Healthcare Drivers Quality of care – consistency, appropriateness Patient safety – diagnostic & therapeutic error rates Cost of care delivery Shortages of skilled healthcare workers Public health – biosurveillance, health policy Biomedical Research Environment

Philosophical Trends Maximizing efficiency - maximizing output per unit of input Moving towards “perfect information” - both evidence and clinical data Computers will become smarter than us The Doctor may not be the best person for the task - new models of chronic disease management - driving behavioural/social change, prevention

GP Practice Trends Movement away from reactive, biological model of health – holistic bio-psycho-social approach Displacement of doctor by computer – but emotional and technical roles remain important Neither GP nor Specialist in charge - decentralized, multi-disciplinary collaboration - patient as active participant Focus on prevention - behavioural/social change - intensive use of social media / internet technologies as enabler

GP Technology Trends 1. Interconnectivity - social media, smartphones, portals; behavioural change - telemedicine, distributed teams, care co-ordination - distributed processing, storage 2. Mass aggregation of data - biosurveillance, research, audit, case finding, policy 3. Rapid innovation - Global/national/regional SDO-like approach to guideline development; filtering evidence; data mining; rapid deployment of guidelines/pathways/workflow

GP Technology Trends (2) 4. Machine reasoning - automated systems for applying information: - information → pathways → advice → autonomous agents - personal intelligent agents co-ordinating everything - machine diagnosis - smarter systems → personalized care; genomics 5. Machine assessment - automated systems collecting information: - computer-guided history, examination - computerized sensors, internet-enabled - machine interpretation of images, x-rays - looking for patterns in data

Predictions for General Practice The role of the GP will go back to what it was at the start – caring and comforting - computers will take over all other functions - the GP's EQ will be their key characteristic - the computer will still need the GP's intuition – the ability to pick up on what is really going on with the patient Knowledge-based specialties will decline, technical specialties will survive Increasing roles for nurses, assistants - physical examination, technical tasks will still need humans - practising under computer direction