Turning to technology

The de-prioritisation of prevention in recent years is perhaps unsurprising, given that the word ‘crisis’ has dominated headlines about the NHS for years. But the risk of this ‘short-termism’ is clear: much like the climate crisis, failure to prioritise prevention today could see patients, the NHS and wider society paying the price tomorrow.

New approaches using technology and AI can make a positive difference in the short and longer term. We’ve seen the rapid rise of tools such as ChatGPT, and we have the technology-enabled models to make an instant and lasting impact in healthcare, too.

One example is the use of predictive algorithms, which can proactively identify vulnerable patients whose condition may deteriorate, months in advance. Recent publications show promising results that visits to hospitals and, ultimately, deaths could be prevented. I’d like to see greater trust put in these tools, as they will help us shift the focus from firefighting at the front door to a proactive, preventative approach that can identify vulnerable patients before they need emergency care.

Unless we embrace new approaches to managing demand and fully utilise the potential of predictive care, lives will continue to be lost because of excess delays. Let’s start to really care and deliver the predictive, proactive, personalised and preventative care people so desperately need.

Dr Steven Laitner is a GP and freelance health consultant in St Albans



Please note, only GPs are permitted to add comments to articles

fareed bhatti 22 May, 2023 7:42 pm

Thank you for highlighting and summarising the plight of General practice in the UK.
I just don’t understand how the last paragraph adds to it. Fancy words blended together, esp ChatGPT seems to be the solution to everything… forgive me for asking how many front line sessions you do and what sort of practice is it, what is your patient satisfaction and staff morale like? I often feel people teaching the ‘art of GP’ and resilience are those who have other gigs going. Good for you!
You are proposing large scale AI based solutions – remember how long it has taken NHS IT systems to be updated(or not updated). IT systems don’t run without workforce or even with workforce who as you say are knackered.
The players who hold the purse strings and approve of these, tender these out etc etc are not GPs therefore by definition not small agile organisations and are not invested in our welfare. Even if we tried to make things better for ourselves, I fear its rather far fetched to expect GPs even in large PCNs to enact these dreams when we have to take pay cuts to keep the lights on and give pay rises to staff. Secondly, your patients yearn for ‘ the family doctor’ and the RH Sir KS is promising them just that not an AI bot hired from Tesla.
Please- such pie in the sky ideas play into the hands of management consultants and politicians. Let us predict months in advance the granny is going to get worse. Its her flipping heart- she is 87, she isn’t going to live forever(though every rag she reads tells her she cant die or get ill), no matter how many ARRS people get involved or MDTs and algorithms I present her to. I also note today Sir KS is promising a liveried GP at your door step in the middle of the night in 5 years. Huzzah!
Chat GPT/ anyone else doing some of my work….what a pleasant dream. Lets get back to shovelling some more shit while the partnership model dies since we cant get out act together and get a meaningful voice-unless you have already divorced your family, are directly communicating through the WiFi and the cloud based telephony service, have electrodes already implanted in your head (or elsewhere) and are running on solar generated clean energy.

Michael Mullineux 22 May, 2023 8:59 pm

Absolute magical blue sky thinking hocum.

Malcolm Kendrick 24 May, 2023 3:47 pm

Let us identify those who smoke, and don’t exercise and have terrible social interractions, and loneliness and cant affod the heat the house and, and, and, and. Tehcnolgoy and AI that they won’t and/or can’t use will magically make them all…. better. By identifying things that they can’t, or can’t be bothered to change.

The NHS was, in part founded on the magic thinking that the NHS would make everyone better, and healthier, so damand would shrink down to almost nothing. We would prevent people getting ill. Such magic thinking seems impossible to cure, however much reality deems it unachievable nonsense.

The NHS is not a health service, it is an illness service. Prevention, like communism, is a wonderful utopian ideal. It may work well on some other planet, with different inhabitants. Here on Earth. Not so much.

Michael Mullineux 24 May, 2023 6:10 pm

Spot on MK

Dr No 26 May, 2023 10:14 am

The “easier access drives demand” point is absolutely true. It started with NHS Direct, a solution looking for a problem. The punters want F2F? Fine, so do I. Let’s stop all other interactions other than for housebound. And while we’re stopping doing stuff, let’s only see patients with symptoms. Everything else is LTC monitoring, screening, or vaccinations or such like. What a waste of our time. Also,let’s stop complying with serial reorganisations of Primary Care. Is only ever a distraction while more deck-chairs are shuffled about.