Doctors and NHS services are becoming too specialised to meet the needs of a rapidly ageing population and should retain generalist skills, the chief medical officer (CMO) for England has warned in his annual report.
Much of the medical profession is organised around single diseases or organ systems ‘in a way that is ill-suited to a future of increasing multimorbidity’ where people accumulate chronic conditions, Professor Chris Whitty said.
This means patients can spend their time going to ‘multiple unrelated specialist clinics, be on several care pathways and are prescribed multiple medications’, which is ‘bad medicine and bad organisation’, he said.
It is essential that doctors maintain generalist skills in order to best care for older populations, and NHS services and research bodies also need to adapt to the rise of multiple conditions, he added.
A cross-sector approach
In this latest ‘Health in an Ageing Society‘ report, the CMO also highlighted inequalities in frailty prevalence, with higher rates and earlier onset in areas of deprivation.
Ill health and disability in old age is not inevitable, he said, but there are stark inequalities associated with deprivation. The NHS needs to focus more on primary and secondary prevention to delay disease, the report concluded.
However, opportunities to engage in the prevention of secondary disease exist throughout the NHS and should not be seen solely as a role for general practice or the relevant specialty, such as cardiology, the report suggested.
‘There are many professionals across the health and social care sector and beyond who can play a role in supporting secondary prevention activities,’ Professor Whitty said. ‘This is especially important to consider for older people, who are often in contact with a wide range of services to support their health and wellbeing.’
The report stressed that the focus should be on improving quality of life rather than longevity. Sometimes this means less medicine not more in older adults where over-treatment can be as inappropriate as under treatment, Professor Whitty noted.
He also warned that older age is becoming increasingly geographically concentrated in England, and services to prevent and treat disease need to be planned on that basis.
‘This should be seen as a national problem and resources should be directed towards areas of greatest need, which include peripheral, rural and coastal regions of the country,’ he said.
’Generalist skills are key’
Welcoming the CMO’s report, Dr Sarah Clarke, president of the Royal College of Physicians, said: ’With an increasing number of people with multiple long-term conditions, generalist skills are key, as are close working links with primary, community care and the voluntary sector. It is vital that specialists are supported to feel confident in their generalist skills to provide joined-up care for these patients.
’It is clear that where people live, their access to healthcare, and their local infrastructure all impact their health and wellbeing. Such conditions fluctuate throughout the country and so we therefore agree with the report’s recommendation that policy, guidance and medical practice must be able to recognise and adapt to the local demand.
’However, as the report also says, we must take a preventative approach to tackling socially-determined ill health in the first place, thereby alleviating pressures on the health service later down the line and improving the quality of life in old age.’
She added: ’The evidence outlined in the CMO’s report supports our call for a cross-government strategy which considers the role of every Government department and every available policy lever in tackling health disparities.’