Barriers to self care caused by NHS structures and risk-averse culture

To mark Self Care Week, PAGB, the consumer healthcare association, has published an analysis of the barriers preventing wider adoption of self care policies and identifies current NHS structures and a risk-averse culture as key challenges that need to be overcome.

During a recent PAGB roundtable with healthcare professional representatives, participants noted the risk averse culture in the NHS, which encourages clinicians to follow rigid and inflexible pathways that result in a transactional relationship with patients. People themselves are also risk averse, often opting to visit the GP ‘just in case’ their symptoms are the sign of a more serious condition.

NHS structures and IT systems also act as barriers to more joined up working, preventing the easy sharing of patient records and supporting referrals between different professionals.

PAGB’s analysis looks at three policy initiatives which would support and empower more people to self care but have not yet been widely implemented. It examines the potential barriers to implementation and highlights case studies where local innovation has overcome these.

• Clinical Commissioning Groups in Sussex have introduced the use of recommendation prescriptions to support local GPs in referring patients to self care and to the local pharmacy for advice. As part of the #HelpMyNHS campaign, they developed a resource pack to support GPs to promote and implement a self care ethos in their practice.

• Encouraging people to visit the pharmacy first, puts the pharmacy at the front door of the NHS. Enabling pharmacists to refer on to other services when required is an efficient way of ensuring people can access the right care. South West London Cancer Network ran a pilot programme giving community pharmacists direct referral to chest x-rays for patients with suspected lung cancer. The 12-week pilot found that the vast majority of direct referrals made by pharmacists were appropriate.

• To support pharmacists in performing a more clinical role and to offer people continuity of care, pharmacists should have read and write access to medical records. In Sheffield, local collaboration between the GP and pharmacy is being delivered using a laptop in the pharmacy that has a connection to the GP practice system. The community pharmacy has read/write access to the system and is able to update patient records in real time. The collaborative work is underpinned by a data sharing agreement between the community pharmacy and GP practice.

John Smith, PAGB Chief Executive, said:

“The benefits of self care have been widely accepted, supporting people to take responsibility for their own health and wellbeing gives them faster access to advice and effective treatment and reduces unnecessary demand on GP and A&E services. Yet despite this, the NHS has been slow to adopt policies that would support more people to self care.

“It is clear from our analysis that when local healthcare professionals work together, the barriers to self care can be overcome. Renewed effort is needed to expand these areas of best practice across the country so PAGB is calling on the next Government to introduce a National Strategy for Self Care and provide the national leadership needed to unlock behaviour change and empower local areas to maximise opportunities to self care across their populations.”