Health and care professionals committed to partnership working: right wall of the House of Care framework.

Abstract

Prevention, intervention, and social improvement have resulted in people living longer with multiple long-term conditions (LTCs). The cost of such longevity and multimorbidity is increasing exponentially without people necessarily ‘getting better’ or achieving a greater sense of wellbeing. There is a universal anxiety about how we can continue to provide high-quality care for patients, balanced against financial constraints imposed by austerity. Terms such as ‘transformational change’, ‘enhanced productivity’, ‘system resilience’, and ‘integration of care’ are invented as we consider new ways to do the above while seeking to ‘balance the books’. Both patient and professional experience are increasingly characterised by such complexity that hearing and delivering what is most important to a patient can frequently be overlooked. The drive to improve quality and reduce inequity means that we work in a standardised manner using guidelines and measure performance; a risk-averse culture has meant that we have moved away from meaningful risk-to-benefit conversations between doctors and patients, with systems of working now more likely to ‘prescribe’ actions to us as clinicians, in order to mitigate risk. Traditional GP training embeds the art of the consultation as a core competence, promoting patient-centred and partnership-based decision making, and recognising the expertise of doctors and patients as having a role in the consultation and its outcome. With the complexity of modern-day general practice, the increasing prevalence of LTCs, sicker patients, and routine data capture competing for precious time within …