To mark Self Care Week, a Suffolk  GP and former medical and public health director talks about her experience pioneering health coaching to empower people to self-manage:  

Imagine health conversations where people identified something so important to them, it ignited their will to learn and changed their thinking and habits around issues such as diet, exercise, and tablet-taking.

Imagine what might happen if one small success led to another, creating the confidence people needed to thrive and reduce their reliance on already over-extended services.

In reality all of this can be sparked by an easily accessible, low cost innovation – a better conversation.

Health-related goals aligned to personal values create focus, energy and commitment to change, and tap into the “renewable energy” or internal motivation of patients, a commitment in the Five Year Forward View.

These goals are mostly not condition but life related. For example, attending a music festival which requires a teenager to control their diabetes; walking to the sea which requires an elderly lady to increase her exercises after a fall and sailing round the world which requires a man with multiple sclerosis to change his self-belief. Yet how successful are we in helping people identify what’s truly important to them that compels them to move forward?

Health coaching is an effective conversational tool that facilitates change in health behaviours among people with long term conditions and bridges patient and clinician agendas.  A person-centred model grounded in behaviour change science, health coaching:

• Is based on partnership between clinician and patient who collaborate to identify personally relevant goals and actions.
• Is built on the belief that people are resourceful, are experts in their own life situations and can draw on their experiences to create change.
• Uses a range of solution-focused communication techniques to generate insight and address barriers leading to patient ownership and empowerment.
• Creates the knowledge, skills and confidence for self-management, especially as people learn to coach themselves.

As a GP, I recognised a skills gap in practice helping people help themselves, and then experienced coaching that filled it.  Since piloting health coaching with practice nurses in Suffolk, we have now trained over 4,000 heath coaches and 50 trainers across the country. New roles and services have subsequently been created in general practice, community and acute settings.

The skills have been found to be useful to all health professionals (clinical and non-clinical coaches), across a wide range of long term conditions and scenarios.  Clinicians report they help change behaviours, structure difficult conversations, reduce appointments and waste, and make their lives easier. The skills are sustainable and are still being used by the majority of clinicians at one year and pioneer local trainers at four years who report very positive results.

By creating coaches, trainers and local champions, health coaching skills also boost other related approaches including prevention, social prescribing, personalised care and support planning, asset-based approaches and shared decision-making.

Local and international evidence is now growing that health coaching can produce positive benefits for patients, clinicians and the system, such as:

• Improving physical and mental health outcomes such as HbA1c, body mass index, physical activity, self-efficacy and levels of activation.
• Augmenting programmes such as cancer, cardiovascular disease and diabetes.
• Achieving cost savings through reduced length of stay and residential care placements, and reducing demand including readmissions and use of primary care.
• Supporting clinician resilience and leadership.

To address the rising cost of long term conditions, health systems need more effective ways to engage people to adopt healthier behaviours. This involves a person and behavioural based paradigm based on what matters to the individual, and working with them, rather than one that is more advice-giving and disease-based. We can all work towards establishing goals important and motivating to people.

However, to make lasting change we need to prioritise communication skills to tap deeper into internal motivation and realise potential – the “renewable energy” of patients – through health coaching.

While there are many ways to move to more proactive management of long term conditions, health coaching skills and better conversations can be the spark that ignites the flame of a new person-centred approach.

• Self Care Week runs from 13 – 19 Nov. You can find out more on the Self Care Forum website and the NHS Choices website.
• Or get updates on Twitter: @SelfCareForum and #selfcareweek.
• Find out more about Better Conversations, or get updates on Twitter at: @betterconvo
• Or email newman1@nhs.net