“If you dwell on the past or future, you will miss the moment.”

Written by: Dr. Usman H Rehman, GP Principal - Lanarkshire Medical Group - Strathaven / East Kilbride

Published: 02/10/2018

The last ten years have brought a significant change in the climate in General Practice and underlined a strong case for working differently

A lot of “big things” happened in 2008! Barack Obama was elected President of the United States, becoming the first African-American commander-in-chief. John Sergeant famously quit Strictly Come Dancing, to the dismay of the viewers. Fears were high that the world was going to end, with the start of the “Big Bang” experiment. Luckily, the world did not end, and I managed to qualify as a General Practitioner that year, the very year that the Scottish Government and the ALLIANCE published Gaun Yersel (The Self Management Strategy for Scotland). Gaun Yersel set out to make us think about our approach to people living with long term conditions and the transformative strategies required to shape service delivery to promote self management.

The last 10 years have witnessed a significant change in the climate in General Practice and underlined a strong case for change and working differently. The Primary Care Workforce Survey Scotland 2017 highlighted a reduction in whole time equivalent GPs since 2013 and that 24% of practices surveyed had a GP vacancy compared to 9% in 2013. Alarmingly, 25% of GPs surveyed by the British Medical Association (BMA 2015) described their workload as unmanageable.

Coupled with this, we have an ageing population with more complex health needs. There is a projected 79% increase in the over 75s in the next 25 years (National Records of Scotland 2017). As we get older, we accumulate long term conditions and statistics show that approximately 40% of the Scottish population have a long-term condition (this link will take you away from our website). Despite the reduction in workforce, we are seeing an increase in patient contacts and the majority of these appointments, around 80%, are with people with long term conditions. Working in the same old way is no longer viable as it will not meet future need and demand.

A long-term condition, by definition, lasts for more than 1 year and is incurable. Therefore, as health care professionals, we need to move away from the traditional “fix-it” role and adopt supported self management strategies in our daily practice. However, to achieve this we need people to be engaged, and open to taking a pivotal role in the management of their care. With the disbanding of the Quality Outcomes Framework (QOF), as GPs, we now have the opportunity to look at other ways to carry out our long-term condition reviews.

Scotland’s House of Care is an integrated care planning process that supports people with long term conditions to get more involved in managing their health and identifying their support needs. As a House of Care GP trainer, I agree, that GPs have a vital role in enabling and empowering people to manage their health but, as GPs, we cannot do it alone. As demonstrated by the House of Care model, we need health and social care professionals to collaborate and work in partnership, we need the right infrastructure and resources in place, and we need to know what “More than Medicine” services are available in the local community to help people with long term conditions.

There will still be people who prefer the doctor to take control, but we need to continue to promote a partnership approach and implement effective care and support planning strategies in order that patients are more informed about their condition and more aware of what other resources are accessible to them. The availability of these services is crucial as without them, the care and support planning process is futile. Hopefully, by bringing patients and health and social care professionals together as equals and experts in shared goal setting and action planning, we will be able to see improved clinical outcomes and quality of life.

Like the game Buckaroo, as health care providers, we are all working very hard and carrying a lot of weight on our backs. We cannot carry anymore, and Scottish government strategy and policy needs to be focused in adequate investment and resource provision to make service delivery safe and sustainable. In conclusion, it is good to look back and learn, it is important to look to the future, but in the words of the poet Rumi, “if you dwell on the past or future, you will miss the moment.”

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