Better care for elderly will replace some “box ticking” under new GP contractBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6909 (Published 18 November 2013) Cite this as: BMJ 2013;347:f6909
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“The 100,000 most frail patients in England will be identified and given a named GP to co-ordinate their care (1).” NHS England and the British Medical Association agreed on this project to relieve the pressure on hospitals due to elderly patients who are frequently in and out the hospital.
The question is: who has been responsible for this co-ordinating care so far?
If these two institutions support this project, it means they conclude that nobody did this efficiently.
But it should be the GPs’ role.
The co-ordinating care is in the definition of General Practice. It was reaffirmed by the WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioner) in 2011: one of the characteristics of the discipline is to make “efficient use of health care resources through co-ordinating care, working with other professionals in the primary care setting, and by managing the interface with other specialties taking an advocacy role for the patient when needed”(2).
A good co-ordinating care is becoming more and more important because
- patients are consulting more and more specialists and benefit of more further tests. And to offer the patient a holistic approach, co-ordinating care has never been so necessary to synthetize all this information. Co-ordinating care is already Care.
- Bad co-ordinating care might be damaging for patients. Every doctor has already met a frail elderly patient in emergency room contracting bedsores. This is particularly unethical when we know that great number of emergency admissions of elderly patients could be avoided if they received earlier and better care.
This socio-economical measure targets the frailest 2% of patients. But, in practice, what does this 2% represent? This is just a statistical decision based on socio-economical assessment of costs.
This spotting of frail patients might be done better by doctors with a human approach instead of a statistical approach. This measure might be the occasion for Doctors to look at frail patients in a new light.
Identifying frail patients requires looking after psycho-social indicators of frailty which are sometimes more important than medical indicators. It can also be an intimate approach: doctors should pay attention to religious beliefs, hopes, fears, self-esteem, cultural hostility, domestic violence, loneliness,... or even then the struggle for their recognition(3).
It is why the social sciences need help from human sciences to have a meaning. This holistic approach shows the limits of Evidence Based Medicine.
Social accountability of medical schools movement is inviting us to be “not only taking specific actions through its education, research and service activities to meet the priority health needs of society, but also working collaboratively with governments, health service organizations, and the public to positively impact people’s health and being able to demonstrate this by providing evidence that its work is relevant, of high quality, equitable, cost-effective”(4).
It is there foe important to assess the efficiency of this initiative in these terms.
1. GPs “to go extra mile” for frailest. BBC [Internet]. 2013 Nov 15 [cited 2013 Nov 15]; Available from: http://www.bbc.co.uk/news/health-24945134
2. Allen J, Gay B, Crebolder H (2011) The European Definition of General Practice/Family Medicine. Short version. WONCA Europe 2011.
3. Honneth A. The Struggle for Recognition: The Moral Grammar of Social Conflicts. MIT Press; 1996.
4. Boelen C, Heck J. Defi ning and Measuring the Social Accountability of Medical Schools. Geneva: World Health Organization; 1995. Available from: http://www.moph.go.th/ops/hrdj/Hrdj_no1/charles.html.
Competing interests: No competing interests