The Changing Face of Medicine:
Shaping an Adaptable, Agile, and Sustainable Future for Patient Care
Charlie Bell
University of Cambridge
Pali Hungin
Newcastle University
Elizabeth Lamb
Newcastle University
On behalf of The Changing Face of Medicine

he COVID-19 crisis forced substantial transformation upon healthcare systems; staff were rapidly repurposed, facilities and services were reconfigured, additional hospitals were created within days, and the fields of biomedicine and engineering advanced at unprecedented rates.

The Changing Face of Medicine, a UK-based commission under the auspices of the Academy of Medical Royal Colleges, brings together representatives from the medical profession, patient groups, and commercial organizations. The Changing Face of Medicine builds on the 2017 British Medical Association presidential project of Professor Pali Hungin. It is intent on shaping an adaptable, agile, and sustainable healthcare ecosystem that empowers the future doctor to meet tomorrow’s changing landscape. In this article, we explore what the future of healthcare might look like, the factors that will shape it, and actions we hope can address challenges to its successful development.

What Might the Future of Healthcare Look Like?

It must be acknowledged that patient perspectives are likely to change in the future, driven by societal shifts in health-seeking behavior, different and more demanding expectations, and a desire for earlier and more accurate diagnoses and solutions. Increasing familiarity with health information and easy access to it mean that patient expectations are likely to be led by what they feel they need and what is appropriate for them.

Against this backdrop, we have diminishing ratios of healthcare workers to members of the public. Allied to this, there is disenchantment amongst doctors about their own roles, which is already accompanied by burnout and health problems. With the advent of new and advancing technologies, a key question is whether the existing models in which doctors provide care will be appropriate or even feasible in the future. Although patients will continue to value and seek human connection in care, the chance of such provision is looking bleak at present and may diminish even further.

The Shaping a Vision for 2040 report by The Changing Face of Medicine summarizes the findings from a series of public webinars held at the end of 2021. These webinars sought to evaluate the current healthcare landscape and examined how policymakers and doctors can best prepare for changes over the next 20 to 30 years. Based on the insights provided during these sessions, we at The Changing Face of Medicine will be working to bring about change across three key areas of healthcare delivery.

1. Changing Populations and the Changing Planet
Present models of health and social care are struggling to meet the challenges of the modern world. It is anticipated that issues around spiraling costs for medicines and technologies, growing and aging populations, and increasing socioeconomic inequalities will remain, and likely increase, in the future.

The pandemic cruelly exposed flaws in our healthcare systems that, although not new, were perhaps not widely appreciated nor thought to be so detrimental in terms of their impact on deprived and traditionally underserved or discriminated communities. The focus in the future should be on location and communities, which are pivotal in addressing physical and mental health challenges. Doctors should be community oriented, considering the challenges different communities face, and seek to involve patients, especially from those communities, in developing solutions.

Approaches like the development of integrated care systems in the UK seek to develop these place-based partnerships. Notably, ongoing projects like General Practitioners at the Deep End are examples of the successful co-design of solutions in underserved communities in Scotland and the northeast of England. Such a healthcare system would allow challenges to be confronted proactively, as opposed to waiting for the next pandemic for action to be taken.

It is predicted that, by 2050, the proportion of the global population over the age of 65 years will increase to 16 percent. As people age, they are progressively more likely to experience multiple comorbidities. Countries with aging populations will therefore face specific challenges that require adaptation of healthcare and societal systems. Emphasizing disease prevention, wellness, social interaction, and the maintenance of independence during times of illness will be key.

Enacting such a fundamental change will require a cradle-to-grave kind of response, with an intentional, lifelong prioritization of well-being rather than a sole focus on treatment. This will require early years education to give people the tools to help them make positive lifestyle choices. We are also calling for multistakeholder collaboration to bring together different groups (e.g., healthcare, social care, and the third sector) to work collaboratively and provide integrated solutions.

Another consideration will be adapting healthcare to align with the global drive towards environmental sustainability. It is increasingly recognized that healthcare itself is a major contributor of environmental pollutants that adversely affect human health. Raising awareness (via online webinars, social media, and published summaries) and acknowledging the duty to address challenges in this area are of fundamental importance. The Changing Face of Medicine will also seek to support initiatives aimed at maintaining safety while reducing single-use equipment and waste; however, we appreciate the potential need for education and for healthcare organizations to be incentivized for these changes to occur. Furthermore, a renewed focus on improving population health and increased care for frail, elderly patients at home may reduce travel to hospital appointments and support environmental sustainability. Finally, treatment considerations may also have a part to play in these moves, with choice of inhaler type having been shown to have an impact on carbon footprint.

2. Harnessing and Humanizing Technological Innovation
The COVID-19 pandemic pushed healthcare services to take big leaps forward in the use of technology; however, patient education has not moved at the same pace. Doctors are experiencing the influence of information—especially misinformation—during consultations, with more and more patients having googled their condition before appointments.

Doctors understand that technology will be inextricably linked to their profession and embedded in patient interactions from now on. It is essential that these changes are embraced to ensure successful incorporation of technology into healthcare systems. Key to achieving this will be the effective use of technology in:

  • the provision, storage, and sharing of data
  • handling administrative tasks
  • diagnostic support
  • healthcare monitoring
  • interactions between doctors and the public.

The good news is that technology, such as machine learning and artificial intelligence, has the potential to streamline processes (particularly for primary care practitioners). Appreciating the importance of human connection, we hope that effective use of technology will optimize the ability of doctors to focus on providing holistic, patient-centered care. Bringing about such advances will require intentionality and the design of systems that start by asking what helps patients and doctors in their relationship. We plan to bring together expert stakeholders and facilitate open and transparent discussions about what these systems should look like.

3. Training and Developing the Clinician
Constructing robust healthcare services to meet the needs of our future populations will require fundamental change. This will begin with how we educate our next generation of doctors and how we select for the role in the first place (e.g., during the university admissions process). Socioeconomic barriers to studying could be addressed by schemes such as HCP-Med in Scotland (University of Edinburgh Medical School), in which healthcare practitioners can work part-time and earn money while studying. Similarly, the University of Central Lancashire is looking at an “earn as you learn” program. These types of programs can facilitate access to education for those who might not be able to do so otherwise. It is our belief that building a workforce that is reflective not only of wider societies but also of our patient groups means reassessing both the selection of our medical students and the culture we instill in them.

Furthermore, the impact of stress and emotional challenges on doctors cannot be understated. Caring for our future clinicians will require delineation between “the doctor in the healthcare system” and “the doctor, per se,” by thinking on three levels:

  1. National: what the system expects of clinicians
  2. Organizational: what institutions should and must do for their clinicians
  3. Individual: what clinicians should be doing to look after their own physical and mental health.

There is also an urgent need to tackle poor mental health and burnout in the medical workforce. Furthermore, future changes must support workforce sustainability through a compassionate culture and proactive support for those who are in difficulty. We believe it is time for a paradigm shift and want to see a future in which doctors have some control over their training as well as working days and are not just at the mercy of demand. Self-awareness, flexibility, and recognition that doctors are human first are all concepts that need to be built into medical culture going forward.

We believe one way in which this could be achieved is during medical training/education by considering the importance of human factors. Indeed, the World Health Organization has highlighted these aspects as key in maintaining patient safety, and initiatives like the Learning to be Safer Programme seek to implement these principles. Indeed, some medical schools have introduced so-called hidden curriculum sessions, which discuss things learned at medical school that are not formally taught, for example, role modeling. Such exchanges can increase awareness of educators and learners about the many influences within medical training and equip them to challenge a culture which is not supportive of clinician well-being.

A key consideration underlying all three of these aspects will be the ongoing empowerment of patients to help maintain a strong doctor–patient partnership. We strongly believe that we are entering a new era of health reform, which will be based on collaboration and co-production. Doctors will be at the forefront of this movement to empower people to take ownership of their health. Doctors and patients value relationship-based care, and evidence suggests it can reduce hospital admissions and mortality. Quantitative evidence from Norway has shown that as the length of the relationship between a patient and a named, regular general practitioner increased, the use of out-of-hours services, number of acute admissions, and mortality all decreased. Working together, we can ensure that this is a key priority in the future.

How Can We Shape the Future of Healthcare?

The Changing Face of Medicine seeks to provide a platform that creates a sense of urgency around the inertia to change in the practice of medicine and considers how to harness future developments to improve patient care. Through our own activities and via strategic partnerships with other initiatives, we aim to drive change in the areas outlined above. We intend to continue challenging current thinking as strategic leaders helping to shape an adaptable, agile, and sustainable healthcare ecosystem that empowers the future doctor to meet tomorrow’s changing landscape.