It is not a lack of information that confronts patients in the NHS now, but a problem with knowing where to get trustworthy and reliable information from. GPs themselves can take a leading role on giving patients a better experience, writes Michael Guida.
It’s a golden opportunity. The public are swamped with information and advice, some of it good and some of it, dangerous. At the same time, GPs are going to be taking a more central role in public health, helping people stay healthy with the right information and advice. GPs have a new job, as well as managing budgets: that of information prescriber.
Patients can’t make better choices or manage their health if they are just let loose on the internet. GPs are perfectly placed to help the public with the information glut, but that means a major change to attitudes and practice styles has to happen. Mark Duman of the Patient Information Forum talks about the need for GPs to “consider information as therapy” and to be facilitators not dictators of health decisions.
Our research with the public suggests that they rely heavily on their GP for reassurance and advice and trust this advice more than internet resources they find themselves. Perhaps it should be no surprise that the personal touch makes a difference, but the public still don’t think of the NHS as an information provider and are often left to find and interpret information on their own.
What can GPs and other NHS staff do to help patients make better use of health information?
1. GPs can take on this role and reduce their workload
This is a new way of behaving for GPs but it is not necessarily extra work. Providing information to enable choice and to help the understanding of conditions and their management should ultimately reduce the number and duration of visits to the GP. But this only can work if GPs think of the initial work as an investment. “It has to be about workload reduction for GPs to have a chance to do this”, says Dr Shanker Vijayadeva, a London GP.
Today GPs have to live with the daily frustration of having website printouts pushed under their noses by patients. This is a time-consuming reality that won’t go away, but GPs can turn this situation around by taking charge of the health information their patients see and making health information something they take a lead on.
While GPs worry about the internet being a threat to their long-held expert status and its use for self diagnosis, now is the time to influence the kind of information the public are consuming. GPs need to think of information as part of the therapeutic toolkit.
2. NHS Choices and Patient UK resources must be used
The recent Bupa and London School of Economics international health survey found that only a quarter of the people surveyed checked the reliability of health information they found online by looking at the credibility of the source. GPs can help direct people to the information sources they recommend. But first GPs need to get up to speed with what is available from the NHS and elsewhere.
Recent research from GE in the US has shown that doctors are even more overwhelmed by information online than the public. So, what is the right information to be putting in front of patients? The answer is anything that the GP feels confident with, which should mean NHS Choices or Patient UK.
NHS Choices has begun to establish itself as the best NHS destination for carefully written and designed health information. While it continues to suffer from gripes about its Department of Health provenance, it is the definitive guide to health in England. Few GPs or the public know about or use it and searching in Google on a condition like asthma tends to find charities and Wikipedia, not NHS Choices information.
However, with an A to Z of conditions and treatments, a local services finder and hospital performance comparison tools it really needs to be put to good use. The consumer group Which? has recommended that NHS Choices be the single online health information provider for the public.
So, NHS Choices should be a best friend to GPs, not a threat, but it has to be used in consultations to be effective. The website is vast and many of the public would benefit from some professional guidance on how to use it and how to interpret complex performance data that is supposed to inform choice.
Beyond NHS Choices, GPs need to be familiar with the key national charity websites and the services they offer – it’s not just information but patient forums, support groups and community activities.
3. Printed information should form part of the consultation
The basis of a good GP consultation is a conversation, but few patients can remember the detail of what was said once at home. Patients respond well to specific information that is printed off for them by their GP. When it works well, there is a transfer of ownership as a page about managing diabetes is given to a patient during a consultation.
GPs most commonly print conditions information from Patient UK, which is part of the EMIS care records system that many doctors use. It’s not NHS branded information but it is good quality material that has gained the Information Standard imprint. NHS Choices also allows the doctor to select and print a tailored set of information, a so-called Information Prescription.
The important thing is for doctors to use one of the many good information resources that they are comfortable with. Plus, the GP needs to make a judgement about a patient’s literacy as it’s all too easy to scare people off with too much complex information.
4. GP consortia and practice websites are not a solution
Will GP consortia websites be the answer? It seems unlikely. Many GPs already have their own sites and the new consortia websites are likely to be more useful for professional and business stakeholders rather than the public. Certainly these new sites will suffer the same challenges that PCTs sites faced, chiefly the lack of public awareness and a difficulty being found in Google. NHS Choices, and GPs when pressed, say there is little value in stand-alone practice sites.
GP consultations are part of a health conversation that should include the right high-quality information. If the public are to take responsibility for their own health they will need a little help from their friendly GP. Gone are the days when it was enough to write the name of a condition on a Post-it note and say: “Google it”.