Facing up to the impacts of an ageing population requires some out of the box thinking
By Dr Jay Verma
CEO of SmartLife Health & President Elect General Practice with Primary Care at the Royal Society of Medicine
In 2040, 1 in 5 of us are projected to be living with a major illness, according to a report from The Health Foundation.[i] That’s 9.1 million people, up 2.5 million from 2019.
Much of this rise will be caused by an ageing population as the baby boomer generation ages and people live longer. Much of the projected rise in illness relates to conditions such as anxiety and depression, chronic pain and diabetes – all of which are predominantly managed within primary care and community health services.
For general practice to survive this projected pattern of illness there must be a change: We need to move from the tactical approach to a business minded strategy where we lift our head up from the firefighting and ask ourselves ‘how can we make things better?’
In a midst of a fire that’s not easy to do, but we have reached a point where we need to invest time in our future, not just the right now.
There are many suggestions to how we can navigate these challenging times and, inevitable, many will involve money. But we need to look beyond that response, tempting as it might be, and perhaps be a little bit brave.
I believe the answer lies not with policy makers and politicians in Whitehall, but in the very people who lie at the heart of the health service: patients.
If General Practice is to survive, patients can no longer simply be recipients of prescriptions and tests; contacting a GP practice when there is an issue and, moreover, viewed as a problem rather than part of the solution.
Patients hold the answer to the sustainability of the health service if we allow them to be major players in their own health: informed and able to improve their health proactively, know what to look out for and how to access the most appropriate support.
This might sound fanciful, and of course there are always people who don’t take advice, but when you consider that the number of people with a major illness is projected to grow at nine times the rate of the size of the tax paying working population[ii], something must change.
Take Type II diabetes and CVD. Obesity is the biggest threat to this nation’s health. But before we reach for the semaglutide, I will tell you about a project in North West London, where Type II Diabetes has a high prevalence. Treatment moved outside the clinical room to group sessions and the clinicians (not GPs, incidentally) made it about education and shared experiences.
By investing patients in their own health, the number of people who received the nine key care processes increased by over ¾ and every practice saw an increase in the patients who met the three treatment targets. Patients shared tips with each other; formed walking groups and went shopping together to keep each other on track.
They were informed participants, not passive recipients and it showed in the results.
That was just one small project but it’s an example of the different approaches I think we need to take to make that change. One way of handling the projected increase in health conditions is to change the trend now.
Another way of doing that is through technology.
Technology has an almost infinite scope to improve health, but what is often overlooked in an age of short-termism and five-year election cycles which dictate the NHS’s strategy, is the unassuming innovations which can save time and money as well as lives.
According to Health Education England, General Practice will be among the three NHS specialities most affected by AI.[iii]
This can include automation of clerical tasks, where many GPs agree that AI can reduce the burden of paperwork. But it can also assist with clinical support, as my colleagues and I proved when we used machine learning to help GPs identify potential asthma patients. It can also be used in triage and reviews, risk stratifying and supporting decision making. And in today’s world of smartphones and apps, it puts the information – and the potential - in the hands of the patient.
Faced with an ever-increasing workload, rejecting these possibilities is a rhinectomy of the highest order.
There is no silver bullet and with an ageing population will come an increase in the number of people with conditions, and their increasingly complex needs from co-morbidities.
These numbers are a projection not a prophecy. By taking action now we can not only address some of those challenges before they happen but be in a better place to manage them.
This article first appeared in GP Online
[i] Watt T, Raymond A, Rachet-Jacquet L, Head A, Kypridemos C, Kelly E, Charlesworth A. Health in 2040: projected patterns of illness in England. The Health Foundation; 2023 (https://doi.org/10.37829/HF-2023-RC03).
[ii] Ibid