Better care for older people

Niall Dickson is Chief Executive of the General Medical Council, sets out how the professional regulator is responding to the needs of doctors when treating older patients. Follow the GMC at @gmcuktaster week

Healthcare is very largely a business for the treatment and care of older people. This is a reality to which not many of us have really woken up.

While there is much talk of long-term conditions and co-morbidities, much of health service delivery and the public’s perception of what an effective healthcare system should be doing remains focused on heroic interventions, lives saved, and patients cured.

We bear some responsibility for this, as the regulator with responsibility for setting educational and professional standards. We have certainly overseen practice which has struggled to adapt to the different needs of a different generation of older people. All too often older people fall through the cracks of organisational and professional silos. We will always need specialist care but we also need to reinvent the generalist physician with the status and authority to co-ordinate care and treatment, and ensure that sufficient attention is given to patients’ mental health and well-being alongside their physical health.

Medical education – both at medical school and postgraduate levels – has to adapt to the needs of the changing demographic. Young doctors need to understand from the outset that the chances are the bulk of their working lives will be spent supporting older people.

Medical schools are already making significant strides in this, but we also need innovation in postgraduate education. We are determined to play our part in seeing the reforms put forward by the Shape of Training Review, co-commissioned by us and chaired by Prof Sir David Greenaway, brought into reality.

And we, along with everyone else in this business, need to do more to support professionalism. Our statutory responsibility to set professional standards is only the start. We have recently revamped our core document Good medical practice but we, together with organisations and individual professionals, must work together to ensure standards are relevant and applied in practice. Our guidance must be useful and used.

The awful reality that emerged from Mid Staffs and indeed other inquiries was that doctors knew about our guidance but were not empowered by it. They felt it was acceptable to ‘walk by the other side of the ward’ knowing that there was unsafe and unacceptable practice going on. We must all do what we can to make sure that does not happen again.

Basic care – including access to food and hydration – has to be a matter for doctors as much as other health professionals.  Healthcare is a team endeavour – where different professionals must learn to work together to provide coordinated support, but with clear, identifiable and responsible leadership to whom patient and relatives can turn.

Over the next year, we will be working with others, including the British Geriatrics Society and Age UK, to help support doctors in their day-to-day care and treatment of older patients. Through our oversight and shaping of medical training, and by making our guidance relevant to the realities of clinical practice and by working with others, we hope we can help the healthcare system begin to meet the changing needs of an ageing patient population.

The GMC guidelines “Better Care for Older People” can be read in full here.

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