The Pharmaceutical Journal
Vol 269 No 7219 p520
12 October 2002

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Self-care: Pharmacists can play a part

This year the Proprietary Association of Great Britain’s annual conference centred on self-care and how it can help to manage demand in the National Health Service. Monika Polak (on the staff of The Journal) examines where pharmacy fits in

SELF-CARE is not just about expert patients effectively managing their long-term conditions day-to-day. It is about engendering a responsibility for one's own health in every individual, whether they have a chronic illness or whether they have a common cold.

The Government wants to move away from a paternalistic health service, where doctors issue prescriptions and dictate to patients, and where patients do as they are told. It wants to see patients and health care professionals working in partnership to achieve better health, and it sees self-care as integral to managing an ever-burgeoning demand. Pharmacists can play a key role in helping patients reduce their dependence on doctors and take a greater responsibility for themselves.

The NHS Plan states: "The frontline in health care is the home. Most health care starts with people looking after themselves and their families at home."

This ideal was reinforced in the Wanless report, published in April, which produced three scenarios for how the NHS could develop over the next 20 years. According to the report, the optimal scenario was a "fully engaged" system, where people would demand high quality care, but would also have a high level of involvement in relation to their own health.

Research conducted by the Proprietary Association of Great Britain shows that 25 per cent of minor ailments are treated with an over-the-counter medicine, but 10 per cent are still taken to the GP and only 1 per cent are taken to the pharmacist. The aim of last week's Self-care — delivering demand joint PAGB/NHS conference was to provide useful suggestions for the Government on how to engage the public more and get them to take up the self-care ethos that appears to be more prevalent among some of our European neighbours.

Health consciousness increasing

Health consciousness and personal responsibility for health are increasing, according to research carried out in eight European countries by the Picker Institute, a health research charity. Research officer Helen McGee says: "These general trends lead to an increase in OTC medicines, which may imply an extended role for pharmacists."

But although the research shows most people find pharmacists a useful source of information for prescriptions and OTC medicines, and they appreciate the role pharmacists play, they are not keen to see this role widen without further training. Ms McGee says patients have also expressed doubts over the benefits of changing more medicines from POM to P status: "There is a considerable amount of self-care in the UK, but some people are concerned about the availability of stronger OTC drugs."

Executive director of the PAGB, Sheila Kelly, says that any medicines switched from POM to P will need to have a high safety profile. But she maintains that people, especially those with long-term illnesses such as skin conditions and asthma, want more freedom to buy the drugs they need to manage themselves.

"This is something that came up when we had a stakeholders group looking at POM to P," she says. "They were very much in favour of buying their own medicines, as they had become experts in managing their own illnesses. It comes down to common sense. People with long-term conditions are more able to look after themselves, but others do not want to become engaged. The job for the pharmacist will be to help people move up and down that spectrum — those who are not confident can be sent back to the doctor."

Graham Lister, chairman of the College of Health, a patient-based charity, believes pharmacy organisations should do more to develop a vision of the role of pharmacists in self-care, as has been done in other parts of Europe. "In Denmark and Finland, their national associations of pharmacy are much more engaged in the system than our own. They have played a very active role in supporting self-medication," he says. "It's not that we are not doing these things, just that our industry seems much more intent on competing with itself rather than getting the pharmacist to be a more central element in primary care."

However, head of practice at the Royal Pharmaceutical Society, Nigel Graham, says UK pharmacists are already central to self-care. "It's part of our normal practice, due to a pharmacist's accessibility. People often come in to ask advice on how to self-care, especially for minor ailments. I think the pharmacy bodies are already pretty active in promoting self-care, through the work of the Doctor-Patient Partnership and other bodies — there are a number of campaigns running," he says.

Patient education is key

As well as national schemes, many local schemes are encouraging patients to visit their pharmacy for remedies and/or advice on self-care. One of these is a self-care scheme in Tyne and Wear (see Panel).

Dr Ian Spencer, who has been managing the project, says it has saved over 3,000 GP consultations so far. However, he recognises there is a danger that patients will simply transfer their dependence from the GP to the pharmacist, rather than take more responsibility for their own health.

"We are offering people a choice and giving them information, but I want more focus group meetings to test people's attitudes. We would like to see if giving people information helps them to help themselves," he adds.

Professor of pharmacy practice at Keele University, Professor Alison Blenkinsopp says: "What came out of our workshop [at last week's PAGB conference] was that an educational programme for the public is needed. There was a strong feeling that this should begin in schools. At the Salford conference on self-care [in January], another suggestion was to create a syllabus on self-care that people could do as evening classes or during the day as part of their local education authority adult education programme," she adds.

According to Derek Wanless, patients who are fully engaged with the NHS will expect primary care to do more diagnoses: "But if you are talking about a system that is short of capacity now, then everything possible has to be done to increase this capacity.

"Therefore, pharmacy and self-care have to be utilised — these should also be regarded as a resource within the NHS," he concludes.