Whilst it is widely agreed that healthcare delivery needs to change in order for it to be sustainable, there is widespread inertia in such a large organisation as the NHS against achieveing that change. Now new findings suggest that, in one area at least, the current financial shortfall may be a force for the good.
Pulse, a weekly publication for GPs and primary care professionals, has found that PCTs have made plans to save money by cutting both unscheduled admissions to hospital and A&E attendances. A survey of PCTs and health boards has shown that there are plans for an average 15% reduction in unscheduled hospital admissions of patients with long-term conditions by April 2012 and an average 31% reduction in A&E attendance. Whilst such plans are fairly ambitious this is a move towards the changes needed, shifting towards a more sustainable approach to long-term care.
One of the factors necessary for this shift is the development of care planning. This involves working with the patient to develop individual care plans, and has been pioneered by general practices in the NHS Yorkshire and the Humber region. Patients and doctors work together to look at all the long term conditions the patient suffers from and to record the issues most important to the patient in managing those conditions . This allows coordination between treatment of the different long term conditions, and is used to create a personalised action plan for self care.
Analysis of 50 patients who have taken part in this scheme has shown a significant reduction in the contact with the health services within a 12-month period after care planning was begun. Overall health care contact was 46% lower, including 71% fewer attendances at A&E and 83% fewer acute admissions in the 12 months after the initial care planning consultation, compared to the previous 12 months.
Such approaches typify the changes needed to streamline the NHS, using more self care and preventative measures taken through primary care to reduce the burden on the acute services. In an ideal world, there would be hospital closures, as the extent of hospital care that we require today would no longer be needed. The development of multi-disciplinary teams in primary care would be able to deal quickly with a wider range of problems and reduce the flow of patients onto hospital waiting lists.
So besides care planning how do we encourage more self care? Two factors could make a difference – greater education, and a culture of shared responsibility. One way of achieving shared responsibility is through allowing patients access to the full GP health record. This is already done at the Haughton Thornley Medical Centres, allowing a partnership approach between the clinician and the patient so that both have the same tools to understand the patient’s condition.
Self care needs patients to understand fully their own condition, and be able to work with the GP to manage their own condition. In the case of patients with long-term conditions, the patient is the expert on how their condition affects them, and should be supported to manage their condition in the way that will best improve their quality of life.