There seems to be a lot of talk about how the NHS will look in 2044. This made me reflect, as it is exactly 20 years since I first joined the NHS and became a practice manager...

I joined with no experience, other than I came from a business background and I hit the ground running, graduating from two small practices to the large one I am now at.

Over these 20 years, I have worked with Primary Care Trusts, CCGs, ICBs, and with QOF, the CQC, PCSE, and PCNs.

These all presented their unique challenges; the goalposts change so many times, I’m not certain what I should be shooting at next.

I have been threatened and assaulted; a patient even tried to sue me, and it went as far as the law courts in London where a judge threw out the case before it even started.

I had to deal with staff dying in service, a partnership that had to be dissolved, and those who follow this column will know that I was sole partner at a practice for 12 months until I decided to leave. That was an experience I would never want to have again as the stress became intolerable.

I have dealt with many undervalued people who were on the side of Primary Care — and also dealt with people who had no idea how things worked.

I worked through the COVID-19 pandemic and saw the selfless work of so many, and the risks that were being taken to keep everyone as safe as possible.

I have experienced the heartache of patients and experienced the thanks of many more. It has always been more to me than just a job and in some ways, I am glad I had no idea what the last 20 years would bring.
Of course, over the last two decades medical advancements have continued at pace, meaning an extension of the services we can and do offer.

But I cannot help looking at the financial state of the NHS. Yes, I know even if we doubled or tripled the money going in it would still not be enough, and no one has the guts to discuss and try and make the money going in work better than it is at the moment.

We can all see the amount of waste within the system and the fact that there could be resolutions to some problems if tackled head on.

It cannot be right that with waiting lists at an all-time high, so many patients are occupying hospital beds just because the care needed on release is just not there.

So, what will the NHS be like in 2044? Now that really is a question, and we’ll all have our thoughts.
Will we still have an NHS in 2044? I think it will still be around, as it is a national treasure, and I cannot believe the population would allow it to melt away.

However, there must be changes from all sides. By that, I mean patients need encouragement in the new ways of working. Like promoting online consultations and all the new categories of staff such as physician associates and advanced nurse practitioners; most patients feel cheated if they do not see a GP, and are sceptical of these new roles.

Over the next 20 years, even more development of care will hopefully take place and even more demands will be put on the NHS staff.

We must invest in the NHS, as a better NHS will cure people earlier; that can be self-funding, as less absenteeism will increase the national output. Staff must be respected and paid accordingly at fair rates, too.

Of course, I could be very wrong and events may overtake us. But I do know that staff, like all of us, will be doing what we can to help our patients and going over and above what is expected.

We will face changes — some good, some bad, and others that just reinvent the wheel. 

The only thing that I can be certain of, is that in 20 years I will not be a practice manager and all being well I will want the NHS to look after me in my old age.