New data from the Royal College of Physicians (RCP) reveals growing concern among physicians that NHS services are not keeping pace with the rising number of patients living with multiple long-term conditions, with two-thirds reporting they have seen poorer care or patient harm linked to fragmentation between specialties and services.
A new snapshot survey of RCP members suggests that caring for patients with multiple long-term conditions is now a routine part of practice across the medical specialties, challenging assumptions that this is primarily an issue affecting only the oldest and frailest patients.
Key findings:
- Over half (55%) of physicians surveyed said the number of patients with multiple long-term conditions in their clinical practice had increased significantly, with 90% saying it had increased at least somewhat.
- Nearly half of respondents (47%) said almost half of their current caseload involves patients with two or more long-term conditions, and a further 36% said it was most of their patients.
- Multiple long-term conditions are not only affecting older patients living with severe frailty. Around four in five physicians (78%) reported that they very often or often see patients with multiple long-term conditions who would not typically be considered severely frail and who are younger than 80.
- Two-thirds (67%) of respondents had seen patient harms or poorer care linked to fragmentation between specialties or services for patients with multiple conditions, while 20% did not know and 13% said they had not.
The findings point to a growing patient safety risk when responsibility for a patient's care becomes spread across multiple teams and specialties without clear clinical oversight.
Physicians described a range of concerns, including breakdowns in communication between teams, medication errors, duplicated investigations, delays in treatment, patients falling through gaps between services, and the mismanagement of risk factors when no single clinician has oversight of the whole patient.
As increasing numbers of patients require input from multiple specialties, physicians warned that fragmented care can make it harder to coordinate treatment plans, balance competing clinical priorities and ensure accountability for key decisions.
The findings come at a time when the management of people with multiple long-term conditions has come under increasing scrutiny, including of the risks associated with taking multiple prescribed medicines to manage different conditions. Medication safety was a major concern to the survey respondents. They described issues such as medication changes not being communicated between teams, drug interaction and prescribing errors, and treatment for one condition worsening another.
Responding to the survey, one physician said:
‘I often notice polypharmacy with multiple potential drug-drug interactions from fragmented non-holistic management of patients.’
The RCP says the findings highlight the increasingly important role physicians play in coordinating care for patients with multiple long-term conditions. As patients' needs become more complex, doctors trained to treat the whole patient, rather than a single condition or organ system, are often best placed to bring together care across specialties and maintain overall responsibility for clinical decision-making.
Responding to the RCP survey, one doctor said:
‘Often there is a need for someone to take overall care of a patient with multiple issues, but specialty teams only want to be responsible for their own areas, and there is a lack of holistic long term decision making.’
Another added:
‘The lack of a single "co-ordinating" specialist or GP for a patient care causes a lack of "ownership" of the patient journey, the lack of sensible next step co-ordination (frequent duplication of tests, visits and advice, multiple appointments, cancelled procedures etc as necessary other updates are not timely etc), and increased anxiety for the patient (being provided multiple assessments for individual conditions; linked or multi-organ disorders not addressed appropriately etc).’
Physicians say this can directly affect patient care. One doctor noted:
‘Fragmented specialist involvement leading to delays in decision making, delayed interventions, or treatment plans that improve one condition while inadvertently worsening another.’
RCP clinical vice president Dr Hilary Williams said:
‘More people are living with multiple long-term conditions, but too often system pressures mean that responsibility for their care becomes fragmented across different teams and services. Our survey shows doctors are increasingly concerned about the impact this can have on patient care, with risks including delays, duplication, poor communication and important issues being missed.
‘Treating patients with multiple long-term conditions is now a routine part of physicians' work. These patients need coordinated, holistic care, but managing multiple interacting conditions is fundamentally different from treating a single condition in isolation. It requires senior clinical judgement, time to consider the whole patient, and clear lines of responsibility across specialties and services.
‘We are excited about new ways of delivering care with physicians working with primary care colleagues are developing in neighbourhoods, but sustained investment across traditional boundaries is key as the NHS develops neighbourhood health services and prepares a new workforce plan, recognising the growing complexity of cases in aligning workforce capability with patient need. Services, training and workforce planning must reflect the need for coordinated care that treats the whole patient. Physicians are committed to providing joined-up, patient-centred care, but that will only succeed if the systems, workforce and generalist skills needed to coordinate care are properly recognised and supported.’