With increasing demands on the NHS budget many CCGs are minimising the prescribing of products which can be easily purchased for acute minor ailments. The name “self-care” implies that the product can be used by the person it is intended for. There are no problems with this as we are able to use patient leaflets to make our own decisions to treat ourselves.
In some areas this is also being extended to service users in care homes or those in their own home with domiciliary care packages. These are vulnerable people, who in many cases, cannot use these products themselves but rely on carers to manage their medications. In the care home environment homely remedies have been adopted and their use supported with guidelines. The difference between self-care and homely remedies highlights three main practical issues:
The social care model doesn't easily accommodate “self-care” as carers are mostly non-medically trained and are commissioned to follow the instructions provided by a healthcare professional through a prescription route. The risks associated with no prescription are:
It remains the duty of the healthcare professional to assess suitability of the product and to check contraindications or interactions with current prescribed medication. The products recommended are often those which wouldn't be prescribed due to limited evidence of effectiveness but provide suitable relief of symptoms based on the experience of the healthcare professional.
Our idea is attempting to make the practical implementation of self-care, in care homes and the domiciliary care environment, robust to address the areas identified above. It is simple and could be adopted as a national model to ensure consistency and safety.
The template is already developed and would need to be approved at a national level.
Printing would be necessary and could be in the same format as the “no prescription” pad for antibiotics. This could be in the form of a “self-care” pad or the most cost effective format could be explored.
At a local level CCGs could make use of the NHS England care home pharmacists and technicians to support implementation.
Ideally a National list of products could be developed based on any available evidence although commercial sensitivity may be an issue for brand named product choices.
It may also be possible to involve the pharmacies who provide medication and support to care homes and domiciliary care agencies. They could be supplied with the “self-care” templates and could make the supply of the product and could complete and provide the template to make it patient specific. The details would be supplied by the carer following the instruction of the healthcare professional
Service users receiving care in any environment would have easy access to products which the general population can just go out and buy. The need and recommendation would come from an assessment by a healthcare professional, who would provide appropriate advice on the product's use to optimise the effects.
Carers would be supported to manage self-care products safely by being provided with instructions endorsed by healthcare professionals. They would not be put into a vulnerable position of needing to make decisions which they may not be competent to do. This would ultimately protect the vulnerable service user and provide a clear auditable process, that doesn't rely on documentation by the healthcare professional in care plans.
Clinical Commissioning Groups (CCGs) would be supported to implement self-care in care homes and domiciliary care, in a consistent, safe and measurable way. This will complement the process for the wider population and will support the work to reduce pressures on the NHS drug budgets
GPs would benefit by having the tool available to fax across to care homes thereby reducing their workload.
We want to promote safe care which supports both care providers and service users. We are aware of the work-load imposed on carers to ensure their service users are safe so we want to support them in a simple way.
This idea is mainly a supportive tool. Potentially the number of self-care instruction leaflets could be counted and costed to calculate savings.
As a simple idea the template design can be extended to include a chosen list of products. The only necessity would be to print in the format required. We have provided four examples of our templates and aim to review and add more as appropriate.
