Tuesday, 22 June 2010

Planning your care

No decisions about me, without me
Andrew Lansley, Sec of State 2010

The General Practice patient survey is now in its 4th year and the 2009/10 report makes challenging reading for those interested in care planning. Some of the elements of the patient experience of GP services have not changed since last year but the questions about care planning are new so it’s not possible to see how they compare with the 2008/09 results.

The new Government has made it clear that patients should be at the heart of the NHS, that quality remains its organising principle and that patient empowerment as much as local clinical leadership should be the driver for improvement.

The GP patient survey published last week, comes hard on the heels of Andrew Lansley’s first major speech as Secretary of State for Health and provides a baseline to gauge progress against. Half of the (over 2 million) patients surveyed had one or more long term health problems, disability or infirmity. Of these, 84% say they have had discussions with a doctor or nurse about how best to deal with their health problems. There are big differences in performances between individual GPs with 1% of practices scoring 100%. Only 1 in 10 patients felt those discussions did not help improve how they manage their conditions. Looking at that another way, combining it with the 16% who don’t seem to have been supported in this way – over 25% of people with chronic diseases have not had helpful discussions with healthcare professionals over the last year. Nine in 10 “very satisfied” people have had discussions about their health and care compared with 68% of “very dissatisfied” patients.

Overall, patients are very positive about some aspects of the discussions they have had with the doctor or nurse about how best to deal with their health problem. Nine in 10 patients say the doctor took note of their views about how to deal with their health problem and the doctor or nurse gave them information about things that they might do to deal with their illnesses. A slightly smaller proportion said they agreed with the doctor or nurse about how best to manage their health problem.

In contrast only 1 in 5 patients (19%) said that the doctor or nurse gave them a written document about the discussions they had about managing their health and care. Only 11% say the doctor or nurse told them that they had a “care plan”. When looking at how practices perform on this measure, a quarter has 15% or more of patients saying they were told they had a “care plan”; however the majority (75%) have 14% or less saying this.

Few, if any, randomised trials have looked at care plans themselves (compared with drug treatments) as instruments to improve outcomes of people with kidney disease. Yet we know that many of the risk factors for progressive kidney injury relate to lifestyle - smoking, obesity and hypertension. We also know that traditional models of care fail to achieve the behavioural modifications necessary to adequately control these risk factors. Wouldn’t it be interesting to know how many of the people with chronic kidney disease (CKD) had useful discussions with primary care health professionals; and to know what was discussed, what information was given? Identifying risk without managing it is of little or no value. Indeed, knowing about a silent condition without understanding it and without advice and support to reduce risk may in fact have more negative than positive consequences. This is an area right for further research and development.