21st century health services challenges for an ageing population

Advance care planning should be added to Oliver’s 10 challenges for general practice for an ageing population.1 Many of the scenarios he describes, such as, multiple conditions, dementia, and repeated hospitalisation, are in fact prognostic markers for end-of-life care. Prognostic indicator guidance is available to assist doctors to identify patients approaching the end of life.2

We know that patients at the end of life with non-cancer diagnoses are less likely to be included in practice registers. Timely identification allows for more systematic care based on patient preferences.

The General Medical Council3 also emphasises a broad non-disease based definition of end of life. Systematic identification of people who are approaching the end of life and advance care planning4 can be the ‘game changer’ that is being looked for.

The issues that Oliver has identified are a massive challenge to general practice. At present, it is difficult to see where the solutions are going to come from, with current approaches best characterised as ‘fire fighting’. But a way forward must be found with better models of care. The advent of clinical commissioning groups affords the best opportunity for a strategic approach to systematically improve care. Key to this will be how geriatricians and GPs work together, and how general practice capacity and capability increases.5

• © British Journal of General Practice 2012