Economic Case for Self Care
The economic case for self care is well established with a study published by the Self Care journal suggesting that up to £2 billion in health service funding could be saved if patients were to utilise self care strategies rather than arranging GP consultations for minor ailments. Moreover, there are a number of long-term health benefits – preventing and delaying the onset of chronic conditions, improving quality of life, and reducing morbidity and complications. Following an examination of 160 systematic reviews, 240 primary research studies, and a number of surveys exploring the impact of self care interventions, the Department of Health concluded in 2007 that: ‘many, if not most, of the self care support approaches mentioned have the potential to help build social capital in our communities by informing, skilling, equipping and empowering people in the most effective way.’ The BMA has continued to support efforts to promote self care among doctors and patients. This is a key year-round priority for our PLG, with National Self Care Week providing a focal point for this activity. Last year, the PLG promoted Self Care Week through producing a series of blogs by PLG members and doctors on the importance of self care. This year, we will be publishing materials on the theme of ‘think self care for life’.
The BMA has run the Patient Information Awards for over 20 years. The awards were established to encourage excellence in the production and dissemination of accessible, well-designed and clinically balanced patient information. The breadth of medical conditions these can cover is immense – everything from guides to help people with cancer navigate the welfare system to leaflets about nutrition and cystic fibrosis – and these resources can be a valuable lifeline for patients and their families.
In addition, our Association continues to design and publish resources to support patients on their self care journey. For instance, our PLG has produced a Q&A document and web page with relevant information and links for patients, and our GPs committee has also produced materials for members who want to learn more about self care.
Exemplary Model of Self Care
One example of a health care provider which has delivered improved outcomes for patients through embedding a focus on self care in its work is the Bromley by Bow Health Partnership (which is chaired by Sam Everington, chair of Tower Hamlets’ Clinical Commissioning Group and a member of BMA Council). This partnership of three GP practices and a community centre have put ‘wellness’ at the heart of their strategy for community-centred care, and this is reflected in the manner in which it supports local residents to understand more about their health and to get involved in activities to improve their physical and mental health. One successful aspect of the partnership’s approach is their When Should I Worry? resource, which helps parents to understand and manage common symptoms in children such as coughs, colds, ear ache and sore throats. To cater to the local population, the resource is available in English and Bengali.
Through the growing practice of social prescribing, doctors and community health workers are developing new ways to support patients to address the underlying issues which often contribute to or cause health problems and to feel more in control of their own lives. By making referrals to volunteering opportunities and gardening, arts and sports clubs – as well as tailored housing and employment support services – doctors are supporting their patients to develop vital social relationships and to acquire new life-enhancing skills. Indeed, the BMA has recently profiled an innovative ‘nature prescribing’ initiative through which GPs in Shetland are working with RSPB Shetland to encourage patients to reap the health benefits of spending time outdoors; and there is emerging evidence to suggest that social prescribing improves wellbeing, reduces loneliness, and boosts mental health .
For these reasons, the BMA’s GPs committee earlier this year negotiated significant additional funding to enable social prescribers to support all practices in England. Our members were partially inspired by a scheme which was launched in Rotherham in 2012 and through which every GP working within the South Yorkshire town (which has a population of around 260,000 residents) can utilise social prescribing methods. The project, run by charity Voluntary Action Rotherham, allows GPs or practice staff to refer patients through one of two schemes, one for people with long-term conditions and another for patients with mental health issues but who do not need acute care, to a link worker who spends time with the patient to ascertain what help would be most suitable for them. The charity holds contracts with a number of local community groups who can help with finances, loneliness or physical activity, among a whole host of other areas.
The advent of new and innovative technology provides even more opportunities to embed self care strategies into clinical practice. Innovations of this sort can deliver vast benefits to patients and doctors. The introduction of the NHS app for patients and the establishment of new health body NHSX are two important gateways to improving the quality and reach of self care resources available to patients digitally, and the BMA has already started working with this new agency to influence its direction. Indeed, our GPs committee had a hand in shaping the NHS app, and has been a thought leader in developing the role of digital first primary care more broadly.
As a GP myself, I have seen the development of self care transform patients in the 30 years I have practised. GP surgeries are increasingly offering online resources to provide patients with guided algorithms which enable them to self-manage their condition and avoid the inconvenience of an unnecessary GP appointment. Patients with hypertension can now self-monitor their blood pressure rather than having to attend their GP surgery.
Improving direct access to health records – including information about routine test results – can reduce the need for patients suffering from illnesses such as diabetes to see a GP as well as giving them more control over their condition. We do, however, need to be aware of the potential risk of a ‘digital divide’ resulting from some patients being less able to avail themselves of this technology, and work to ensure that all patients are able to access information on an equal basis.
The BMA will further explore the exciting potential for transforming the way we involve patients in their own treatment and care through the next phase of our Caring, supportive, collaborative project – a programme of policy development designed to put forward a positive vision for the NHS.
By Dr Chaand Nagpaul CBE, BMA Council Chair
100 years of self regulation explains why the BMA was instrumental in PAGB’s formation in 1919.