It’s Time to Talk about the Future of Care

We all have a part to play in changing our healthcare system to meet the challenges coming in the future, writes Ian Welsh. First published in the Scotsman


As we now develop the operational arrangements for health and social care integration, the most significant piece of public service reform since Scottish devolution, it is crucial to remind ourselves that the GP and the extended primary and community care sector need to be at the heart of transformational change.

And that change is already happening fast in general practice, driven in part by the shortage of doctors coming to the service. Many more young doctors are choosing not to become general practitioners and are instead, working abroad or in specialist areas. With no replacement for retiring GPs, an increasing number of practices are being reorganised amidst a developing recruitment crisis in the sector.

All this is a stark reminder that there is an urgent need for our models of health and social care to change.

One of these changes will be about how our primary care services operate and how we as patients can play a part in influencing that change.

The GP recruitment crisis, therefore, is an opportunity to raise awareness of the skill and experience of other professionals in our communities, such as pharmacists, nurses, links workers and third sector organisations. In that context, “I’m seeing the doctor” is the sort of phrase which may be heard less often in the future not only because there will be simply less of them but also because there are other people who can help.

The Royal College of General Practitioners Scotland’s challenging and thought-provoking publication A Blueprint for Scottish General Practice (June 2015) has described the problem and suggested ways to reverse the impact of GP workload and recruitment.

The Health and Social Care Alliance Scotland, as an intermediary organisation, recognises these problems through our regular contact with people using the service and our 1,200 members; organisations, individuals and professional associates. In recognition of the requirement for transformational change in our health and social care systems, The Alliance supports emerging new models of care, many of which are championing the vital contribution that citizens and the third sector make to maintaining and improving health and wellbeing.

Future models will focus more attention on individuals having the expertise and confidence to protect their health and the health of their community.

There will be much more access to information and data about our health – some of it coming from digital technologies such as apps and the emerging personal “wearables” such as watches, which will help to foster a sense of individual control and help to demystify healthcare. This emerging personalisation has potential to improve health literacy, how we find, understand and use health information, and promote a culture of wellbeing.

All this will need local and national systems to develop a more connected approach, where every local asset is known and used to the full. These assets include other people, informal and formal groups, third sector organisations, public services, schools, faith groups, housing, social enterprises, local authorities and many others.

Through time, this community networked approach will begin to address the frustrations of compartmentalised working practices and encourage self-management, joint learning, systems for signposting and local information sharing.

Importantly, feedback from The Alliance member organisations and reference groups echo the RCGP’s call for improved continuity of care and a more holistic, personalised approach.

This has particular relevance for the rising numbers of people living with multiple conditions who are passing through a system which remains designed for single conditions and short episodes of care. Many conditions, one life: An action plan to improve care and support for people living with multiple conditions in Scotland described actions which support the RCGP’s blueprint for general practice. These include making sure that appointments are long enough for the person to talk about what really matters to them, introducing local volunteers and new roles, such as links workers in GP practices, encouraging access to sources of community support, improving access to technology and information and supporting joint learning. This way of working should help attract young doctors to working in general practice.

Whatever the challenges, it’s good to talk and The Alliance is a partner in the Scottish Government’s current National Conversation about the nation’s health and how services should be delivered in the future; a timely opportunity for us all to contribute ideas for promoting co-ownership of our precious health and social care services.

The National Conversation gives all of us in Scotland a chance to have a say in how we want our health services to run in the future – this is your invitation to take part.

This article was first published in the Scotsman. Ian Welsh OBE is chief executive of the Health and Social Care Alliance Scotland

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