Unblocking primary care: time for a self-care revolution

Workload and capacity challenges are on the rise in the NHS. One thing that could make a difference is heavily promoting a self-care agenda, to help manage increasing demand and ensure resource is committed where it is most needed.

Minor conditions now take up 15% of all GP time

In October 2016, the Local Government Association released a report ‘Helping people look after themselves’[1] which highlighted some statistics which would be funny if the implications weren’t so serious – including, more than five million GP appointments a year are for blocked noses and 40,000 GP appointments a year are for dandruff. Whilst this may appear bizarre, it is potentially very worrying. It is estimated that contacts relating to minor illnesses and conditions account for over 15% of all activity in general practice, equivalent to 90 mins per day for every GP and Practice Nurse.

Feeling the pressure

The Kings Fund report ‘Understanding Pressures in Primary Care’, released in May 2016, identified a significant workload increase for GPs and their staff. Survey studies and data revealed that total contacts with patients increased by 15.4% across all clinical staff groups between 2010/11 and 2014/15. During the same period, the average patient list size increased by 10%.

With more patients seeing their GP more often and taking more time in each appointment, tiredness, dissatisfaction and stress levels of General Practice staff are consistently cited as being on the rise. With clinical models increasingly focused on driving more activity into the community, pressure on GPs is likely to rise further. How will the service continue to thrive if demand keeps rising? And, is it appropriate for patients to go to their Doctor for minor ailments?

Managing demand is critical

The natural conclusion is to enhance our promotion of self-care and prevention. This means two things: patients learn where to go for the most appropriate care (perhaps being directed to pharmacies for more minor ailments rather than GPs or A&Es); and the population learns how to look after itself and prevent illness in the first place. Doing these will help to manage demand on the overall system – not just on the GP workforce.

This requires investment in Self Care and Preventative services. Educating the public is vital, but in the short term comes at a price. Whilst funding is tight, it will be a challenge to convince planners to direct resources towards self-care – this will inevitably be viewed as reducing focus on front line services, and the return on investment is unlikely to be seen in the short to medium-term. It will take bravery and foresight, but in the long-term the benefits (for health, cost and workforce viability) are clear. 

Technology and IT can also play a crucial role. Health apps are increasingly popular, and can support the public to be better able to manage health and prevent sickness (think Fitbits, My Fitness Pal, portable heart rate monitors). They too can help to direct people to the most appropriate profession when sickness does strike.

A combined approach

A combination of measures will be key to encouraging self-care. Investment in educating the public will be vital, with self-care and population health becoming key measures of success for our health system.

[1] http://www.local.gov.uk/documents/10180/7632544/1.20+Helping+people+look+after+themselves%3B%20a+guide+on+self-care/b0798a77-5266-46ef-b734-a77eb28523d6

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Alex Goodman Manager