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Can self care save practice resources?

June 27, 2019 by Practice Index in GP Practice Management

Across the pages of the Practice Index blog, one of the common themes that keeps cropping up is the need – and attempts made – to free up resources. Whether it’s a push to save time and free up appointments, cut wastage, reduce drug over-prescribing or an automation of tasks, plenty of schemes have been thrown at practices over the last decade or more.

One of those schemes – and one that seems to be gathering momentum if our conversations with practice managers are anything to go by – is the idea of self care. Launched in 2013, the NHS Self Care programme is all about encouraging people to take a key role in protecting their own health, choosing appropriate treatments and managing long-term conditions.

This notion was further supported by the NHS Long Term Plan, which focused on the need for healthcare, most notably at primary care level, to drive forward self care in a number of key areas, including cancer, mental health, diabetes, multimorbidity and healthy ageing. It also looks at other areas including cardiovascular and respiratory conditions.

Reducing unnecessary demand

Dr Pete Smith, co-chair of Self Care Forum, which is well worth a look for any practice manager looking to increase their knowledge of the self care programme, said: “Our aim is to further the reach of self care and embed it into everyone’s everyday life making it a life-long habit and culture. We want people to instinctively understand how to look after their own physical health and mental wellbeing. Self care is nothing less than actions to lead to a happier, healthier, more fulfilling life.

“People practice self care every day when we brush our teeth, choose to exercise or eat healthily, this is self care. However, self care is also understanding how to self-treat common ailments, manage long term conditions and avoid preventable illnesses such as diabetes, heart disease and some cancers.”

Health literacy is key to reduce unnecessary demand on the NHS by empowering people with the information they need to self care appropriately

In a recent blog on the NHS England website, Wendy Saviour, Managing Director for Nottinghamshire Health and Care Integrated Care System, commented: “A key future priority for us will be to help prevent ill-health and promote good health. If this is going to happen, then we must rebalance the relationship between people and public services and using a personalised care approach will be a key way to make this happen.

“Personalised care gives people more choice and control over the way their care is planned and delivered, and results in better health and wellbeing outcomes for them plus more effective and joined-up services.

“Our work is already demonstrating the benefits of this when health and social care is integrated in a very real and tangible way. People we are working with are now more empowered than ever to set their own health and social care outcomes; create their own plans to meet those outcomes; and to identify the support they need regardless of sector or organisational boundaries. And it can often be very simple changes which have resulted in a major change in their life.”

Successful projects

Understandably, given it accounts for 10% of NHS spend, one of the focus areas of the self care push is diabetes. The NHS plans to double the size of the NHS Diabetes Prevention Programme for type 2 diabetes and, predictably, there will be a big emphasis on engaging patients in managing their health and on disease prevention.

As is so often the case with modern healthcare and the future push, the Long Term Plan features technology heavily in the drive to move diabetes services out of hospitals and support self care. Newly diagnosed patients, for example, will be offered expanding provision of structured education and digital self-management support tools, including HeLP Diabetes – an online self-management tool for those with type II diabetes. The Plan has also pledged that patients with type I diabetes will benefit from life-changing flash glucose monitors.

Then there’s self care of respiratory conditions. The Bradford Breathing Better programme, for example, has proactively identified people, either living with or at risk of COPD, for targeted interventions. This includes admissions avoidance through identifying patients at high risk of admission and/or following up with those who have had a previous admission. This approach enables patients to better manage their condition and adopt self-management techniques.

Best practice

Another example of self care best practice has been shared by Compass House Medical Centres in Brixham, Dorset. There, the 11,000 patient practice used Self Care Week (which runs every November) as a promotional vehicle to engage and empower people to look after their own health, promoting self care as much as possible to patients in the surgery, online through Facebook and Twitter, at local pharmacies and in local schools.

The main objective, according to a patient champion at the practice, was to empower the younger generation, by equipping them with an understanding about how to live healthily and take care of their health and wellbeing, in the hope they will grow up with this knowledge and an ability to embrace self care for life.

The practice met its objectives by teaching 185 teenagers to embrace self care for life through face to face presentations. It also reached a further 20,000 people in the local community with its messages. Schools fed back positively and believed the sessions improved the student’s general capability to look after their own health and wellbeing in addition to their knowledge and understanding of when and where to seek help.

Meanwhile, Bedminster Community Pharmacy in Bristol used Self Care in 2017 to proactively promote the self care for life message, linking it to self-treatment of minor ailments, antibiotic prescribing, health literacy and social prescribing solutions to raise awareness of health and wellbeing and to promote public health interventions, such as flu and pneumococcal jabs.

South Bristol, where Bedminster Pharmacy is located, has the highest percentages of incidents of coronary heart disease, asthma, diabetes, COPD, chronic kidney disease and cancers in Bristol. It also has levels of social deprivation that are generally worse than the city average. Adult obesity, adults that do not take regular exercise and women that smoke during pregnancy are also areas where this locality has a worse picture than average.

For Self Care Week a series of activities took place, including:

  • Promotion of the antibiotic guardianship message to help people understand when prescribing is inappropriate.
  • Winter health evaluations for free cold home assessments and free funded home modifications by the Centre for Sustainable Energy.
  • Proactively encouraging positive lifestyle changes to prevent avoidable diseases and improve physical health and mental wellbeing by:
    • Promoting sugar smart messages and providing free vouchers for weight management programmes;
    • Interventions to reduce alcohol intake;
    • Smoking cessation service advice and signup
    • Promoting and signposting people to local social and interest groups such as ramblers and the volunteering centre.
  • Advertising digital health solutions such as NHS choices and Expert Self Care’s free health apps to encourage self-treatment and improve health knowledge.
  • Teaming up with the local ITV channel to communicate messages around winter flu vaccine (the feature was aired during Self Care Week).
  • Providing opportunistic diagnostic testing such as blood pressure check-ups.

As a result of this activity, the pharmacy saw more people, especially during the winter months, self-treating minor conditions, better managing long-term conditions and taking up seasonal influenza vaccination.

The potential is there

These two examples demonstrate how some relatively straightforward efforts can boost self care – and further savings can be achieved using effective technology.

For example, GPs and other prescribers have been prompted more than 5 million times in the last 12 months to encourage patients to take action to look after themselves, rather than relying on medication, through a commonly used prescribing decision support technology.

Analysis conducted between April 2018 to the end of March 2019 showed that these alerts, if all were acted upon, could have avoided costs to the NHS of over £10 million.

On the face of it, the potential of self care is clearly there. The good news for practices is that they can place themselves at the heart of its delivery – and be among the big winners as the drive really starts to pick up speed.

What are your thoughts on self care? What has worked? What are the drawbacks? Let us know by commenting below or take it to the Practice Index forum thread here.

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