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Primary care “dependency culture costs £2bn a year”

10 December 2009

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Primary care can be improved and made more cost-effective by changing the “culture of dependency” to one of personal responsibility in which patients are encouraged to be more self-reliant in dealing with minor ill health.

This was the message at a reception of the All Party Parliamentary Group (APPG) on Primary Care and Public Health, held yesterday (9 December 2009), entitled: “Time to change the culture of dependency in primary care?”

Health Minister Mike O’Brien (pictured) joined the event to present the government’s view on this issue, in light of research suggesting that there are more than 57 million GP consultations a year involving minor ailments (such as coughs, colds and indigestion) at a cost of £2bn to the taxpayer.

Dr Howard Stoate MP, Chair of the APPG, said: “Addressing the dependency culture at a time of public funding crisis would bring about tangible savings in the NHS and lead to a more efficient service.

“Recent debate suggests a two-pronged approach is required to do this. Firstly, the introduction of GP training to help GPs feel more comfortable about communicating messages to encourage and empower their patients to self-care, rather than ending the consultation with writing a prescription – as currently happens in 91% of cases.

“Secondly, targeted local and national public health campaigns to help change behaviour towards self-care, especially if messages are built-in to explain how long the symptoms of minor ailments last.”

Mr O’Brien said that, following the Chancellor’s pre-budget report statement, the government was committed to protecting frontline NHS spending for the next two years to 2012/13, but that “tough efficiency savings” would need to be implemented.

Mr O’Brien said that, as an example, a focus on primary care and prevention will save NHS London approximately £1.3bn over the next eight years.

“GPs say they would rather a patient come to them than risk missing something serious. We don’t want to change that,” he said.

“But things like NHS Choices, NHS Direct, better use of pharmacies and a focus on prevention and public health can have a big long-term impact.”

Mr O’Brien added: “Primary care is the backbone of the NHS. We have the best primary care system in the world – but we want improvements to continue so the best gets even better.”

Stephen Hesford MP, Secretary for the APPG, added: “The time is now right to educate and encourage patients to be more self-reliant in dealing with their minor ill health and this has to happen in partnership with the doctor and the patient.

“However, unless people themselves engage in cultural change on a national scale it will not become a reality. If our NHS is to survive in the future, it is imperative that the next generation understand the value of the NHS; to know when it’s right to use the health system and when and how to look after your own health and live a healthy, happy life.”


What’s your view? Do you agree that there is a “dependency culture” when it comes to GP services? Should patients be encouraged to be more self-reliant over minor health issues? Your comments (terms and conditions apply):

“I agree with the sentiments below. Raise expectations to this level and how are you ever going to tell people that they shouldn’t use the service? Politicians love to play with the country’s public services and then leave someone else to clear up after them when they move to the next exciting game” – Name and address withheld

“There is a lack of knowledge regarding self-limiting ailments; for example, how long to expect a sore throat or a cold to last and also lack of knowledge about simple self-medication. The general public take for granted the NHS and think it is their ‘right’ to demand of it what they will. This culture needs to be changed through education of the public. Most visits to the GP are unnecessary as minor illnesses will improve over time without needing a doctor and information and assessment can be gained via approved self-assessment websites; leaflets from GPs and contact with NHS Direct. The government’s concept of primary care through the building and creation of new ‘one stop shop’ primary care centres that patients can access in addition to their GPs is divisive with regards to the current GP practices and will lead to a complete deterioration of those GP services over time.  More importantly, patient safety will be compromised because those doctors/staff within the new centres will not know the patient so will not have a benchmark of what is normal for that patient or whether their health has deteriorated over time. There is great potential for lack of communication betweeen the new centres and the regular GP that the patient sees and this could lead to over or under-medication/treatment and the service could also be potentially abused by patients addicted to painkillers and night sedation. Those parents and families involved in abuse of children will be more likely to go from one practice to another to avoid uncovering their crimes and again there will be a loss of continuity between healthcare provider and patient with messages and concerns perhaps not being communicated, with everyone involved perhaps thinking the concern is someone else’s responsibility. Instead of employing yet more managers who make yet more changes in the name of ‘improving healthcare quality provision’ when in actuality they are concerned about their own personal profile and moving on to an even more lucrative job within the NHS – gaining but not actually giving anything of value – it is time to listen to those who do the work. Contrary to the mostly useless, self-serving managers are the doctors; nursing; radiology; physiotherapy; laboratory; catering; ancillary staff who do give of value to their patients and do want to make things better for them but who constantly battle a bureaucracy that benefits no one but those who create it. If only they could be listened to – most of the faceless managers could be axed instead of those that provide the care, and a lot of NHS money could be saved instead of being completely wasted on yet another organisational change. After over 30 years in the NHS, I have witnessed many changes for change’s sake, and seen many of the same changes come round again for a second or a third time and very few have been to the benefit of patients, with a working environment being made increasingly difficult and frustrating. One thing I do know: I do not look forward to being a patient where once upon a time I would have felt safe and confident that I would be investigated, treated and cared for well, instead of passed from pillar to post whilst someone decides if and who is commissioning the care and how long the patient episode should last before being prematurely discharged into a community where the process of if and who pays for what and when begins again. Commissioning costs are important and necessary – it is how this and care is organised, delivered, measured that is awry. Ask the doctors – they know the difficulties they face every day and that is before they see the patient” – Lorraine Lowe, Manchester

“It has been the doctrine of this government for years to convince ‘Joe Public’ that they can go where they want, when they want, ask and it will be supplied and don’t foget to have your Choice of all of the above. We have been battling this crazy doctrination (which is only really aimed at running primary care  down and winning votes at the same time) for ages. Now because every single PCT in the country is asking (Oliver style) for more and the government can’t print enough, we are being advised that we could save £2bn a year by converting ‘Joe’ back to reality.I know this is a cynical point of view but you will have a very hard job convincing me otherwise” – Ian, Bournemouth

“I agree with Mike on this. Here we have an 8–8 walk-in centre which is prescribing very expensive drugs for very minor ailments. On the other hand, the same trust has put in place a Community Pharmacy Minor ailment scheme, which assists GPs with offloading some of the burden of ‘unnecessary’ appointments. Obviously patients are referred back if the pharmacist can’t deal with the case. This all seems a little contradictory to me. I think that the pharmacy schemes are great but 15 million on a walk-in centre? Sorry, but it is under-used and over-resourced; if it wasn’t for establishing centres like this, maybe the GP surgeries would have better funding for more support staff and a better standard of service all round eliminating the need for ‘extras'” – Amanda Cullum, Lincolnshire

“That culture has been growing for a long time and has been exacerbated over recent years by the political agenda on GP income. Everyone with an ounce of common sense has known that for years – but as usual Parliament has only just worked it out. Patients state they pay for it and have rights so they are gonna have it, whether needed or not. A product of nanny state?” – Justin Pearce, Rushden

“That should be FIRSTLY the targeted public health campaigns. GPs would welcome this with open arms as they are fighting an uphill battle with patient expectation – fuelled, I might add, by this current government! I extend an invitation to any government minister that would like to come and see what’s really happening on the ground” – Carol Wotherspoon, High Wycombe

“Yes we should, but the government shouldn’t have encouraged people the other way and established centres where patients are just given what they want” – Mike, Barnsley