Intended for healthcare professionals

Rapid response to:


Thinking about the burden of treatment

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6680

Rapid Response:

Multimorbidity affects the poorest people disproportionately, so working as a GP in Hackney the burdens of illness, polypharmacy and multiple-specialist care is clear to see.

I invite patients with multimorbidities to come and describe their experiences of care to myself and my medical students. We take up to an hour with these discussions. What comes out is how patients are continually balancing symptoms and priorities, skipping medications, ignoring symptoms and missing appointments in order to maintain some kinds of quality of life. They are infuriated by the loss of continuity of care and days spent waiting for hospital transport, public transport and late-running clinics. Repeatedly cancelled and rearranged appointments are frustrating and confusing, and when they are finally seen a doctor they have never seen cannot find the notes.

The RCP Future Hospital Commission rightly called for more expert Generalists and the RCGP is calling on apparently deaf ears for more GPs. We need this. We also need to make continuity of care a priority. In my practice of 14000 patients, 12 GPs, most of whom work between 4 and 8 sessions we have increased the % of patients who see their own GP from 50% to nearly 80% in 2 years.

I may know less than the sum parts of half a dozen specialists, but I might have known my patient with half a dozen multimorbidities for a decade, and if we are to have a safe, effective, sustainable NHS we will need more specialists in people.

Competing interests: No competing interests

14 November 2014
Jonathon P Tomlinson