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GPs buried under trusts' workload dump

How we are promoting 'pure' self-care

Dr David Mummery 

In both the NHS Five Year Forward View and Long Term Plan, self-care rightly gets a piece of the pie. 

For instance, the former states that ‘many (but not all) people wish to be more informed and involved with their own care, challenging the traditional divide between patients and professionals, and offering opportunities for better health through increased prevention and supported self-care’. 

Indeed, it’s argued that the future of a viable, affordable and efficient NHS depends on safely and effectively supporting and enabling increased levels of appropriate self-care for large cohorts of patients.

In its current form, the NHS simply isn’t clinically and financially viable, largely thanks to the ever-increasing demands and expenses it incurs. And while this is already overwhelming, it's likely to only increase with an ageing and expanding population, multi-morbidities following suit.

When broaching the broad topic of self-care, it helps to fall back on a definition or theory about the specific context in which it’s being discussed. The Self-Care Forum promulgated ‘The Continuum of Self-Care’, a concept that indicates how individual usage of self-care fluctuates greatly.

It’s argued that the future of a viable NHS depends on safely and effectively supporting and enabling increased levels of self-care for large cohorts

According to this continuum, self-care ranges from being complete, or ‘pure’, such as via self-management of minor ailments like the common cold, to complete or ‘pure’ professional care, in the trauma of severe traffic accidents, for example.

Throughout their lifetimes, individuals will engage with their health status for wildly different reasons - from daily lifestyle choices to the occasions requiring complete professional responsibility, whether having surgery or being sectioned under the Mental Health Act. Therefore, this continuum is a useful tool for navigating the spectrum of emotions and responses that ensue. 

Over the last few decades, one of the factors that has led to the seemingly near-endless demand of NHS resources and appointments is a generalised societal shift. This change in public behaviour leans towards the right side of the continuum, with increasing professional care and responsibility in self-care of areas such as:

If promoted among community groups and applied correctly, self-care could help lessen the collective strain on NHS services. With this in mind, Imperial College London’s Department of Primary Care and Public Health established the Self-Care Academic Research Unit (SCARU).

Set up in alliance with the Self Care Forum and International Self Care Foundation, SCARU is the first academic unit in the world that studies self-care to this extent. It recently published its first paper, on the Self-Care Matrix as a tool and method of analysing self-care ideas and interventions.

Given the volume of interest in self-care, both nationally and further afield, there is a particular emphasis on ageing and multi-morbidities; coping with demands on healthcare systems; improving patient empowerment and health literacy; and supporting people to proactively lead healthy lives, SCARU aim to occupy the forefront of the efforts moving forwards.  

Dr David Mummery is a GP in west London and academic clinical research fellow at Imperial College London

For more information about SCARU, please visit here

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Readers' comments (8)

  • You could start by getting definitions of medical care to make common sense.
    PRIMARY CARE should be about how a person takes care of themselves, family members/friends/neighbors etc
    SECONDARY CARE should encompass services of GP, HV, CPN, etc. and
    TERTIARY CARE is going to hospital etc

    Apologies for the pedantry but clarity of thought does matter

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  • And the main thing you don’t mention- doctors scared to tell patients off for attending with trivia because of a vicious complaints industry.
    This won’t help- you can’t reverse the tide with anything but pure hard cash i.e. patients need to pay

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  • If all my patients had trivia my surgeries would not overrun, even when I’m booked at 15 min intervals.
    People who write this have no idea of the complexity of a typical deprived uk population, and how disempowered they are (by secondary care, social care, community services, employers, benefits agencies) to manage any aspect of their care without going via the gp for referrals and letters.

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  • Azeem Majeed

    Excellent work David.

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  • This is so important. The only way to square the circle of how to deal with an increasing workload with static resources is increase self care which is actually not that hard. Patients are checking their own bp etc, but this needs broadening. One of the main methods should be teaching people to use reliable websites not effing Google.
    This needs to be facilitated ++++++
    And yes, some form of incentive may be needed

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  • @ 5 is the new 10 excellent point the GP as the fall back guy for taking responsibility for everything is a major problem but if we are "free" then the economics of the health industry mean we will always play that role.....

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  • Benn Gooch

    Well said 5 sessions is the new 10!

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  • |WhoamI | Locum GP|13 Sep 2019 12:12pm

    Oh not just pay for their care, but have less/no legal aid for complaints, and allowing for counter-suing for malicious complaints.

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