{"id":43969,"date":"2019-01-29T16:15:22","date_gmt":"2019-01-29T15:15:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43969"},"modified":"2019-01-31T10:31:15","modified_gmt":"2019-01-31T09:31:15","slug":"richard-taunt-rethinking-medicine-a-longer-term-plan","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/29\/richard-taunt-rethinking-medicine-a-longer-term-plan\/","title":{"rendered":"Richard Taunt: Rethinking medicine\u2014a longer term plan"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Change takes time. We need to prepare for the future, not just firefight the present.<\/span> <span style=\"font-weight: 400\">The recent publication of the <\/span><a href=\"https:\/\/longtermplan.nhs.uk\"><span style=\"font-weight: 400\">NHS Long Term Plan<\/span><\/a><span style=\"font-weight: 400\"> has given commentators an opportunity to wheel out some of health policy\u2019s favourite clich\u00e9s.<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, the development of <\/span><a href=\"http:\/\/rethinkingmedicine.co.uk\/\"><span style=\"font-weight: 400\">Rethinking Medicine<\/span><\/a><span style=\"font-weight: 400\">\u2014a collaborative improving how medicine supports better health and healthcare in England\u2014has me thinking about how you define &#8220;long-term;&#8221; and how setting a &#8220;long-term&#8221; endpoint changes where you begin.<\/span><\/p>\n<p><span style=\"font-weight: 400\">So is &#8220;long-term&#8221; 5 years, 10 years, 20 years? In working it out you need to consider the scale of change needed, but also quite how embedded the status quo is. The Long Term Plan\u2019s aim to reverse decades of hospital dominance sounds like a task for at least a decade. The plan\u2019s aim to balance the attention given to physical and mental health is likely to be even longer.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet what Rethinking Medicine seeks to achieve is longer still. This is partly due to size. Rethinking Medicine tries to change how the art and science of medicine is undertaken across England. 125,000 doctors. 1.4 million healthcare staff. A health service seeing more transactions every day than debit cards. This is behaviour change on shock and awe scale.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But it\u2019s also about the long-arm of history. Central to Rethinking Medicine are healthcare staff, in particular doctors, viewing their role in a completely different way: less about treatment of disease, more about understanding of people; as<\/span><a href=\"https:\/\/patientrevolution.org\/\"> <span style=\"font-weight: 400\">Victor Montori<\/span><\/a><span style=\"font-weight: 400\"> writes, &#8220;less healthcare, more care.&#8221; The roads people travel to arrive at these conclusions are varied\u2014concern about overtreatment, desire for shared decision-making, embrace of determinants of health\u2014but all share a discomfort that modern medicine doesn\u2019t have the answers to the questions being asked of it.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Think of it not as junking medicine, but giving it a much needed upgrade. Yet the power the current medical model has is all around us. My 6 year old daughter\u2019s doctors kit is one of her favourite toys. White coat and glasses to look clean and clever? Tick. Bandages and syringe to heal the sick? Tick again. (In a UK twist, every game starts with a spell in the waiting room). I\u2019m yet to try sneaking down in the night and replacing the contents with some<\/span><a href=\"https:\/\/www.england.nhs.uk\/rightcare\/useful-links\/shared-decision-making\/\"> <span style=\"font-weight: 400\">decision making aids<\/span><\/a><span style=\"font-weight: 400\">, a<\/span><a href=\"http:\/\/www.open.edu\/openlearncreate\/mod\/oucontent\/view.php?id=80395&amp;printable=1\"> <span style=\"font-weight: 400\">primer in sanitation<\/span><\/a><span style=\"font-weight: 400\">, or a<\/span><a href=\"https:\/\/www.amazon.co.uk\/Limits-Medicine-Medical-Nemesis-Expropriation\/dp\/0714529931\"> <span style=\"font-weight: 400\">lecture by Ilyich<\/span><\/a><span style=\"font-weight: 400\">, but I think I know the reaction I\u2019d get.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our understanding of what doctors are there to do, and in return how we as patients respond to them is woven into the very fabric of our society. These roots are in part structural\u2014the Royal College of Physicians has existed longer than the Royal College of GPs, the NHS, women\u2019s suffrage, and the abolition of slavery, <\/span><i><span style=\"font-weight: 400\">put together<\/span><\/i><span style=\"font-weight: 400\">. But its roots are also cultural, based on elemental human fears. Until the 1850s it was more likely that going to see a doctor would harm rather than help you; why did people still go?<\/span><\/p>\n<p><span style=\"font-weight: 400\">To change the daily practice of both the givers and receivers of healthcare is a century long task. We shouldn\u2019t shy away from this. Besides a complete shift in public and professional social attitudes, for Rethinking Medicine to be complete it will also require an overhaul of education, regulation, and service delivery. We don\u2019t have long: while the doctors of 2119 are not yet alive, 5% of their patients are, as well as a larger proportion of their teachers.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Which brings us back to what we do now. Rethinking Medicine is not a normal sort of programme. In fact, it\u2019s less a programme (\u201ca set of related measures or activities\u201d) than a movement (\u201ca group of people working together to advance their shared ideas\u201d). Success for Rethinking Medicine in 2019 is not to execute measures or activities, but to expand what is already a fast growing group of people, sparking a range of conversations and ideas which can travel far further than from any one individual alone.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The public health professor<\/span><a href=\"https:\/\/www.kaleidoscope.healthcare\/melting-pot\/simple-but-wrong-complex-but-right\"> <span style=\"font-weight: 400\">Harry Rutter<\/span><\/a><span style=\"font-weight: 400\"> talks of 20 year plans where, if you move 5% towards your goal every year, you make it. It\u2019s the same for Rethinking: if we get 1% closer this year, and next year, and the year after, eventually we\u2019ll get there.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The NHS Long Term Plan is admirable in making the case for the need to plan further than simply beyond the next crisis. However, to see the real level of healthcare change we want to see, we need to set our sights on longer term goals.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Richard Taunt<\/strong> is part of Kaleidoscope Health &amp; Care. <\/span><\/i><\/p>\n<p><b><i>Conflict on interests: <\/i><\/b><i><span style=\"font-weight: 400\">Kaleidoscope is a Community Interest Company which is supporting the development of Rethinking Medicine, a <\/span><\/i><i><span style=\"font-weight: 400\">non-commercial collaborative <\/span><\/i><i><span style=\"font-weight: 400\">funded by NHS England and the Royal College of GPs.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Change takes time. We need to prepare for the future, not just firefight the present. The recent publication of the NHS Long Term Plan has given commentators an opportunity to [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/29\/richard-taunt-rethinking-medicine-a-longer-term-plan\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43401,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-43969","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Taunt: Rethinking medicine\u2014a longer term plan - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/29\/richard-taunt-rethinking-medicine-a-longer-term-plan\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Taunt: Rethinking medicine\u2014a longer term plan - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Change takes time. 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