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by Josiane Wadey
13 March 2012

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Managing expectations

How can we engage meaningfully with the public to ensure that the NHS has a future, asks Josiane Wadey, Practice Manager and member of the Practice Management Network

I’ve just returned from an amazing holiday experience in Kenya. However, one of the biggest things that came across to me was that, despite the poverty, the Kenyan people are very happy and relieved to receive any kind of medical attention. 

While on a fishing trip last week, a fisherman told my husband and I that he had to attend a burial in Mombasa of his brother’s little girl, aged four-and-a-half years old. When we expressed our shock and sadness, he shrugged his shoulders and with sadness in his eyes replied: “It happens, medical care is too much money”.

In our practice last week, our patient demands nearly brought our duty doctor to her knees – she had an emergency surgery full of a variety of different viral infections and all the patients wanted to see a GP. While we try very hard to signpost our patients to the pharmacist, for telephone advice or for minor-illness clinics held by our nurse prescribers, patients still want the choice to see their GP for any ailment or condition they currently have. Our practice ethos is currently to provide a service to our patients that they would like to receive.

I wonder how we can inform our patients and the wider public of our financially challenged NHS in an ageing population. How can we lower their expectations of what we can continue to provide and educate them to choose well?

We currently have an NHS to be proud of, which is free at the point of access for everyone. But will we have this in years to come without a great deal of public engagement and being open and transparent about the significant challenges the NHS faces?

We need to challenge the expectations of our patients and educate them in self-care, keeping well and choosing well when they need to see a healthcare professional. We need to promote the roles of our entire primary care team – for example pharmacists, healthcare assistants, nurses and other allied health professionals such as physiotherapists, health visitors etc.

We also have a fantastic voluntary sector out there too, which is perhaps under-utilised at times, and we need to continue to support carers of all ages – without them, the NHS would be under even further pressure.

In order to safeguard our medical care, we need to ensure that people are educated to use it wisely so we can continue to have the reassurance of a safe, efficient and free-at-the-point-of-access system for our entire population.

Do you agree with Josiane? Should the NHS devote more time to informing patients about its resources and costs? Your comments (terms and conditions apply):

“I agree that we have an ever increasing demand on the services within the NHS as there is no natural gate – which in other countries is usually money. It does not necessarily mean that is correct however patients need to become more empowered and responsible for looking after their own health, which includes utilising the wider community such as pharmacist, fitness centres, and free advisory services to help both a proactive and reactive approach to managing their health. We as a Practice continually push the message but it needs to start much earlier in a patients life ie, from school age to bring awareness that the NHS funding is not a bottomless pit and they have a responsibility to look after their health” – Moira Moore, Wales

“I totally agree with Josiane. We are currently working with our PPG, who are being very supportive on this very topic, to get the message out there to our patients. As a practice we are holding multidisciplinary brainstorming sessions to find initiatives to manage the huge demand and patients unrealistic expectations. I have forwarded this piece on to staff and to our PPG committee members as it is so current and relevant” – Katie Hill, West Sussex

“I also agree but unlike Julie [see comment below – Ed] I think GP’s should be the first point of call, its one way to reduce A&E admissions which our trust are striving for! I think patients need a short sharp education to bring home the fact that the NHS is not sustainable with the new health bill” – Tricia Simpson, West Sussex

“Absolutely, i think we do patients a disservice by promoting expectations the country just cannot afford to the extent the public are led to believe we can. We tell patients they have all the choices they want when we know perfectly well that is not true, we ask them repeatedly to tell us what they want when we know we can ill afford to give them it and continuously struggle trying. Lets tell them the truth and conncentrate on educating the well and treating the unwell, that would be novel” – Val Hempsey, Tyne and Wear

“An interesting read – and I totally agree.  One day last week we took 7 calls after 5pm from parents worried that there children had slight temperatures, the majority had not taken simple measures, given capol etc…beacause of the time of day these children were brought down to see the duty GP rather than being given advice and saftey netted. Today the surgeries are full of patients with colds, coughs and sore throats and many problems that really should be self monitored or perhps discussed with a pharmacist. We are managing in excess of 400 calls every day and offering over 250 appointments a day, but its not enough to cope with demand. We try to promote how to access our services appropriately, but this needs to be reinforced at a national level alongside a clear message about our limited resources” – Tracey Osborne, Sussex

“Couldn’t agree more. We are continuously promoting the roles of the different health professionals in our practice to try and encourage patients to choose wisely.  It’s a very slow process but I do feel we are getting somewhere at last!” – Jeannie Bee, Lincolnshire

“Nationally there is a great deal of focus on “inappropriate” access to secondary care and efforts to manage some of this demand and admissions through more pro-active work in primary care. This will place more strain on primary care and yes, lost in this attention, is the “inappropriate” access to GPs. The NHS is NOT free. Every consultation in any setting costs money. Would patients be more thoughtful if for example they were advised of the cost of their attendance? The other question I would ask is what are GPs themselves doing to correct “over demanding” or “inappropriate” GP access?” – Steve Cribb, Hove

“As a Centre that “enjoys” an average of 300 DNAs each month I cannot agree more and go further to say that we should be allowed to charge a fixed fee for every failed appointment where we have not had reasonable advance notice. The Voluntary Sector is however as stretched financially and by a lack of resources as we are so suggesting we pass work over to them is a bit like Secondary Care dumping any work they cannot handle down to GPs – and we do complain bitterly about that!” – Alan Moore, Cheshire

“Absolutely, if we are not more pro-active in our approach to this, quality will suffer. The compulsory registration to the Care Quality Commission will add to the pressure of us providing a safe and excellent service and with demand by patients increasing we may all struggle to maintain a safe standard” – Jane De Jong, West Sussex

“Absolutely agree with Jo. There is a real issue around patients lack of understanding of how their own body works and the disease process – and how some minor illnesses (colds etc) just have to get better on their own. Combine this with the totally unrealistic expectation that some people have that they should be able to see a GP whenever they wish and you create discontent when this expectation is unfulfilled fuelled by unnecessary dependence on primary care” – Paula Salerno, West Sussex

“I absolutely agree with Jo, we all seem to be struggling with the increasing demands of our patients who seem to use the GP practice as the first point of call for every minor ill. I really believe that patients do need to be educated and informed about the best use of services and the limited resources we are all working within” – Julie Hannaford, West Sussex

“I could not agree more – we always try and deal with today’s work today but last monday we were nearly brought to our knees. We had over 100 telephone calls to deal with plus all the other pro-booked appointments. We had over 150 Rx requests. Patients are no longer willing to wait and expect everything done immediately. I do think we need to educate patients on when to call the doctor or when to call a pharmacist. I also think more information should be given to patients on how the new Health Bill will affect patients – the truth though not what they read in the papers” – Sandy Maslen, West Sussex