We can transform the lives of 15 million people

NHS England’s Deputy Medical Director, Mike Bewick, calls for bold leadership to seize opportunities in primary care innovation

My first blog painted a rather bleak picture of the challenges facing all of us in the health and care sector but the Call to Action for primary care is an important step in starting the debate.

For my second instalment I want talk about the opportunities – the opportunities for primary care to transform and improve the lives of the 15 million people in England who currently live with one or more long-term conditions.

Progress and innovation in the diagnosis, treatment and care for long term conditions such as diabetes, asthma and heart disease over the past few decades have drastically improved the quality of life for patients, carers and their families.

We know that good management of long-term conditions keeps people from having to go to hospital. We know that better patient education, multi-disciplinary teams and patient-centred care all help reduce complications and keep people well for longer.  For example, multidisciplinary teams with foot care specialists for patients with diabetes have been proven to reduce amputation rates by up to 85 per cent.

Yet long term conditions and the management of complex health needs remains one of the biggest challenges faced by the NHS today.  But why is this?

GPs know that sound management of long-term conditions is good for patients and is the most cost effective approach.  Where the patient is empowered and works with clinicians there is a safe level of self-care possible even in the most of complex conditions, so what’s the problem?

While some practices are making good progress on redesigning their working day and targeting resources to bring about improvements for people with long-term conditions, many are not.  Time pressures, competing priorities and pressures on resources all play their part.

But of all the hundreds of competing priorities, improving continuity of care and meeting people’s needs through sustained reform to ensure general practice provides a wider range of services, closer to people’s homes surely must be number one?

GPs must be bold and take a leading role but we can’t rely on GPs to do this alone. Local health and wellbeing boards which bring together health, public health, social care and local leaders will be critical to success.  We must all work together as one system for the benefit of the patient to tackle problems where they surface – pharmacists, carers, social care and housing colleagues often spot quickly when health is deteriorating. Carers and patients themselves must also play an active role.

The trick here will be to apply existing best practice and the latest evidence of effectiveness and roll it out an industrial scale for the benefit of every patient in every part of the country, all 15 million.

NHS England’s first Future of Health conference, led by Martin McShane, running tomorrow and Friday (Oct 3 and 4), and the Royal College of General Practitioners conference on primary care in Harrogate at the weekend will both focus on these pressing issues.

I’ll be speaking to colleagues about leadership opportunities in primary care medicine and am hopeful that both events will be a great stimulus for turning these ideas into widespread action.

Dr Mike Bewick is Deputy Medical Director at NHS England.


  1. Kevin says:

    Why set a limit at 15million, with around 62million people in the uk, 13million children and the rest adults, all of us will need some sort of primary, secondary and further care?

  2. Chris mimnagh says:

    Agree Mike, – there are building blocks out there that need to be used widely and wisely- shared medical appointments, compound appointments, clinician first assessment together could shift GP into promoting and supporting self care, delivering access AND continuity.
    Interesting times ahead.