Helen Stokes-Lampard, Chair, Royal College of General Practitioners
Jul 09, 2018
The impact of multiple long-term conditions on the lives of individuals, their families, the communities in which they live and the wider health and care system, is ever-growing.
Analysis by the Royal College of General Practitioners (RCGP) has shown that the number of people living with more than one serious, long-term condition in the UK will increase by nearly 1 million to 9.1 million by 2025.
General Practitioners play a major role in diagnosing, treating and supporting patients who are living with multiple conditions, however we often find ourselves facing many barriers to delivering the best possible care. A lack of research into the multiple long-term conditions is one significant barrier; another is understanding how to best treat patients living with both physical and psychological conditions.
The new research from Guy’s and St Thomas’ Charity crucially addresses the need for data on people living with multiple conditions. It reveals evidence to help us better understand people’s life course ‘journeys’ to multimorbidity, in order to accurately recognise risks and opportunities for early intervention. The College supports this finding and its emphasis that multimorbidity is not just a health issue or one only associated with age.
A lack of research into multiple long-term conditions is one significant barrier; another is understanding how to best treat patients living with both physical and psychological conditions.
As confirmed in the Charity’s local exploration, more people are being diagnosed with multiple long-term conditions at a younger age. In the case of the inner-city London area the Charity has explored, 1 in 3 people are diagnosed under the age of 65. This challenges prevalent thinking and practice, demanding that we look further up a person’s life course if we want to help prevent onset and progression.
The evidence in the research also suggests there is a strong social element to this growing challenge. People from areas of high deprivation tend to develop multiple conditions much earlier when compared to those living in areas of low deprivation. In the case of the South London boroughs where the Charity works, the difference is on average 13 years.
Ensuring patients have access to the most appropriate services in their community to effectively manage their conditions, is imperative.
The challenge of the social determinants of healthcare has been known for a long time, indeed the ‘Inverse Care Law’ was first articulated by London-born doctor and campaigner the late Dr Julian Tudor Hart in 1971. He said: ‘The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.’ This phenomenon is still today a key issue in the debate about health inequality.
Whilst GPs are experts at providing generalist holistic medical care in the community, it is the voluntary and community sector which provides an invaluable and unique role that builds on this. Ensuring patients have access to the most appropriate services in their community to effectively manage their conditions, is imperative. Due to the pressures on the NHS and primary care, general practice is now forced to think more creatively to deliver better outcomes for all patients, and particularly those with long-term conditions.
The RCGP is currently working in a unique partnership with the Richmond Group of Charities and Guy’s and St Thomas’ Charity to improve the lives of people with multiple long-term conditions. The partnership intends on gaining a better picture of the voices of people living with multiple conditions, starting with understanding a wide range of lived experience, so that together we can deliver an effective, tailored response to this challenge across the UK.
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Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.