How to make self-care work for both patients and the NHS

Each time we brush our teeth we are taking part in self-care. Photograph: stevepb
Each time we brush our teeth we are taking part in self-care. Photograph: stevepb

Are there ways to encourage more people to take an active role in managing their health? Yes, says Jeremy Bushnell

In our interconnected age, there’s more information available about how to keep and stay healthy than ever before. But this is also a time when health services are struggling under unprecedented demand.

One way to tie these two developments together is self-care. If more people could be persuaded to take an increasingly active role in looking after themselves, it could relieve some of the stresses on the NHS – particularly GP practices.

Our research suggests there are ways to encourage more self-care in a way that benefits both doctors and patients.

What is self-care?

The idea of self-care is that patients take a more active role both in monitoring their own health and taking decisions that prevent them becoming ill. As a concept it is cropping up more and more.

Why is self-care important?

The NHS is one of the world’s largest workforces employing more than 1.5 million people. In 2014 it was rated the best healthcare system across 11 western countries which included the USA, Switzerland and Sweden.

Yet it is constantly in the news for lacking the resources to cope with Britain’s ever-increasing health demands. An ageing population, rise in long-term conditions and burgeoning expectations threaten to overwhelm the NHS.

In 2014 the NHS outlined a Five Year Forward View outlining how the health service should change to close gaps in health provision. Prominent in this vision is the concept of self-care. It has the potential to reduce the number of unnecessary doctors’ appointments, taking pressure off GPs.

We have discussed self-care with a variety of patients in our recent research and have noticed similarities in the ways they view the topic.

How prevalent is self-care?

Self-care is something we all do every day. Each time we brush our teeth or go for a run or buy a salad we are making decisions to help keep healthy.

These are simple enough but the next step is making educated decisions about when not to go to the GP. This is easier said than done – and there seem to be some common reasons why people hold back.

From my research with a range of patients a common theme emerged: the trust people invest in their GP, and the reassurance they gain from speaking to him or her.

For most of us our medical knowledge doesn’t stretch much further than knowing where the paracetamol is at the local chemists. We look to GPs as the experts. When you ask them a question about health you tend to believe it. The concept of self-care – which shifts control away from your GP to yourself – seems to directly contradict this belief.

And trying to self-care via information online can prove stressful. Many patients we listened to said they would type various symptoms into Google and often end up reading that they had ten days left to live!

That’s because the same symptoms can be present in any number of illnesses. When you Google “headache and sickness” it returns 16.3 million results. They can’t all be right – so patients are instantly put off the idea of self-care: how can they begin to differentiate between valid, helpful links and the rest?

It is also important to acknowledge that not everyone has the same amount of contact with their GP. Our research found that young men are far less likely to visit the doctor compared to, for example, young mothers.

These differences mean that the potential for self-care can vary dramatically between different groups of people. Young men might well be doing this regularly already.

What would make more people do it?

Ideas for health care self-management generated at a Qa Research session

So what would make us actually take a more active role in managing our own health?

Firstly, the self-care information needs to come from someone or somewhere we trust. Our research has shown that most people have that trust in GPs and the NHS. If these are the principle sources of information, patients are more likely to engage with self-care and self-management.

And such self-care is already working effectively in the form of social prescribing (see Kay Silverside’s blog) where GPs refer patients to social groups or charities to help them overcome feelings of loneliness and other conditions.

And this brings us to a second important factor. During our research many individuals identified community groups as key to their self-management success. Often centred on their specific health condition these groups take the form of either an online forum or face-to-face peer support group.

The attitude to the online forums contrasted sharply to other internet resources like those Google symptom trawls. The personal nature of the groups – and the fact that you were talking to people who had experienced the same things – established the sort of trust and confidence that can never exist when looking at a random webpage.

Another way to help extend self-care and self-management is to utilise digital technology. Patients we have spoken to have been positive about the way smartphone apps can help people engage with health care, particularly the younger generations.

These apps both obviate the need for them to go searching for help and allow them to access reliable information in a way that they like and will use every day.

There are many other ideas that patients have generated within our research suggesting ways the NHS and health practitioners can encourage self-care. The image above shows a selection of these recorded at a recent deliberative event we conducted.

What does the future hold?

From my experience of talking to patients and doctors there does appear to be an appetite for self-care that could benefit both individuals and the NHS in different ways.

However, many people lack confidence in their ability to access accurate information and use it in the right way.

To get over these legitimate concerns, patients need two things to happen. Firstly they require any tools to undertake self-care to be supplied by authorities that they respect, such as the NHS or their own GP. Secondly these tools must come in an easy to understand and use format that will help them feel more confident about managing their own health.