Putting Self Care Into Practice

26 • Self care 17 August 2012 Putting self care into practice Integrating self care into everyday practice ensures consistent messages for patients – but requires the involvement of the whole practice team

ecognising the important role self care can play in the battle for NHS survival is an R important step for practice nurses. A far harder step is ensuring self care becomes an essential component of everyday practice. And the burden should not only fall upon the nursing team. Promoting self care at every patient interaction – from the receptionist and the healthcare assistant through to the nurse practitioner, the practice nurse and the GP – ensures the patient receives a consistent message. With the changes underway from the Health and Social Care Act 2012 (England),1 there may not be a better opportunity to enshrine the principles of self care into daily practice, but what changes are needed to deliver this within your practice ?

SUPPORTING SELF CARE In 2009, the Department of Health outlined different categories of self care support and also the expectations and knowledge needed for healthcare Encouraging professionals to support self care for patients to take patients.2 control of their The four categories are:2 Information – particularly for those health is essential with long-term conditions. This should not simply focus on health but take a whole systems approach, providing information on social care and voluntary services, housing and education. Have information available within the practice that patients can to Sara Richards RN access, or can be signposted to Specialist Primary Care Nurse, Practice Nurse Facilitator, Berkshire Skills and training – encouraging Self Care Forum Board member patients to take control of their health is 17 August 2012 Self care • 27 essential. While they are the person who resources and technology available that conditions,3 often with nurses involved knows the most about their condition, can be used to self care for minor in providing support and advice. The albeit minor or long-term, they often do ailments and long term conditions is use of mobile phone apps to help not realise that they can self care most important. For example, highlight the patients monitor long-term conditions of the time. It is as though they need role of the pharmacist to patients; not will become increasingly important, permission from a clinician to do so. only can they offer advice on minor with free apps being available to Providing training and awareness ailments but many pharmacies offer ‘prescribe’ from the surgery in the sessions within the practice, referring to medicine use reviews or are involved in future, said the DH earlier this year.4 the Expert Patient Programme or support for those with long-term Patients can be directed to apps involving the practice’s Patient conditions. There is also a role for new available through NHS Choices and NHS Participation Group can give patients technologies. Currently there over 1,000 Direct that offer symptom checking and the right skills and knowledge to be able small trials underway globally to trackers for smoking, drinking, BMI and to self care. determine the impact of telehealth in exercise. Tools and devices – awareness of the helping patients manage their long-term Support networks – involving ibrary Encouraging self care requires L hoto a whole practice approach, P but change begins with one cience champion – the practice nurse? /S arney V im J

4 17 August 2012 Self care • 29

4 Table 1: Top 10 minor ailments TOP TIPS FOR PRACTICE by consultations per annum7

Work with the practice to develop Minor ailment Total consultation Total Rx cost • a coherent, consistent approach to (millions) (millions) self care so patients get the same Back pain 8.4 £64.0 message repeatedly, from the receptionist to the doctor. Dermatitis 6.8 £35.3 Bring the GP team on board with Heartburn and indigestion 6.8 £54.0 • self care, this validates the self Nasal congestion 5.3 £17.4 care messages from the rest of the practice team. Only when all team Constipation 4.3 £22.2 members see the team leaders Migraine 2.7 £51.9 valuing and actioning self care will Cough 2.6 £9.0 they recognise the need to adopt the practice too. Acne 2.4 £25.7 Start with minor ailments. Run Sprains and strains 2.2 £12.1 • an audit on the number of minor Headache 1.8 £11.7 ailments seen in a practice in a given week. How much time could be saved per annum if just 10% of these patients undertook self care? patients in their needs assessment can and repeated interventions to nudge the place them in the centre of their care patient along the path to effective self • Think self care for every patient package, can improve quality of life, care. If we are honest, as healthcare interaction: from advising on a minor ailment to signposting to an Expert services and patient satisfaction. professionals we also need nudging Patient Group or further sources of Recommending a support group can along this route too. information for patients with long- also help. Teaching patients self care skills is not term conditions. Being able to provide these categories enough, change is needed to the way Involve the Patient Participation of self care support places additional we think about self care with an • Group and other service users to demands on the healthcare care team, approach that engages both the patient, design, plan and get feedback on which the DH acknowledges. According the healthcare professional and the self care initiatives. 5 to the DH, healthcare professionals NHS. The National Primary Care Tap into other self care resources. need to have right skills and knowledge Research and Development Centre, • For example, the NHS Choose Well to be able to:2 Manchester University, advocates a campaign on summer ailments communicate effectively whole systems perspective to self care, encourages patients to use • identify people’s strengths and the WISE model (the Whole System pharmacy for minor ailments and • abilities Informing Self management understand when to utilise NHS provide advice on support networks Engagement model).5 resources, recommend apps from • promote choice and independence The WISE approach envisages NHS Choices, be aware of what • services local pharmacies can offer. • enable people to manage identified providing opportunities for patients to risks receive and utilise information through • Really listen to patients – create a provide relevant and evidence-based support and guidance from healthcare partnership in managing their health that recognises their fears and • information. professionals trained to be more concerns, while acknowledging that 6 responsive to their needs. This has to a patient fully engaged in self care WISE words take into consideration the different needs more support than being told Crucially, effective self care is not about ways patients self care and the current they can and should do it. a one-way dialogue where the healthcare system.5 For example, healthcare professional gives one-size- training for healthcare professionals in fits-all information, recommendation self care often focuses on certain and support, but requires the ability to healthcare groups or conditions, frame this support within the context of therefore training should encompass the patient’s own experiences, desires the whole team and can be applied to and concerns. How patients are any long-term condition and many equipped to manage their conditions minor ailments.6 In addition, the needs varies by background, socio- of the patient have to be considered, so economics, living arrangements, the patient feels in partnership with the locality and their own personal healthcare professional.6 experience.5 To facilitate this change in behaviour requires deep understanding 4 30 • Self care 17 August 2012

4 A patient who feels ‘fobbed off’ with a self care option will be back in the surgery soon

MANAGING MINOR AILMENTS How long have you tried this? frequency and duration to ensure they With minor ailments accounting for one • What were you trying to achieve by are appropriate and safe. For example, in five GP and nurse consultations in the • doing/taking this? in considering pain relievers, UK,7 encouraging patients to self care Has it worked and how? paracetamol is present not only in can also enhance patients’ ability to • Have you stopped doing what you analgesics but also in cold and flu manage long-term conditions when • tried and why? remedies, and patients need to be these arise. Adopting a self care for What would you do next time? reminded that ibuprofen should not minor ailments strategy within the • These questions can help you be taken by those with aspirin- practice can save substantial time and determine the patient’s willingness to sensitive asthma. resource in the surgery – as outlined in think about their health options, their the previous article (Practice Nurse, 20 potential for change (both now and in SUMMARY July 2012) minor ailments consultations the future), the reasons for the Encouraging self care requires a whole cost the NHS around £2 billion per consultation (is any one symptom of practice approach, but change begins annum.7 concern, is it duration of disease, is it the with one champion. As practice nurses, Table 1 outlines the top 10 minor need for a sick note and time off work?), it makes sense for us to be that ailments by consultation volume.7 A the patient’s reasons for consulting and champion and become the surgery self significant proportion of these the potential for suggesting self care at care expert. consultations are suitable for self care, the end of the consultation.8 • leading to a substantial cost saving and If self care is an option for a patient, The next features in this series will give freeing up valuable resources that can embark on a process of shared decision- practical advice on self care for the most be allocated for the care of more making. A patient who feels ‘fobbed off’ common minor ailments. complex conditions.7 with a self care option will be back in Changing behaviour in the the surgery soon, whereas a patient who management of minor ailments takes feels involved is more likely to try self commitment and time, both within and care and to be successful. The following outside of the surgery. The Royal College can help explain the benefits to the REFERENCES of General Practitioners has launched patient and foster a shared approach: 1. The Health and Social Care Act 2012. Available at: an e-learning module on self care for Acknowledge and praise any self care http://www.legislation.gov.uk/ukpga/2012/7/ minor ailments that is available for all • measures undertaken, whether contents/enacted 2. Department of Health Self Care Support for the healthcare professionals. This outlines non-pharmacological or Workforce. May 2009. Available at: UK:http://www. how to develop a self care consultation pharmacological dh.gov.uk/en/Healthcare/Longtermconditions/ approach that is responsive to patients’ Share information about why you do supportingselfcare/DH_084350. • 3. Sunday Telegraph Business Technology needs and acknowledges their previous not believe a problem is serious – this Supplement, April 2011. Available at: http://www. experiences. can help the patient recognise scribd.com/doc/61360105/Sunday-Telegraph-UK- symptoms in the future and realise Business-technology-supplement-April-2011. 4. Department of Health Press release. GPs to Undertaking a minor they can self care ‘prescribe’ apps for patients. February 22, 2012. ailments consultation Encourage a follow-up if symptoms Available at: http://www.dh.gov.uk/health/2012/02/ Begin every minor ailments consulation • persist beyond the expected duration apps/. 5. Kennedy A, et al. Support for self care for patients with two aims in mind: to exclude or deviate from normal – however, this with chronic disease. BMJ, 2007;335:968-970. potential ‘red flag’ symptoms and need not be in person in the surgery 6. Kennedy A, et al. Delivering the WISE (Whole encourage a self care solution. In the but could be via telephone or a visit to Systems Informing Self-Management Engagement) training package in primary care: learning from case of the latter this may not always be the community pharmacy formative evaluation. Implementation Science. possible. To understand the patient’s Promote the services of the 2010 : 5 :7. openness towards self care, take a • community pharmacy 7. Pillay N, et al. The economic burden of minor ailments on the national health service (NHS) in the history that includes the following Support any verbal advice with further UK. SelfCare 2010;1:105-116. questions: • information, e.g. a patient leaflet, or 8. Blenkinsopp A, et al. Joining up self-care: What have you already tried? Bear in advice on where to access credible evaluation of a PCT wide programme of support for • self-care. Primary Health Care Research & mind that this can include information, such as NHS Choices Development. 2009:1-15. doi:10.1017/ non-pharmacological options, such as Clarify a patient’s use of over-the- S1463423608000984. rest, a hot bath, etc. • counter medicines including dosages,