TY - JOUR T1 - James Mackenzie Lecture 2013: the Tao of family medicine JF - British Journal of General Practice JO - Br J Gen Pract SP - e675 LP - e677 DO - 10.3399/bjgp14X682021 VL - 64 IS - 627 AU - Nigel Mathers Y1 - 2014/10/01 UR - http://bjgp.org/content/64/627/e675.abstract N2 - General practice faces the challenges of an increase in the prevalence of long-term conditions (LTCs) and multimorbidity, coupled with increasing demand and the need for more collaborative partnerships with patients. To address these challenges, I believe we need a fundamental change in our definitions of health and health care, the way we ‘do’ general practice, and a transformation in our relationships with our patients.An increase in long-term conditions and multimorbidityAn LTC is generally defined as any medical condition that cannot currently be cured but can be managed with the use of medication and/or other therapies. More than 15 million people in England have LTCs: accounting for some 30% of the population and 70% of NHS spend.1 People with LTCs account for at least 50% of all GP appointments.To address this challenge we need a new definition of health; one that includes the ability to ‘adapt and self-manage’,2 and which can provide a framework which focuses on the empowerment of patients and improves doctor and patient communication.Increasing demands on GPsBetween 1995 and 2008 there was a 75% increase in the number of GP consultations, from 171 to >300 million consultations per year. The average number of consultations/person/year also increased from 3.9 to 5.5 and the length of consultations increased from a mean of 8.4 minutes to 11.7 minutes.3 There has also been a rise in the complexity of the problems that our patients present to us.Patients want better partnerships with GPsThe evidence is unequivocal that our patients want improved collaborative partnerships with us: NHS patient surveys consistently show that 46–49% of patients want more involvement in treatment decisions.Recent responses to this challenge include initiatives such as care planning,4 support for self-management,5 and shared decision-making initiatives.6Care planningFigure 1 shows the ‘House of Care’7 approach to care planning which has been pioneered by Diabetes UK … ER -