In an audit of our urgent same-day appointments, conducted to support a ‘Self Care Aware’ pilot in the CCG that runs into 2014, we found that around half were for minor ailments – cough, common cold, sore throat, and strains and sprains.
We have concluded that as a CCG and as an NHS we must challenge ourselves to reduce the time and resources we spend on unnecessary medical appointments for minor ailments.
Appoint a self care lead
Appoint a self-care aware practice/project lead who can coordinate and manage your self care aware activities on an ongoing basis. Engage the CCG in this area. People will need reminding from time to time to continue the self care aware effort, and someone needs to be appointed to coordinate the use of self care aware resources. There is a very good range of resource materials available from the Self Care Forum, www.selfcareforum.org, that can be downloaded and printed out for staff to use in their self-care aware consultations: for GPs there is the RCGP e-learning course on self care in general practice, and a ‘How to…’ guide to implementing a self care aware approach to demand management, as well as a self care aware ‘whole system’ strategy resource pack.
Remind colleagues that promoting self care can be used as evidence for appraisals
Give your team good reasons to engage in the self care aware effort. When people are busy, it’s easy to see new initiatives as ‘just something else I need to do’. We made it clear that self care aware messaging doesn’t need to take long – 20 or 30 seconds at most - and this is time well invested if it results in an appointment not booked next time. When we asked our GPs and nurses to do the RCGP e-learning course, we reminded them that it could be used to count towards revalidation, appraisals and CPD.
Involve your whole team in the challenge
Use the whole healthcare team in your self care aware activities, and if possible, make it a regular part of your clinical meeting – always think of self care. Receptionists, nurses, local pharmacists – they can all support the self care aware messaging. Staff can direct patients to the fact sheets, they can advise patients of the value in having a medicines cabinet at home and they can remind people that the pharmacist is more than happy to give advice and treatment, when necessary. The cost of these activities is virtually nil.
Audit your urgent appointments
Focus your efforts on the ‘same day’ and ‘urgent’ consultations. Consider doing an audit of those consultations. You could look at your prescribing of medicines also available over the counter (such as ibuprofen and paracetamol) as this is an area to tackle. We found that four or five minor ailments accounted for 50% of all our same day, urgent care consultations. In my practice these figures equate to around 25 appointments a day.
Develop an antibiotic prescribing policy
Back up messages with actions. There must be a consistent antibiotic prescribing policy, and consistent messaging from the whole healthcare team, including local pharmacists. Every contact must count: patients soon learn where the ‘chinks’ are.
Stop telling patients off
Don’t be afraid of raising the subject of self care with patients. Our approach is not ‘to tell patients off’ rather it is about giving patients some advice about ‘what to do next time’ – something the Self Care Forum factsheets really help with. As a general rule, we have found patients appreciate that surgeries are busy places and are happy to help the practice in any way they can. They are also happy to take on board suggestions that might save them a trip to the GP. Patients just need a little help to understand what is ‘normal’ such as that coughs can continue for two weeks and don’t need antibiotics
Save time by using ready resources
Make the widest possible use of available patient resources. The Self Care Forum website has a wide range of free resources for patients. These include patient factsheets on self care of common ailments – in our practice the factsheet on back pain is the most popular.
The Self Care Forum factsheets can be printed off and turned into reception area/waiting room posters/leaflets. Copies can be printed off and given/left for patients to take away.
This website also provides access to the Treat yourself Better Without Antibiotics campaign aimed at patients. The website features a symptom checker and warning signs support material, to help patients understand how long symptoms could last for and when it is appropriate to seek medical assistance.
Broadcast self-care advice outside the practice
Use local media to disseminate the self care aware message as widely as possible. Local radio and publications such as the local paper and church parish magazines, are often quite open to articles on health, particularly if they are written by the local GP, and these can be very effective in getting the self care aware message across. It is well worth pursuing: self care really is one of the few effective strategies for demand management in general practice.
Dr David Wrigley is a GP in Carnforth, Lancashire, and a member of the General Practitioners’ Committee.
