As the NHS marks its 75th anniversary, GP Dr John Ribchester of Whitstable Medical Practice gives an insider’s view of how the service has changed since its inception and how it can adapt to the challenges of modern society.

I am a GP who has worked for the NHS for 48 years. There, I’ve said it. So I have known the NHS for two thirds of its long life. It is arguably the greatest post-war achievement of any government. The NHS was initially set up to tackle illnesses caused by the Second World War, poverty and infectious illnesses, notably TB (tuberculosis).

The population was smaller, and the range of operations, treatments and diagnostic tests was rather limited by today’s standards.

Fast forward to 2023 and our population has exploded. The extent and type of disease has altered, and the range of surgical interventions, diagnostics and medical treatments have all undergone transformational changes. For example, in 1948 the treatment of a ruptured aorta was to admit the sufferer to a hospital bed, administer an injection of morphine and await the grim reaper. Today emergency life-saving surgery followed by a spell in an intensive care unit is the treatment of choice. The outcome has changed from death to life.

General Practice today is mainly concerned with managing a seemingly unstoppable increase in chronic diseases such as diabetes, hypertension, high cholesterol, asthma and more. It is also noteworthy that 70% of GP attendances are said to be stress-related. Therefore there is a greater need to also focus on mental health and wellbeing.

Currently the NHS is having to cope with two major issues, namely a dwindling workforce and an expanding population. We are all sadly familiar with headlines about long waits, both in A&E and for elective services. The Covid backlog has worsened this. But with 112,000 vacancies in the NHS now, set to rise to between an estimated 260 - 360,000 by 2037, one can begin to see the scale of the problem.

An emphasis on recruitment and retention of doctors, nurses and all other healthcare workers is long overdue. Further investment in NHS buildings, to replace inefficient older ones and also to cater for our enlarging and ageing population, should be another priority. Note that the population of over 85 year olds, the greatest consumers of healthcare, is set to rise by 55% by 2037.

Despite an increase in longevity since 1948, it is a sad fact that both years of life and also years of healthy life have been in decline for the past decade. Surely this is alarming. Diseases said to be caused by old age are beginning to be recognised as being caused instead by loss of fitness.

Why is this? Known causes include sedentary lifestyles and work styles, and poor nutrition including a proliferation of ultra processed food and drinks, which contain harmful quantities of non food additives and which are often calorie dense. Hence the increase in the number of people who are overweight and obese.

Other harmful substances include smoking, vaping, alcohol and pollutants. So-called recreational drugs are also a serious problem, but affect less people than the above.

The NHS is mainly a National Illness Service which we consult only once we believe we have a health problem. In my view there is inadequate emphasis on preventive measures, otherwise known as Lifestyle Medicine. Real healthcare begins with our own behaviours and choices, long before a trip to a GP surgery or hospital. Is it the responsibility of the NHS to encourage change? The answer is surely yes, in collaboration with those responsible for the wider determinants of health, such as health inequalities, the built environment, recreation facilities, the food industry and more.

“Whatever stress is generated by being ill or injured, one stress the NHS spares us all is the stress caused by not being able to afford the bill...”

What else needs to change? Greater use of technology, ranging from robotic surgery to online consultations and the use of AI has potential. New drugs, including biological agents which can target cancer cells, are showing promise. New types of scans and other tests to diagnose illness earlier can reduce suffering and improve health outcomes.

I have been an NHS doctor all my working life, and remain a fervent enthusiast. I recognise its challenges and shortcomings, but also its daily successes. These are due to a workforce who continue to strive to do their best for patients, despite the difficulties posed by vacant posts and inadequate buildings.

I know it can be difficult to think of those delivering NHS services when one is ill and anxious, but please do try to spare a thought for them. And lastly, whatever stress is generated by being ill or injured, one stress the NHS spares us all is the stress caused by not being able to afford the bill.