What patients need. Julian Tudor Hart’s planned care law.

In 1974 Julian Tudor Hart established that patients with high blood pressure were much less likely to die from complications if he asked them to come back to have it checked rather than waiting for them to return to the surgery the next time they felt unwell. This radical finding he called ‘planned care’ and changed forever how GPs worked.

Not that he needed any extra work. At that time up to 300 patients a day were coming to see him. But he knew that reactive care, the model for the previous 2000 years of medical history, whereby doctors sat at their desks waiting for patients to come in, could be radically improved.

In his book, The Political Economy of Healthcare which is shortly to be published in a significantly redrafted second edition, he proves false the assumption that what patients want exceeds what they need, which exceeds the resources of a healthcare system.

As our population grows older the burden of chronic disease increases and most people will spend the last quarter of their life with a number of chronic diseases such as hypertension, diabetes, ischaemic heart disease, chronic kidney disease, dementia, incontinence and even cancer, since so many cancers are treated and monitored long term now. Most of the time these conditions are asymptomatic even when they are irreversibly damaging your most delicate organs. To wait until you feel unwell before visiting the doctor is to invite catastrophe or death.

The rational way to care for people with chronic diseases is to plan their care, to regularly monitor, educate, negotiate, treat and review their lifestyle, medication, organ function, ability to care for themselves and so on. This kind of care requires a relationship between doctors (and others involved) and patients. This is ‘continuity of care’. It is in contrast to the instant access healthcare and multiple provider choice that is the contemporary political obsession.

We have the resources abundantly in a country as rich (albeit indebted) as ours and we know what patients need -planned care. By focusing instead on what we think they want -instant access and choice, we’re wasting our precious resources on a model of unplanned reactive healthcare that should have died when it was conclusively proved wrong in 1974.

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