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As we approach Self-Care Week this November I want to reflect as a GP on this important issue and the associated language used by frontline staff in general practice.
I hear this term used widely across general practice but what does it actually mean, and how realistic are the ambitions for the patients we strive to look after and keep well?
The BMA’s Patient Liaison Group’s helpful Q&A document was one of the first places I looked for a definition of self-care.
It states: ‘Self-care is about putting people in control of their own health and wellbeing. It involves the things individuals can do to protect their health and manage illness.’
In thinking this through I thought of the patients that myself and colleagues meet on a day-to-day basis and how the reality of the social determinants of health have such a huge effect. The conditions in which people are born, grow, live, work and age – and how these influence their resistance to illness and disease, as well as their ability to self care. I see the language and other barriers that some of those who are on my practice list have to tackle each day.
For me there are some questions to ask when looking at the ability to self care:
These questions do not always sit comfortably with the wider messaging that is used in general practice about valuing your GPs. We rightly point out that there are only a defined number of appointments in general practice and these are precious resources that should not be wasted. But as members of the general practice team we have a critical role in supporting patients in making healthy choices and in directing people to useful (and practical!) sources of information.
For me there is a risk that without easily accessible support and advice the ‘rewards’ of self-care will only be felt by those from higher socio-economic backgrounds. It is critical that we are able to instil the capacity for autonomy for all those we are responsible and caring for. With the fragmented health and social care system and different organisations seeking to provide solutions we have seen some guidance for individuals seeking to provide a ‘magic bullet’. The reality is that there is no ‘one-stop’ solution and integrated care services need to work in tandem with those providing information prescriptions, voluntary organisations signposting individuals through the system, and carer organisations … the list goes on!
We need to celebrate more when individuals do move towards adopting healthier lifestyles, staying active, eating healthily (and avoiding the accessibility of ‘junk food’), using alcohol in moderation and not smoking. Sometimes we get too concerned with negative stereotypes (people sitting on trains eating take away food for example) when we as professionals within the system use language that many individuals do not always recognise. Social prescribing has been referred to in a number of different forms; there is no agreed single term. It can be ‘arts on prescription’, ‘photography sessions for those with alopecia to enable them to enhance their self-esteem, gardening or exercise classes, all these can utilise an individual’s strengths to enable them to manage their own conditions. At an even more fundamental level these things help people escape from their ‘bubble’, reduce their sense of social isolation and participate where possible in their community networks. Through the implantation of Primary Care Networks we can scale up efforts in this area.
GPs are highly trained specialists in family medicine, expertly treating patients with a wide range of conditions on a daily basis. However, in Self-Care Week let’s celebrate where we properly recognise the realities of the outside environment that we all live in and the changing needs so that all of us have a greater sense of confidence to navigate around the complexities of the system. When Self-Care Week approaches I would like to see general practice advocating positive solutions and individuals recognising not just that our surgery appointments are precious resources (that still needs to happen) but also that they do have some real choices, options and some practical support to enable them to self care.
Samira Anane is a member of the BMA general practitioners committee and GPC policy lead for education, training and workforce
Read the BMA's guidance on patient empowerment and self-care
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