I have sat through many meetings discussing patient pathways for many diseases. It has long been a disappointment that the GPs and the consultants focus on their interface and how to make it better. Doctors and nurses become the sound bites, rather than patients, homes and communities. I hear a bit of rapid access here, direct referral there, intermediate service specification, outreach, locally enhanced services and a plethora of others. And of course the solution is so often a specialist nurse, a GPwSI or a new overlaid service.
I often ‘cough’ and remind them that community pharmacy manages 70% of the population with that condition with over the counter medicines and advice before they enter the pathway. If it was 75% would that make a difference?
I might add that a simple campaign with screening in community pharmacy would help identify more people and get them to treatment quicker (on a daily basis, community pharmacy sees more people than all other healthcare professions put together).
Or that even some NICE guidance recommends the final disposition of patients with that condition is community pharmacy. And community pharmacy support might prevent another block of expensive NHS care.
I sometimes ‘bang on about’ supported self-care and how a 10% improvement in self-care might reduce healthcare costs by 25% (see Charles Allessi and the NAPC for the reference). I might mention access to NHS choices, healthy living advice, smoking cessation, obesity management exercise signposting and simple treatments. In the end, it is all about people looking after themselves and others around them.
A pathway isn’t a conveyer belt and we shouldn’t focus all out attention on the middle bit – the interface between general practice and hospitals. There is a front end where community pharmacy and self-care sits and a back end where community pharmacy and self-care sits and a middle section where community pharmacy and self-care sits. And I haven’t even mentioned the ubiquitousness of medicines throughout – before, during and after.
And all the way through is a patient who should be helped to make a choice. A pathway starts with a patient in their own home and should finish there – you realise that this is a big hint! Does anyone think of including housing in the discussion – don’t be too radical – who ever thinks that housing has any contribution to health – just me then. Patients start in their own homes with their own families in their own communities don’t they? And they want to end there as well – well and in control of their condition, gaining confidence all the time.
So the next time I sit at a meeting where pathways are discussed – will I see representatives from community pharmacy there? Will I meet my housing colleagues there?
Patient pathways – but what should be the tagline – perhaps from community to community or even from home to home. Definitely not from GP to hospital to GP – that is only part of the story!