Doctors can be a driving force for change, says RCP

Building on the RCP’s previous work on medical professionalism, the report, supported by The Health Foundation, provides a telescopic look into the challenges and opportunities facing healthcare in the future – demographic change, science and technology, the economy and social trends. For the first time, it gathers all these elements into a coherent narrative and shows how doctors, in partnership with patients and others, can be the catalyst for change and improvement.

Issuing a strong challenge to doctors, working party chair Baroness Julia Cumberlege, and RCP president Professor Ian Gilmore say in their introduction:

We believe that the second decade of the 21st century provides a unique opportunity for doctors to lead on the things that matter to them most: high standards of care and service to patients. Doctors will not be able, in all cases, to realise this on their own – but if doctors do not accept the challenge, they do not deserve to lead.

The working party collected written and oral evidence from a broad range of medical and lay opinion, and held a seminar attended by over 75 people with an interest in the future of doctors and healthcare. Three subgroups of the working party investigated three major areas of change - health services, economics, and health information and communication technology:

Health services

Increased access to healthcare information will change the nature of the doctor patient relationship, as the emphasis turns to interpreting and managing information within the context of the doctor/patient therapeutic relationship. Clinical decision-making will be affected by increased scrutiny, guidelines and budgetary considerations, and there will be more emphasis on continuing professional development and re-accreditation. Changes to the provision of care and the breakdown of barriers between primary and secondary care may result in a drive to rebalance specialist and generalist skills

Health information and communication technology (HICT)

Although we cannot accurately predict the evolution of health-related technology, utility will be the most important aspect of when and why a particular technology is adopted. The real difference will not come from the advances themselves, but from their potential to affect communication, workflow and relationships as the latter have the most potential to engage the patient in the process of creating reliable healthcare.

The economy

Healthcare costs are likely to increase faster than the growth in national income, forming an increasingly large part of the economy, and the growing proportion of older people will amplify these costs. Demand for doctors will not only remain strong, but they will also be expected to play a central role in ‘doing more with less’. As public finances come under intense strain, there will be policy pressure to draw on more diverse sources of finance, such as employers, local government and private individuals.

Doctors as leaders – calls to action

Based on the evidence gathered, the working party call for actions they believe necessary to equip future physicians for the changing times ahead, so that they can continue to meet the needs and expectations of patients and the public for the provision of excellent healthcare. These include:

• Embracing new information technology and ensure its potential is realised, including the research potential of nationally coordinated electronic records

• Developing a clear vision of the best way to engage with other partners in dealing with health inequalities, the prevention of disease,and the broader social determinants of health

• Engaging with areas of public policy that seek to reduce health inequalities, improve wellbeing and promote understanding of health

• Committing to leadership – in health, policy, and politics – in order to accelerate improvement in health outcomes

Engage fully with patients, their organisations, and the health service to develop valid measures (including patient reported outcome measures) that are clinically meaningful and that improve patient care.

Professor Ian Gilmore, president of the Royal College of Physicians, said:

This report traces out the stark challenges facing health and healthcare for the next generation, and it clearly identifies medical leadership as one of the key solutions. Doctors must be prepared to take a lead, not just in developing their own clinical services but in shaping the wider landscape on which our futures depend.

Geoff Bell, RCP Patient and Carer Network, said:

Although patients often have reservations about the NHS as an organisation, it is my experience that there is a high level of trust and confidence in doctors. I believe that physicians at every level have key roles to play in leading change for the benefit of patients.

Krzysztof Rakowski, fourth year medical student, Brighton and Sussex Medical School, said:

We need to look beyond medicine if health is to be improved in a changing world. Young doctors need to engage with policy and politics to accelerate improvements.

Professor Peter Smith, Professor of health policy, Imperial College London, said:

From an economic perspective, the key challenge facing the NHS is how to reconcile ever-increasing demands with constrained resources, a dilemma brought into very clear focus by the impending financial austerity. This report highlights the crucial responsibility that doctors have for ensuring that NHS money is spent wisely. How doctors respond to the challenge will have a major influence on the shape of our future health services, and the wellbeing of the country.

Martin Marshall, Director of clinical quality, Health Foundation, said:

The medical profession cannot afford to ignore ‘Future Physicians’. The pace at which society is changing sometimes only becomes clear when thoughtful people stand back from the joys and stresses of everyday life and look at the world through a new lens. It has been a privilege for The Health Foundation to support this work, which we hope will encourage lively debate about the future role of the doctor.