'The tectonic plates of healthcare are moving'

Doctors leader, Chaand Nagpaul, has a difficult path to tread in these times of radical change. Photograph: Manpreet Romana/AFP/Getty Images

Commenting on my open letter to the new chair of the GPC, Dr Chaand Nagpaul, David Cruise asks: "Could you clarify what it is you want. You call both for change and for continuity, for a return back in time and for a step into modernity." I confess that my call for a return to the old days of GPs taking responsibility for out of hours service might have sounded a shade retro. But I can assure you that the way I see general practice developing is quite radical, and there will be little room for GPs who want to carry on in the old way. I hope that Dr Nagpaul sees it the same way.

The tectonic plates of healthcare are moving, whether individual clinicians like it or not. Patients are getting older and more demanding and the younger ones are adopting ever unhealthier lifestyles. Hospitals will be reconfigured, A&E departments will be "consolidated" (ie closed). Drop-in centres will spring up; the private sector will come up with innovative ideas (mixed in with dollops of snake-oil). Social care and general practice will converge. GPs will have to learn new skills, like diplomacy and how to work with other people, to cope with it all. Their lives will be turned upside down, but they must stop harking back to a golden age where doctors were respected and patients knew their place. Dr Nagpaul has to show real leadership to point his unruly members forwards not backwards. Then there is the pressure of money (saving £30bn) and time. On one side, Dr Nagpaul will have to fight like a tiger to win the funding and resources needed to cope with the new pressures and new responsibilities. But on the other side, he will have to persuade doctors to see what they can do to use money more effectively. That will be an uphill struggle.

Forgive me if I give a trivial instance of waste that I experienced this week. A junior member of my GP practice asked me to come in to get a blood-pressure reading from the sister. I told him that I took my blood-pressure regularly at home. He pooh-poohed me, insisting that I come in, which I did obediently, to find that the sister's reading was the same as my home reading. To me, that was a waste of NHS resources, albeit a tiny one and a waste of my time. Not only that, he was going against the stated policy of the NHS to make patients more involved in their own care.

And that is another challenge for GPs. They have to get patients to involve themselves in their own treatments, and, hopefully, to persuade patients to avoid unhealthy lifestyles. And to understand their own patient records, which they should do by 2015, when the government wants patient records to become accessible to patients.

There is another challenge for Dr Nagpaul. Healthcare technology is moving fast, but GPs – and clinicians in general – have historically been obstructive. In these columns, I have often deplored the lack of email between doctor and patient, when the rest of the world uses email pervasively. When I see how dependent my GP is on my electronic patient record (EPR), I am shocked that out of hours practitioners are not given access to the GPs' records. This is a recipe for inappropriate treatment. And similarly, the opposition by clinicians on doctor/patient confidentiality grounds, to the summary care record, seemed to me to delay the adoption of electronic patient records by five or more years. Some senior doctors are currently trying to rubbish telehealth, without realising the benefits.

IT people get mad ideas from time to time, and need a restraining hand, and there are security problems with EPRs, but it is up to clinicians to engage with IT people to sort them out in pursuit of the greater good. Dr Nagpaul must somehow persuade GPs to engage positively with technology. He must get a new generation of young IT leads to help him. Everybody under the age of 35 is a digital native nowadays. And older GPs should get some training.

Dr Nagpaul, in a letter to GPs last week, wrote: "Now, more than ever, we must make the case for general practice to show how remarkably effective, and cost-effective, it is. I will aim to forge a renewed relationship with government, demonstrating how investing in general practice is key to managing escalating pressures in an NHS increasingly beleaguered by austerity measures." Indeed, but I hope he realises his task is bigger than that. It is to drag his members, kicking and screaming into the 21st century.

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