TY - JOUR T1 - Designing health care for the people who need it: James Mackenzie Lecture 2018 JF - British Journal of General Practice JO - Br J Gen Pract SP - 458 LP - 459 DO - 10.3399/bjgp19X705413 VL - 69 IS - 686 AU - Chris Salisbury Y1 - 2019/09/01 UR - http://bjgp.org/content/69/686/458.abstract N2 - A typical afternoon surgery. A middle-aged woman with chronic back pain who has seen numerous doctors already. A child with a lump in the neck, which might be insignificant but could be life changing. A man with multimorbidity for review after a hospital admission. He takes 15 regular medications, sees three different specialists, but no one is sure why he keeps collapsing.These are not simple problems. Many patients bring a list of problems to the consultation1 and many consultations involve multiple long-term conditions, or multimorbidity.2 Half of the population aged over 65 have multimorbidity, with poor general health and quality of life, poor mental health, and reduced life expectancy.3 Over the next 20 years the number of people with four or more chronic conditions is going to more than double, and more than two-thirds of these patients will have dementia or mental health problems.4 People with multimorbidity have high health needs and should be the top priority for the health service.Like everyone else, they not only need treatment for simple illnesses, but also need well-organised chronic disease management. National Voices found that patients want the people caring for them to know them as a person, know about all of their relevant conditions, and have knowledge of local support services.5 They want a single trusted point of liaison for advice and to help them coordinate the help they need.General practice is a system that, when it works well, can do all of these things because it is local and accessible, generalist, and comprehensive. If you have got multimorbidity, you do not have to go to a different clinic for each condition. General practice is person centred, not disease centred, and builds trust through repeated contacts over time. It is the route to almost … ER -