Bismillah, alhamdulillah: With the changes in the economic prospects of the UK following the results of the Brexit and other unpredictable global financial winds, what is the future of General Practice or Family Medicine in the UK? This is a three way discussion on the pros and cons and future direction of family medicine in the UK.  The sad conclusion was that most GPs will eventually become NHS employees and the idyllic picture of small to medium size practices run as businesses will be a thing of the nostalgic past.


There are many factors for this change.  One that was identified was the way patient demand and expectation has changed over time. The following question illustrates this: when patients are asked the question: ‘Do you wish to see the doctor of your choice in a few days or any doctor within a day’? The response of the majority is the latter. 

This is an example of the age old rule of economists, time discounting. The value of something further in the future diminishes the further away it is. If people are offered 10 dollars now or 20 dollars in a week the vast majority choose the 10 now, over the 20 next week. 

In the long run those who wait are richer and better off but our desire for quick gratification has resulted in prioritising our long term health over our short term desire to be seen. Most doctors will agree that waiting a few more days to see the doctor who is most familiar with a patient’s case – in the long run – is the best option. This naturally excludes problems of a critical nature and that need to be solved in a very short time period. 

It is a pity that though the long term costs and outcomes of good health care have been well studied and reported on by the late Professor Barbrara Starfield and others in the field. One of the key findings has always been continuity of care. Yet, we still ignore the findings and are pandering to quick wins and slowly undermining the long term quality of the once excellent health system in the UK.

All of this is potentially good news for the private sector and community medicine. If they can succeed and target the patients who value continuity of care there is a market in the community sector awaiting them. They will have to convince their customers of the value of continuity of care and sell it – not as a unified medical record – but as something far greater. 

It is a pity that the UK model of family medicine which combined business entrepreneurship and continuity of care and managed to bring this to the masses is playing out its final scenes.

Have a listen…
Head to head – Should all GPs be NHS employees?
The BMJ Podcast
Duration: 16:48
Published: Fri, 07 Oct 2016 15:44:30 +0000
URL: http://feeds.bmj.com/~r/bmj/podcasts/~5/k4GTmjZHOk4/286590794-bmjgroup-head-to-head-should-all-gps-be-nhs-employees.mp3

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