What next ?

1. What next ? Emily Steedman, Kate Miller, Edwin Obazee & Gavin Kurkal

2. Overview • Key determinants of Change • Group Work • Presentation

4. 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”

5. Looking to the future: common mistakes • Making predictions rather than attaching probabilities to possibilities • Thinking of only one future

6. Why bother with the future? • The point is not to predict the future but to prepare for it and to shape it

7. What I want to talk about • Drivers of change • Futures not the future • Possible futures for general practice • Visions of Primary Care 2015 • Conclusion

8. Drivers of change

9. 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)

10. Futures not the future

11. 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 http://resources.bmj.com

12. Possible futures for general practice

13. 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

14. 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

15. 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

16. Visions of Primary Care 2015

17. 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%). Wensing M, Jung HP, Mainz J, Olesen F, Grol R. (1998)

18. Visions of Primary Care 2015 • Patient needs & values • Interpersonal Care • Relationship based care and continuity • Reducing Health inequalities • Healh promotion agenda Lakhani M, Baker M (2006)

19. 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

20. Simple steps for a 21st century health care system: Institute of Medicine

21. Simple steps for a 21st century health care system: Institute of Medicine

22. Conclusion

23. 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

25. 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 Change the whole model: Christian Koeck

26. References • 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.

27. Thank you