View all news

Experts call for health system change to tackle the challenge of multimorbidity in the NHS

Press release issued: 25 October 2018

The number of people with multiple long-term conditions, known as multimorbidity, is rising internationally, putting increased pressure on health care systems, including the NHS.

‌Researchers from the 3D Study – the largest ever trial of a person-centred approach to caring for patients with multimorbidity in primary care - at the Universities of Bristol, Dundee, Manchester and Glasgow, are hosting a conference today [Thursday 25 October] with the Royal College of General Practitioners to discuss the challenges facing general practice and how the health care system needs to respond.

The researchers have also published a ‌report, launched at the conference today, which makes detailed recommendations to policymakers about what that system change should look like.

People with multimorbidity – one or more long-term health conditions, such as diabetes, heart disease, and dementia - are more likely to experience poor quality of life and poor physical and mental health.

They use both general practice and hospital services far more often than the general population. However, healthcare systems around the world are largely designed to manage individual diseases or episodes of illness rather than patients with complex multiple health care needs.

Professor Chris Salisbury, a GP and multimorbidity research lead from the Centre for Academic Primary Care who will be speaking at the conference today, argues that a new approach is needed. “Health services, including the NHS, need to adapt to address this challenge”, he said. “We need patient-centred care, with more emphasis on generalist rather than specialist care and better integration between general practice, hospitals, and social care.

There will need to be a new relationship between patients and healthcare professionals, which will engage patients more in managing their health conditions themselves.”

In the report aimed at policymakers, published at the conference today, Professor Salisbury and co-authors, Professors Bruce Guthrie (University of Dundee), Peter Bower (University of Manchester) and Stewart Mercer (University of Glasgow), said: “People with multimorbidity account for a disproportionately high number of consultations in general practice and their treatment is expensive because they are likely to be prescribed numerous drugs.

People with multimorbidity also have high rates of emergency hospital admissions and attendance at out-patient appointments. The economic impact of increasing multimorbidity in the population is therefore substantial. We need to consider new ways of providing health care which more effectively supports self-care, reduces inefficiencies and reduces reliance on expensive hospital care.”

The report makes a series of policy recommendations including:

  • Promoting patient-centred approaches to the management of multimorbidity in primary care, which requires training, support and changes in incentives.
  • Developing and evaluating new approaches to managing patients with multimorbidity within hospitals.
  • Exploring new models of integration of primary and community care, hospital care and social care which enable better coordination and support for people with multimorbidity, which is likely to require substantial changes in commissioning and funding mechanisms, and a rebalancing of resources.
  • Changes to professional education, training, and regulation to prepare professionals to manage patients with multimorbidity in new and more integrated systems.  
  • Engaging and enabling people to manage their own health and long-term conditions, requiring coordinated action across many aspects of government and public life.
  • More research to understand and improve care for multimorbidity.

The recommendations can be read in full in the PolicyBristol report ‘How should health policy respond to the growing challenge of multimorbidity?’.

The results of the 3D Study were recently published in The Lancet. The trial found that the 3D approach significantly improved patients’ experience of their care but not their health-related quality of life. An easy-to-read summary of the study is available from the National Institute for Health Research Collaboration for Leadership in Applied Health Research West (NIHR CLAHRC West).

Further information

About the Multimorbidity Conference

Multimorbidity Conference: the challenge for primary care is being held at the Royal College of General Practitioners, London on Thursday 25 October 2018 from 10 am – 3.30 pm. See the RCGP website for more details, including a full list of speakers.

About the 3D Study

This was a multi-centre study trying to help general practices to improve how they treat patients with multiple long-term health problems and the largest trial ever of an intervention for multimorbidity in primary care. The study was funded by the National Institute for Health Research Health Services and Delivery research programme. The views expressed in this publication are those of the author(s) and not necessarily those of the MRC, NHS, NIHR or the Department of Health and Social Care. The study was the subject of a recently published NIHR Signal. You can watch videos about the study on the CAPC YouTube channel.

Edit this page