In the 1950s morale in general practice was at a low ebb. It was seen as the career choice for those ‘who had fallen off the ladder’ of speciality training.
A group of dedicated and talented GPs had a vision of general practice as a speciality in its own right. During the 1950s and into the 1960s they set about creating the academic speciality of general practice, vocational training for general practice and helped to create a new general practice.
In 1972, the RCGP published the ‘The Future General Practitioner’. That was nearly 50 years ago, it is time for a new vision and new persona for general practice, a transformation, no less that the regenerations of Dr Who.
Crisis in general practice
Again, general practice is facing a number of conflating crises: problems with recruitment, problems with retention, work overload due to increasing demand and burgeoning administrative chores. This all leads to low morale with doctors leaving general practice early.
It is not just a matter of funding, there is a deep-seated problem underlying the problems of general practice and this deep current of discontent is being generated by the sense of an existential threat to future of general practice.
Since 2008, the introduction of the iPhone, life has changed. Computing, knowledge and the access to immediate information and services has arrived for the consumer.
This is the digital revolution, where knowledge is shifted to the population and with it, power. The locus of power is changing in society in general and the health system in particular. With the changes in society, massive changes are and will continue to progress in health service delivery.
eHealth, virtual consultations, technology-supported health coaching, artificial intelligence amongst others will impact and disrupt professions. General practice will not be immune to change.
In 1972, Spitzer and Kergin published their ‘Randomised trial of nurse practitioners in Southern Ontario’. This demonstrated that well-trained nurse practitioners could perform 80% of the tasks performed by general practitioners.
The emerging primary care health professionals are the nurse practitioners, pharmacists, physician’s assistants and health coaches.
We are now also seeing the emergence of new virtual models of care and patients being given more choice in the way they access their first line services. Digital-first general practice is becoming a reality.
This is only the beginning.
General practice is in the middle of an existential crossroads. It will need a clearly articulated vision to have confidence in its future and for future graduates to have the confidence to choose general practice as a speciality.
General practice and, indeed, the whole of the NHS will be disrupted within the next decade. There are two paths - the first is ‘managed disruption’, which will allow practices to be the early adopters of new technologies and to incorporate them into their daily routines.
The second path is disruption from the outside. In this scenario, patients are increasingly given choices and models of care that are not in general practice.
This disruption, damages and undermines the continuity of care and the doctor-patient relationship. It also has the capacity to undermine the fabric the NHS.
The NHS and general practice are going to change in the most fundamental way over the next decade and it is difficult to predict whether either will survive.
Just putting £20bn into the system will not regenerate and create the new. It will be blood transfusion to an ailing and weak system that may not survive.
General practice needs a new vision as a dynamic specialty that is agile, responsive and remains at the leading edge of change for the next twenty years and beyond.
- Dr Simon is a retired GP living in West Sussex and a former honorary secretary of the Royal New Zealand College of GPs