Generalism vital as multimorbidity rises, warns NICE chair

NICE must change how it works to reflect the importance of general practice and the shift towards multimorbidity as the population ages, the institute's new chair has said.

Professor David Haslam: generalists increasingly vital
Professor David Haslam: generalists increasingly vital

In the opening speech at the NICE annual conference in Birmingham on Tuesday, former RCGP chairman and new NICE chairman Professor David Haslam vowed to make NICE’s guidance ‘much more relevant’ to GPs.

He said: ‘The spectacular demographic changes that this country is facing… inevitably means multimorbidity is the norm, and generalism becomes ever more important. I’m passionate therefore that NICE’s work should become, and be seen as being, much more relevant to GPs, and not forgetting all the other invaluable clinical and non-clinical professionals in primary care.’

NICE’s work must also shift with these changes, he added. The institute has too often focused on single diseases and has not addressed the complex needs of patients with multiple long term conditions, he said.

Since 1 April, NICE has taken on a wider role advising not just on healthcare but also on social care and public health. At the same time, Professor Haslam took over the role of NICE chairman from Professor Sir Michael Rawlins.

In his first address as NICE chairman, Professor Haslam said much of the institute’s work had focused on single conditions. ‘But when it comes to long term conditions, single conditions are actually a rarity. Across the UK, it’s fascinating to realise there are more patients with two or more long term conditions than there are with one long term condition,’ he said.

‘In my work as a GP, I had many patients like a man I remember with coronary artery disease, hyperlipidaemia, diabetes, CKD, osteoarthritis of the hip and, hardly surprisingly, depression. I’m absolutely certain good medicine doesn’t involve adding together all the guidelines for someone like that, otherwise patients end up with massive polypharmacy, as well as multimorbidty, taking 60 tablets a day, blood test every third day.’

Similarly, medical education is based around single conditions but this ‘doesn’t match the way that real patients present’.

He said producing guidance that reflected complex mix of conditions presenting to primary care was a ‘real challenge’ but one which NICE must tackle.

Professor Haslam also welcomed the move by political parties to integrate health and social care. ‘If you were designing a health and social care system from scratch, you’d never put health and social care into separate boxes,’ he said. ‘I hope that in 10 years we’ll look back with astonishment that the NHS spend decades separating health and social care.’

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