Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Developed with members of the local patient forum

Liz BrittlebankEleanor HaywardTina Trowbridge

Sam Harrison

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

How it started – why self-care?• Patient Empowerment – understanding

yourself, your medical problem and your treatment, so reducing health anxiety

• Reversing the trend of dependency

• Using NHS resources wisely for maximum gain – knowledge, materials and funds

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Why• Aim: To look at why self care should be an

issue for practices and their patients• Objectives: • To understand the key factors• To hear the Forum’s response and decide

how the Forum may want to be involved• To hear members’ views about taking this

back to their own PPGs

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

What is minor?

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Size of the challenge• Self care conference in 2012 “can patients

help save the NHS” outlined some stark problems

• Increase in consultation rates – from 3.2 per patient per year to 5.5 now

• Tightest period in NHS funding for 50 years

• Dependency Culture – creating bottlenecks all the way up the system

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Issues• Understanding of common health problems is

often lacking• How long does a common cold last?• How long does a cough last?• What are “normal” symptoms and what are

“worrying” symptoms?• What will get better with symptom control

and what will require a treatment

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Education • This is not a criticism! – there could be an opportunity

for teaching, for learning and for improving “health literacy”

• Evidence shows that social background has no impact on use of health resources

• “There’s nothing to help this” v “There’s nothing wrong with you” – they are not the same thing

• If we don’t help patients to understand this, then expectations are too high

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

What people need to knowOne challenge is to get everyone to know:

• acute otitis media: 4 days  

• acute sore throat/acute pharyngitis/acute tonsillitis: 1 week

• common cold: 1½ weeks

• acute rhinosinusitis: 2½ weeks

• acute cough/acute bronchitis: 3 weeks

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Key questions• How long will it last?

• What can I expect to happen?

• What are the signs I should worry about?

• What can I do to help myself (and possibly prevent recurrence)?

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Anxiety• Anxious people want to be seen quickly• Being seen quickly reinforces the perceived

“health need” – a vicious circle• People who are seen quickly do not learn that

problems can resolve by themselves• Anxious people put huge pressure on GPs

and their teams• Anxious people teach their families to have

health anxieties

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Cost• The estimate is that nationally there are

57million GP consultations per year for “minor ailments” which could be managed by the patient themselves

• Prescribing costs for items supporting these consultations (emollients and creams, simple analgesics, linctuses) are £371m nationally

• We may be able to have an impact on making wiser use of resources

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Cost -2 • There may be resistance to paying for OTC medicines

BUT …

• GP time is not free

• Practice Nurse time is not free

• Prescribing budgets are finite (and being squeezed)

• If we have to make hard decisions about prescribing, is it preferable to have them at this end of the care spectrum?

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Asked what the patient forum members would like to do• We asked the Forum, if they wanted to

• Look at ideas for increasing “health literacy” (the understanding of health problems) across our patch

• Look at ideas for supporting similar themes (maybe on a smaller scale) in our own practices

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Idea from patient survey and Self Care Forum website• The medicine cabinet

• 24 hour shopping means easy access – but when there is illness in the house the time isn’t right!

• Having a well stocked cabinet means symptom control can start right away, giving some control to the patient / carer

• There are posters and resources to help organise this type of campaign

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Timing• ‘Involved Patients, Excellent Care’: Patient

Participation Week, 1st – 8th June 2013

• The first ever National Patient Participation Week ran from June 1st – 8th 2013.

• The week was organised by the National Association for Patient Participation, (N.A.P.P) a national charity, formed in 1978.

• The Forum was keen to use this opportunity to raise its profile, and work as Involved Patients trying to make space for Excellent Care

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Process agreed – mini campaign to get started• Letter to GP practices, local community

venues, asking them to display posters• Leaflets available in practices• Members of the self care group visited

venues and spent time in their own practices talking to patients to promote the campaign during Patient Participation week

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Campaign – a start

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Source of resources• www.selfcareforum.org

• www.napp.org.uk

• www.patient.co.uk

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Uptake/ interest• Opt-in approach for practices and venues

• Support needed for distribution of materials

• Limited uptake

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Further campaigns wanted!• Patients keen to explore more opportunities

to make a difference

• The aim is to tackle the Top Ten conditions for which patients contact GPs but which are amenable to self care

• Winter viral illness the topic for Self Care week – November 2013

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Building up

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

The campaign• 18 November - national self-care week

and European Antibiotics Awareness Day

• The launch event at intu MetroCentre

• Patient forum

• Pharmacists

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

How the idea developed• Developed from discussion with CCG

members, patient forum and self-care group members

• Talking about the issues

• ‘Keep calm!’

• Tested out with patients forum members

• GPs and pharmacists were involved to contribute to the campaign and provided essential clinical input.

•  

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Supported by • CCGs across Northumberland, Tyne and

Wear, Durham, Darlington and Teesside

• Working with other NHS and LA partners to support activity in each locality

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Timeline • w/c 18 November – launch of keep calm • w/c 25 November – keep calm and ask your

pharmacist• w/c 2 December – keep calm and antibiotics aren’t

always the answer• w/c 9 December – get repeat prescriptions • w/c 16 December – keep calm and order your repeat

prescriptions plus having a well-stocked medicine cabinet

• w/c 23 December – keep calm and call 111 this Christmas

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Posters for the Keep Calm Campaign

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Patient Forum self care members in action

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

http://www.youtube.com/watch?v=gehmdAGeuGY&feature=youtu.be

Research feedback during the campaign

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Patients’ practiceevaluation• Survey conducted 4-9 November and 2-7

December

• There was a slight increase in % of people who said they would self help

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

• The % of patients who sought advice such as phoning 111 increased from 34% to 40%

• The % of patient who would make an appointment with a GP or Nurse fell from 92% to 56%

• Use walk in went down from 67% to 46%• Attend A&E went from 26% to 24%

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

What patients in the practice said

Before AfterI am confident that I can deal with Minor Illnesses myself 63% 87%

Pharmacists can give me advice if I have a Minor Illness 88% 82%

I worry that it might be something more serious therefore go to the Doctor or Nurse

75% 50%

Prescription drugs are more effective than over the counter drugs

62% 60%

I am confident to consult a trusted website e.g. choices 25% 39%

I maintain a well-stocked Medicine cabinet at home 50% 58%

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Campaign evaluation• Potential coverage of 1.38million• 53% of the north east population having

seen/heard the campaign• 48% of those surveyed (3,000) recalled the

campaign • 9/10 of those surveyed understood the campaign • 24% would change their behaviour• Those people surveyed who didn’t recall the

campaign• 97% understood the campaign • 41% said that it could change their behaviour

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Lessons learned• Campaign effective from a communications point

of view• The campaign grew in complexity and breadth • It was a challenge keeping everyone involved as

they could/ should be (timescales, fast moving preparation)

• Monitoring – relying on other people not as involved for publicity within member practices – boxes in surgeries!

• Strengths of the project and what gave it credibility

• active patient support • endorsed by clinical professionals

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

For the future• Co-production!

• Next: • workshops for parents of young children on

how to care for their children with eczema

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

• Better self care is good for people and makes sure there’s time for longer consultations with people who need them…Help the NHS to help you.”

National Association for Patient Participation