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Gold, incentives and meh

Teaching patients about self care this winter could cut demand in the long run

Getting patients to take control of their own health will be instrumental in reducing demand on GPs, especially over flu season, writes Dr Beth McCarron-Nash

It’s that time of year when consultation rates soar and we all dread what lies ahead over the coming months. Entertaining the mother-in-law at Christmas and the sound of the latest X-Factor winner’s single? No. It’s much worse than that. It’s the huge rise in demand for GP appointments when we are already working at full capacity, and this year on top of the influx of winter URTIs we face the added pressure of last year’s imposed QOF changes and targets.

If Jeremy Hunt wants to get a snapshot of the demand crisis facing GPs, he can spend a day in our surgeries any day in November and see the winter pressures we face every day first hand. It’s estimated that GPs in England have 340 million consultations each year, peaking during the winter season. Even though last winter was mild, GPs still managed to do 750,000 consultations for flu alone, to say nothing of the other respiratory tract infections we tackled.1

The single greatest challenge facing the profession right now is how to manage increasing demand and workload when we have seen the percentage of NHS funding into general practice fall from 10.5% to 7.4% since 2005. Yes, the Government has pledged an additional £250m to help ease winter pressures in England, but that money has been directed to A&E and NHS 111. Where is the additional resource for GPs?

The GPC is continuing to fight for the vital shift of resources into general practice, and as part of this year’s contract agreement we have managed to stop some of the box-ticking and most damaging effects of last year’s imposition.

However that doesn’t help us now – we have to start doing things differently ourselves. We must enable patients, as much as we can, to start taking control of their own health and change the way we practice if we are to cope with what is ahead. We must equip patients with the knowledge and confidence to know when to seek help and when it is safe to manage their own illness.

There’s no better time to kick-start a self care-aware approach at your practice – it may just help you cope this winter. The Self Care Forum has a raft of resources freely available on its website to help, including a new initiative Treat Yourself Better without Antibiotics as well as information for patients about managing the top ten common ailments, normal duration of symptoms and advice about red flags and when to see a GP.

Skills for the long-term

We need to have a commitment to enable self-care that goes beyond just meeting winter pressures, but helps us meet the demands of a growing elderly population where long-term conditions are the norm. Self care is not just for treating minor ailments, it’s about supporting patients to optimise their health long-term.

The new GPC consultation document Developing General Practice Today Providing Healthcare Solutions for the Future sets out the solutions to some of the most difficult challenges the NHS faces and how general practice needs to be supported and developed to achieve its full potential. It raises self-care as a potential solution along with integrated care, closer to home, supported by extended teams built around the GP practice with patients empowered as partners in managing their own conditions.

But GPs can’t fit anything else into a packed consultation - it takes time and resources to enable us to deliver patient education. A national campaign for patients, and local and national incentives could help self-care aware consultations become the norm, an investment to save long-term. To that end, the Self Care Forum recently produced a mandate with a six-point action plan calling for an open and honest debate about the future role of the NHS.

The push for 24-hour convenience is fuelling patient demand when the NHS is not adequately funded for need, let alone want. Unless we have an honest debate about appropriate use of resources and help patients help themselves stay healthy the NHS in my view unsustainable. Let’s support self care – not just to help our workload this winter, but for our patients’ health and the future health of the NHS

Dr Beth McCarron Nash is a GPC negotiator, member of the Self Care Forum and a GP in Truro, Cornwall.


GOV.UK. Hunt - NHS must fundamentally change to solve A&E problems. 10 September 2013.


Readers' comments (5)

  • I agree - but the politicians/media will simply direct the public into contacting their GP at the first sign of a sniffle and demand to be seen. Punters no longer seem capable of self-managing minor illnesses. Jeremy Hunt seems to think all GPs do is see those with minor illnesses and lays the blame firmly at the GP door for all those patients attending A+E inappropriately, instead of advising self-management. A+E's should be allowed to simply refuse to see those who should not be there.

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  • Beth is correct, however the reality of the situation is that while GP practices swiftly become the only "fixed cost unlimited volume" providor contract in the NHS there is not the political will to address this.
    The system places us in contract jeopardy for failure to see a person with a cold the same day , as well,as more "proactive health promotion" and a community role of day to day management of indiciduals with complexities of their co-morbidities that used to be in the realm of a general,medical outpatients department.

    The only perspective clinical comissioning has taught me is the the "owner operator and small business" component of the NHS is doomed because:-
    bears a disproportionate provider risk, has to struggle to,get any kind of resource based on throughput
    , runs the largest "quality target" related pay component,
    Can have its contract withdrawn and close without a ripple in the health economy,
    Whilst in contrast :
    large foundation trusts have joined the banks in the "too big to fail" and are supported by unbounded bailouts for failure and poor performance from central government.

    And the end game - we all end up,salaried in HMO type organisation with an explicit"
    get more clinical contacts than last years organisational average or pick up your P45" hamster wheel.

    And by all I mean primary and secondary care medical staff, Nursing and professions allied to medicine.

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  • Why not use homeopathy for colds and other infections? Saves clogging up surgeries and it works.

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  • Some families don't even have a basic first aid box!

    It is about time that patients that are not an emergency were turned away from A&E and told to go to their GP.
    Anyone under the influence of drink / drugs should be banned from all NHS premises!

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