Please let me indulge myself a little.
When I first came to primary care (GP land) a chap came into the corridor complaining of chest pain, and promptly collapsed. A colleague and I administered a jab of morphine, sent for the ambulance and got him seen at hospital.
Thankfully he survived. (This was before the time of using aspirin/clotbusters.) Apart from reducing the risk of cardiogenic shock, it's likely we didn't make much a difference to the outcome. He survived through luck. Ever since, he equated the jab, with the saving of his life, and every Christmas, he brought my colleague and I a bottle of whisky.
In those days, we worked as hard as we do now, but we weren't organised. The average patient would come along with his sore toe, we'd treat the sore toe, and off home he'd go, happy with his prescription of flucloxacillin. The other stuff which should have been performed, like ensuring his blood pressure was controlled, or making sure the patient had the correct blood tests, mostly fell out of the window.
We (!) decided if we could organise things better, ie positively invite the patient to come along for the tests, monitoring, treatment etc. This was aided by various mechanisms, including the way we paid GP's, (through the PMS/GMS and what eventually became QOF-paying GP's for jumping through hoops, which impacted on health outcomes), extending the scope of other professionals (eg allowing nurses to prescribe), and putting someone in charge of the whole thing, (Practice nurses were good at this.)
We (roughly) estimated, that as a result of putting these measures in place, there were 4 extra people walking around at the end of the year, that may have died of heart disease previously.
It wasn't rocket science- no new drugs, no fancy clotbusters, no millions spent on tertiary care centres, just getting things organised for our 12,000 patients.
The system was rolled across the PCT, and eventually the country. I reckon there are thousands of people walking around as a result of this systemised approach to care.
AND NOT ONE OF THE B*GGARS HAVE EVER BOUGHT ME A DRINK.
A simplistic view point, I'm not here to defend QOF, I've got my own reservations, just trying to make the point that in Primary Care/GP land, the work isn't always that sexy, but it does make a difference to both the quality (morbidity) and quantitiy (mortality) of our patients lives.
I'd agree with homon, communication is key to keeping the art of medicine and nursing alive.