Compared to many, my health problems are minor; osteo-arthritis which has led to hip problems and which has aggravated spinal stenosis. Both required surgery four years ago. Continuing symptoms are virtually all in my feet and legs: changes in sensation, involuntary muscle spasms, and, increasingly if not frequently, sudden loss of muscle power in my joints, most often my knees.

Putting aside the failure of a locum at my then GP practice to diagnose early neurological symptoms, two things stand out about the treatment and management of my conditions. The first is that, in the early diagnostic situation where it was difficult to know what was attributable to what, my neurological and orthopaedic teams never met. The second is that neither team gave me information that enabled me to calibrate my experience against other patients who had presented with similar symptoms or who had undergone the same procedures. A corollary of this second limitation is that only after surgery did I learn that over a hundred different hip prostheses were available under the National Health Service. It appeared I was being offered only two.

The alternative is patient-centred healthcare. Since I am aware that this term is used in a variety of ways, let me explain the three changes I advocate.

First, patients should be treated on a holistic basis, including cross-disciplinary diagnosis and treatment by specialists whenever necessary. The emphasis on medical disciplines and sub-specialisms has served well the development of new skills and new procedures, and has distributed career rewards accordingly. However, it seems to impede the sort of collaboration across disciplines that the strategic treatment of real patients requires. I am conscious that many medical specialists will not recognise the interdisciplinary nature of the challenges of patients who present to them. In some cases this will be a case of the person with the hammer seeing every problem as a nail. In others a referral for specialist treatment may be the result of a failure to look in a holistic way at a patient’s healthcare needs before they reached a critical stage.

The second change arises directly from the first. GPs need the time and capacity to act not just as referrers to specialists and reporters back from them, but as initiators, integrators and as necessary interrogators of all their patients’ services. The reference point in this process would be to provide each patient with a long-term health plan including advice on diet and exercise. The considerable extra resources this would require would be offset by the savings which the more integrated and preventative perspective should deliver.

The ultimate responsibility in this approach would fall on the patient themselves, the beneficiaries of a major shift of power. In the third major change, with the informed consent of participants, patient experiences would become a key resource in helping each patient to understand their condition, select treatments, and calibrate their progress.

None of these are entirely new as separate elements; together they would constitute a major change of focus and power within our health system.