Dr Martin McShane, NHS England’s director for improving the quality of life for people with long term conditions, has called for radical change to the way we care for our ageing population.
He said: “Over the last two decades I have experienced the impact and consequences of the changes in ageing and the eruption of complex care, as a clinician and commissioner. The context has changed but has our model of care? I would say it has – in a direction which has compounded, rather than addressed, the problem. In particular, I would say it has for the medical profession.
“The generalist in the community and the specialist in the hospital have moved further apart. General practice has maintained its base, its key role in dealing with the chaos at the frontier land of healthcare. Meanwhile specialists have become more specialised.”
These changes, he says, have resulted in uncertainty for patients with complex needs and has called to this ‘care gap’ to be addressed. “Evercare, community matrons, virtual wards have all been models aimed at bringing care to people with complex needs who are at risk of poor quality of life and emergency admissions to hospital. The problem is that the medical input for this group has not been clearly defined, supported or delivered,” he argues. “It has been assumed that other professions, nursing, allied health professions and the third sector, can help keep this group afloat. Yet this is exactly the group that needs their comorbidities managed in a way NICE has yet to articulate.
“They need anticipatory care from a multidisciplinary team which includes a medic with skills that straddle the care gap. These are people who require time, frequent review, active care plans and medical input, yet it is assumed this can be delivered from a general practice which has seen a massive increase in workload and a relative decrease in investment.
“We need to be radical and recognise that new models of care are needed that bring care into the system that is truly dedicated to meeting the challenge of complex care in the community and that the medical profession embrace.”
He believes that one such model might be to establish Complex Care Practices – registered lists with a multidisciplinary team where the doctor has less than 500 people, but only people with the most complex care needs. It could have a capitated budget drawing on the ineffective way resources are currently used for this group in the community and acute sector as well as the parsimonious amount invested in general practice.
