Helping patients to help themselves | Dr Graham Jackson

Graham Jackson

Today starts Self Care Week and Dr Graham Jackson, co-chair of NHS Clinical Commissioners, discusses the significance of self-care for individuals and for the NHS.

The Secretary of State recently announced plans to revolutionise prevention as part of the NHS long term plan. When he spoke about “ensuring people take greater responsibility for managing their own health,” he was in the most part talking about self-care.

Self-care - the things people can do to develop, protect, maintain and improve their own health and wellbeing - has a really important role to play in health promotion and illness prevention. Traditionally when we think of self-care, it can be the well-stocked bathroom cabinet brimming with over the counter products that comes to mind, but it is much more than that. The unremarkable ways we look after ourselves such as brushing our teeth, exercising, and getting enough sleep - not to mention more significant changes like giving up smoking - can have significant benefits for individuals by preventing poor health in the first place and allowing the body to recover from illness more quickly.

Today is the first day of Self Care Week, run by the Self Care Forum; and NHS Clinical Commissioners (NHSCC) is pleased to be supporting the initiative to encourage medical professionals to promote the benefits of self-care to their patients and the populations they serve.

It’s important for us as clinicians to acknowledge that self-care can be difficult for some people. It used to be common to ask a relative what to do about a bad back or sore throat, but changes in the structure of society means that some people have nobody in their family or social circle who they feel able to ask for advice.

The knock-on effect

Without someone close to them to turn to, patients are presenting in primary care for minor ailments which often require nothing more than time and rest. This can have a significant knock-on effect to the rest of the system. When I see people in my surgery whose conditions are suitable for self-care, it means others, who should be treated in primary care, find it difficult to get an appointment. We know that when people aren’t able to see their GP they might turn up at A&E instead, adding pressure further up the system and creating longer waiting times for those who really need to be in an emergency department.

As clinical commissioners, our priority is getting the best value from the NHS’s finite resources, so NHSCC has been working with NHS England on behalf of its members to develop new commissioning guidance for over the counter items which should not routinely be prescribed in primary care, which was published in March this year. This guidance applies to self-limiting conditions which do not need treatment such as coughs and colds, or are better suited to self-care, like indigestion or verrucae, which can be treated with easily available over the counter products. This initiative alone has the potential to release up to £136 million each year which can then be recycled into higher priority areas.

Supported self-care

Self-care doesn’t mean leaving patients to get on with it. As clinicians our priority must be to get the right patient the right treatment. Encouraging self-care, with support, will educate and empower the population to make better decisions about their own health, which means they can in turn help others to help themselves. It also gives people the confidence to know when self-care isn’t enough, and that sometimes doing nothing - to wait and see - is the right course of action. Supported self-care requires accessible, usable and free resources available to help patients to help themselves. There are some excellent up-to-date resources available from the Self Care Forum and the NHS Choices website.

We have for too long gone down the route of medicalisation of the population, and healthcare professionals need to take some of the responsibility for this behaviour. An outdated, paternalistic delivery of health and care services has not encouraged individuals to care for themselves. In a resource-limited health service, it is entirely appropriate that those who pay for the system (ie the taxpayer) should expect good value. Part of delivering that best value for money is about making the most of the resources we have; appropriate self-care has its role in supporting best value from the NHS.

Dr Graham Jackson is co-chair of NHS Clinical Commissioners, clinical lead at Buckinghamshire ICS, and a trustee of NHS Confederation. Follow the NHSCC  and the NHS Confederation on Twitter.

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