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\begin{document}

\title{The impact of ageing on the NHS}



\author[1]{Edoardo Cervoni}%
\author[1]{Francesca Cervoni}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\selectlanguage{english}
\begin{abstract}
The human body is, by definition, a ``corpus''. This Latin term
emphasises the synergy and interdependence of each of its parts. There
is no scientific basis for estimating the number of specialists of
various types needed to meet the population's needs of the type of
interventions that confer benefit. However, it is virtually certain that
the proper functioning of the filter could free up more time for
properly deployed specialists to provide services that would
significantly improve health and, above all, equity in health.~
Recognition of the importance of first contact function in Primary Care
as a filter and co-ordinator, should lead us to better clinical outcomes
for the most part.~The government should recognise, protect, and
prioritise, the role of the Primary Care interface.~%
\end{abstract}%



\sloppy


We are living in unprecedented times. The ongoing COVID-19 pandemic and
the Russo-Ukrainian war are amongst some of the dramatic changes that
are inflicting lasting damages on our fragile~NHS. Currently, the NHS is
at risk of being put under further pressure if cuts to healthcare budget
are made in order to provide for military expenses.

~

I have practiced medicine in three continents, taking on different
roles, for the past three decades. To me, the world and our profession
have changed beyond recognition. There have been many scientific and
technological advancements. Moreover, society itself has changed. Yet,
what has remained unchanged is the trend in healthcare expenses.
Healthcare budgets have dramatically increased.

~

However, when we look at both the quality of life and the life
expectancy in Western countries, it is evident that there has not been
considerable improvement. In fact, in some cases, the life expectancy
has decreased, and the quality of life may have become poorer.

~

General discontent and concerns about our profession have been in the
public domain. Nonetheless, disruptive measures have been taken without
considering the potential consequences. For example, medical records
will fully be accessible to patients in April 2022. Although, there are
significant downsides to the government's decision regarding our
patient's medical records.

This is the latest radical change to a 74-year-old Institution.~

~

I am concerned about the psychological impact that this will have on
practitioners.

~

I believe that the practice of defensive medicine will become more
widespread, and the role of a filter to access the secondary care of
general practitioners may be jeopardised.

The duration of the consultation will increase, potentially lasting well
over 10-15 minutes.

There will be more referrals to secondary care and for further
investigations.

This then leads to fewer appointments being available.

Similarly, we are more likely to see an increase in healthcare costs.

~

Furthermore, a plethora of potentially very serious safety and
confidentiality risks compounds to all the problems I have just
highlighted.

Consequently, I feel that it is vital that concerted measures are taken
to avoid these apparent risks. The effect on the NHS system, which is
already suffering, could be disastrous.

Before the beginning of the pandemic (February 2020), there were 4.43
million people on waiting lists for various treatments.

At the start of the pandemic, the number of people who joined waiting
lists decreased. Nevertheless, this is no longer the case. In December
2021, there was a record of more than 6 million people awaiting
treatment. Two million patients have waited more than 18 weeks, and over
300 patients have waited more than a year. This is 200 times the number
of waits seen over a year before the pandemic (December 2019).

I believe that primary care should embrace the role of filter and
coordinator of care, applying the best possible clinical evaluation
skills and being strongly supported in doing so.

Doing otherwise could be catastrophic and detrimental for some patients,
particularly for those who are considered to be ``more patient''.

~

Unfortunately, the concept of ``filter'' has been confused with
``gatekeeper''. This is a serious error of assessment. A filter is not
the same as a gate. It is designed to select the features that benefit
from the switch, whilst the latter does not. Also, it selects features
with a high probability of being helped by the passage.

On the other hand, a gate can be opened or closed arbitrarily,
frequently with pressure, and sometimes depending on factors not related
to need or benefit. As well as this, gates can be opened or closed at
various levels by the gatekeeper. This depends on their characteristics,
the area in which they are located and the degree of entry demand.

~

The usefulness of specialised interventions depends on the prevalence of
people with a high probability of pathology, which requires specialised
care. As a result of their specialised training, specialists are exposed
to people with a greater likelihood of having the specific problem.~In
the absence of the filter, specialists are faced with a high percentage
of people with a low probability of having a problem in their area of
expertise. Thus, they perform a cascade of increasingly invasive
procedures and treatments, each with its own potential to cause adverse
effects, or even death. The more specialists that see patients with a
low likelihood of disease, the higher the chances are that more harm can
be done than good. This is a phenomenon related to high mortality rates
from adverse effects in hyper-specialised health systems e.g., the
United States.

~

Over-specialisation has often overlooked the risks and leaves some of us
with questions. It is unclear why doctors prefer to manage only one
organ, and surgeons prefer to operate on one type of bone. Why is it
that the narrower the speciality, the greater the prestige when the
average patient with multiple chronic conditions desperately needs
someone to pay attention to the big picture?

~

The human body is, by definition, a ``corpus''. This Latin term
emphasises the synergy and interdependence of each of its parts. There
is no scientific basis for estimating the number of specialists of
various types needed to meet the population's needs of the type of
interventions that confer benefit. However, it is virtually certain that
the proper functioning of the filter could free up more time for
properly deployed specialists to provide services that would
significantly improve health and, above all, equity in health.~

~

Recognition of the importance of first contact function in primary care
should lead us to better clinical outcomes for the most part. Therefore,
the design of the filter should be set to maximise the effectiveness of
primary care and special services, just as manufacturers position
filters to achieve specific purposes.

~

The government should recognise, protect, and prioritise, the role of
the Primary Care interface.

~

Perhaps, a new title should be created: that of Chief Physician, for the
one in charge of putting all the pieces together and agreeing on the
general plan of action with the patient.

~

It is time for action, and I fear that the government is following a
political agenda, perhaps in bona fide, which can be detrimental to the
most.

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