Editorial: Self-care is almost being without a care

Pour a cup of tea, put your feet up, and relax. Don't worry about seeing those pesky patients - you'll be doing the DoH's bidding.

It's true. The DoH, and in particular its primary care czar Dr David Colin-Thome, wants to pay you for not seeing patients. As part of the recent health White Paper's emphasis on self-care, Dr Colin-Thome has suggested that in future, the quality framework includes an indicator to measure how successfully practices help patients to manage their own conditions.

His alternative idea is to include a question on self-care in the patient survey, and make yet more payments dependent on patients' memories.

The concept of making patients more able to manage long-term conditions should be a positive step for patients and practice staff alike - at least for those patients who are comfortable with this approach. But the idea of paying GPs for it through the quality framework is definitely backward thinking. The quality and outcomes from this project rest with the patients.

Relying on the patient survey is a meaningless approach which depends on patients' understanding of what self-care is, and identifying that advice for when to use inhalers, or monitoring their blood sugar.

If it is appropriate to reward GPs for instituting schemes to increase self-care in long-term conditions - and that depends on whether self-care education forms part of normal practice or involves running actual workshops and courses -then surely the correct system would be to develop a national enhanced service setting out standards for the schemes.

This is yet another example of the DoH not fully understanding the mechanisms it has put in place.

Meanwhile, as those in Whitehall work out exactly how to institute this latest bright idea, you can take the time to think how you might use the time freed up by these marvellous self-managers.

Perhaps you could open a rheumatology clinic, revise for your knowledge test, or revalidate your practice nurses ... yes, that's on the DoH's list too.

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