Transcript What next - Shropshire VTS

What next ?
Emily Steedman, Kate Miller,
Edwin Obazee & Gavin Kurkal
Overview
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Key determinants of Change
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Group Work
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Presentation
Predictions of Lord Kelvin, president of the
Royal Society, 1890-95
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"Radio has no future“
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"Heavier than air flying machines are impossible“
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"X rays will prove to be a hoax”
Looking to the future: common mistakes
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Making predictions rather than attaching
probabilities to possibilities
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Thinking of only one future
Why bother with the future?
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The point is not to predict the future but to
prepare for it and to shape it
What I want to talk about
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Drivers of change
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Futures not the future
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Possible futures for general practice
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Visions of Primary Care 2015
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Conclusion
Drivers of change
Some of the drivers of change
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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)
Futures not the future
Three possible futures:
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Titanium
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Iron
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Information technology develops fast
Huge choice of technologies and information
overwhelmed by information
Experts are important
Wood
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People react against technology (no mobile phones!)
Legislation restricts technological innovation
http://resources.bmj.com
Possible futures for general
practice
The GP in the titanium world
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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
The GP in the iron world
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A trusted figure
Central to the community
Evidence based information
Tight management of GPs
Rationing of healthcare is accepted
The GP in the wood world
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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
Visions of Primary Care 2015
Patients value
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A systematic review on patients' priorities for
general practice care
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examined 19 studies published between 1966 and 1995,
"humaneness," which ranked highest in 86%
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"competence/accuracy" (64%),
"patients' involvement in decisions" (63%),
"time for care" (60%).
Wensing M, Jung HP, Mainz J, Olesen F, Grol
R. (1998)
Visions of Primary Care 2015
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Patient needs & values
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Interpersonal Care
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Relationship based care and continuity
Reducing Health inequalities
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Healh promotion agenda
Lakhani M, Baker M (2006)
Visions of Primary Care 2015
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First contact care & MDTs
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Improved skill mix & intelligent booking systems
Integration & coordination of care
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Services closer to home
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More OOH care
GPs may be responsible for some patients in
hospital
Simple steps for a 21st century health care
system: Institute of Medicine
Current approach
New rule
Care is based primarily on visits
Care is based on continuous healing
relationships
Care is customised according to
patient needs and values
The patient is the source of control
Professional autonomy drives
variability
Professionals control care
Information is a record
Decision making is based on
training and experience
Knowledge is shared and flows
freely
Decision making is evidence based
Simple steps for a 21st century health care
system: Institute of Medicine
Current approach
New rule
Do no harm is an individual
responsibility
Secrecy is necessary
Safety is a system property
System reacts to needs
Needs are anticipated
Cost reduction is sought
Waste is continuously decreased
Preference is given to professional
roles over the system
Cooperation among clinicians is a
priority
Transparency is necessary
Conclusion
What will survive as the world
changes completely:
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Clear ethical values
Putting patients first
Listening
Accepting limitatons
Basing what we do on evidence
Leadership and teamwork
Learning
Conclusion
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Now: doctors are natural scientists who apply
their knowledge to solve patients’ problems
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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
Change the whole model: Christian Koeck
References
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Lakhani M, Baker M (2006): Visions of primary care in
2015. BMJ; 332:41-43
http://resources.bmj.com
Koeck Christian (1998): Editorials: Improving quality for
patients means changing the organisation.
BMJ;317:1267-1268
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 Med;47: 1573-88.
Thank you