A group of people with complex, long term health conditions recently gained the ‘right to have’ their care delivered through a Personal Health Budget. Adults who are eligible for NHS Continuing Healthcare and children in receipt of continuing care can now ask their CCG for more control over how they manage their chronic health needs or disability. In the first of a series of blogs on the subject Dr Raj Mitra, a Lambeth GP and a member of the NHS Lambeth CCG Governing Body, explains why he believes personal health budgets will be an important option for his patients to better manage their long term health conditions:
I’m proud to work in Lambeth, both as a GP and as a Clinical Governing body lead for the CCG where we take the idea of co-production very seriously. Not just as a theory, but as something we need to genuinely take on board if we are to change the relationship between health professionals and patients: this is our NHS and we need to be in this together.
This is one of the reasons that we have been looking in Lambeth at how people with mental health concerns can be offered personal health budgets.
Supporting people to be ‘patients in control’ is particularly important for the ever-increasing number of people I see in surgery who don’t come expecting a quick fix.
I’m sure like many other people in the medical profession I became a doctor with grand intentions to ‘cure sickness’ and ‘make people better’, but with more people living with complex long term conditions and disabilities that just isn’t always an option. The truth is that there are limits to what I can offer someone with conditions such as chronic obstructive pulmonary disorder (COPD) or a degenerative neurological condition such as multiple sclerosis (MS).
So why do these patients book an appointment with their GP?
For some it’s to sensibly monitor their condition, do what they can to manage their symptoms and make positive lifestyle changes. More often though it’s because those conditions are incredibly difficult to live with, and they come because, for example, they’re no longer coping with pain, experiencing more frequent chest pains or not sleeping.
Of course there are medications I can prescribe and treatments I can refer people to, but when it comes to living with chronic conditions, as health professionals we don’t always know best. Yes, there are evidence based treatments for managing pain, but the real evidence is ‘does it work for you?’
If a person remains in pain, I can expect to see them back in my surgery next week – or worse still, ending up in A&E or being admitted urgently to hospital. That doesn’t work for anyone.
I believe in the option of personal health budgets so that, where appropriate, people have real choice to direct their care, particularly when it’s clear that what I have in my medicine chest isn’t enough.
If I know that a particular treatment hasn’t worked for someone, why waste more NHS funds referring people to more of the same, when there may be alternatives that keep them out of hospital that?
As a GP, the time I have with people is limited, so the opportunity for people with complex health needs to spend time co-creating their own care plan in partnership with their NHS team is really valuable. It’s about understanding what matters to you, and not just “what’s the matter with you?”
Clearly personal health budgets wouldn’t work for acute care or for treating illnesses such as cancer. As a doctor there’s no way I would want to see someone choosing to treat cancer with an unproven alternative therapy, but if someone finds yoga can help them to cope with chronic pain better than traditional physiotherapy, then surely that’s a sensible use of money?
His specialist interests are mental health, dementia, cancer and end of life care, and patient engagement.