Hopes and fears – what might 2025 bring for doctors?

It is far from a new concept, but continuity of care is Carey Lunan’s great hope for 2025.

Dr Lunan, who chairs the Scottish Deep End GP project and advises the Scottish Government on health inequalities, has – of course – always been aware of the benefits of the continuing relationship between clinician and patient but fell for the magic of continuity once again when writing a briefing note for policy makers arguing its case.

With the help of researchers at Exeter University, the team of legendary GP Denis Pereira Gray, Dr Lunan (pictured above) found a litany of evidence, which combines to create an argument she hopes will help drive change in policy.

‘In our model of care, where it is all multidisciplinary, the focus is on access rather than continuity but the truth is that if this was a drink we would put it in the water supply,’ Dr Lunan says.

‘The evidence is so strong that it improves safety, it improves quality, and it improves patient experience. It reduces early mortality and morbidity and reduces any attendance, and it improves people's uptake of medication. It means people are more likely to attend screening appointments and get their smears done, and all these things if they are having the conversation with somebody that knows them.

‘It’s really not rocket science, but we are so obsessed with things like the technical aspects of medicine that we've lost the relational stuff.’

For Dr Lunan, this isn’t just about talk – conversations between national leaders, ministers, academics and experts. It is about action. When asked how she remains hopeful and optimistic, despite working in the most deprived communities whose needs are so often ignored and whose outcomes have often stagnated or worsened during recent years of austerity, economic instability, and perma-crisis, her answer is that the people she works with care, that they are committed to presenting the case to do things differently and better, and – crucially – they do have successes and wins despite all the difficulties.

‘Sometimes I think it’s difficult to remain optimistic – but I do believe there are desires for things to be better, and it’s about keeping going with presenting solutions rather than problems,’ she says.

‘And you do have successes as well. It’s about holding on to those and celebrating them.’

Dr Lunan adds: ‘I’ve worked in lots of different jobs and I’ve learned that presenting problem doesn’t win hearts and minds. There are ways of saying things are difficult but here’s how general practice can be the solution.’

The Scottish Deep End project, which Dr Lunan chairs, has produced many examples of these successes. It is made up of a group of GPs from the 100 most socio-economically deprived practices.

It has had significant success in raising awareness of health inequalities and affecting public policy and their model has been adopted internationally, with 16 Deep End groups operating in seven countries.

The project is founded around a relentless drive to overturn the inverse-care law – the idea that those who need healthcare the most are the least likely to get it. In recent months and years those involved with the project have been successful in winning funding for a wide variety of projects and roles, as well as advocating for communities and services faced with cuts.  

Continuity would likely benefit most – but its effect on the most marginalised and disadvantaged, those at the sharp end of growing health inequalities in the communities Deep End GPs serve, could be enormous.

Dr Lunan says: ‘Imagine if you could achieve something where continuity was baked into all policy. I can only wonder how transformative that could be.’

Dr Lunan adds: ‘This is an important moment because we need to really focus on continuity – what it is and why it works. You sort of forget to make the argument because we’ve been talking about it for so long. And the truth is that everything we’ve been doing has pushed us in the opposite direction offering an Amazon Prime-style health service, which largely works for young, fit and healthy people who need quick healthcare that is convenient for them.’

So, how should systems and leaders make the continuity dream a reality in 2025?

Dr Lunan says: ‘We need to grow our workforce. We need to teach it. We need to train it. We need to celebrate it. We need to match the people who really benefit from continuity with having a named doctor, and then we need to measure it so that we know we're doing better.

‘We could do all those things. Then it's a win, win-win for patients, for doctors working in the system who enjoy that way of working for the NHS. I feel quite excited because I think that there might be some interest in looking at how that could work in the contract.

‘I have the same hope for myself, for my organisation, and for my patients – I want us all to be given what we need to be able to flourish. When one person flourishes it creates a ripple effect and helps others to, too.’

Dr Lunan (pictured top) no longer works at the Craigmillar Medical Group.

Idura Hisham knows more than most about adversity and what people need to flourish. The specialty trainee 2 in psychiatry, who grew up in Malaysia, has lived with a number of health conditions since she was a child including Ehlers-Danlos syndrome, Tourette’s syndrome, ADHD, OCD and generalised anxiety disorder.

At the age of around 12 or 13 Dr Hisham’s mother took her to see a child psychiatrist – and it was an experience which changed everything. ‘It really helped pivot my life in a more positive way,’ she says. ‘I saw the potential and how life-changing child psychiatry can be – it changed my life and that’s why I’m on this journey, to give that to other people.’

It hasn’t been an easy journey, however. Before reaching medical school, Dr Hisham had people trying to discourage her from becoming a doctor – suggesting her conditions would make her unable to take on patient-facing roles.

Studying medicine was challenging but her university helped with reasonable adjustments and accommodations. And in the workplace those adjustments were even more necessary, but harder to obtain – with issues around access to learning, disability advisers and clinical supervisors with lived experience of disability or long-term health conditions. 

The state of services – and the rocketing need in communities – has also been difficult to deal with, too. ‘We see constraints everywhere,’ Dr Hisham says. ‘There are long waiting lists for things like ADHD, you end up seeing people in [the emergency department] who haven’t been able to get treatment, and sometimes you might feel a bit powerless to tackle these issues with the resources the NHS has.

‘It extends to social care and everyone works in tandem. When one part of the system struggles the other struggles too.’

However, for Dr Hisham, the feeling of powerlessness which sometimes comes with the strain on services is bested by the hope she finds in colleagues. She says: ‘The thing that’s been amazing is how much people care and how much people try in such difficult circumstances. My colleagues and the people we work with are going above and beyond to do what they can with what they have.’

So, with 2025 stretching out ahead, what would Dr Hisham like to see changed to harness that care and compassion – to give people the resources they need?

‘The service needs more resources in terms of finance and manpower to address the increasing mental health needs of the population. That’s in prevention, primary care and in hospitals. I would also like there to be more well-being support for staff. As clinicians we want to help but sometimes, we get injuries ourselves. A lot of staff who are going above and beyond need resources to help with their own well-being as well.’

As Dr Hisham says – it’s not just patients and organisations who need to be given what they require to flourish, but staff too.

Ask Wan-Ley Yeung about his hopes and ambitions for the year ahead and he will give you a long list: improving services for people coming out of prison, investment in mental health services specialising in areas such as addiction and rehabilitation, increasing housing stocks and implementing trauma-informed learning throughout systems and services.

And that’s only the abridged version.

But this is not just a lofty wish list for Dr Yeung – who is the GP lead for the Salford Inclusion service providing care to marginalised groups such as homeless people, asylum seekers and refugees and people re-entering society from prison – he, along with colleagues, is already getting to work on making them a reality.

Dr Yeung, who grew up in London and trained in Leeds before moving to Greater Manchester, is helping to lead efforts to make Salford a trauma-informed area, he is trying to win contracts or pots of money to help provide better services for people coming out of prison, and he is juggling an impressive list of roles as a frontline GP working with the most vulnerable in society and a local leader advocating for them.

The motivations for all the work Dr Yeung takes on become clear when he talks about his early experiences working in inclusion healthcare. He remembers the extent of the childhood trauma the people he saw in night shelters were living with, he remembers the people living in their cars, the lives ruined by one bad financial choice or the death of a relative or loved one.

And he remembers the parents told they have to clear out their houses in 10 minutes by the bailiffs. And in recent years – as austerity cuts tore into services and economic turmoil hit households – the causes of homelessness have become less dramatic in many cases. 

‘I’ve been seeing people that don’t have big traumas, who have had a good life, but the cost-of-living crisis has hit and it has led to mental health crises, relationship breakdowns and ultimately homelessness. It’s so frightening for people.’

It’s for each of these patients that Dr Yeung puts in the hours on contract tender applications, leadership committees and the day-to-day general practice that his community needs so dearly.

Dr Yeung also hopes 2025 will bring a commitment to the sort of specialist inclusion health services which NICE (the National Institute for Health and Care Excellence) guidelines recommend – despite 2024 bringing cuts and closures in many parts of the country, not least with the closure of a well-loved GP service at Hunter Street in Glasgow.

He says: ‘The impact of not having a service like this is that people need to go to mainstream GPs but they can’t get in because lots of practices are just not set up to help these patients. The knock-on impacts are huge. You might be making budget savings but you will cost the wider system loads more.’

While Dr Yeung will clearly strive to achieve the ambitions he has in his small part of the world during 2025 he also desperately hopes for wider change – for genuine societal change.

‘We need to stop all of this happening upstream. We need to work on a better society that is fairer and kinder.

‘It’s almost wilful ignorance of the problem in the face of so much evidence to the contrary. That is beyond frustrating.’

Devon emergency department consultant Ian Higginson has one desperate hope for 2025. That this is the year where empty platitudes, short-term strategies and cheap conversation finally evolve into meaningful, serious, long-term change.

Across the country, crowded emergency departments undermine patient safety and damage staff well-being. The care doctors and other healthcare professionals are able to give is compromised by hospitals full to bursting and rising need in communities – each driven by under-investment in social care, primary care, prevention and rocketing inequalities across communities.

As Dr Higginson says, none of this is news. These are problems, which have been fully understood for years, with potential solutions equally obvious in many cases. Yet nothing changes. The frustration the president-elect of the Royal College of Emergency Medicine speaks of is hard to contest.

‘When I go to work I am with amazing people and there are bits I really still enjoy. I find joy in those interactions with other humans – whether they’re patients or members of my team. I love teaching and mentoring, and I enjoy treating children and helping with medical emergencies. Those things remain a real privilege.

‘But the frustration is that you can’t do your job as you’d like – or as we are needed to – because of the environment in which we are caring for patients and the conditions we are working in.’

Dr Higginson adds: ‘That frustration is compounded when you look at what’s around us and the evidence we have of these problems but we see no sense that central policy makers have got the bit between their teeth – we don’t see any evidence of strategic thinking around emergency care, urgent care, social care or primary care and all the problems we are facing.

‘On top of that, I see no efforts to make the workplace a more human, friendly, and sustainable place to be. We hear so many words about valuing the workforce but I don’t see any action. And I fear for the future of the specialty and I worry about people who are at the beginning or the middle of their careers looking at all of this. People working in the NHS are amazing and we should treat them right.’

In the spirit of hope for change in 2025, what does Dr Higginson – who qualified in Southampton and has worked in Bristol and Plymouth as well as further afield in Australia and New Zealand – want to see from national leaders and policy makers?

‘I think it is clear hospitals do not have enough capacity or the workforce available to deal with the demand coming in. The major evil for us is that we can’t get our patients out into hospital beds and that means we overcrowd. Everything about overcrowding is bad. So, if we could find ways to take overcrowding away we could probably deal with everything else.’

Dr Higginson adds: ‘I would like to see policy makers afford urgent and emergency care the highest priority – and I would like it backed up with strategic thinking and strategic planning rather than short-termism. We need that backed up by meaningful investment. And the other thing I want to see is action over words when it comes to looking after staff within the NHS and in social care as well. These staff are incredibly valuable, highly skilled people and they are not treated well.

‘If these two things could happen then we would be able to see a future in which we could treat our patients well and our patients wouldn’t be coming to active harm because of the environment we are working in.’

While Dr Higginson – who still loves being an emergency department doctor because of the ability to have an ‘immediate’ effect in people’s lives – hopes to see change, he has a warning should inaction continue to be the modus operandi for those in charge.

‘If nothing is done then patients will continue to come to active harm, staff will continue to leave, and it will be harder to recruit. I think in social care and primary care there is a real risk of accelerated degradation of what’s happening. My worry is we don’t just see a continued, managed, decline and we actually see an accelerated decline despite the best will of my colleagues across health and care and the obvious need for our services for patients.’

(Main image credit: Douglas Robertson)