{"id":5949,"date":"2010-11-29T11:10:29","date_gmt":"2010-11-29T10:10:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=5949"},"modified":"2010-11-29T11:10:29","modified_gmt":"2010-11-29T10:10:29","slug":"harriet-vickers-the-one-in-front-of-me-or-all-of-them-out-there","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/11\/29\/harriet-vickers-the-one-in-front-of-me-or-all-of-them-out-there\/","title":{"rendered":"Harriet Vickers: The one in front of me, or all of them out there?"},"content":{"rendered":"

\"HarrietAs the government\u2019s white paper promises to change the role and duties of GPs, this week\u2019s King\u2019s Fund conference asked \u201cdo clinicians have a responsibility for the population as well as the individual patient?\u201d<\/p>\n

From all the speakers the answer was a resounding “yes,” however each had their own perspective on how this could fit into healthcare, and how it could be harnessed by a future NHS.<\/p>\n

\u201cFor clinicians working in a national tax-funded service, obviously yes, it couldn\u2019t be anything else,\u201d said Dr Iona Heath, president of the Royal College of General Practitioners. She sees doctors as constantly oscillating between polarities, of which patient-population is just one. However with commissioning, doctors who have so far avoided a community regard will no longer be able to. They must, with support, be able to go between the two: \u201creality is the particular patient in the consulting room with the doctor, justice is all the patients who are not there.\u201d<\/p>\n

She also pointed out that maintaining registered lists is imperative, to make it clear who is whose responsibility.<\/p>\n

\u201cMany of the causes of ill-health that clinicians see and treat, they often lie beyond the individual. I think clinicians do have a duty to treat health as well as disease, and that means taking a population, as well as an individual perspective,\u201d \u2013 another “yes” from Dr Anna Dixon, director of policy at the King\u2019s Fund. She sees commissioning as \u201cbasically a financial responsibility for meeting the health needs of the population.\u201d<\/p>\n

For a practical perspective, Dr Dixon drew on research from the London School of Hygiene and Tropical Medicine<\/a>\u00a0which highlights barriers to GPs effectively caring for the health of a population. The first of these was that the quality and outcomes framework (QOF) focuses too much on secondary care in this respect, and doesn\u2019t have enough incentives for primary work. Secondly few GPs, even in primary care trusts where reducing inequality was a priority, believed they had a duty to the health of a community. Thirdly, QOF prompted little case-finding, and there was scant evidence of GPs using population data to target at-risk patients.<\/p>\n

In Dr Dixon\u2019s view, different incentives, innovative use of data and time to step back are \u201cneeded more than ever.\u201d<\/p>\n

Sir Muir Gray also had a pragmatic solution for getting clinicians to care better for community health. However he wanted dedicated individuals to focus on population health, \u201c3000 of them\u2026with their map on the wall, thinking where the action isn\u2019t.\u201d The NHS Atlas of Variation<\/a>, published yesterday, shows huge variation in the proportion being seen in different communities. His proposed solution is to give chosen clinicians or scientists time each week to look into the geographical prevalence and risk of certain conditions. Each clinical directorate would have one, and they would look at the public information available, identify new GPs in the area and briefing them, train pharmacists and produce an annual report.<\/p>\n

For Professor Elisabeth Paice, dean director, London Deanery,\u00a0\u201cour last untapped resource in the health service is our young population of trainees.\u201d She believes our doctors-in-training, \u201chave a habit of communicating. They maintain big networks of friends and colleagues, and are collaborative, passionate about social responsibility, innovative and have high expectations.\u201d<\/p>\n

She summarised writing from Simon Sinclair<\/a>, who wrote that junior doctors come into medicine with very strong personal values. However these were replaced after a year with professional values \u2013 those of autonomy, power, status. Their sense of shared responsibility was eroded, and they lost contact with the outside world.<\/p>\n

Professor Paice doesn\u2019t want, or see, this happening to our future, better-connected, clinicians. \u201cThe consequence of that, I think, is playing out. I think a generation of young doctors who do have a work-life balance, are not chronically sleep deprived and do have time for their friends and family, will stay much more in touch with the values of patients and the public.\u201d<\/p>\n

As some GPs express anxiety over the details of commissioning, let\u2019s hope these views settle some nerves.<\/p>\n

Harriet Vickers<\/strong> is a multimedia intern with the BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

As the government\u2019s white paper promises to change the role and duties of GPs, this week\u2019s King\u2019s Fund conference asked \u201cdo clinicians have a responsibility for the population as well […]<\/p>\n

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