Boost self care to cut consultations

Join forces with a local pharmacy to help reduce unnecessary consultations, suggests, Dr Paul Stillman.

Consulting rates in general practice have always increased throughout the NHS's history.

More recently, the move from a responsive service to one also concerned with screening and monitoring has brought people into the surgery who would not formerly have had the need to visit.

With extra demands such as these, and the unpredictable nature of presentations for acute illness - where some people demand urgent help for conditions that others are prepared to delay - many doctors have found that responding to self-limiting problems is an inescapable part of primary care.

The promotion of self care might seem a lost cause for many patients, and not a profitable use of professional time.

Bad attitudes

The beliefs, attitudes and expectations of at least a substantial sector of the population, often fortified by the convenience of prescription charge exemption, overwhelm any efforts in health education.

Therefore, each day there are a staggering 300,000 consultations for conditions that do not need medical intervention, at a cost of £7.5 million.

Self care is essential if primary care is to evolve and specialise, taking a substantial share of the work traditionally done by secondary services.

Enormous investment has been made in agencies such as NHS Direct, drop-in centres and minor illness centres.

These are seen by the government as alternative sources of information that do not involve the GP, whereas general practice sees it as a further stimulus to dependence on professionals for minor ailments.

Access to information

People who practise self care will need access to sources of information they feel they can trust.

A survey by the DoH in February 2005, 'Public Attitudes to Self Care', confirms the GP at the top of this list of advisers (85 per cent) with the pharmacist only third (68 per cent), behind family and friends.

The internet is rising in popularity (42 per cent) ahead of NHS Direct (33 per cent) and walk-in centres (14 per cent).

If we are so valued as sources of advice, why do we find it so difficult to affect future behaviour?

Perhaps, despite the changes in consulting style where it is becoming more patient centred, we still find it quite difficult and often inappropriate to let go of our ownership of the consultation.

A seemingly well child with a respiratory infection still needs examination.

It might be negligent not to examine, even if this reinforces the belief in the medical expertise needed in what, for many, will be minor problems.

Promoting self care

Yet do we have time to fulfil the needs of the consultation, promote self care and explore what actions the patient might have already taken in managing their symptoms?

We need to be recognised as an important source of both advice and reassurance when appropriate, while avoiding the temptation to intervene in self-limiting conditions.

For common ailments, the GP is consulted more than the pharmacist (see box), yet for the majority of symptoms the pharmacist is always a good alternative.

More information needs to reach people about the help that can be provided by the pharmacist and, as GPs, we should endorse this behaviour.

Answers to the questions in the box below on tips for self care can help build upon the patient's own efforts and encourage self-care behaviour.

Providing reassurance that nothing more serious exists, the doctor can support and advise without taking over the care of the patient.

In many instances, the strategy chosen by the patient might be sound, but the duration is too short.

Success will be influenced by endorsing any current self-care behaviour and building on it, while placing other members of the primary team as consultants to stress the role of the community pharmacist who, in turn, will advise on the wide range of available treatments.

- Dr Stillman is a GP in Crawley, West Sussex

WHERE PATIENTS SEEK ADVICE

Minor ailment GP Pharmacist

Cold 74% 30%
Headache 82% 12%
Sore throat/cough 80% 23%
Stiffness in joints/back pain 76% 7%
Muscle aches/pains 79% 7%
Indigestion 84% 17%

TIPS FOR SELF CARE IN YOUR CONSULTATIONS

Try these questions:

- How long have you had the symptoms?

- What treatment have you tried and for how long?

- What were you trying to achieve by doing this?

- How has it worked?

- Have you stopped doing what you tried - and why?

- Do you think you have given your own treatment enough time?

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