Long term conditions framework: consultation analysis

15. Question 13

How do you think long term conditions can be detected earlier or more easily?

Introduction

The vast majority (85%) of respondents answered Question 13. The analysis identified four themes, including:

• theme 1: screening and regular check-ups
• theme 2: education and awareness raising activities
• theme 3: workforce development for healthcare professionals
• theme 4: greater availability of GP appointments

Theme 1: Screening and regular check-ups

Most respondents identified the importance of screening and regular check-ups as a way to help long term conditions be detected earlier or more easily. These respondents emphasised the importance of early detection and diagnosis in achieving positive population health outcomes, including for people with long term conditions and that screening and regular check-ups were the most effective way to do this.

Some respondents felt the provision of screening services in local community settings (for example, pharmacies, supermarkets, leisure centres, and in workplaces) could be useful to increase uptake of these services as this may reach people who may not otherwise engage in traditional healthcare settings. Some suggested that screening services could be ‘opportunistic’ and undertaken when people were there for other reasons (for example, at pharmacies, podiatrists, or during home visits).

Some respondents felt that a targeted approach to screening was equally important as a way to help long term conditions be detected earlier or more easily. For example, responses frequently mentioned the targeting of: younger age groups; people living in deprived areas; population groups who experience health inequalities; and at risk groups or other vulnerable groups who already have long term conditions (for example, people with diabetes, people living with chronic pain, people with mental health issues).

A small number of respondents felt that care should be taken to ensure screening programmes were evidenced- based and proportionate. They said that screening was not always cost effective and it could sometimes lead to overdiagnosis.

A respondent quote to illustrate theme 1 is presented below.

“Early detection may require active screening. Many long term conditions can be detected early before symptoms appear. Resource into disease screening must strike a risk/benefit balance, but early detection of diabetes, hypertension, cancer, COPD and CKD for example are conditions where early detection can result in better outcomes. There are a number of pilots where community pharmacies have been involved in early detection such as point of care testing for diabetes in NHS Tayside.” The Royal Pharmaceutical Society

Theme 2: Education and awareness raising activities

Many individual and organisation respondents identified awareness raising activities as a key method to help long term conditions be detected earlier or more easily. These respondents said it was vitally important the public were made aware of risk factors, warning signs and symptoms – and that this may encourage earlier engagement with healthcare providers.

Prevention and early intervention activity (and health literacy) was emphasised given the role of lifestyle factors (such as diet, physical activity, alcohol consumption, smoking) in influencing health and wellbeing. Encouraging healthier behaviours and lifestyles was considered vitally important in this regard – among the general population as a whole and for at risk groups.

Theme 3: Workforce development for healthcare professionals

Many respondents identified the need for additional and ongoing workforce development and training for healthcare professionals, including GPs and frontline healthcare professionals, to help improve the early detection of long term conditions.

These respondents emphasised the need for healthcare professionals to have an up-to-date and good working knowledge and understanding to enable them to recognise the early signs associated with long term conditions. This could improve early detection, reduce misdiagnosis, and improve long term outcomes for people.

A respondent quote which illustrates theme 3 is presented below.

“We regularly hear from older people that if someone is living with one long term condition, for example dementia, if they go to their GP with new concerns, they are often quickly dismissed as being due to dementia, when they may be entirely unrelated. Therefore, improving GPs and other primary care professionals’ awareness of less common symptoms and co-morbidities between long term conditions, would help to detect conditions earlier and easier.” Age Scotland

Theme 4: Greater availability of GP appointments

Many respondents reported that a key barrier to the early detection of long term conditions was that many people found it difficult to access GP appointments and/or that GP appointments were too short.

The main feedback was that people often struggled to get a GP appointment which then made it difficult for them to discuss their symptoms and to receive an early diagnosis and appropriate signposting.

Some respondents reported that when they did have a GP appointment, appointments were short in duration. They said this meant people did not have long enough with their GP to discuss their symptoms in any great detail (particularly if they were managing multiple long term conditions) and that GPs were often time constrained which meant that long term conditions were not always detected early, or progression of a condition may be missed. A small number of respondents said some people may delay going to see their GP because they know GPs face a range of challenges, including increased demand for appointments.

A respondent quote which illustrates theme 4 is presented below.

“GP practices are experiencing lengthy waiting times, which may discourage people from attending who perceive themselves to only have a minor issue, even if it might be something they only considered checking due to an awareness raising campaign. If people cannot access timely services in the right place, opportunities to prevent the onset or progression of a condition may be missed. That person’s minor issue may be an early indication of a more serious condition.” Health and Social Care Alliance Scotland