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DH to mandate GPs to encourage lifestyle change every time they see patients

The Government is set to include a statutory duty in the NHS Constitution for GPs to ‘make every contact count’ to ensure their patients and colleagues are leading healthier lives, despite concern it will be used for performance management.

In a document summarising the responses to their consultation on the proposed changes, the Department of Health concluded that mandating NHS staff to ‘maximise opportunities’ at each contact on health and wellbeing would be a ‘welcome’ change to the constitution.

But the DH admitted a ‘significant’ number of respondents were concerned about its implementation and enforcement, voicing concerns about whether this would be used as a tool for performance management.

The duty was first suggested by the NHS Future Forum last January to require GPs to ask about diet, smoking, exercise and drinking habits, but was described at the time by the RCGP as a ‘muddled’ idea.

But the DH looks set to push ahead with the change, after holding a consultation on the plans, and despite it admitting a ‘a significant number of respondents were concerned about how the practical implementation and enforcement of “making every contact count” will occur’.

There were also concerns about possible extra workload, whether the proposal could be achieved with the current resources, whether staff would require extra training, and whether it would be hypocritical for unhealthy staff to advise patients on healthy living.

Another said that it would improve health outcomes for patients and could have a ‘profound impact on service users’ by making them feel ‘valued on an individual basis by staff and service providers’.

The DH said it had concluded from the consultation that: ‘health professionals are very well placed to support patients with wider support around their health and wellbeing… A more holistic approach which maximizes opportunities for each contact is therefore to be welcomed in the NHS Constitution.’

Dr Andrew Mimnagh, chair of Sefton LMC, said he was concerned about how this proposal, which he supported in principle, would be implemented.

He said: ‘The aspiration, the principle is fine. But it’s often in the implementation that the DH falls down.

‘If it’s saying that everyone in the NHS should take to have a responsibility to encourage to empower patients, explain that the accepted conduct in a society with a national health service is that there is a demand to take their social obligation to look after their health seriously - fine. I welcome that the DH are picking up on what holistic care has been provided since long before I qualified.

‘But if the NHS are doing a Virgin airways style: “Did you smile at the patient?”, “How long for?”, “What was their response?” and instead of it being an ethos that pervades the organization it becomes a tick box exercise with 48-page long forms, then it’s a worry.’

The proposal comes after the RCGP has endorsed a recommendation to include the referral of patients to weight management in the QOF, as part of a programme of changes to reduce obesity in the UK.

Readers' comments (15)

  • I think the GPC should counter with a proposal for us to go to 15minute appointments from the moment this becomes a statuary duty.

    The government will not be able to argue because what they are asking is impossible in a ten minute appointment. At a stroke the country will have lost 1/3 of it’s GP capacity and we will have solved our stress levels.

    This could be a win win situation.

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  • This drive is wrong on so many levels. Firstly, it suggests that a contact without lifestyle advice *doesn't* count. At a time when GPs and practices are struggling with workload pressures, this gives the impression that DH/government doesn't value what GPs *are* doing. Secondly, how precisely is this patient-centred or holistic care? There is a time and opportunity to give lifestyle and preventative advice, but probably not when a person has just become bereaved, been given a diagnosis of a serious life-threatening problem, or their relationship has broken up. Are we seriously to consider these contacts don't count? GPs and patients aren't machines that can be programmed, they are human beings engaged in a personal, therapeutic relationship. The path to effective personal and population care relies on the effectiveness of that relationship and not another box-ticking, reductionist exercise.

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  • Let common sense prevail

    Who on earth are the medical advisors to the DH? Give them some sound advice for a change. My morning surgery frequently consists of people who ARE ILL. I spend the precious 10 minutes treating THEIR ILLNESS. That's what proper doctors do. I squeeze in a bit of QOF etc, but I'm not going to waste that precious time taking on a public health advertising programme. Saatchi and Saatchi would be better than me at that.
    My last patient has gone over the 10 minutes because I have had to break the news of her terminal prognosis to her. I don't feel inclined to warn her off McDonalds and encourage her to take up jogging. So does that mean I need to exception report her??
    Get an f''ing grip on reality!!!!!

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  • The DoH seem to think Primary Care is a bottomless pit with endless capacity. Every new idea, every efficiency saving seems to be dumped on the GP's. Theonly way this attitutude will change is if we move away from a block contract.
    All these changes are going to make a lot of GP's retire or move elsewhere, and those who continue will work with no zeal. This the start of the end of the good old NHS Primary Care- thank you DoH, you got what you wanted

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  • I was listening to somebody complaining bitterly about this from a patient's perspective the other day. She bitterly resented that at every encounter her own agenda seemed to be thrust aside, while the bean-counting insistence on doing another blood pressure check, asking about diet, etc., took precedence. She was telling me how startled the practice nurse was when she refused to have her blood pressure taken when she attended for a cervical smear test. As she (patient) saw it, having a smear test makes her anxious anyway; and she wasn't expecting to have a BP check as well, so why should she agree to it. The request made her angry.

    She may or may not be reacting "reasonably", but this is the effect it has on her; and probably on many other patients. Perhaps we should work harder to mobilise patient support, here. "Patients - do you really want us to give more priority to the Department of Health's diktats than to your fears, concerns, and expectations when you make an appointment with your doctor?"

    And in any case, have all the DH diktats which are about screening been agreed as worthwhile by the national screening committee? If not, then why are we wasting time on them?

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  • Does the DH actually understand what 'holding a consultation process' means? We appear to be railroaded into doing everything the DH decides regardless of the opposition. It would be far more effective for the GP to pick the timing of any consultation on lifestyle - such as when the patient is likely to be most receptive to change. I suspect more and more patients will react like the lady who refused a BP check whilst attending for a smear if this goes ahead. Who are these 'medical' advisers to the DH? I suspect not medical in the slightest.

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  • widespread changes in lifestyle can only ever be achieved through a vigorous public health campaign with attached legislation to ensure compliance (North Karelia)
    Perhaps the DH would like to read about it. What can the individual GP achieve in the midst of a busy 10min consultation in the face of the food industry's vigorous campaign to encourage us all to consume more of the wrong stuff. This is where the DH and government should focus their attention.

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  • I suppose the DOH will want us to give cooking lessons next.

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  • Vinci Ho

    RCGP , please wake up
    Your proposal of asking government to invest 100 million into weight management every year for the next three financial years will be totally negated by this as DoH will say that GPs can 'make' people lead a healthier life style through this . There will be no need for further investments , ha ha ha
    Don't be so naive , you are up against a right wing government here......

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  • The reason I am fat is that when I get out of surgery at 2100hrs I meet the very patients who 4 hours earlier had finished work consulted me and advised me that I ought to take some exercise i agree.


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