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Self-care is critical to the Five Year Forward Plan… but social prescription alone will never be enough

Teaching patients self-care is the future for UK health, says Dr Michael Dixon,  National Clinical Lead for Social Prescription for NHS England, but only if the whole community – from Government to grassroots get involved…

The great medical iconoclast, Ivan Illich said in the Sixties: “The greatest single advance in medicine will not be some new drug or procedure but an increased ability of patients to care for themselves”.

Self-care and improving personal and community health feature high in the Five Year Forward Plan but when it comes to translating this at local level there are huge disparities in the amount of funding available.  Somehow, hospital deficits always seem to mop up money that was laudably earmarked for improving health and self-care.   

Self-care is somewhat counter-intuitive to the traditional medical model. After all, doctors have always been paid by the care that they provided. There is hardly any profit in patients self-caring.  Ditto for hospitals, who continue to be paid for by activity.  Our system and our professionals are, in a way, incentivised to do exactly the reverse of what we all know to be necessary.

Nor will effective self-care come about through national programmes, videos or leaflets.  That is because most of those, who are not effectively looking after themselves at present, need first to overcome enormous motivational barriers, which often start with poor self-esteem and  self-confidence as well as feelings of hopelessness and disconnection.

These issues can only be addressed by personal interventions and relationships such as social prescription and coaching.  These interventions need to be integrated – not simply coming from traditional health sources.

For instance, in the Finnish town of Seiajok, childhood obesity has been reduced by half over the past six years and the aim is to eliminate it altogether.  Their secret is local health authorities working with education, nutrition, recreation and urban planning.

It has to be a ‘whole community’ thing.  Social prescription is a means but not an end on the journey to developing health-creating communities, which enable self-care and more effective personal and community health improvement.

There was a proposal at the beginning of the first David Cameron Government that all Government Departments should relate their work to health.  This needs to be so at both national and local level otherwise our health service and its clinicians simply become apologists for all the other factors that make our patients demoralised and unhealthy in the first place. 

The College of Medicine is committed to all means of improving individual and community health – both biomedical and non-biomedical.

Creating an environment where self-care prospers cannot be done by GPs, Directors of Public Health, Public Health England, NHS England, Department of Health or Secretary of State – not to mention Local Authorities, Schools, voluntary and volunteer services Department of Work and Pensions etc… It  needs to be a combined effort with funding to make it happen – some of which needs to be national – to ensure that the benefits of self-care are effectively open to all. It is the only way that we can create sustainable health, sustainable communities and a financially sustainable health service.


Dr Michael Dixon

Michael Dixon is a GP and National Clinical Lead for Social Prescription (NHS England), as well as being Chairman of the College of Medicine. Dr Dixon has been appointed as a government advisor on GP commissioning. Dr Dixon is a strong advocate of preventative medicine, healthy living and integrated care. In his Devon practice, patients are able to directly access a range of health check and self-help initiatives; emergency and maternity services; NHS community services including podiatry and physiotherapy and, for certain patients and certain conditions, complementary therapies. The philosophy is to help patients keep well instead of waiting until they are sick before helping them. Its success is demonstrated by the practice’s low referral rates and high scores on all performance indicators. Dr Dixon is also Visiting Professor at the University of Westminster; Honorary Senior Fellow in Public Policy at the Health Services Management Centre, University of Birmingham; and Honorary Senior Lecturer in Integrated Health at the Peninsula Medical School. He is also a Senior Associate at the King’s Fund where he is a member of the Steering Group of the Inquiry into quality of GP care.