Jane Dacre

Professor Dame Jane Dacre is Professor of Medical Education at University College London, and Director of UCL Medical School. She is a former president of the Royal College of Physicians.


The NHS Long Term Plan sets out a vision for the future of the NHS that begins to rebalance the way the NHS will care for the population for the next 10 years.

It focusses on care in the community, prevention, and addressing the biggest health challenges of our time. It is difficult, however, to change the culture of an organisation, but this is a good start. The difficulty will be in turning plans into reality. 


We are living in uncertain times in healthcare, as political instability causes uncertainty in our publicly funded health system and provides an excuse for not changing the status quo. The Rethinking Medicine movement emphasises the need to embrace change in the biomedical model of healthcare, and move to a more person and population centred approach. The Long Term Plan is therefore an opportunity to do this.


Why do we need to rethink medicine?

Health systems all over the world are struggling to cope with rising demand. This is caused by an increasingly aged population, with complex health needs, and an expectation of care that our creaking health systems cannot match.


If we in the UK add austerity, political turmoil and Brexit into the mix, then we have a potentially insoluble problem. So do we continue to struggle with the same old problems in the same old ways, or do we think of a different approach?


What would it mean doing?

As the Long Term Plan comes out, the clues are clear. We should be focussing on people’s health, not illness. The NHS was a wonderful strategic vision, which has made the UK the envy of the world for the last 70 years. To keep that position, we must modernise our approach to health, rather than sickness, and prevention rather than cure.


The traditional science-based, so-called biomedical model of disease has served us well, but needs updating. We now recognise the impact that individuals, lifestyle, society, environment and mental health have on the wellbeing of the individual.  Now that we are confident in using research evidence about the causes of disease, it is time to adjust the way we work and make medicine sophisticated enough to deal with all of this.

We should be using the NHS Long Term Plan as an opportunity to redress the balance.

The patient is a person, with a complex set of needs and expectations. The reaction they have to wellbeing and to illness is based on who they are, what they believe, what they are prepared to do. For too long, this has been neglected in favour of the science and the diagnosis. Patient choice, based on available evidence and taking into account population-based data, needs emphasising, so that well informed decisions can be made, and over-treatment can be contextualised and minimised.

While we, of course, need to build on the strengths of the biomedical model, we should be using the 10 year plan as an opportunity to redress the balance, and to recognise and benefit from the diversity of the people we serve, not just as complex organisms, but as complex individuals. We need to work with people: patients, health care providers, policy makers, and funders to provide the momentum to modernise our approach.


How should we do it?

Change is always difficult to initiate, and even more difficult to embed. There are some recognised approaches, which start by a vision of where we need to get to. So, a shared picture of a health system that focusses on the individual, while taking account of populations, and scientific and technological advances is a good starting point. The Long Term Plan could be the vision we aim for.


​Education and training of a workforce capable of achieving the goal is crucial, so a push to get the NHS workforce plan, and education and training right are crucial steps. As is the development of a social care system that can cope with current and future demands. All of this is possible, but the thinking needs to be developed.


The Rethinking Medicine movement is an opportunity for the NHS to deliver care that is proportionate and appropriate for the population as well as the individual.  The NHS Long Term Plan is a very good starting place. Not only do we need to keep talking about it. We need to begin to make the small changes that will result in a change in healthcare culture. We need to rethink medicine.

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