Commissioning health education in primary careBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38958.498484.80 (Published 28 September 2006) Cite this as: BMJ 2006;333:667
- Kristin McCarthy (), joint chief executive,
- Pamela Prentice (), joint chief executive
In the United Kingdom most people acknowledge personal responsibility for their own health,1 and 87% say they have to be “really ill” to visit the doctor.2 Yet most general practitioners who responded to a study in Family Practice said that they are often consulted about illnesses or symptoms that they consider to be minor.3 Meanwhile, people with chronic conditions that are treatable continue to present late to their general practitioners.4 How can we explain these apparent contradictions? Most general practitioners regularly provide education and information to patients, but the message and style of this information is often not optimal. A Reader's Digest survey in 2005 found that more than four fifths of the population rely on information from their general practitioners and over half use health leaflets from their surgery or pharmacy. Even so, market research conducted for the policy group Developing Patient Partnerships found that nearly three quarters of respondents would be less likely to visit their general practitioner if they had more information about managing common ailments.
A recent international study that compared data from Australia, Canada, New Zealand, United States, and Germany with the four UK nations, showed that British patients are the least likely to receive advice from doctors on disease prevention and lifestyle changes.5 Oral advice alone may be inadequate. Reinforcing advice from general practitioners with written information can have a positive impact on patients' understanding and education.6 Furthermore, evidence supports the value of patient information delivered by computer, in print, or by video as long as both the design and content are evidence based, but a recent review found that the access to such communication tools varied greatly.7
Since 2004 health policy in the UK has encouraged people to understand the part they should play in looking after their own and others' health, as an important way to make efficient use of local services and improve self care and wellbeing. The English white paper Our health, our care, our say published in January this year is expected to result in more personalised care, with health professionals informing patients and enabling them to make choices about their health and care.
In a telephone survey of more than 300 primary care staff for Developing Patient Partnerships, four fifths of responders agreed that several initiatives and bodies will increase the need to give patients information about their health; these include the quality and outcomes framework (a UK-wide system linked to improved health outcomes that financially rewards general practices for treating patients effectively), practice based commissioning (by which general practitioners in England manage the NHS budget and commission local health services for their patient populations), and guidelines from the National Institute for Health and Clinical Excellence (NICE) (which provides national guidance for the NHS on the promotion of good health and the prevention and treatment of ill health). Who can best unite policy and practice on this issue? Can newly configured primary care trusts and practices meet the challenge to ensure that the public can make informed choices about their health and health care? Primary care trusts and practices need cost effective, well designed, and unbiased resources that give consistent messages, support central strategies, meet local needs, and are properly tested and evaluated. These resources must also overcome inequalities in access to information and meet the needs of people with low literacy who may speak little or no English, and who often do not make the most effective use of health care.
It is inefficient to expect individual practices to design and produce such resources and bear the cost, and this would raise many questions. Are workers in primary care competent to apply the evidence base concerning design and content of information for patients? Will they need their primary care trusts to produce or commission information resources on their behalf? And who would take on such a role in the restructured primary care trusts? Who will represent patients' perspectives and commission information on access to services as well as on health protection and wellbeing?
Primary care trusts and practices could meet these challenges by commissioning advice and resources, dependant on local need, from independent third party organisations that specialise in providing health information, and then by evaluating the impact of this on the public's health literacy and health behaviour. Indeed, 88% of health professionals surveyed for Developing Patient Partnerships said they would welcome a single source of high quality, unbiased health information for their patients. An evaluation by the University of Keele of the usefulness to patients of a self care booklet Better health at home and at work, produced by Developing Patient Partnerships (http://www.dpp.org.uk/) showed that most respondents found it helped them to recognise and treat common ailments and encouraged them to exercise more or to improve their diet. More than four fifths had used the booklet at least once and a similar proportion said they intended to keep it for future reference.
Some patients such as school age children and workers, especially working men who are often low users of health services, may be reached more easily outside the NHS. One such initiative is Best Treatments from the BMJ Publishing Group (http://www.besttreatments.co.uk/). Making Sense of Health, a website funded by the Department of Health that aims to help school children take control of their health (http://www.makingsenseofhealth.org.uk/) has had positive results.8 Similarly, Health at Work—a work based health education initiative from Developing Patient Partnerships (http://www.dpphealthatwork.org.uk/)—has been welcomed by workers who said it encouraged them to improve their diet and lifestyle.
Will primary care organisations use this opportunity to commission the information that is needed or will the information be spontaneously produced, inefficient, incomplete, and unmonitored data provided by individual healthcare professionals and patients? If the second situation proves to be the case, the gaps in provision of information will probably affect those people who most need good information and know least about health, thus accentuating inequalities in their health status.
Competing interests Developing Patient Partnerships is a charity partly funded by the Department of Health that produces health information resources. The BMJ Publishing Group is the publisher of Best Treatments.