Education And Debate Managing demand

A patient led NHS: managing demand at the interface between lay and primary care

BMJ 1998; 316 doi: (Published 13 June 1998) Cite this as: BMJ 1998;316:1816
  1. Anne Rogers, reader in sociologya,
  2. Vikki Entwistle, research fellowb,
  3. David Pencheon, consultant in public health medicinec
  1. aNational Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL,
  2. bNHS Centre for Reviews and Dissemination, University of York, York YO1 5DD,
  3. cInstitute of Public Health, University Forvie Site, Cambridge CB2 2SR

    This is the second of five articles on ways of managing demand for health care

    People currently deal with many, if not most, health problems without consulting the health service. Relatively small decreases in these self care behaviours or increases in the accessibility of services could produce large changes in demand for formal care. We believe that scope exists for the health service actively to promote self care and improve the way it responds to people's illnesses so that needs are met efficiently in appropriate and acceptable ways. This may mean both encouraging demand for some forms of care — for example, for problems where early intervention is desirable and promoting self care for other problems. We examine particularly how the NHS should support self care as a way of managing the demand for formal health care.

    Summary points

    Knowledge, culture, attitudes, experience, and healthcare organisation are the key determinants of when, why, and how people access formal health care.

    To ensure the most appropriate demand on the health service, the NHS needs to encourage some demand and promote alternative ways of managing other demand.

    This can be done by building on the ways in which people already take responsibility for managing their health and illness

    Information that is relevant, accessible, meaningful, and integrated with other formal care is important

    So is a culture in which risk, responsibility, control, and uncertainties can be discussed and shared between providers, funders and users

    More graduated access to the system should be offered, through a single point of entry-triage

    Patterns of self and informal care

    Informal and self care constitute an important but often hidden aspect of the supply of health care. Ordinary people are providers of care. They have experience of caring for themselves and others and regularly provide advice about, and take responsibility for, matters of health and illness. …

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