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Friday 30 September 2016
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Do keep up: focusing on our real needs is a tough balancing act

AMSPAR

TOM BROWNLIE

Chief Executive, AMSPAR

Do you ever get the feeling you have to run just to stand still; that you just can't keep pace with the changes? In this 24-hour news culture, it's difficult to keep up. However, you might expect to be kept informed of changes that may affect not only you but also issues you need to deal with.

For instance, recently I've had a problem with print deadlines. In the last edition of this magazine, I made reference to the manoeuvring in Whitehall that was taking place the morning after the election. By the time your copy came through the letterbox a couple of weeks later it may already have seemed out-of-date.

I had a similar problem with the AMSPAR Professional magazine. The summer edition was almost ready to go to press and carried a feature on the coalition government's health programme, when Andrew Lansley stood up in the House of Commons and presented Equity and Excellence: liberating the NHS. The divergence meant a complete rewrite was necessary.

I'm a bit off the pace too when it comes to technology. For years I fought against having a mobile phone. I always insisted it wasn't necessary. I always said that I could be contacted if needed.

On one occasion when going to a football match, the group decided to meet at a certain watering hole at a particular time. I duly arrived as arranged, only to find no one else there. Racking my memory, I was certain that I had the right pub and the right time. But after a while, when they still hadn't arrived, I decided senility had set in and that I'd better check some other bars.

As I set off down the street I heard my name called and turned to see some of the missing bodies. Although I had done everything as arranged, apparently I was at fault – for not having a mobile phone. There had been a change of plan for some reason. No one could tell me because I couldn't be contacted. I did point out that I could be contacted at the appointed bar at the appointed time, but this didn't seem to go down well …

In with the new
Some years later, I almost feel that my arm has been amputated if my phone is further than stretching distance from me! I say "phone", but this gadget does so much more. It's a wonderful thing that takes pictures, sends emails, accesses the internet, has "Sat Nav", as well as many other things I can't even get my head around.

This summer, I found myself stranded on a rural train station platform, helplessly watching my missed train chug off into the distance. In previous times, I would have been inconsolable, but the benefits of technology were swiftly apparent. I took out my phone, pressed a few keys and there it was – the live broadcast of the Switzerland vs Spain World Cup game in the palm of my hand. Brilliant!

Of course, my gadget has now been superseded. I happened to be in Hong Kong when the iPad was first launched (some months prior to its introduction in Europe). I saw a salesman standing in the doorway of the electronics shop, proudly displaying his tablet to the passers-by. My first thought, however, was not, "I must get one of those!" but quite the reverse.

My next iPad experience gave foundation to my reservations. Just imagine a crammed London underground train at the peak of the morning rush hour, and a standing commuter trying to use one held inches from his face while surrounded by jostling commuters.

I'm sure the iPad does have a use and one day I may even recognise it. But at this point I'm still trying to make the most effective use of the technology I have. It is worth asking if we all could look at making more use of what we already have.
Earlier this year, the British Medical Association (BMA) issued a consultation document entitled Striking a Balance. The purpose was to seek views on how, in the current economic climate and increasing demand for services, the BMA can work with policymakers "to protect, develop and strengthen general practice in line with patient, public and GP priorities."

The document asked a number of pertinent questions focusing on four key areas (the evolving practice team, getting a suitable appointment, care and treatment outside normal working hours, continuity and coordination of care in the modern NHS). Considering access, there was the question of whether telephone and email communication/consultations have a legitimate role in modern general practice.

Do we even have to ask this question? Of course we should be exploiting every possible tool to increase efficiency. We can go even further than Alexander Graham Bell's invention. Why shouldn't I be able to sit in Scotland and have a "face to face" consultation with my doctor in London? This could be done quite easily via my laptop with its camera or even with my smart phone while standing at 
the bus stop.

This would save me taking time off work and drumming my fingers in a dismal waiting room while my GP is over-running due to a few people turning up late because their bus didn't come. Of course, a physical examination may be required, but the hours saved in unnecessary visits would allow more time for these.

A purposeful question
Although Striking a Balance was published some months ahead of the white paper, its relevance is not diminished. In fact, AMSPAR's submission urged the BMA to use the questions in the white paper debate to ensure that the outcome does focus on the real needs of the community.

The opening paragraph of Striking a Balance sums up our quandary:
 
"One of the biggest challenges facing the government and practices is meeting the needs and expectations of patients within a limited budget using the GPs and health professionals available."

The term "practices" can be replaced by "the NHS". To try to solve this, we need to go back to basics and, just like the iPad, ask: "Just what is the NHS for?" It is essential that we focus on this in the coming months to ensure that we have the kind of NHS that meets our genuine needs.