A GP’s Diagnosis: It’s time to look ahead to the challenges facing our NHS, says GP John Havard

Dr John Havard

Dr John Havard - Credit: Archant

While the New Year is a traditional time for resolutions, it is also a time for reflection and taking stock before the year ahead.

UK General Practice has the great strengths of cradle to grave records and rapidly evolving IT to try to control a scary demographic shift towards an ageing population.

10million people in the UK are over 65 and one in five live alone. These changes have highlighted the impact of social isolation which, apart from being sad, has also proven to have an impact on illness.

If the NHS is going to cope with the challenges ahead it really has to work hand in hand with social care and GPs can provide the crucial link to the primary care setting. GPs need to be able to provide quick solutions (like InstantCARE) for patients who are unable to cope with the activities of daily living by themselves, but do not require hospital admission.

They need to be able to admit patients to a range of community units. That could be nursing homes as well as cottage hospitals. NICE has recently published guidance on the relative safety of home births when compared to the hospital setting.


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I think other aspects of healthcare will start to demonstrate a similar trend.

The public need to perceive home care as the best and hospital care as only necessary for seriously ill patients.

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At present far too many patients with a wide range of minor health problems are presenting to accident and emergency departments all across the country.

This must be reserved for real medical emergencies. If we continue to use emergency departments as walk-in clinics, the spiralling costs will bring the NHS to it’s knees.

n Almost half a million people in the UK are in nursing homes but many do not require the round-the-clock care that this setting provides. Supported living is essential since institutional care tends to actually worsen both the physical and psychological state of patients.

Dementia rates are rising quickly and more and more patients are thought to be ‘unsafe’ living alone. These patients are often moved into care homes, which unfortunately worsens their prognoses.

n Modern technology can be utilised to combat these two troublesome problems – social isolation and safe independence in the home. Off the shelf set top boxes like Facelook, previously described in this column, are available to provide Skype with no need for technological aptitude.

The device rings like a phone and answers automatically after three rings and changes the TV from BBC to the caller on the HDMI channel. When the call ends then the TV reverts to BBC.

Because broadband is required it is possible to add on other features that all integrate to keep the patient safe. It is imperative that these add-ons are discrete as patients hate badges that confirm any disability.

Accelerometers within a normal looking wristwatch can be activated in a fall and door bell web cams can be answered via the TV – and a relative anywhere in the world can also see who is at the door. Normal looking domestic smoke/fire alarms can incorporate movement sensors to check the normal activities of daily living are taking place.

All this equipment can be now bought and linked together via broadband for family or commercial monitoring. Older people would still not be interested unless this was the only way in which they could remain independent – or the only way they could see their grandchildren.

n The technology is all readily available but maybe we need GPs to take on a co-ordinating role positioned above technological call centres to keep elderly people independent and safe in their own homes?

Above all we need you, the public, to help define the way your NHS is developing and to use it appropriately. Throwing scarce resources at a failing system can only delay and not avert the crash.

n Our relationship with the NHS is currently in a winter of functional discontent. Our collective New Year resolution must be to look after more patients at home whether they have acute or chronic illnesses. A little more common sense and less ‘minding your back’ would not go amiss either.

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