If the NHS is serious about shifting from treatment to prevention, it must confront an uncomfortable truth: the public is already doing far more self-care than the system recognises, and far more than many professionals realise. The real problem is not a lack of willingness among patients, but a lack of alignment between public behaviour, professional attitudes, and the support structures needed to make self-care safe and effective.
Our new UK-wide study by the Self-Care Forum and Self-Care Academic Research Unit, published in BMJ Open throws this disconnect into sharp relief. Surveying over 3,200 adults, it found that confidence in self-care is strikingly high: nearly nine in ten people feel able to maintain a healthy lifestyle, and over 90% believe they can manage common illnesses. These are not the responses of a disengaged or dependent population. They suggest a public that is willing—indeed eager—to take a more active role in its own health.
And yet, at precisely the point where this confidence and enthusiasm should be harnessed, the system falters. Healthcare professionals overwhelmingly agree that self-care matters—94.7% rate it as important or very important—but simultaneously perceive patients as reluctant, poorly informed, and insufficiently engaged. This contradiction lies at the heart of the problem. It reveals not just a gap, but a profound mismatch in how self-care is understood, supported and delivered.
This gap matters. It risks undermining one of the few scalable solutions to rising demand in primary care. It also risks pushing patients towards unregulated sources of information, where enthusiasm is abundant but quality is uncertain.
The roots of this disconnect are complex, but they are not mysterious. First, there is a fundamental difference in how ‘self-care’ is defined. For many professionals, it is mainly something that happens within a clinical framework— ‘supported self-care’, closely guided and monitored. For the public, it is broader, covering the full ‘Self-Care Continuum’ that includes lifestyle choices, symptom management, and everyday decision-making undertaken independently. When these definitions collide, misunderstandings are inevitable. Patients feel they are already self-caring; professionals, seeing something narrower, perceive a deficit.
Second, there is the thorny issue of information. The study highlights that while people feel confident, many struggle with key aspects of health literacy. More than half find it difficult to weigh up treatment options, and nearly half report challenges accessing mental health information. Confidence, in other words, is not the same as capability. Without clear, accessible, and trustworthy information, self-care can become guesswork rather than informed decision-making.
Professionals are right to worry about this. The explosion of online health content has created both opportunity and risk. But when clinicians avoid conversations about self-care, they do not eliminate misinformation—they simply leave patients to navigate it alone.
Third, there are structural barriers within the system itself. Time-constrained consultations, inconsistent messaging, and unequal access to digital resources all limit the ability of healthcare professionals to support self-care effectively. Even the most motivated clinician will struggle to deliver meaningful self-care guidance in a ten-minute appointment, especially when faced with competing clinical priorities.
What emerges is a paradox. The public appears ready and willing to engage, but feels insufficiently supported; professionals are willing to promote self-care, but constrained by both perception and system design. The result is a missed opportunity—one that the NHS can ill afford.
So what needs to change?
We must start where people already are. Self-care is not a new behaviour to be imposed; it is an existing reality to be shaped. Recognising the full breadth of self-care—from wellness to illness management—would allow health policy to build on, rather than overwrite, public experience.
Health literacy must be treated as a core component of healthcare, not an optional add-on. The ability to access, understand, and appraise health information is as fundamental as the services themselves. This means investing in clear communication, trusted information sources, and tools that help people distinguish credible advice from noise. It also means acknowledging that health literacy is not solely an individual responsibility, but a property of the system—how information is presented, how services are organised, and how professionals communicate.
The relationship between patients and professionals must evolve. The traditional model, in which knowledge flows in one direction, is increasingly out of step with reality. Patients arrive informed—sometimes well, sometimes poorly—but almost always with questions shaped by what they have read or experienced. Rather than seeing this as a challenge to authority, clinicians should treat it as an opportunity for partnership: a starting point for discussion, clarification, and shared decision-making.
Finally, self-care must be embedded, not bolted on. It should be a routine part of primary care conversations, supported by training, time, and multidisciplinary teams. Pharmacists, social prescribers, and digital platforms all have a role to play. Without this infrastructure, calls for greater self-care risk sounding like little more than cost-shifting.
Crucially, this is not about offloading responsibility onto patients. Supported self-care is about enabling informed choice—helping people understand what they can manage themselves, what requires professional input, and when to seek help. Done properly, it strengthens the safety net rather than removing it.
The prize is considerable. A health system that aligns with public behaviour, supports informed decision-making, and fosters genuine partnership could ease pressure on primary care while improving outcomes and patient experience. But this will not happen by accident.
The public has already moved. Policy, practice, and professional culture must now catch up.
By Dr Peter Smith, President of the Self-Care Forum and lead author of ‘What is the interplay between self- care confidence, professional support and health literacy among UK adults? A cross- sectional online survey study.”
