Updated: May 28
As 2020 draws to a close the Oxford English Dictionary will decide on its 'Word of the Year'. In truth, it's not always a word in the strictest sense; past winners include 'Climate Emergency', Post-Truth and even an emoji, while my favourite has to be omnishambles, a 21st century invention that is as much a delight to imagine as it is to roll off the tongue. I'm guessing that for this year all bets are off, with COVID-19 seeming an absolute shoe-in; and it doesn't even have the good grace to be named after the year it has dominated.
If there were an equivalent opportunity to name an unpopular word or phrase that would be best forgotten, consigned to the dustbin of history and spoken of only in hushed whispers and shame that we could have ever thought it worthy of our breath, I would have no hesitation in nominating 'new normal' to this fate. Alas, I have no such opportunity, and the phrase is everywhere; a new normal for the economy, a new normal for business, a new normal for general practice. It is driving me to distraction and I stop listening every time I hear it.
What is so wrong with thinking about a new normal? After all, there will be new developments that come out of this time, and some of them will become normal. Many of these changes will be very positive - there is a chance to maintain some of the reduction in CO2 emissions, for instance, while in general practice the ability to conduct video appointments has become almost universal. We could choose to describe these changes as a new normal, but can we not be more upbeat than that? At its best, new normal is a depressingly downbeat way to describe the positive developments that will no doubt emerge from this time of crisis. New developments or new opportunities might help to generate a more positive mood; it's hard to do much worse.
There are much more concerning aspects of this seemingly innocuous phrase, however. Its darkest side has overtones of Animal Farm, especially when ushering from the lips of someone in power or authority. The implication is 'you have to accept this, so just get on with it.' We need to be alert to potent vested interests that are already jostling to shape the normal that the rest of us come to accept so that it brings them the most advantage. The new normal mantra can be used to make us more compliant and come into line; one new normal for the elite, and another for the rest of us if you like - or most definitely don't like!
Of course there are restrictions we do just have to accept right now, but it is the idea of calling this 'normal' that I cannot accept. We don't know how long these restrictions will be in place, it could be months, it could be years, but that doesn't mean we have to accept them as normal. Food rationing lasted 14 years after WW2 and people had to get very used to it, but they did not have to accept that it was normal. There is nothing normal about not being able to hug your grandchild or visit your sick relative in hospital. A fundamental part of being human is being social, and we should not declare life to be normal until we can be social again in its fullest sense, including large cheek-by-jowl gatherings, be it in a church, a rock concert or a football match, with singing at its most raucous and no-one looking over their shoulder at who may or may not be wearing a mask.
When it comes to general practice, however, my main concern is how 'new normal' thinking may lead to planning the future of general practice based on the requirements for the situation we find ourselves in now, and not the best model for primary care in the future. There is so much that is not normal about now; wearing PPE, worrying about putting our patients at risk just by asking them to come and see us, and treating people remotely when we know best practice would be to see them face to face. Most of all, it is not normal that our patients are scared to see us, as a result, demand is low and many of us are getting home on time more often than usual. If we believe this is all down to this new, wonderful way of working remotely then we deceive ourselves and the shock will hit when demand returns to normal.
Some great new developments are here to stay, and we should celebrate these; it is fantastic that patients can now send us a photo via text to be saved into their record at the click of a button; we will always be glad to have the facility to conduct a video call, even if it never proves as useful as we first thought, and the final push towards electronic prescribing can only be a good thing. That digital consulting is not only here to stay but will also bring great benefits is also indisputable. However, we must evaluate these developments as dispassionately as we would any new intervention. What benefits do they bring? How is this better than what we have already? What are the downsides? What does it mean for the most disadvantaged? And, most of all, how will it change our relationship with patients? Because it is this relationship, developed through continuity of care, that is at the heart of general practice and must remain at its core whatever the future looks like.