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Chapter 4 - part 2
Getting organised for supporting self
care as a general practice team
Stage 2: choosing one or two conditions to focus your self care support initiative on
The interventions you select will depend on your practice priorities and target groups. Tool 13 will be key to action planning as it assesses the clinical and organisational workload generated by a variety of example health conditions. Then consider what you and patients can do in respect of those conditions in relation to:
P: Preventing the condition developing
A: Awaiting resolution of the symptoms
R: using self care skills for Relief of symptoms
T: learning to Tolerate symptoms that do not resolve or cannot be reasonably
alleviated.
Your PCT may be able to support your efforts with parallel community initiatives
Try out on a patient pathway to self care
Chapters 10 to 13 illustrate four different patient pathways in relation to conditions
about which patients commonly consult their GP or triage nurse, and for which there
are plenty of self care options: sore throat, back pain, asthma and cough and colds.
Work through one or more of our example patient scenarios and fictional practice
team action planning in Chapters 10 to 13, as a practice team. You can:
- read through a patient story and the discussions and actions the fictional practice
team take in responding to the patient story to optimise self care. Then consider
how it applies to your practice
or
- substitute your own patient story – a recent consultation maybe – and get ready to work through the same stages as the fictional team to get your own action plan and outcomes.
The learning issues that could result from such a team discussion appear throughout
the sequence of the scenario. What you discuss and learn depends onmembers of your
group, their situations, their interests, your resources, and the skills of your facilitator
or lead. Examples of advice and guidance you might relay to patients are given in each
chapter. Alternatively, you can direct them to the associated algorithm from NHS
Direct.12
Choose one of the four conditions we have illustrated or use your own topic, and research the various self care support options or look at more examples on the WiPP website.2 To decide your priority conditions, identify the frequency with which patients are consulting for specific conditions in your practice or group of practices, using the workload assessment tool (see Tool 13). After that, focus your initial activity for supporting self care for people with long term conditions whom you identify as being frequent consulters at your practice, or who have had several emergency admissions in the last 12 months. Tool 3 (SWOT analysis) or Tool 5 (gap analysis) might help you select which interventions will be a priority for your practice. Read through Chapter 2 for more ideas on self care support initiatives that others have tried, that you could adapt. Consider the resource implications of your chosen interventions using Tool 8.
Stage 3: keeping going
Look back at Figure 4.1 which maps your route to establishing a self care culture
across your practice with self care routinely promoted effectively.
Everyone in your practice team should be clear about practice goals, their roles and
responsibilities, the timetabled programmes for improvements, and standards
required.
Overcoming barriers and facilitating change
The most commonly perceived barriers to supporting self care initially in the Joining Up
Self Care initiative were described in Box 3.5 (see p. 40).
Encourage team members to keep a learning log during their everyday practice, as
in Tool 15, or to undertake a significant event audit relating to trying to promote self
care – and succeeding or failing (see Tool 12). Consider what worked well, and what
got in the way, using Tools 12 and 14 or any other Tools. Then find solutions to
overcome barriers and move towards supporting self care as part of everyday practice.
Establishing support and development
Concentrate on meeting team members’ learning needs (see Tool 10), sustaining good teamworking (see Tool 11), encouraging reflection on performance and learning from experience (see Tool 15). Rethink the way that you book consultations and that patients access services so that there is time to promote self care during consultations (see Tool 16). Check everyone has self care as a priority for learning and service development, using Tool 17.
Supporting self care
You need to encourage good patient-centred consultation techniques across the
practice team. Advocate Tools 19 and 20 to check out everyone’s consultation skills
and styles. You could use Tool 21 as a core component of a workshop on self care
aware consultation techniques for an in-house workshop. Complete our aide me´moire
(the last stage of Tool 21) as a progress report to trigger reflection on improving your
approach (see Box 4.3).
Box 4.3: |
Remember that promoting self care will be tough. Anything new that requires patients to make significant changes will be difficult and, to your team already working under pressure, may seem an overwhelming task. Encourage your workforce and health professional community to look after themselves too. Tool 18 is a good start, for individuals to map out the types and extent of support in their own lives, and see which sources of support can be boosted.
Stage 4: monitoring and evaluation
Evaluation is an essential component of any programme or service. Incorporate it into
your action plan from the beginning, matched to your vision and aims. Keep it as
simple as possible and do not waste resources on unnecessarily bureaucratic evaluation.
Use Tools 9 and 12 to undertake audits of self care outputs and activities being
generated by your self care support strategy and its implementation. Look at Chapter 9
for more on evaluation.
Mainstreaming and sustaining a self care culture in your practice
You will have generated a co-ordinated series of activities and developments leading to the promotion of self care among patients with the priority health condition(s) you have selected. Re-assess your priorities and resource needs as you gather data evaluating your progress to date. You will be moving in a circular fashion to reexamine barriers to progress and facilitate further change (see Figure 4.1).
References
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