View From the Ground, by Dhara Shah
In 2019, NHS England approved the recruitment of health and wellbeing coaches (HWCs) through the Additional Roles Reimbursement Scheme to help raise awareness of, and increase responsibility for, patient self-management across England.1 The aim was to ensure that patients are given timely support and are empowered to manage their own health and wellbeing. HWCs are having positive impacts at North Blaby Primary Care Network (PCN), where I provide services as a certified HWC and qualified neurolinguistic programming practitioner.
As an HWC, I am responsible for managing the wellbeing needs of patients within the PCN. The coaching sessions are used to understand the patient’s current situation, determine the root causes of their behaviours and attitudes, identify what the patient would like to achieve, and set goals towards meeting these targets. Over the past 12 months, the HWC team has been supporting patients with health coaching sessions, and the data collected show that there is a huge demand for the new service—of the 320 patients referred to the HWC team to date, 291 (91%) have taken up the offer of coaching sessions (source: internal data from North Blaby PCN).
Before the coaching sessions begin, participants estimate their Patient Activation Measure (PAM®), a score calculated via a questionnaire that determines the baseline level of their knowledge, skills, and confidence (referred to as ‘patient activation’) in managing their own wellbeing;2 this is assessed again directly after the course of sessions has finished. Of the 291 patients who have undertaken a course of sessions, 84% have shown an improvement in their PAM®. Scores for the remaining 16% of patients were the same as at baseline (source: internal data from North Blaby PCN). Thus, 100% of patients using the service reported that there was no deterioration—according to their PAM® scores, they had either maintained or improved their ability to self-care. These data are very encouraging, and show that the health coaching service is having a positive effect on patient confidence.
The benefits of HWCs for patients and practice staff have also been demonstrated by other GP practices. For example, in December 2017, a similar scheme in South Somerset provided health coaching sessions to 12,508 patients with long-term conditions across 17 practices. One of the practices involved described a decrease in the requirement for appointments with a GP that was directly linked to the introduction of HWCs, key workers, and musculoskeletal practitioners, illustrating the benefits experienced by GPs as well as patients.3
From my perspective, an important positive outcome of the introduction of HWCs in North Blaby PCN is that there has been an increase in the number of ways that referrals can be made to the service. For example, in the past, a patient experiencing mental ill health may have had to seek an appointment with their GP; now, they also have the option to self-refer directly to an HWC. Referrals can also come from a complementary service within the PCN; for example, a practice pharmacist doing a structured medication review may recognise that a patient could benefit from an HWC, and refer directly into the service. Social prescribers and mental health practitioners can also refer their patients for health coaching sessions. This saves GP appointments and means that patients are seen more quickly.
We have been fortunate to receive positive feedback from clinicians and patients who have used the service. For example, one patient said that their life ‘has completely changed’ as a result of receiving health coaching, and healthcare professionals in the PCN report that patients are ‘extremely satisfied’. Importantly, clinicians have also indicated that they ‘really appreciated’ the support.
Founder of Ripple Touch, which provides health and wellbeing services to North Blaby PCN
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View From the Ground, by Dhara Shah