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Introduction
SUPPORTING SELF CARE IN
PRIMARY CARE
Ruth Chambers
Gill Wakley
and
Alison Blenkinsopp
With the Working in Partnership Programme
Foreword by
David Colin-Thome
RADCLIFFE PUBLISHING
Oxford . Seattle
Radcliffe Publishing Ltd
18 Marcham Road
Abingdon
Oxon OX14 1AA
United Kingdom
www.radcliffe-oxford.com
Electronic catalogue and worldwide online ordering facility.
(c) 2006 Crown copyright, with the exception of the material listed on p.iii, which remains the copyright of Ruth Chambers and Gill Wakley.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner.
Ruth Chambers, Gill Wakley and Alison Blenkinsopp have asserted their rights under the Copyright, Designs and Patents Act, 1998, to be identified as Authors of this Work.
Neither the publisher nor the authors accept liability for any injury or damage arising from this publication.
British Library Cataloguing in Publication
Data A catalogue record for this book is available from the British Library.
ISBN-10 1 84619 070 3
ISBN-13 978 1 84619 070 4
The material listed below remains the copyright of Ruth Chambers and Gill Wakley.
- Chapter 3. Entire section on ‘devising an education and training framework for the PCT in relation to the promotion of self care’, including Figure 3.2 and Boxes 3.3, 3.4, 3.5 (pp. 35–41).
- Chapter 4. Section on ‘building your team’, including Box 4.2 (pp. 47–9).
- Chapter 5:
Section on ‘developing and sustaining an effective communication style’, including Box 5.1 and Figure
5.2 (pp. 54–6).
Section on ‘sharing decision making’, including Box 5.11 (pp. 60–4).
Section on ‘helping people change’, including Figure 5.3 (p. 65).
Section on ‘demonstrating your competence in relation to self care through a personal portfolio’, including Figure 5.4, Box 5.14 and Box 5.15 (pp. 69–72).
Section on ‘matching your knowledge and skills to the Agenda for Change framework’, including Box 5.16 (p. 72).
Section on ‘illustrative example of evidence to demonstrate that you are competent at enabling patients to adopt self care’ (pp. 72–4).
Section on ‘communicating risk to patients in relation to self care’, including Box 5.17 (pp. 74–6).
Section on ‘time management’ (pp. 76–7).
Section on ‘self care for you too ...’ (pp. 77–8).
- Chapter 8 in its entirety, including all tables (pp. 114–17).
- Chapter 9 text in its entirety, including all tables (pp. 118–22).
- Tools 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 17, 18, 19, 20 (pp.173–228 inclusive, excluding
Tool 13).
- Appendix 2 in its entirety (pp. 236–38).
Contents
Foreword |
vi |
Part 1 |
Making self care happen |
| Chapter 1 | Supporting self care Ruth Chambers |
| Chapter 2 | What we know about the practice and impact of self care Ruth Chambers |
| Chapter 3 | Getting organised for supporting self care as a primary care
organisation Ruth Chambers |
| Chapter 4 | Getting organised for supporting self care as a general practice
team Ruth Chambers |
| Chapter 5 | Getting organised for supporting self care as an individual
professional in the general practice team Ruth Chambers |
| Chapter 6 | Getting organised for promoting and supporting self care as a
pharmacy team Alison Blenkinsopp |
| Chapter 7 | Seeing self care from the patient’s perspective Ruth Chambers, Health First and Matthew Critchlow |
| Chapter 8 | Managing change – moving to a self care culture Ruth Chambers and Gill Wakley |
| Chapter 9 | Completing the cycle: evaluation Ruth Chambers |
Part 2 |
Illustrative patient pathways to self care |
| Chapter 10 | Illustrative patient pathway to self care: sore throat Gill Wakley |
| Chapter 11 | Illustrative patient pathway to self care: back pain Gill Wakley |
| Chapter 12 | Illustrative patient pathway to self care: asthma Gill Wakley |
| Chapter 13 | Illustrative patient pathway to self care: cough and colds Gill Wakley |
Part 3 |
Tools to help you plan and support self care Ruth Chambers and Gill Wakley |
| Tool 1 | Force-field analysis |
| Tool 2 | Devising your PCT/practice strategy and action plan to establish a new culture of promoting and supporting self care |
| Tool 3 | Strengths, weaknesses, opportunities and threats (SWOT) analysis |
| Tool 4 | The basic planning process: taking account of political, economic, sociological and technological (PEST) factors |
| Tool 5 | The gap model |
| Tool 6 | Plan, do, study, act (PDSA) model for improvement |
| Tool 7 | Timetable tasks with a Gantt chart |
| Tool 8 | Infrastructure and resource matrix |
| Tool 9 | Undertake an audit of how well established support for self care is in your practice |
| Tool 10 | Training needs analysis |
| Tool 11 | How well is your team functioning? |
| Tool 12 | Significant event audit |
| Tool 13 | PART/workload assessment |
| Tool 14 | Moving through change |
| Tool 15 | Keep a reflective learning log |
| Tool 16 | Reduce time pressures at work |
| Tool 17 | Check out whether self care support is a priority for training and whether the way in which you plan to learn about it is appropriate |
| Tool 18 | Draw up a personal map of support mechanisms in your life |
| Tool 19 | Assess your consultation skills and style |
| Tool 20 | Determine your consulting style |
| Tool 21 | Self care aware consultation style: encouraging, guiding and providing support to patients to adopt self care |
| Appendix 1 | Useful resources |
| Appendix 2 | Record sheet to plan and describe your progress in supporting self care |
| Index |
Foreword
Many of our patients would benefit from, and indeed welcome, more information and support for self care – advice on lifestyle changes, how to manage minor ailments or to better self manage their long-term medical conditions.
There is evidence to support claims that more confidence in dealing with these challenges will improve quality of life for such individuals, but also it can give them better self esteem which, in itself, leads to better health. If you agree and/or you wish to explore what self care entails and how best to support it within your practice, this book is essential reading.
It sets out a training programme for general practice and pharmacy teams as a route to a practice culture where promoting and supporting self care is integral to every aspect of the healthcare and services the team provide. As a result of this programme, the team will be aware of the evidence for supporting self care, knowing what works and what is worth trying. It will also be well coordinated so that everyone is giving out similar advice and thinking of all aspects of a person’s health. This might be by preventing a condition arising in the first place, by helping them manage their condition themselves as far as they are able, with treatments they can buy over the counter or initiate themselves, or by living with the symptoms until they improve spontaneously or tolerating them as part of every day life.
The training programme is a great resource for any primary care organisation or practice, GP, nurse, pharmacist or other health professional who wants to champion the support of self care. Its success relies on a good strategy and action plan, with enough enthusiasm across your team for the time and effort it will take initially. In order to get you started, the book provides four worked examples of how to help and support patients to self care if they have asthma, back pain, cough and colds or a sore throat.
Reading this could literally change your (working) life. Evidence shows that once support for self care is in place and your patients are taking more control of their healthcare, you should notice the drop in demand for unnecessary consultations, but, more importantly, this book can improve your patients’ health and wellbeing.
I strongly recommend it and congratulate the authors on such an excellent contribution to enhancing primary care.
Dr David Colin-Thome´
National Clinical Director of Primary Care
June 2006
Preface
About the training programme to enable primary health care professionals to support self care
This book is a guide for anyone involved in commissioning or providing primary care, to help them understand what people can do to care for themselves or those they look after. Then they can set up systems in the primary care organisation (PCO) or their practice to support self care and enable patients and the public as a whole to self care whenever possible.
Self care is about people’s attitudes and lifestyle, as well as what they can do to take care of themselves when they have a health problem. Supporting self care is about increasing people’s confidence and self esteem, enabling them to take decisions about the sensible care of their health, and avoiding triggering health problems. Although many people are already practising self care to some extent, there is a great deal more that they can do.
The key is having health and social care professionals enthusiastically supporting self care. A practice needs all the team to be signed up to advocating self care and finding ways for patients with all kinds of health conditions to be able to self care. This book explains the importance of self care and its potential benefits in managing demands on health services by patients. It guides you to undertake self care effectively as a PCO, as a general practice or a community pharmacy team, as a practitioner, seeing the patient’s perspective, learning to manage change and evaluating your progress and achievements. There are 21 tools to help you establish the self care culture that you will need, and four illustrations of patient pathways to self care – on sore throat, back pain, asthma and cough and colds.
The book is a part of the multidisciplinary training programme for health professionals to learn to promote self care, and introduce self care support interventions for common health conditions in their patients. The book is an additional resource to the online training programme for general practice teams and PCOs. You can look online (www.wipp.nhs.uk) to see how to run working groups or action learning sets for your colleagues – all the materials you will need are there. Download the facilitator’s handbook from the site if you have lead responsibility for establishing and learning about self care, especially if your practice or PCO aspires to establishing a self care culture and not just a one-off try at self care.
Go on – try it.
Ruth Chambers
June 2006
About the authors
Ruth Chambers has been a GP for more than 20 years and is currently Director of Postgraduate General Practice Education for the West Midlands Deanery, and Professor of Primary Care at Staffordshire University. The focus of Ruth’s academic career has been to develop education and learning initiatives for the NHS that fit health professionals for practice. She is the education lead for the NHS Alliance. Ruth has undertaken research and written widely on ways to encourage patients to be involved in managing their own health and wellbeing; and to contribute to the development of NHS services. She led the Staffordshire University team who were commissioned by the Department of Health Working in Partnership Programme to evolve this training programme for health professionals and managers on supporting self care by patients.
Gill Wakley started in general practice in 1966, but transferred to community medicine shortly afterwards and then into public health.Adesire for increased contact with patients caused a move back into general practice, together with community gynaecology. Throughout she has been heavily involved in learning and teaching, adding some academic primary care later in her career, becoming a visiting professor at Staffordshire University. Like Ruth, she has run all types of educational initiatives and activities from individual mentoring and instruction, to small-group work, plenary lectures, distance learning programmes, workshops, and courses for a wide range of health professionals and lay people.
Alison Blenkinsopp has researched and written widely on self care since qualifying as a pharmacist in 1981. She has research interests in extended roles for community pharmacists and patient experience of pharmacy services. She led on the evaluation of patient experience in the national community pharmacy medicines management study. Alison’s work on self care includes several reports, and along with Ayesha Dost she developed a compendium of examples of self care support for the Department of Health. She is one of the academic advisers to the Department of Health Working in Partnership Programme and a member of the steering group for the Joining Up Self Care project.
Alison is Professor of the Practice of Pharmacy at Keele University, a post she has held since 1999. Prior to her work at Keele she was founder Director of the NHS Centre for Pharmacy Postgraduate Education for England.
Matthew Critchlow and Health First. Matthew has a PhD in animal biology and has worked in the health care sector (both NHS and industry) for the past 16 years. More recently, Matthew has worked as an independent consultant in the health promotion field, as well as being co-ordinator and trainer for the Expert Patients Programme.
Health First is a specialist NHS health promotion agency serving Lambeth, Southwark and Lewisham and hosted by Lewisham PCT. Health First works in partnership with health and social care providers, local authorities, and voluntary and community organisations to improve the health of local populations and reduce health inequalities. The agency offers advice and consultancy, opportunities for learning and development, access to a specialist health promotion/public health learning centre as well as a variety of other services linked to health promotion.
Acknowledgements
Wegratefully acknowledge the help and input from colleagues in the five primary care trusts (PCTs) that piloted the self care skills training programme for health professionals – North Bradford and Airedale PCTs, Lambeth and Southwark PCTs and Central Cheshire PCT. We thank members of the Working in Partnership Programme self care steering group and project management for their guidance and feedback including: Clayre La Trobe, Helena Stone, Drs Pete Smith and John Chisholm, Ayesha Dost, Gopa Mitra, Louise Jarvis, and Lynn Joels from Medicom. Especial thanks go to Sara Buckley, the Staffordshire University project manager, who contributed to the production of the training programme with support from university colleague, Barbara Brown. Thanks to Christine Glover, Robert Hallworth, Alastair Buxton, Gopa Mitra, Sadia Khan and Heidi Wright for reviewing Chapter 6 and their suggestions for improving it.
Material for Chapters 5 and 7 was derived from a series of five focus groups that explored patients’ and practitioners’ perspectives of self care in summer 2005, organised, facilitated and reported by Matthew Critchlow on behalf of Health First in partnership with Lambeth and Southwark PCTs; we thank Dee Dulku, Charles Aina and Ros Band for their help in co-ordinating and facilitating the focus groups and providing input on the design and final report of that study.
Content throughout this book has been drawn and adapted from the following publications:
- Bayley H, Chambers R and Donovan C. The Good Mentoring Toolkit for Healthcare. Oxford: Radcliffe Publishing; 2004.
- Chambers R, Drinkwater C and Boath E. Involving Patients and the Public (2e). Oxford: Radcliffe Medical Press; 2003.
- Chambers R and Wakley G. Clinical Audit in Primary Care: demonstrating quality and outcomes. Oxford: Radcliffe Publishing; 2005.
- Chambers R, Wakley G, Iqbal Z and Field S. Prescription for Learning: techniques, games and activities. Oxford: Radcliffe Medical Press; 2002.
- Garcarz W, Chambers R and Ellis S. Make your Healthcare Organisation a Learning Organisation. Oxford: Radcliffe Medical Press; 2003.
- Mohanna K and Chambers R. Risk Matters in Healthcare: communicating, explaining and managing risk. Oxford: Radcliffe Medical Press; 2000.
- Wakley G and Chambers R. Chronic Disease Management in Primary Care: quality and outcomes. Oxford: Radcliffe Publishing; 2005.
- Wakley G, Chambers R and Gerada C. Demonstrating your Competence 5: substance abuse, palliative care, musculoskeletal conditions, prescribing practice. Oxford: Radcliffe Publishing; 2005.
About the Working in Partnership Programme (WiPP)
Workload is a key issue for primary care. This was confirmed in a national survey of general practitioner (GP) opinion in 2001 and later during the General Medical Services (GMS) contract negotiations. Survey responses demonstrated that there was a real need to address demand management. The consequences of not addressing GP workload would be widespread dissatisfaction and recruitment and retention problems.
At the GMS Contract roadshows, GPs complained about:
- excessive bureaucracy
- inability to spend sufficient time with patients
- some patients’ unrealistic expectations
- undertaking consultations with patients who need not see a doctor.
The Working in Partnership Programme (WiPP) was established as part of the new GMS Contract arrangements, to address workload management in general practice.1 Specifically, WiPP will identify, develop, signpost and mainstream effective ways to manage demand in general practice. This should create capacity in the primary care sector. Over the next two years, the programme will deliver a package of support that will enable practices and primary care trusts (PCTs) in England to:
- identify and analyse high-demand interventions as part of the development and delivery of effective services to manage those demands
- implement new ways of working, including new skill mix arrangements that have patients’ support, which have safely and effectively demonstrated a reduced demand for services and/or more effective use of clinicians’ time
- develop the public’s capability to self care and take care of minor illness
- develop and deliver effective, integrated self care support resources for the public, largely provided by the community and voluntary sectors, and reduce reliance on mainstream NHS services
- simplify and improve the processes relating to the employment, training, development and retention of general practice managers, general practice nurses and health care assistants
- implement initiatives aimed at reducing bureaucracy.
The programme will focus on general medical practices, involving community pharmacists, local dentists and optometrists and their staff, allied health professionals and community health professionals.
Self care and the development of self care behaviours is a key work area for WiPP. WiPP supports four work programmes relating to the development of self care behaviours. These include:
- Making Sense of Health: support and resources for schools to embed health care messages with young people
- Joining Up Self Care in the NHS: a pilot scheme evaluating the benefits of an integrated self care model in Erewash PCT, Derbyshire
- Self Care for Primary Healthcare Professionals: this is a multidisciplinary training package and related resources for PCTs and practice teams
- Self Care for People: an initiative developing the role of a self care support coordinator in a PCT, developing a self care skills training course for local people.
Louise Jarvis
Reference
1 General Practitioners Committee/The NHS Confederation. New GMS Contract. Investing in
general practice. London: British Medical Association; 2003.
Abbreviations
| ABPI A&E AHP BMI CAM CBT CHD CHIC COPD DAFNE DESMOND DH DiPEx DPP EBV EHC EMIS EPP FEV1 GABHS GMS nGMS GP HDL HbA1c INR KISS KSF LDL LEAP LES LMCA LPC MAS MUR NLP NPA NPSA NSAID NSF OOH OTC P PAGB PART PCO PCT PDSA PEST PGD PiP PLI PMR POM PR PSNC QOF RNIB RPSGB SIGN SIP SOP SWAT SWOT URTI WIC WiPP |
Association of the British Pharmaceutical Industry accident and emergency allied health professional body mass index complementary and alternative medicine cognitive behavioural therapy coronary heart disease The Consumer Health Information Centre chronic obstructive pulmonary disease Dose Adjustment For Normal Eating Diabetes Education and Self Management for Ongoing and Newly Diagnosed Department of Health Database of Individual Patient Experiences Developing Patient Partnerships Epstein–Barr virus emergency hormonal contraception Electronic Medical Information Service Expert Patients Programme Forced expiratory volume in 1 second group A beta-haemolytic streptococcus General Medical Services new GMS (contract) general practitioner high density lipoprotein haemoglobin A1c international normalised ratio keep it simple and short Knowledge and Skills Framework low density lipoprotein Learning and Employment Action Package local enhanced service Long-term Medical Conditions Alliance local pharmacy committee minor ailment scheme medicines use review neuro-linguistic programming National Pharmaceutical Association National Patient Safety Agency non-steroidal anti-inflammatory drug National Service Framework out of hours over-the-counter pharmacy medicine Proprietary Association of Great Britain prevention, await resolution, relief of symptoms, toleration of symptoms primary care organisation primary care trust plan, do, study, act political, economic, sociological and technological patient group direction Patient Information Publications prescription-linked intervention patient medication record prescription only medicine public relations Pharmaceutical Services Negotiating Committee Quality and Outcomes Framework Royal National Institute of the Blind The Royal Pharmaceutical Society of Great Britain Scottish Intercollegiate Guidelines Network social inclusion partnership standard operating procedure StaRNeT website assessment tool strengths, weaknesses, opportunities and threats upper respiratory tract infection walk-in centre Working in Partnership Programme |