Abstract
The month of October was steadily approaching and I still had much to take from the last RCGP annual conference in Liverpool. I could only attend for one day, and even though I wished to stay for it all, one day was more than enough to witness the energy and optimism of those present and take it back home. I am very grateful to the RCGP for enabling me to attend the 9th RCGP annual conference this year in Glasgow: ‘Expanding horizons of care’ through a Great Expectations Bursary.
In her passionate chairs address, Professor Maureen Baker thanked the profession for their continued hard work and dedication. She stated that the current single disease pathway of the NHS model of patient care needs to change in order to meet the rising challenges of multi-morbidity, which could cost the NHS £1.2 billion by 2025. The potential of general practice is currently being stifled with the on-going poor levels of investment, and for general practice to efficiently prosper it requires at least 11% of the annual NHS budget. General practice is the cornerstone of the NHS, and those in government should appreciate that robust general practice will result in robust nationwide healthcare. The real deal (in response to the Secretary of State for Health’s new deal proposal) points were reiterated, with the need for more freedom and time for innovation striking a note. Amid all the well-documented challenges, continued innovation in general practice is crucial to the further growth of the profession, and this must be allowed to flourish. Professor Baker concluded with a recently heard phrase: ‘for the NHS to improve incrementally we compete … but to improve exponentially we must collaborate’. She certainly had the support of the audience.
Professor Frede Olesen enlightened us all with a thought-provoking and profound talk on the therapeutic nature of the patient–doctor meeting. He encouraged us to reflect on the proven value of the meeting between the patient and doctor and mourned the loss of teaching on contextual thinking in medical schools. With personalised patient lists disappearing and workload pressures rising, I find it difficult to really nurture the relationship with each patient that I see. However, now appreciating the nocebo effect, I hope to further develop this important quality; recognised by Hippocrates all those years ago:
‘It is far more important to know what person the disease has than the disease the person has’.
Multi-morbidity is ever prevalent and will only surge and continue to challenge GPs daily. Professor Neal Maskrey highlighted the limitations of current approaches to polypharmacy, and stressed that we are using ‘mindlines’ rather than guidelines founded on tacit past experience and pattern recognition when managing such patients in practice today. It was interesting to hear David Haslam, chair of the National Institute of Clinical Excellence and also a retired GP, reveal that guidelines for multi-morbidity are currently in development. Without doubt these will be useful, however, these must be used in combination with the up-skilling of GPs with expert generalist skills to provide personalised illness care that goes beyond protocol.
Mental health was a reoccurring theme throughout the conference. Dr Joanne Reeve introduced the ‘flipped care’ model (which is grounded in local research) when thinking differently about mental health consultations. This results in a change from the traditional ‘bio–psycho–social’ model to a ‘social–psycho–bio’ approach. This focuses on one’s activities of daily living and balancing personal resources with one’s current demands. The modifiable factors present opportunities for change and therefore a reweighting of the seesaw when tackling common mental health illness in primary care. This break away from the ingrained bio–psycho–social model is certainly worth wider testing given the overwhelming occurrence of anxiety, stress and low mood in general practice.
Iona Heath, former RCGP president, encouraged us to hold onto the joys and memories of good general practice. This pearl of wisdom can only help in preventing burnout and demoralisation in the profession. Positive recollections have an effect on the heart, mind and body of an individual, and can assist in reinvigorating energies and greater satisfaction in the workplace. She persuasively argued that too much medicine is making us sick and advocated ‘slow medicine’ for the betterment of global healthcare. Professor Martin Roland presented his national review on developing the primary care workforce of tomorrow. He remarked that we can have world-class primary care in the future if it is well supported and funded – further strengthening the case for increased and sustained investment in the future.
In the closing session, Samuel Shem spoke of the healing power of connection; the connection to a patient as to a loved one. He urged a change in language from ‘communication to connection’, from the ‘I’ and ‘you’ to ‘we’. I feel that it is this connection – to patients, families and communities (expanding horizons of care) – that will bring success in future general practice and primary care. I return from Glasgow feeling refreshed, but conscious that the hard work starts now to fulfil the rights of our patients, families and the communities that we work in.