Medical model of care needs updating, say experts

The NHS should shift its focus away from the medical model of care and place more emphasis on tackling social determinants of health, a panel of experts has said.

An overemphasis on medical care would not defeat “the five giants” of want, disease, ignorance, squalor, and idleness that the NHS and the welfare state were founded to tackle, said speakers at the 2018 Nuffield Trust Health Policy Summit on 1 March.

The panel—consisting of Jonathon Tomlinson, a GP in inner city London, Nick Timmins, senior associate at the Nuffield Trust, and Clare Tickell, chief executive of Hanover Housing Association—urged the NHS to engage more with other agencies to tackle problems such as childhood poverty and poor living conditions.

Tomlinson, who practises in Hackney, east London, said that doctors working in deprived areas saw lots of chronic pain, depression, and anxiety among their patients. In his experience, these were largely driven by social not medical factors.

Tomlinson said that enactment of Michael Marmot’s principles for tackling health inequalities, including heavy investment in early years and tackling childhood poverty, would make the biggest difference to improving people’s health and wellbeing.

He added, “We need to confront this diagnostic problem of seeing every symptom as a medical problem and embed health trainers, community health workers, and others in primary care so that we’re not making misdiagnoses on a massive scale. And we need to keep lines of communication open between people doing different things, as we’ve all got interesting perspectives of the same set of problems.”

Speaking from the floor, Martin Marshall, vice chair of the Royal College of General Practitioners, backed Tomlinson’s comments. “Professional leaders [from the Academy of Medical Royal Colleges] are getting together to challenge the deficiencies that are inherent in the medical model, around overdiagnosis, overtreatment, wasteful use of resources,” he said. “The medical model is so dominant, so seductive in the health service, that unless we challenge it in a very concerted and focused way, we’re not going to be able to develop an alternative.”

Tickell urged NHS leaders to involve housing associations more in decision making. She said that colleagues in the housing sector had “found it almost impossible to talk to people in health” when trying to influence policies such as the design of healthy new towns.

Timmins, who presented a brief history of the welfare state with reference to his book, The Five Giants, said that NHS founder Nye Bevan was minister for both health and housing when he introduced the welfare state. “Bevan was rock solid about the importance of housing,” said Timmins. “That clearly got lost down the years.”