| Providers of health services still fail to pay enough attention to how
people can be helped to understand and take control of their own long-term
conditions, Lord Warner, Minister of State for NHS Reform, argues in
the Department of Health’s new self care guide. “As a result,” he
says, “resources are wasted, medication goes unused, people’s
health deteriorates more quickly than it should, and quality of life
is compromised.”
Supporting self care
This new self care guide, “Supporting
people with long term conditions to self-care — a guide to developing local strategies and good
practice”, is designed to be used alongside the White
Paper on community services for England (PJ, 4 February, p123) to help local organisations
and health professionals — including pharmacists — develop
strategies to deliver self care support for people with long-term conditions.
Such strategies should, it argues, be based on a combination of generic
solutions, good planning and individually tailored support. In addition,
the people who will use the services should be consulted during the development
of self care strategies. “If self care is based on this approach
it is likely to be more effective, and achieve significant benefits for
people as well as the NHS,” the guide says. Pharmacists’ role
The document outlines how health and social care services can support
self care through information, self-monitoring devices, education
and training and support networks. It also explains what pharmacists
should
be doing to help patients with long-term conditions care for themselves
and gives examples of innovative projects that pharmacists are running
to help patients take control of their own long-term conditions (see
Panel).
Pharmacy self care projects already under way
“Supporting people with long term conditions to self-care” describes
examples of good practice in self care support, including three pharmacy
projects. The head of pharmacy at Norfolk and Norwich University
Hospital, together with rheumatology consultants and a rheumatology
nurse practitioner, has developed guidelines for methotrexate therapy
for patients with inflammatory arthritis. An education programme
for patient self-administration of subcutaneous methotrexate and
study days for all health professionals were also organised and the
programme helped to address a number of safety issues around methotrexate
therapy.
In Manchester, a pilot scheme currently under way is allowing patients
with cardiovascular disease or diabetes to have consultations carried
out in one of 22 community pharmacies taking part in the project.
When patients visit the pharmacy to collect their medicines, they
are offered the chance to have point-of-care HbA1c and cholesterol
tests. In addition, the guide describes how the community pharmacy
diabetes service being run in 10 pharmacies in Hillingdon — a
personalised programme of health monitoring, education and medicines
management — is improving patients’ health and their
understanding of the condition. |
Community pharmacies can be a valuable source of information for people
suffering from long-term conditions, the guide says, because of their
convenient locations, because people can ask for advice without having
to make an appointment and because advice and support are often available
during longer hours than is the case for other health care providers.
The guide recommends that those developing a self care support strategy
should work with their local pharmaceutical committee to ensure that
community pharmacists are making the most of the opportunities in the
community pharmacy contract to support self care and medicines management.
Developers of self care support strategies should also, it urges, explore
how national initiatives for community pharmacy and medicines management
link into self care support initiatives. And support strategies should
aim to improve people’s knowledge and understanding about how they
can connect with the wider community and professionals working in GP
surgeries, local hospitals and health centres, community pharmacies and
social, voluntary and community groups.
The document also recommends that, to make the most of their advantageous
position, pharmacists should ensure that they maximise their expertise
in the effective and safe use of medicines and the promotion of healthy
lifestyles, particularly in relation to people with long-term conditions.
In addition, it outlines how the essential services of the community
pharmacy contract can be used to support patients with long-term conditions,
as well as those with minor ailments, to self care by signposting, providing
prescription-linked healthy lifestyle advice, online prescription ordering
and medicines use reviews.
The DoH also emphasises the importance of tools and devices in helping
people to monitor their conditions and control their medicines. It recommends
that health care professionals developing strategies for self care should
explore ways of making more self care tools, self-monitoring equipment
and technological aids available, as well as increasing support for their
use, and that all health care professionals should be “aware of
the tools and devices — both technological and non-technological — that
can make a significant impact on a person’s ability to live independently
with a long-term condition”.
Government commitments
The Government makes a number of commitments in the guide as to how
it will help to encourage support for individuals to take control of
their
long-term conditions. “The DoH will be taking forward work that
not only creates a clear self care competency framework for staff,
but also embeds key elements, including values and behaviours around
assessment and support in appraisal and continuing professional development
requirements,” the guide says.
To achieve this, the DoH says it will work with a range of organisations,
including Skills for Health and Skills for Care (to develop a self care
competency framework for all staff), NHS employers (to include self care
in the knowledge and skills framework, so that it is embedded in job
descriptions and annual appraisals under Agenda for Change) and professional
bodies (to include self care in core curricula). The DoH is also, the
guide reminds us, developing a health search engine to allow people to
find information they need and an accreditation scheme for information
providers to help people easily find trustworthy information.
The changes and tools outlined in the document set out to empower patients
with longer-term conditions to manage their own care with the help of
skilled health care staff, Lord Warner says. But, he acknowledges, minds — as
well as systems — will need changing if this is to succeed. “We
need to reach the stage where doctors, nurses, pharmacists, allied health
professionals and others recognise that self care is a real choice and
actively support the individual in this choice,” he says. |
The
Pharmaceutical Journal