Increased self care brings many benefits, not only for the individual, but for clinicians, the NHS, government and society as a whole.
- More needs to be done to effectively support people to self care for self treatable conditions, either by themselves or with the support of a pharmacist
- In 2014, there were 3.7 million visits to A&E for self treatable conditions at a cost of £290 million to the NHS
- There are approximately 57 million GP appointments each year for self treatable conditions at a cost of £2 billion to the NHS
- Empowering people to self care will give them appropriately safe and effective relief from their minor ailments and ensure a more appropriate use of NHS resources, allowing efficiencies to be reinvested in other areas.
Self care does not mean no care
Self care is defined by the Department of Health as:
‘the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital.’
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”.
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 dedicated national lead (Minister or National Director) is needed to provide leadership and co-ordinate work across the Department of Health, NHS England, Public Health England and other government departments if progress is 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.
Inconsistency of 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 information from NHS 111 and NHS Choices 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 winter campaign ‘Stay Well This Winter’. This campaign provides consistency over the messages people receive about managing their winter ailments. 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 manage their minor ailments effectively.
Improving Health Literacy
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.
In 2013, people bought 942 million packs of OTC medicines to treat themselves for minor conditions. This underlines the important role that self treatment continues to play in the delivery of sustainable healthcare in the UK. Despite this, the NHS still spent more than £83 million on prescribing 22.6 million packs of paracetamol in 2014. This is a significant price to pay and further highlights the importance of changing the way that people use the NHS.
Self Care Continuum
The self care continuum, developed by Dr Pete Smith for the Self Care Forum, illustrates the sliding scale of self care in the UK, starting with the individual responsibility people take in making daily choices about their lifestyle, such as brushing their teeth, eating healthily or choosing to do exercise. At the opposite end of the scale is major trauma where responsibility for care is entirely in the hands of the healthcare professionals, until the start of recovery when self care can emerge again.
The Self Care Forum is an independent charity which aims to further the reach of self care and embed it into everyday life. PAGB is pleased to provide funding and resources to support the work of the Self Care Forum, which includes the organisation of an annual Self Care Conference for healthcare and public health professionals and an annual Self Care Week to raise awareness of self care among the UK population.