The future of the physician: practice and policy

General Policy

Globally there is a growing gap between supply and demand of medical professionals. Advanced healthcare systems such as the UK’s National Health Service are no exception. Vacancy rates across the service have increased and waiting lists for elective care across a range of specialisms are at politically unsustainable highs. For NHS policymakers, this is fundamentally a productivity question, which has emerged against a backdrop of a constrained budget set by central government. The better use of technology is seen by many, not least current health secretary Matt Hancock, as a route to addressing this challenge. 

There are (at least) two interlinked problems facing the adoption of technology in the NHS. One is the barriers to speedy adoption of innovation generated by the fragmented nature of the NHS. It is not, as some external spectators may think, a universal system run centrally through a command and control model. It is a fragmented patchwork of hundreds of local commissioners and providers, each with their own pressures, priorities and personalities. NHS Improvement chair, Baroness Harding, has suggested that there should be rewards in the NHS not just for innovating, but also for copying. 

A second barrier is the juxtaposition between basic and advanced technology. While funding and policymaker attention is understandably invested into cutting edge technology from gene therapy to robotic surgery, this can be to the detriment of solving basic IT infrastructure challenges. Clinicians, especially in the hospital setting, are often frustrated by the lack of a single sign on, often having to navigate, at great length, multiple IT systems. The presence of pagers, paper patient notes and unconnected systems all stymie the efficiency of clinicians but overcoming these hurdles is often not an operational priority or one that would generate the political goodwill that policymakers think they can gain from cutting edge innovations.

In the longer-term, overcoming these problems and improving the productivity of clinicians will have broader ramifications for what the role of the clinician actually is. An effectively networked, augmented clinician, who has a range of digital tools to aid efficiency should have more time for patient facing activity, for the listening and explaining that is at the core of patient care. Their knowledge base, and therefore training, will be different, meaning fewer deep subject specialists but more broad based technological training. The burden on clinician’s intellectual capacity for observation and diagnostics in particular will be reduced as machine learning innovations allow for more accurate assessment.

Our latest report summarises some of these issues and Global Counsel will be exploring several of the policy implications over the coming months.

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