Chronic kidney disease: a new priority for primary care.

aid of written information or, at best, a telephone hotline. The Department of Health’s enthusiasm for self-care may be based on the premise that visits to health services, including primary care, will reduce as a result. There is some evidence to support this, for example self-monitoring of hypertension led to reduced consultations for blood pressure measurement. Over three-quarters of the public say, however, that they would be far more confident about taking care of their own health if they had guidance and support from an NHS professional. As this role is likely to fall to primary care, primary care professionals will need to be enabled to give guidance and support if potential benefits are to be realised. Some may see patient-initiated self-care and self-testing as a threat to their professional role — some patients do not disclose their self-care to their doctors, and a possible extension of the current situation might be that primary care becomes redundant for those patients who can test, treat and refer themselves. It could also be viewed as an important opportunity to strengthen the patient–professional partnership and health outcomes by encouraging people to appropriately use and share their experiences of self-initiated self-care and self-testing. A recent study of GPs’ perspectives on their involvement in the facilitation of chronic disease selfmanagement suggested that increasing patient involvement and control is valued, but that it is not necessarily prioritised because it conflicts with other issues, for example professional responsibility and accountability and contextual factors, such as consultation length. We need to ensure that the public have enough information to make informed choices about when and how to care for themselves and when they should share information about self-care with their primary care team. Primary care doctors and nurses also need access to enough good quality information about available self-care activities to be able to ask questions and then advise patients appropriately, and any barriers to them doing so need to be addressed: they need to be able to adapt themselves to consultations with patients who are even more proactive and informed, but also, at the other end of the spectrum, with patients who are unable or unwilling to take a more active role. The clinical and academic communities will certainly have a role to play in listening to the public about why, how and when they self-care or self-test, and in generating and then providing the public and professionals with the information to make sensible selfcare choices.