Health Service Focus

04.02.14

The knowledge and confidence for patients to treat themselves

Source: National Health Executive Jan/Feb 2014

Self care could be ‘the first step to saving the NHS’, by radically shifting demand and easing the burden on strained parts of the system. But it needs a national strategy and proper funding, argues GP Dr Beth McCarron-Nash, board member of the Self Care Forum.

Self care messages are becoming more and more common; they can be found on posters in GP surgeries and in A&E, in Department of Health press releases and advice, in pharmacies and even in advertising campaigns.

But achieving the core aims of self care – ensuring patients always access the most appropriate treatment, and only interact with the NHS when really necessary – and reaping the financial and patient safety benefits of doing so, still seems some way off.

The Self Care Forum has launched a new mandate – ‘Save our NHS: Time for Action on Self Care’ – which outlines a six-point action plan of critical steps.

Board member Dr Beth McCarron-Nash told NHE: “Self care is something that’s been talked about for many years, and here we are, 10 years later, without things formally having moved on. The NHS has to find £20bn worth of efficiency savings, and in real terms we’re looking at a cut in health spending over the foreseeable future. I absolutely feel that unless we  do  something to address the rising expectation and demands placed on the health service, it won’t be able to keep delivering services in the way it currently provides them.

“Part of the solution is educating patients and working with them, giving them the tools and ability to self-care and self-manage, so they optimise their health before they become unwell. When they are unwell, whether with long-term conditions or minor ailments, they should have the ability and confidence to know when and how to treat themselves and when to go to the doctor and when to use other services, such as community pharmacy or A&E.

“We’ve seen a doubling in the number of appointments per patients in general practice in the last 10 years, with funding that’s significantly decreased. There’s a huge mismatch there.”

The Self Care Forum has produced fact sheets for the top 10 minor ailments, offering treatment suggestions and advice on when medical help is actually needed. “They do need to know what isn’t normal,” Dr McCarron-Nash said. “We’re not saying ‘don’t come’.
We’re saying, ‘these are the things you can do to help yourself feel better’. Evidence shows that patients who take more control of their health get better outcomes, not just physically but also mentally.”

It has also worked with the Royal College of GPs to set up an online course for GPs who want to enable patients to self care.

National strategy, local commissioning

But the Self Care Forum cannot win the battle itself. National policymakers and local commissioners must make decisions that enable clinicians to take a pro-self care stance, she said. They need tools, resources and time during consultations to have these conversations.

Dr McCarron-Nash said: “We all know that in a packed consultation, talking to someone about how they don’t need the antibiotic takes three times as long as giving them the prescription. It’s about giving clinicians the space, time and tools to enable them to start managing patients in a different way. I want local commissioners to actually think about enhanced services or funding local mechanisms to support doctors and other healthcare professionals to deliver this message.

“There also needs to be a national strategy, starting with formal education in schools. We need to start young and to start helping people to manage their own health from a young age.”

But, she acknowledged, “there’s no money”. Similar work has been funded through the DH in the past, but when the funding for that initiative dried up and the responsibility passed to PCTs, many simply chose not to fund it properly. “Instead they did their own local public health campaigns. Those were often very piecemeal, though we have seen some excellent pockets of work; for example
in the north west, ‘Living Well’.

“It’s part of the NHS Mandate, and I’d like to see that much more apparent. I want to see that self care conversation happen at
every stage – through the commissioning process, and also by providers, but for that to happen there needs to be local and national funding mechanisms.

“There is an awareness, it’s on everyone’s minds, but they need to put their money where their mouth is. Otherwise, we’re going to carry on talking about this for another 10 years, and the NHS is still going to be in the same difficulties.”

The action plan

1) Recognise that supporting self care can create capacity in general practice for longer consultations 

2) For all healthcare professionals to support self care behaviour at every contact

3) Adopt a self care aware conversation in all consultations

4) Implement the NHS Constitution at practice level to underpin support for self care

5) Support Patient Participation Groups to implement the National Association of Patient Participation programme supporting self care for the practice population

6) Encourage healthcare professionals to enable patients to self care by developing national and local incentive schemes.

Tell us what you think – have your say below, or email us directly at opinion@nationalhealthexecutive.com

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