GPs Dr Simon Fradd and Dr Amir Hannan share their tips on how your practice can encourage patients to take responsibility for their health
I am sure that we all have had those frustrating surgeries filled with headaches, upset stomachs and other ailments that could be dealt with at home. But if the NHS is going to meet the challenges of the next few years, then GPs are going to have to encourage patients to take more personal responsibility for their care.
Evidence shows that encouraging self- care could save the NHS around £2bn a year [1] and in your practice can free up valuable GP, nurse and healthcare assistant time that can be redeployed elsewhere.
In this article, we will give you some practical ideas about how to tackle this issue. Many practices around the country are already running initiatives that work for them, and here are a few that we all can learn something from.
Develop your practice website
If you are not updating your practice website regularly then you are missing a huge potential opportunity to educate your patients.
Patients are very used to accessing health information online, and you are well placed to provide the information they are looking for and encourage them to separate their needs from their wants.
To do this you need to ensure you have a website that is easy to update – make sure this is a priority when you upgrade your site – and create a dedicated patient information section describing what self-care is, common problems they can solve and the services you provide that can help. [2]
Provide information on self-treating minor ailments such as back pain, coughs, colds, headaches, sprains and strains. Also enable patients to leave comments on their experiences.
In addition, you can direct patients' attention away from the surgery towards pharmacies and trusted sites such as www.patient.co.uk, NHS Choices and Map of Medicine, where they can access good and reliable health information.
Encourage patients to access their records
Key to creating a culture of patient responsibility is giving patients ownership and greater control of their health records.
At Haughton Thornley Medical Centres in Hyde, GPs have been actively encouraging patients to access their online records, with a policy for GPs to ask them about it in every consultation and insertion of the question ‘how would you like to access your records' into the nurses' QOF template.
As a result, more than 1,100 patients have signed up through a web portal to securely access test results, previous GP consultation notes and any correspondence between hospital consultants and the GP.
This scheme empowers patients and reminds them that they can access their records any time and take control of their care, whereas they can only access their GP in working hours.
Start a practice library
As well as developing your website, the more information you can provide to patients in your surgery the better. Look at creating a patient group to take care of a library of medical guides and journals so that patients can learn about their conditions and take positive steps themselves.
Evening lectures held every two months about a current health topic are a good idea and it is also worth looking into machines in the waiting room for patients to take their own blood pressure and check their height, weight and BMI.
They have been doing this at NHS Alliance chair Dr Michael Dixon's Culm Valley Integrated Centre for Health for years. Blood pressure machines can cost around £1,500, but if patients can take their own blood pressure there is the potential for freeing up an appointment slot for someone who needs it more.
Use information prescriptions
Often patients will not take in what you say in a consultation and it is good practice to give them some information to take away. There are easily adaptable templates on the internet you can use to develop an ‘information prescription' for common illnesses that you diagnose.
Look at websites such as www.patient. co.uk and NHS Choices [3] for useful examples with details of free services or facilities that are available for patients, a number to ring, a website to visit or homework for a patient to do. Giving a patient a web address will encourage them to take control of their condition and it is guaranteed that they will find out information that you didn't think to tell them – saving you time and improving their care.
At one centre in east London, an impressive 50% of patients leave their consultation with an information prescription.
Audit the messages your staff are giving
It is crucial that the whole practice team is involved in encouraging greater independence in your patients. One of the most effective ways to do this is to audit the messages that you are giving patients, and ensure that they are consistent.
Green Bank Surgery in Warrington, Cheshire, along with a cluster of practices in the area, took part in an audit of sore throat consultations in response to high number of patients attending on the first day of a sore throat.
The audit enabled GPs to become more joined up on the advice they were giving, and send a consistent message that patients should try over-the-counter medicines before visiting the doctor with a sore throat. This has had a noticeable impact on patients' attitudes to self-care, with fewer people now attending on the first day of a sore throat.
Go to neighbourhood boards
It can be difficult to find the time, but task one of your practice staff with attending meetings of neighbourhood boards that operate in your area. They can give good information about public health initiatives you can refer to in your area and recommendations for taking self-care advice out into the community.
For instance, many areas have ‘health and wellbeing' services that GPs can refer to – these have volunteer advisers trained by a paid co-ordinator, and can visit pubs, job centres and social housing properties to look at people's health needs and give health and lifestyle advice.
Crucially, they also signpost people to services that operate in the area, to make sure people know how to access the correct service for them. It is a valuable option for frequent practice attenders who have psychological, rather than physical, problems.
Set an example
As well as attending meetings, see if you or your staff can set a positive example. At Nuffield Road Medical Centre in Cambridge, practice manager Greta Evans leads healthy walks into the countryside in her lunch hours, receptionists are in charge of publicising national health weeks, services in the area and general health advice, and the nursing team use all their consultations to communicate messages about self-care.
Government initiatives can also provide funding for self-care initiatives. Weight Matters as part of Change4Life provided funding to train receptionists to provide one-to-one coaching for patients to help them lose weight over a six-week period.
Upskill your healthcare assistants and nurses
Sometimes you have to accept that you are not the best person to give self-care advice to patients. Healthcare assistants and nurses can build up lasting relationships with patients in order to encourage them to self-care.
Encourage healthcare assistants to attend regular training sessions and conduct new patient checks, wound care, diabetic clinics, well-woman checks and medication reviews. Healthcare assistants are able to spend more time with the patients than nurses and can get to know them through repeat visits.
Similarly, use your nurses to manage morning walk-in services and see a wide range of ailments that may require diagnosis, prescribing, ongoing treatment or referral. At Concordia Health, nurse practitioners are used to manage the majority of chronic conditions and work with the rest of the team to provide lifestyle advice, and guidance on smoking cessation and self-care.
Dr Amir Hannan is a GP in Hyde, Greater Manchester, and Dr Simon Fradd is medical director at Concordia Health. Both are advocates of the Self-Care Campaign.
Saving time and money by promoting self-care
