Disjointed NHS services leaving patients exposed to harms, leading medical body says
Patients with several long-term conditions are coming to harm owing to fragmented services, doctors have warned.
Listen to this article
A new snapshot survey from the Royal College of Physicians (RCP) found two-thirds of doctors are witnessing poorer care or patient harm linked to disjointed services, and not all cases involve older people.
More than half (55%) of 452 physicians surveyed said the number of patients with multiple long-term conditions in their clinical practice has increased significantly.
Some 47% said almost half of their current caseload involves patients with two or more long-term conditions, and a further 36% said it was most of their patients.
Multiple long-term conditions are not only affecting older, frail patients, the survey also revealed.
Almost four out of five medics (78%) said they very often or often see patients with multiple long-term conditions who would not typically be considered severely frail and who are younger than 80.
Some two-thirds (67%) say they have seen patients come to harm or receive poorer care due to fragmentation between specialties or services for patients with multiple conditions, meaning there is a lack of oversight.
Issues reported include breakdowns in communication between teams, medication errors, duplicate investigations, delays in treatment and patients falling through gaps between services.
RCP clinical vice-president Dr Hilary Williams said: “More people are living with multiple long-term conditions, but too often system pressures mean that responsibility for their care becomes fragmented across different teams and services.
“Treating patients with multiple long-term conditions is now a routine part of physicians’ work.
“These patients need co-ordinated, holistic care, but managing multiple interacting conditions is fundamentally different from treating a single condition in isolation.
“It requires senior clinical judgment, time to consider the whole patient and clear lines of responsibility across specialties and services.
“We are excited about new ways of delivering care physicians working with primary care colleagues are developing in neighbourhoods, but sustained investment across traditional boundaries is key as the NHS develops neighbourhood health services and prepares a new workforce plan, recognising the growing complexity of cases in aligning workforce capability with patient need.
“Services, training and workforce planning must reflect the need for co-ordinated care that treats the whole patient.
“Physicians are committed to providing joined-up, patient-centred care, but that will only succeed if the systems, workforce and generalist skills needed to co-ordinate care are properly recognised and supported.”