Chapter 3
Getting organised for supporting
self care as a primary care organisation

This chapter describes how you can get organised in a primary care organisation to design a strategy and implementation plan in relation to supporting self care. The outcome should be a culture where supporting self care is integral to all the PCO’s functions; and the workforce promotes and supports self care in effective ways as part of their everyday work.

Stage 1: getting commitment - developing your vision

First ensure that you are committed to embracing the comprehensive strategy that Wanless envisaged, to

incorporate a wide range of approaches and models of self care, including finding ways of providing funding, information, facilities, equipment and technology to support its development.1

Identify a minimumnumber of champions in your PCT to promote self care and to join up as a working group. They will need to interact with key committees and individuals in the PCT whose support and commitment are essential to enable self care support interventions or evolve a self care culture. Make the case for a PCT strategy and implementation plan – as in the algorithm of Figure 3.1 (adapted from the Faculty of Public Health).2 Or use the Working in Partnership training programme (WiPP) to run an action learning set (see Box 3.1).

Box 3.1:

Using the WiPP multidisciplinary training package in a PCT Rather than a traditional working group run as part of PCT core business, you could use the WiPP training programme to work out your approach as a PCT to supporting self care, and implementing your plans. The WiPP website has instructions on running the action learning group and the facilitator’s handbook. 3 Use the electronic versions of the 21 tools (see Figure 3.1) reproduced in Part 3 of this book. Log your progress online. The training programme cannot be prescriptive, as participating PCTs will be at varying levels of expertise and have different capacity in their evolution of a self care culture. PCTs already have their own traditions as to how they plan and establish new initiatives, and the training package takes account of these. The exact nature of self care interventions and activities you prioritise will depend on local resources, the nature of your local population, the educational environment and enthusiasm of your local workforce.

Wepropose a minimumof three facilitated learning and development sessions with intervening associated work being undertaken by individuals and subgroups or committees. Some PCTs may organise more facilitated meetings – exact arrangements will depend on local preferences and capacity.

While a draft PCT strategy is developing, or has been evolved and agreed, those in lead or responsible positions in the PCT should involve general practice teams and other individuals and teams relevant to self care, such as patients and pharmacists, to revise and finalise the strategy and action plan. General practice teams and others involved in providing self care will then be encouraged and facilitated to mirror or adapt the strategy and actions relating to self care for their own teams in their workplaces.

A PCT might consider the following options:

1 running an action learning set in the PCT – around eight leads and champions who work together over a period of time (e.g. a year), meeting regularly (e.g. two-monthly) under the guidance of a facilitator (not necessarily present at all meetings)

2 a working group to establish self care support within the PCT, with minuted meetings and review of actions, to evolve and implement a self care support strategy; with a chair who is a champion for self care. This is likely to span a minimum of a year. Sub-groups may develop particular elements of the integrated self care support resources between meetings.

Who should you involve?

Include one or more of the champions in the following development areas who will assume leadership and take responsibility for:

overall strategy/development
co-ordination of the strategy action plan, learning lessons and subsequent change
co-ordination with other PCT initiatives and priorities and other stakeholders e.g. out of hours and emergency care, long term conditions, Expert Patients Programme (EPP),minor ailments schemes, the Quality and Outcomes Framework (QOF) in GP practices, pharmacy and dental contracts, local delivery plans, colleagues in secondary and tertiary care sectors or social services, community and voluntary groups
finance and other resources
education and training – facilitation of learning across the PCT
clinical governance – patient safety, risk
changing workforce
special interests e.g. health promotion, disadvantaged groups, patient and public involvement
monitoring and sustainability – cost effective review
clinical pathways and subsidiary protocols: to include self care support components
public health – interface with self care
communication and dissemination/public relations
liaison between discipline groups: e.g. general medical practice teams, community staff (district nurses, school nurses, health visitors, allied health professionals), pharmacy teams, PCT management, health trainers, community matrons.

Start with Tool 1 which explains how to undertake a force-field analysis and consider the positive drivers in your PCT for deciding to draw up and implement a strategy for supporting self care. You can derive many of the positive factors from the evidence for the effectiveness of self care described in Chapter 2. On the opposing side will be the negative factors you should take into account before committing to the strategy. Include them in your implementation plan in considering how to overcome barriers to change.

Having decided at PCT board level to proceed to draw up a strategy on promoting self care, use Tool 2 to help you work through the stages of drawing up the strategy and setting priorities. You might find Tool 3 useful to run an analysis of the strengths, weaknesses, opportunities and threats (SWOT) relating to establishing a culture of self care support in your PCT. Key steps are described in Box 3.2 and in more detail in Figure 3.1.

Box 3.2:

Developing a self care support strategy in a PCT

Agree the need for a self care support strategy

Develop a committed working group
Define clear and realistic aims and objectives
Appoint a project lead
Ensure the right people are involved and key stakeholders are with you
Identify and plan adequate resources
Maintain stakeholder commitment and motivation in a working group3

There are three key challenges for PCTs in supporting self care for people with long term conditions:

1 developing the skills of professionals to support self care – some health professionals
may mistakenly interpret self care as compliance with medical instructions

2 improving the provision of information about long term conditions and the local
services available

3 increasing the flexibility of service provision to fit in with patients’ other commitments. 4

The vision will capture the aspirations of your PCT. Your vision needs to be embedded in reality otherwise there is a danger of it becoming more of a hallucination! A clear, shared vision of the future will help shape change. The person responsible for communication needs to get everyone on board. Your vision should be underpinned

PCT perspective for establishing an intergrated resource to support self care

by the principles and attitudes underlying your values. Self care must be safe care and promoted for all in an equitable way.

Making your action plan

Consider the political, economic, sociological and technological (PEST) factors that will influence your PCT’s action plan, as in Tool 4. Or undertake a gap analysis considering where you are now (with unstructured self care support initiatives) and where you want to be (an evolving culture of self care support rolled out as an integrated resource across the PCT) – see Tool 5. Refer back to the vision you described
at the first meeting of your working group when defining your aims.

As a next stage, undertake a self care needs analysis to feed into Tool 4 and/or Tool 5 of your local population including minority groups. Consider the:

perceptions and expectations of your population
perceptions of health professionals providing the services – PCT employed staff and those in independent contractor practices
perceptions of commissioning managers and those responsible for providing services, based on available data about the size and severity of health issues for your population and known inequalities
priorities of the PCT and population linked to national, regional or local priorities.5

The ‘plan, do, study, act’ (PDSA) approach of Tool 6may be the model that helps you to construct your action plan. Map out a timetable for your prioritised actions – adapting the example Gantt chart in Tool 7 to include your actions and milestones.

Resource mapping

Think about resources you already have for supporting self care within your PCT and its constituent practices, and those you need. The infrastructure and resource matrix of Tool 8 should help you map out your current resources, and then plan what extra resources you need. This includes all kinds of resources – knowledge and skills and attitudes of your workforce, self care materials, other local stakeholders or partners in your self care initiative, your information resources or those freely available nationally, etc.

Remember you are not building up an integrated self care support resource on your own. Harness the enthusiasm of general practices, pharmacists and dentists who are promoting self care. Work with social care, community and voluntary groups and share their resources too. Work on creating a healthier community for your local population, with other local organisations who share that responsibility. A self care
support strategy can run through your joint initiative. There are several resource packs and toolkits you could use to guide you on a community-wide strategy in general, or specifically focused on a health issue such as reducing the prevalence of obesity.2,6,7 Box 3.3 includes some top tips on creating effective partnerships.

Box 3.3: Top tips for effective partnerships

Effective partnerships in relation to supporting self care should have:

shared vision and common priorities
a strategic planning framework – themes, population groups, areas, settings
strategic partnership structure and accountability arrangements
champions and leaders at strategic and operational levels
co-ordinated needs assessment and community involvement
cross-cutting commissioning arrangements
flexible use of resources – staff, money, time, facilities
a co-ordinated approach to mainstreaming initiatives
common local targets and indicators
partnership learning and staff development.8

Commissioning self care support: for your priorities and target groups

The commissioning section of your action plan will rely on the data you have gathered, the evidence for self care support (see Chapter 2), information from your working group and workforce, evaluation (see Chapter 9) and knowledge management. 9,10 Self care commissioners need to:

understand their population, knowing its needs and wants
understand self care and its norms, benchmarks and evidence
understand how to make change
have good processes in the PCT which enable decisions to be made quickly and
securely.

Use Tool 3 to undertake a SWOT analysis and/or Tool 9 to carry out audits of your current performance or application of resources relating to self care, to help you gather data about your baseline position, in respect of your patient population and any target groups. This should identify or reaffirm your priorities – the type of self care support and patient groups you will focus on.

Devising an education and training framework for the PCT in relation to the promotion of self care

Promotion of effective self care support as a common activity by health professionals will only happen if the workforce has the right knowledge and skills and a positive attitude to self care, as well as practical options for providing support. Your working group should consider agreeing an appropriate education and training programme for all health staff to meet the requirements of the PCT in establishing self care support (see Figure 3.2), before finalising the PCT’s self care support strategy and action plan. Start at the bottom of Figure 3.2 at the baseline and work upwards through the figure.

1 The baseline includes your starting point as regards the budget, numbers of staff, their skill base and the extent and quality of education and training activities Getting organised for supporting self care as a primary care organisation 35 available relating to self care. Think about knowledge, skills, and positive attitudes
and behaviour.

2 The next stage is the preliminary identification of the education and training needs of the workforce you are planning for across your PCT. This should take account of gaps in the baseline resources you identified, the short and longer term visions of development for your PCT, and how national, regional and local workforce planning strategies affect you. Anticipate workforce trends in designing your education and training programme. Otherwise delays will occur while you recruit and train new staff if you need additional personnel such as a PCT trainer to lead on supporting self care.

3 The constraints of your budget will start to bite as you begin to plan your education and training programme and turn your preferred vision into your affordable vision. Budget limitations, the workforce’s willingness to co-operate with the programme, and the need to make the programme relevant to service needs, other competing priorities and local issues, will all influence its design. The nature of your education and training programme relating to self care will be influenced by:

– the historical provision the workforce are used to and may be willing to take up (e.g. going to lectures)

– their preferences for particular modes of delivery (team members learning together and putting learning into action)

– current fashions (self care in this case; type of delivery such as e-learning)

– pressure from local champions or special interest groups like public health, for their favourite causes (e.g. encouraging healthy lifestyles, or the ‘Back in work’ campaign).

4 Once the affordable vision is agreed at a planning stage, provision can be mapped out. This should include meeting the needs of all the PCT/practice workforce involved in respect of:

– generic knowledge and skills e.g. interacting effectively with patients and the public

– uni-professional education and training e.g. special roles for reception staff or pharmacists

– multiprofessional provision whenever appropriate and practicable (to learn together around a protocol for particular conditions where self care is viable)

– managerial or organisational education and training for those with roles associated with evolving a safe culture of self care across the PCT.

Appraisal and evaluation of the skills, knowledge, attitudes and competence of the workforce involved should be a regular feature of any education and training programme, with feedback about achievements and gaps in provision at all stages in the cycle. Recommend Tool 10 for individuals in your working group or workforce at large, to help them identify their training needs – to be addressed by the PCT’s (or their employer’s) education and training strategy and implementation plan.

Framework for the education and training programme for a PCT in relation to supporting self care for patients and the local community

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Chapter 3 Getting organised for supporting self care as a primary care organisation