John Launer: Faces or candlesticks? Why we need continuity in teams

Sometimes a remark stays in your mind for a very long time because of what it symbolises. One such remark has remained with me for many years. At the time, I was a GP partner during what now seems a golden age. We had a wonderful primary care team, including a practice nurse, three district nurses, a midwife, a community mental health nurse, and other colleagues including two full time health visitors. We didn’t need to employ locums or salaried doctors. We all met once a week to discuss cases that were complex or causing concern. Sometimes a local social worker would join us.

One day a man from the local hospital board came along to our meeting. I think he was a non-executive director with a background in banking. He was visiting us because the NHS was going through one of those occasional periods when it becomes fashionable to show an interest in primary care. At the end of the meeting, when we invited him to offer his impressions, he said, “I’ve enjoyed it, but wouldn’t it be more efficient just to record all this information in the patient notes?”

I found his remark breathtaking. It encapsulated a view of healthcare that couldn’t have been further away from how we understood it. For us, the weekly meeting was about sharing uncertainty, assessing risk, weighing up options, and above all building trust and offering mutual support. All he’d noticed was an exchange of information. It was like looking at one of those trick images where you either see two faces or a candlestick but never both. We saw faces. He saw candlesticks.

The technical way of describing these two views of healthcare is “relational” and “transactional”—but faces and candlesticks will do just as well. I doubt whether many UK doctors will disagree when I say that his view has now prevailed. We’re increasingly in a world of candlesticks, in both primary and secondary care. Teams such as my old one, where people from several disciplines worked alongside each other for many years and all knew their patients and each other well, have largely gone. Nowadays they’ve generally been replaced by groups with a constantly fluctuating membership and a focus on throughput and productivity.

Narratives have yielded to numbers. Dialogue has given way to data. The man who observed our team would no doubt have approved. He’d probably be celebrating the fact that NHS boards now include many more people like him, although probably not with the time or inclination to sit in on case discussion meetings.

We know how beneficial it is for patients to see the same faces each time they come to the surgery or hospital clinic, especially for their medical outcomes. As professionals, we too need to see friendly and familiar faces around us every day. Human attachments, continuity, and trust are basic needs for everyone. We need to restore and protect these for our own wellbeing, just as much as for our patients.