Pressure on NHS Services
There are currently too many people relying on the wrong NHS services for self treatable conditions. This costs the NHS nearly £2.3 billion a year and creates significant additional pressure on GP and A&E services, affecting those people with serious and long-term conditions who need urgent medical attention.
Reduced capacity in GP and A&E services means that there are fewer appointments and longer waiting times.
- The Royal College of General Practitioners (RCGP) estimated that in 2015, people would have to wait over a week to see a GP or nurse on 67 million occasions. This comes at a time of significant shortages in the number of available GPs. For GPs, self care would also save an average of over an hour a day, reducing current workload pressure.
- There has been a 50% increase in the number of people using A&E services within the past decade, while GPs are managing 370 million consultations a year, 150,000 more per day than five years ago.
This additional pressure on already overstretched GPs and A&E departments is having a negative impact on patient outcomes, increasing waiting times and creating workforce problems. With an ageing population, growing numbers of people with long-term conditions and an increase in lifestyle-related diseases, this pressure on the NHS will only become more intense.
The use of health services needs to be promoted as a way of augmenting and supporting self care decisions. NHS England’s Five Year Forward View (2014) states:
“challenging the traditional divide between patients and professionals, and offering opportunities for better health through increased prevention and supported self care. As people become expert patients, the need to use services will reduce. The intention is to break the cycle of unnecessary dependency on direct medical advice when this is not necessary.”
In 2016, NHS Alliance urged GPs to support “community pharmacy as the first port of call for patients with acute self-limiting conditions and minor ailments” and “GPs should identify elements of holistic care that can be identified as self care opportunities for delivery within a community pharmacy”. NHS Alliance found that “5.5% of all GP appointments could have been seen by community pharmacy or the patient could have been given support to deal with the problem through self care”.
You can read more about PAGB’s campaigns on the importance of self care to the sustainability of the NHS here.
National leadership for self care
Implementation of self care policy has not been prioritised in the NHS and responsibility for improving population wide health and empowering people is not joined up.
To drive long-term behaviour change, where people become fully engaged in their health and self care for self treatable conditions, resources need to be provided at a national level to ensure self care is a national priority and is effectively embedded across the NHS.
A national strategy for self care and a dedicated national lead (Minister or National Director) are needed to provide leadership and co-ordinate work across the Department of Health, NHS England, Public Health England and other government departments for significant progress to be made.
In 2015, the BMA published ‘Responsive, safe and sustainable: Towards a new future for general practice’ which stated
“Measures to empower patients to manage their own care better through a government-backed national self care strategy and encouraging commissioners and practices to promote self care.”
Accessible information and support
Empowering people with the skills and confidence to look after their own and their family’s health means that they know how and when to access services, ensuring they receive timely support which is appropriate to their needs.
Where people need advice or reassurance about a self treatable condition, pharmacies provide fast and easily accessible support, with many providing out-of-hours services. Pharmacists are expert healthcare professionals. They can provide information and reassurance to people on a range of self treatable conditions and on medicines use; and they are trained to know when a referral to another health care professional is advisable. Pharmacy assistants also receive training to ensure they are able to advise people and recommend appropriate treatments, under the supervision of the pharmacist.
According to NHS England, 99 per cent of the population is within 20 minutes travel time of a community pharmacy with 96 per cent walking or by public transport .
Every day 1.6 million people visit a community pharmacy in England – this equates to a total of 438 million opportunities a year7 to reinforce positive self care messages while people are in the pharmacy.
It is important to increase awareness among members of the public that pharmacy is a good first point of contact for dealing with the vast majority of health concerns.
Health literacy and self care information
PAGB is concerned about the inconsistency of information which people receive about self care and where to access support for self treatable conditions, creating confusion and resulting in unnecessary pressure on GP and A&E services.
It is essential that people receive consistent advice about self care, including that pharmacy is the first port of call for minor ailments. Frontline healthcare professionals and local services should reinforce the message that people should self care before visiting a healthcare professional and seek the advice of a pharmacist if they are unsure.
If people are supported and advised to self care by healthcare professionals they will repeat this behaviour the next time they experience those symptoms.
PAGB is delighted to be a partner in the Department of Health, NHS England and Public Health England national ‘Help Us, Help You’ campaigns, which include messaging on the role of pharmacy in self care. We believe that this approach, of ensuring one national message which can be consistently delivered and readily understood by people, is the most effective way to increase awareness of self care and empower people to self-treat their minor ailments effectively. However, with the expansion of digital healthcare, there is a need for effective signposting to trusted self care information such as nhs.uk and the Self Care Forum.
Self care and the curriculum
Longer term, Public Health England and the Department for Education should ensure that education about self care and healthy lifestyles is a key part of the national curriculum, in order to drive a long-term change in health behaviour. Poor health literacy, combined with low awareness of self care, means that individuals are more likely to seek advice from a healthcare professional for minor ailments than self treat. The focus must be on ensuring that children receive the basic information and tools to self care effectively throughout their lives.
Other opportunities to improve health literacy and engage people with their health and wellbeing at key life stages, such as starting university, new parents and retirement, should also be developed.
PAGB research has found that 36% of people who go to the GP with cold or flu symptoms do so because they need or want antibiotics. Giving people antibiotics for coughs and colds is not only a waste of NHS money and a contributing factor to antimicrobial resistance, it reinforces the behaviour, meaning that those people will expect antibiotics for the same condition next time. This needs to change and NICE guidance on respiratory tract infections explicitly states that GPs should delay giving patients antibiotics for colds and flu.
PAGB supports the Antibiotic Guardian campaign, and campaigns that seek to raise awareness of antimicroial resistance including World Antibiotics Awareness Week and the European Antibiotics Awareness Day.
Self Care Continuum
The self care continuum, developed by Dr Pete Smith for the Self Care Forum, illustrates how self care is relevant at all stages of healthcare, from the individual responsibility people take in making daily choices about their lifestyle, such as brushing their teeth, eating healthily or choosing to do exercise to recovery after major trauma. PAGB’s focus is on empowering people to self care for self-treatable conditions.