Primary care 'unsustainable' without self-care overhaul

General practice will be unable to meet demand in the near future even with added investment and recruitment unless more patients with chronic illness self-care, an expert has warned.

Health policy analyst Angela Coulter: advocates self care
Health policy analyst Angela Coulter: advocates self care

Primary care must make better use of the ‘untapped resource’ of patients themselves, according to Angela Coulter, a health policy analyst from the University of Oxford and honorary fellow of the RCGP.

Speaking at the RCGP annual conference 2013 on Friday she added that the NHS was ‘failing’ patients with chronic conditions.

The number of people with multiple health conditions is likely to rise from 1.9m in 2008 to 2.9m by 2018, according to the DH.

Ms Coulter said multimorbidity was the biggest issue facing primary care with respect to long-term conditions.

An analysis of data from the CQC’s annual adult inpatient survey by Ms Coulter’s group found patients with multiple long-term conditions are less likely to feel involved in their care than patients with one or no chronic conditions. These patients’ families less frequently received information to help them with support and recovery.

In her speech to the RCGP conference yesterday, Ms Coulter said: ‘We are failing people with long-term conditions. We’re not doing as well with them as we probably need to.’

She said the GP contract and the QOF ‘encourages GPs to think along disease silos’. ‘In fact, what patients are saying is: "We’re not a collection of diseases, we are [people] trying to live with these conditions, and we need co-ordinated support to help us do that".’

‘Even if all those extra GPs that we’ve been promised are going to be recruited, even if there is more money going into general practice instead of less, I still think that it won’t be possible to keep up with demand, unless this untapped resource of the patient is really the starting point for planning a new way of working.’

Dr Sue Roberts, former national clinical director for diabetes, urged GPs to change how they conduct consultations to incorporate more care planning for patients so they feel more involved in their care.

She said this should include routinely choosing health goals with patients and setting out the actions they can do to achieve them. ‘It needs some new skills, thinking about supporting people to become problem-solvers in their daily life, rather than just with you in the consulting room.’

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