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Challenges to concordance: theories that explain variations in patient responses

02 October 2019
Volume 24 · Issue 10


To meet the challenges of an increasingly ageing and multimorbid population, patients must be fully engaged to work in partnership with their health professional (HP) in the management of their condition(s). The NHS Long Term Plan (2019) outlines goals to manage the increasing demands on the health service—hospital admission avoidance, shorter length of hospital stays through enhanced recovery pathways, increased management of patients within primary care and ensuring a person-centred approach to care provision. Meeting these goals is predicated on HPs being equipped to activate patients using the skills of motivational interviewing, person-centred care and a willingness to share decision making. This article presents a range of psychological theories that could explain the everyday challenges faced in care delivery. Awareness of these theories may help HPs target their approach to care delivery more effectively, to understand patient responses and, therefore, optimise the provision of person-centred care.

Over the last 30 years, health professionals have increasingly faced challenges posed by an ageing population, that presents with multiple conditions (Kingston et al, 2018). Clinical care in the UK, most often delivered by the NHS, is a finite resource. The overwhelming effect of ongoing demographic changes in the UK directly impacts capacity within the NHS, a situation that is being mirrored worldwide (Vetrano et al, 2017). These pressures are most often noticed through national newspaper headlines, featuring concepts such as ‘bed-blocking’, trolley wait breaches in emergency departments, emergency service call-out and attendance delays, a lack of social care capacity, restrictions to drug funding imposed by National Institute for Health and Care Excellence (NICE) and cancelled operations (Iacobucci, 2017). Thus, this finite service seems to face infinite demands.

Alongside these substantial demographic changes is the challenge of considerable staff shortages across NHS provision, which are predicted to rise to in excess of 250 000 by 2030 (King's Fund, 2018). These shortages impact on the full range of clinical roles, with an estimated 40 000 nurse vacancies (Royal College of Nursing, 2017) and a reported fall in GP numbers by 450 full-time equivalents (FTE) between September 2017 and 2018 (Iacobucci, 2019). A further challenge is the ongoing impact of economic recession, which has led to considerable and wide-ranging austerity measures (Stuckler et al, 2017). Healthcare expenditure is often the first to experience funding cuts, which impacts on core services but, in addition, there has been a stark reduction in community support services (Age UK, 2018). Indeed, Mencap (2016) reported a 33% decrease in community-based support services for older people and those with learning disabilities.

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