Intended for healthcare professionals


Looking beyond “the house of care” for long term conditions

BMJ 2013; 347 doi: (Published 19 November 2013) Cite this as: BMJ 2013;347:f6902
  1. Graham Watt, professor of general practice
  1. 1University of Glasgow, Glasgow G12 9LX, UK
  1. graham.watt{at}

Some patients are at risk of being left outside

Spike Milligan once described the invention of a machine that did the work of two men. Unfortunately, it took three men to work it.1 As populations age, multimorbidity accrues, budgets tighten, and inequalities in health widen; patients, practitioners, and health systems cannot afford multiple services that provide fragmented care. We shall need machines that do the work of two people but need only one person to work them.

With its intrinsic features of contact, coverage, continuity, flexibility, cumulative knowledge, and trust, general practice has the potential to deal with this challenge. It is the natural hub of local health systems, providing unconditional personalised continuity of care for all patients, whatever combinations of problems they have. But practices cannot do this on their own; they need a host of effective partnerships—with patients, other services, NHS managers, and community resources.2

In England, the “house of care” has been adopted as a central metaphor in plans for improving care for people with long term conditions.3 The house of …

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