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