James Mackenzie Lecture 2013: the Tao of family medicine.

Abstract

General practice faces the challenges of an increase in the prevalence of long-term conditions (LTCs) and multimorbidity, coupled with increasing demand and the need for more collaborative partnerships with patients. To address these challenges, I believe we need a fundamental change in our definitions of health and health care, the way we ‘do’ general practice, and a transformation in our relationships with our patients. ### An increase in long-term conditions and multimorbidity An LTC is generally defined as any medical condition that cannot currently be cured but can be managed with the use of medication and/or other therapies. More than 15 million people in England have LTCs: accounting for some 30% of the population and 70% of NHS spend.1 People with LTCs account for at least 50% of all GP appointments. To address this challenge we need a new definition of health; one that includes the ability to ‘adapt and self-manage’,2 and which can provide a framework which focuses on the empowerment of patients and improves doctor and patient communication. ### Increasing demands on GPs Between 1995 and 2008 there was a 75% increase in the number of GP consultations, from 171 to >300 million consultations per year. The average number of consultations/person/year also increased from 3.9 to 5.5 and the length of consultations increased from a mean of 8.4 minutes to 11.7 minutes.3 There has also been a rise in the complexity of the problems that our patients present to us. ### Patients want better partnerships with GPs The evidence is unequivocal that our patients want improved collaborative partnerships with us: NHS patient surveys consistently show that 46–49% of patients want more involvement in treatment decisions. Recent responses to this challenge include initiatives such as care planning,4 support for self-management,5 and shared decision-making initiatives.6 ### Care planning Figure 1 shows the ‘House of Care’7 approach to care planning which has been pioneered by Diabetes UK …