With each person in Wales visiting their general practitioner an average of six to seven times a year, primary care and its contribution to the nation’s health has never been more vital.
And as advances in the medical field continue to unfold every day, experts predict that the role of GPs will evolve and change drastically in the next few decades.
Up to 40 years ago, the idea of MRI scanners mapping your body’s insides and computers with information allowing you to diagnose yourself would have seemed like the leftover chapters of a science-fiction novel.
Swansea-based GP Professor Malcolm Lewis said we can expect similar gigantic steps forward in the next forty years.
Prof Lewis, a former council member of the General Medical Council, said: “I qualified 30 years ago and medicine is so much different to what it was then.
“Technology will never move as slowly as it does now. So as we move further and further into the future, technology will continue to improve and expand how we treat patients.”
Dr Charlotte Jones, deputy chair of the British Medical Association’s GP committee in Wales, thinks that social media, “virtual surgeries” and online consultations could play an increasing part in primary care treatment, with it possible that GPs could one day be skype-ing their patients.
“I can see that we might have a wider use of technology to help patients in many different ways,” she said.
“It may also be that we may begin doing skype consultations rather than sitting face to face and television conferencing in terms of managing.
“It’s an alternative means to providing GP care.
“But what we need to make sure is that we’ve got the basics of health care before we start looking at futuristic technology.”
Dr Simon Braybrook, an academic GP at the University of Cardiff, said that a shift toward futuristic technology had already begun, with GPs communicating with patients through emails and text messages.
But Dr Braybrook said his concern with primary care being delivered through technology was that “the people who have best access to technology are going to be the healthiest, wealthiest people, who are not in need of health care”.
Making reference to the Inverse Care Law – the principle that the availability of good medical or social care tends to vary inversely with the need of the population served – he stated computer and mobile technologies may not be available to an elderly patient with dementia or an unwell baby from a poorer family – even though they might be the most in need.
He said: “The greatest proportion of money gets spent on the people who least need it. “What we are seeing with technology is that inequality is rising and the people who most need health care are the ones who are finding it increasingly hard to access it.
But with new technology comes future pressures on GPs, such as the fresh challenge of dealing with an aging population.
Some GPs are concerned that while new cures and treatment processes are prolonging human life, they are not necessarily prolonging the quality of life.
“As the population ages the government isn’t recognising that although we’re living longer, we’re not necessarily increasing the number of healthy years we’re living,” said Dr Braybrook.
“That’s going to be a big burden. That’s a large proportion of people who are in need of care and aren’t able to work and that’s something we need to plan for.”
With this in mind, having a vital grasp on every aspect of a patient’s life will be even more important for the GPs of tomorrow, and doctors will need to focus not just on treatment of a specific ailment but how that relates to the patient’s general health.
“For GPs, awareness of elderly health care issues and mental health are going to be crucial because we can’t just keep filling hospitals with people,” said Prof Lewis.
“Changing population demographics, with increased longevity will result in more complex care provision as patients live to potentially develop multiple problems requiring multiple treatments. These complexities will continue to be co-ordinated by general practitioners in the community.”
And Prof Lewis is hopeful that the full-bodied knowledge of patients’ lives will reach secondary care more efficiently thanks to technological improvements.
He said: “There is currently a palpable divide between hospital and community based health care delivery and the movement of patients across that divide, in both directions, can be a difficult and occasionally risky journey.”
Dr Jones said that an improved fluidity between primary and secondary care was her main hope for the future, with the need for both areas to work “smarter and more efficiently”.
“We need to think about more efficient ways to communicate with our secondary care colleagues. How we share important information about the patients. We need to develop that sort of sharing of the information,” she said.
And Prof Lewis said technology could be the solution to this problem, with technological improvements eventually turning the stacks of paperwork found in both GP surgeries and hospitals into well structured computer systems connected between all departments.
He said: “Access to services is terribly important. There’s a great divide between hospital procedures and community procedures and it’s one of the most significant barriers in terms of quality of cost.
“How patients move around the system it needs to be improved. In hospitals you still see people pushing around trollies of notes.”
Another aspect that may change in the future, is the way GPs are trained, with proposals already underway for the three year postgraduate to be extended to four.
“It is close to certain that training programmes for GPs will extend beyond the current, all too brief, three years of postgraduate training,” said Prof Lewis.
Dr Jones said increasing training by a year would allow student doctors to spend more time experiencing specialist fields before taking on a more general medical field, letting future GPs sharpen their expertise in as many possible areas.
But remembering that general practice is a specialism in its own right is the key to successfully delivering primary care in the future, according to Dr Jones.
She said: “The thing that concerns me most about the future of GPs is having a sustainable workforce. We must never think that the function of other health professionals can replace the GP. GPs are experts in their own right.”
With studies showing that more community- based general practitioners lead to improved morbidity and mortality figures, GPs may also see their workload increase in an attempt to make them more accessible.
“There are issues with GPs out of hours. It may well be in the future, you’ll have both in hospital and GP practices 24-hour care. This happens in other countries already,” said Prof Lewis.
The rise of the internet has also changed the face of general practice and is likely to do so even more in the future, with more and more people able to look up their symptoms on websites like WebMD and NetDoctor.
But Dr Jones said that the internet could act as a double-edged sword which caused people to become anxious about their symptoms, often unnecessarily.
“The internet can be useful and it can be a force of brilliance but it can also do the opposite and cause unnecessary anxiety. I do think it’s good but again I don’t think it can replace a clinician. Use it for basic information but other than that consult a doctor,” she warned.
Prof Lewis said the web was also beneficial to GPs, with archives of information allowing doctors to be better informed on a range of topics.
“I think the internet has helped people to be so much more self sufficient,” he said.
“It’s just not possible to have the whole thing in your head all the time. It’s all online now and very helpful it is too. To have that kind of fingertip knowledge, I’m sure that will increase.”
But economic constraints are bound to hamper some of the future improvements in GPs’ care.
Prof Lewis said: “We’re in a situation where money is pretty tight and until that changes in the future, there’s going to be certain limits.”
For GPs, differences in the way healthcare is delivered during the next few decades is certain, with the profession on the brink of significant change, but whether it will be for good or bad is less so.
“The biggest thing is I do think we’re at a big turning point. Probably at the biggest point since the creation of the NHS. The primary care system is one of the biggest achievements in Britain.
“We’ve got to make sure we retain that against these challenges,” added Dr Braybrook.