The Wrong Sort of Health Change

It’s been a particularly torrid few months in the world of the NHS.

As Government tries to modernise the NHS, and particularly square the increasing and changing demands on the health service with the reality of available funding, we find ourselves with our junior doctors on strike.  Meanwhile, the resistance by NHS GPs to proposed seven day contracts appears to be growing with the majority not willing to sign up to the new regime.

A Government-envisaged consumer friendly, seven-day access service offering extended routine appointment times 12 hours a day, seven days a week is being pitched against doctors’ claims that with already severely stretched resources and a workforce cracking under the pressure to safely deliver care for patients during a five-day week is already proving impossible.

Something is lacking

It strikes me, though, that something is lacking in the discussion.  The focus has been on what is provided not how it is provided. The wrong sort of change.

I can’t help thinking that one of the major issues is that the model of healthcare delivery is exactly the same now as when the NHS was established back in 1947, yet the needs of the population it serves has changed beyond recognition as has the NHS’s technical capability to deal with our ills.

What has not changed is the service model.  The NHS still requires us to go to a physical location to interact with all forms of medical professionals – form GPs to specialists to physiotherapists and pharmacists.  Thus the resulting arguments as to whether an increase of opening hours will equal an increase in funding for surgeries in the long term or even if that increase would be proportional to the extra opening hours and so on.

Missing the point

I think this and other arguments being bandied about miss the point and reveal the 1947 mindset that frames the positions of both sets of antagonists in the current confrontation.  In every other walk of life consumers expect seven days-a-week service, but the models by which that service is delivered are not those of post-war organisations. New ways of delivering healthcare provision need to be found and it’s not the paradigm of the traditional doctor’s surgery and doctors and patients traipsing to it for consultations.

Primary healthcare in future has to deliver flexibility for both doctor and patient. Like all other areas of the economy where efficiency in service has increased massively, that means using technology and the sort of applications and interfaces that are used every day by patients and practitioner alike. These must underpin a service delivery model that is fit for the demands of the 21st century and not be technologies that simply lock in existing practices which are at the root of the challenges we face currently.

A new partnership  

Thus seven day-a-week appointments may be possible but using mobile platforms that allow doctors to decide when, where and how they want to work and patients to decide when, where and how they want consultation.  In effect, a new partnership in healthcare requiring increased patient responsibility and practitioner flexibility in exchange for better service provision and more rewarding work.

Until the NHS administration and healthcare mindset changes and new models of service provision are adopted then I fear the divisions between the two currently warring blocs will get deeper and more entrenched.  And for the good of us all that cannot be allowed to happen.