Finally, the NHS has realised: patient-doctor relationships should be partnerships

Funnelling science-obsessed sixth formers into six years of study and then spitting them out in the direction of poorly people is not always a recipe for success. 

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Despite chronic stress and low morale in the NHS, medicine remains a popular choice for school-leavers. Around ten people apply for each place. Faced with such a large pool of candidates, how do universities decide whom to choose?

When I applied in the mid-1980s, the process was relatively straightforward. You needed top-flight A-levels in the sciences or maths, and you had to pass muster at an interview conducted by a panel of senior medical academics. The focus was on selecting people who would be able to cope with the highly demanding course, and who had at least some idea what a career as a medic might entail.

Over time, there has been a gradual realisation that these criteria might not be producing the best doctors. Funnelling brainy, science-obsessed sixth formers straight into another five or six years of intensive study and then spitting them out in the general direction of poorly people from every walk of life is not necessarily a recipe for success. The first graduate-entry medical course was launched in 2000, the aim being to bring into the profession people with more life experience and greater maturity, qualities that may enhance their ability to relate to patients. There are now 15 such courses in the UK.

In parallel, medical schools have become more liberal in the kinds of A-levels sixth formers can take. You still need chemistry, but a demonstrable interest and talent in the arts or humanities – which in my day would have made an applicant appear distinctly suspect – are now viewed as markers of a rounded, empathic individual.

Medical schools also now require candidates to undertake one of two additional examinations – UKCAT and BMAT. These probe knowledge beyond sixth form syllabuses, but also test candidates’ abilities in critical reasoning and problem-solving. And many medical schools have abandoned the traditional grey-beard interview panel in favour of a series of role-play scenarios (called OSCEs) designed to explore, in a structured way, candidates’ performance in a variety of tasks and situations. Think of them as mini versions of The Apprentice.

Most revolutionary of all is the trend over the past few years to include actual patients in assessing candidates’ performance: patient-examiners can give perceptive insights into prospective students’ interpersonal skills.

It is extraordinary that this has taken so long, but it parallels the decades-long process of turning paternalistic doctor-patient relationships into partnerships. Throughout the NHS, patient input is actively sought: all general practices have patient participation groups to provide feedback. While the “Friends and Family Test” (which asks patients how likely they’d be to recommend a practice to friends and family) may be glib, it does provide a way to gauge how people experience the care they receive.

This is a slow revolution, however, and one that has yet to penetrate the inner sanctums of the Department of Health and NHS England. Our ultimate bosses seem remarkably content with the status quo of top-down diktats informed purely by the prevailing political climate.

There is no better example than the unexamined transformation of general practice in England. The government is determinedly pushing GPs to “work at scale”, creating “super-practices” serving anywhere between 30,000 and 100,000 patients. We are sleepwalking into a world of GP services being provided by huge health centres where your next appointment is with Dr AN Other, who you’ve never seen before and will probably never see again.

In June, an important study showed that continuity of care – consulting with the same doctor over a sustained period – halves risk of premature death. And it is certainly something valued by most patients. If the DoH and NHSE were to catch up with the new orthodoxy, and actually ask patients to help design the sort of general practice services they want, they might be in for a very big surprise indeed.

This article first appeared in the 13 July 2018 issue of the New Statesman, The Brexit farce