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What is self-care?
Self-care is about more than managing minor
self-limiting conditions. Self-care is a person’s ability
to look after themselves and their family. It includes what an
individual does to stay
healthy, to manage minor ailments and to manage chronic conditions.
More information about self-care is available in a new PAGB booklet
called “Advancing self-care: helping people take care of
their own health”. It can be obtained from the PAGB at www.pagb.co.uk or by telephoning 020 7242 8331. |
Self-care is high on the Government agenda. But ask most people what
self-care means and they will not be able to expand beyond “looking
after yourself”. The concept has been hard to grasp. So what does
self-care mean in reality? This was addressed by a conference this week
organised by the Proprietary Association of Great Britain.
Self-care includes all the decisions and actions that people take in
respect of their health. This covers not just treating illness, but being
able to recognise symptoms, knowing when to seek advice and making lifestyle
changes to prevent ill health.
Speaking at the PAGB conference, Professor Mike Pringle, University of
Nottingham, described self-care as a jigsaw: it is about providing patients
with the confidence, skills, information, equipment, professional back-up
and peer support to enable self-care. But he cautioned that the barriers
to this are formidable. They include a lack of skills and confidence
among the public, an unwillingness among some professionals to empower
patients and a lack of user-friendly equipment. What self-care is not
about, he said, is telling people what to do. Instead, it is about helping
people make decisions. “We have to make sure that people understand
the disease and that they have the confidence and skills to make decisions
and choices,” he commented.
Government agenda
Health minister Rosie Winterton told the conference: “Self-care
is one of the key pillars of the NHS plan.” The NHS plan states: “The
front line in health care is the home. Most health care starts with people
looking after themselves and their families at home.”
The NHS expert patient programme is one aspect of self-care. It supports
people self-managing chronic illness. Other Government initiatives that
demonstrate the commitment to self-care are NHS Direct, walk-in centres
and the appointment of a new director for self-care (see p482).
However, despite these developments, Sheila Kelly, executive director,
PAGB, said that funding to support self-care is low, there is no delivery
programme of self-care and good examples of self-care are not widely
disseminated.
To help address this, a new project to promote self-care was announced
at the conference. The project, “Joining up self-care in the NHS,” is
being led by a steering group representing health professionals, and
local and strategic bodies in the NHS.
The project will tackle the prevention of coronary heart disease in adults,
offer a minor ailments scheme directed at mothers and families, and provide
management of asthma aimed at parents. For the CHD programme, interventions
will include making risk assessment available in places such as the workplace,
public houses and pharmacies to encourage people to change their lifestyle.
Public campaigns to advertise the minor ailments scheme are planned.
The asthma programme is about developing expert parents.
The next step is to establish funding and a PCT will be selected as the
location for the project. The project is planned to start next July and
run until April 2005.
Developing self-care
A clear theme that emerged at the PAGB conference was the potential for
pharmacists to play a greater role in self-care.
Ms Winterton said: “Community pharmacies have traditionally been
a place where people go for advice on self-care. This traditional role
is being expanded in many areas with the support of PCTs.” She
added: “But this role can undoubtedly be developed further nationally.”
Growth in OTC medicine sales has not been seen despite the availability
of new medicines. Dr Simon Fradd, chairman, Developing Patient Partnerships,
said: “I don’t believe that this is driven by finance. The
problem is that the public does not know the range of medicines available
to buy.” He suggested that appropriate dispensed medicines should
be labelled “this is also available for retail sale from a pharmacy”.
Minor ailment schemes: examples of self-care
Minor ailment schemes have a new focus on the
health agenda. Professor Alison Blenkinsopp, University of Keele,
reported that a national
survey of PCTs showed that 75 per cent of PCTs planned to have
or had such a scheme in place. The National Pharmaceutical Association
will produce a tool kit for establishing minor ailments schemes
in a few weeks’ time.
• Self-care in community pharmacy Under a scheme
in Peterborough, Cambridgeshire, community pharmacists write
about 170 prescriptions
a month for minor ailments at an average cost of £1.57 per
item. In addition, a patient group direction is used for chloramphenicol
for conjunctivitis. Future PGDs are planned for contraception,
smoking cessation, urinary tract infection and impetigo.
• Self-care in GP practices When patients consult Monkfield Medical
Practice in Cambourne (a new town near Cambridge) with a minor
ailment, the receptionist guides the patient away from a traditional
GP consultation and instead offers a consultation with a pharmacist
or nurse. This helps to promote future self-care.
• Self-care in out-of-hours services Fylde Coast Medical Services
offers an out-of-hours
service (PJ, 26 April, p568). Since May
this year, a local pharmaceutical service contract has allowed
pharmacists and nurses to take calls about minor ailments. They
now manage 20 per cent of the total workload and prescribe fewer
drugs than GPs. |
Dr Fradd is concerned that the minor ailment schemes that allow patients
to obtain medicines free of charge from community pharmacies being developed
in Scotland have not had similar support from the Government in England. “If
you are receiving benefits then the thought of buying OTC drugs is an
anathema,” he said. “I will go on fighting the Government
on this; the discrimination against the poor is absolutely appalling.” He
added that since many PCTs are deciding to develop minor ailment schemes
at a local level that there would be many different schemes across England:
a unified approach would be better (see also Panel, left).
Meanwhile, Dr Paul Stillman, a general practitioner in Sussex, highlighted
the challenge of good communication. Consumers have to be provided with
sufficient incentive to undertake self-care, he said. “To make
self-care work it has to be seen as desirable and pleasurable by consumers,” he
said. This includes convenience, satisfaction and pride. “Self-care
must be supported, encouraged and rewarded,” he said.
An important message from Dr Fradd is: “Self-care is not about
rationing NHS resources, it is about better care.” In order to
achieve this better care, attitudes of patients and professionals need
to change. When patients are asking about their medicines next week,
pharmacists have the ideal opportunity to talk about self-care. |
