What next ?

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What next ?

• Emily Steedman, Kate Miller,
• Edwin Obazee Gavin Kurkal

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Overview

• Key determinants of Change
• Group Work
• Presentation

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Predictions of Lord Kelvin, president of the
Royal Society, 1890-95

• "Radio has no future
• "Heavier than air flying machines are impossible
• "X rays will prove to be a hoax

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Looking to the future common mistakes

• Making predictions rather than attaching
  probabilities to possibilities
• Thinking of only one future

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Why bother with the future?

• The point is not to predict the future but to
  prepare for it and to shape it

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What I want to talk about

• Drivers of change
• Futures not the future
• Possible futures for general practice
• Visions of Primary Care 2015
• Conclusion

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Drivers of change
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Some of the drivers of change

• Ageing of society
• Environment
• Internet Death of distance
• Cost Effectiveness
• Science and technology --particularly molecular
  biology and IT
• Growing gap between rich and poor (Particularly
  Internationally)

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Futures not the future
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Three possible futures

• Titanium
• Information technology develops fast
• Huge choice of technologies and information
• Iron
• overwhelmed by information
• Experts are important
• Wood
• People react against technology (no mobile
  phones!)
• Legislation restricts technological innovation

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Possible futures for general practice
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The GP in the titanium world

• Patients shop around, collapse of the list
• GPs compete with specialists
• Patients know more than you do
• Technology runs your life
• Most consultations are e-consultations

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The GP in the iron world

• A trusted figure
• Central to the community
• Evidence based information
• Tight management of GPs
• Rationing of healthcare is accepted

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The GP in the wood world

• A local sage with a long beard
• Central to the community
• The GP almost alone has access to the internet
  and the information it contains
• EBM is bunk

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Visions of Primary Care 2015
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Patients value

• A systematic review on patients' priorities for
  general practice care
• examined 19 studies published between 1966 and
  1995,
• "humaneness," which ranked highest in 86
• "competence/accuracy" (64),
• "patients' involvement in decisions" (63),
• "time for care" (60).

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Visions of Primary Care 2015

• Patient needs values
• Interpersonal Care
• Relationship based care and continuity
• Reducing Health inequalities
• Healh promotion agenda

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Visions of Primary Care 2015

• First contact care MDTs
• Improved skill mix intelligent booking systems
• Integration coordination of care
• Services closer to home
• More OOH care
• GPs may be responsible for some patients in
  hospital

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Simple steps for a 21st century health care
system Institute of Medicine
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Simple steps for a 21st century health care
system Institute of Medicine
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Conclusion
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What will survive as the world changes
completely

• Clear ethical values
• Putting patients first
• Listening
• Accepting limitatons
• Basing what we do on evidence
• Leadership and teamwork
• Learning

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Conclusion

• Now doctors are natural scientists who apply
  their knowledge to solve patients problems
• Future doctor are change managers who help
  patients overcome or adapt to illness, come to
  terms with death, or change the lifestyles to
  stay healthy

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References

• Lakhani M, Baker M (2006) Visions of primary
  care in 2015. BMJ 33241-43
• http//resources.bmj.com
• Koeck Christian (1998) Editorials Improving
  quality for patients means changing the
  organisation. BMJ3171267-1268
• Wensing M, Jung HP, Mainz J, Olesen F, Grol R.
  (1998) A systematic review of the literature on
  patient priorities for general practice care. 1.
  Description of the research domain. Soc Sci
  Med47 1573-88.

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• Thank you