What’s important to me: not what you think is important for me

A GP and Clinical Commissioner at Horsham & Mid Sussex CCG explains how their Tailored Health Coaching service is helping them understand people’s skills, knowledge and confidence to deliver more personalised, person-centred care.

It is well known that people who feel in control, empowered and confident to take a lead role in their health and care have better outcomes.

Besides recognising their role in self-managing their long-term conditions, they also need the skills and knowledge to do so. As a result, they experience better health outcomes, fewer admissions to A&E and an improved experience of care.

However, the ability of people to care for themselves varies hugely from person to person.

At Horsham & Mid Sussex CCG, we are using a tool called the Patient Activation Measure (PAM) in our Tailored Health Coaching service to capture the extent to which a person feels they can manage their conditions – also known as their activation level.

Our health coaching service provides the opportunity to people living with long-term conditions to identify with a Health Coach what is important to them – rather than what we, as the health care professionals, might think is important to them. It places people at the heart of their health, empowering them to take control and make decisions about the care they receive.

When you have a PAM score, you can begin to understand which interventions would be most suitable for that individual’s level of activation. Tailored health coaching is remarkably helpful for this and is very much enhancing our person-centred care offer to our population.

Our coaches have received specific training in tailoring approaches to individual levels of activation. They use language and goal setting skills to boost a person’s confidence, and also signpost them towards solutions to improve their ability to self-manage from our ‘Menu of Care’. This is a comprehensive holistic directory of services that includes not only health, but also self-referral to psychological support, e-learning opportunities about specific long-term conditions, social care information, housing and financial support and third sector community groups.

The coach tailors their approach to the person according to his or her PAM level. Some people are less activated than others, that is, they have low levels of skills, knowledge and confidence. They may have experienced a great deal of failure to self-manage in the past. They may not yet understand that they have a significant part to play in their own health.

The coach spends more time with these people – compared to those at higher activation – supporting them to identify what matters to them, and then helping them to break these goals down into easily achievable steps where they are likely to experience success. As we all know, experiencing success can be highly motivating!

Our coaching service was launched in May 2015 and, so far, feedback from clinicians, coaches and most importantly people using the service, has shown it’s been highly valued to support people to manage their health, care and wellbeing.

Ross Joannides, our Team Leader for the Health Coaches, notes: “Our experience over the past 12 months within the Tailored Health Coaching Service is one of great satisfaction regarding the impact our service has been able to make on the lives of many individuals.

“We have seen a number of people identify a wide range of issues that they would like to address, including knowledge of condition, physical activity, diet, social isolation, and awareness of other support and care services.

“Following the health coaching intervention – which usually lasts anywhere between 4-12 sessions – people find they have achieved goals that have had a huge benefit on their levels of  confidence and ability to manage their own  health and quality of life.  It has also helped people to have greater confidence to meet the challenges facing them in the future.”

From my perspective as a Clinical Commissioner and a GP, this has been an exciting time for us – to finally see holistic care in place which ‘meets people where they are’.

Here, in Horsham & Mid Sussex, we plan to extend the use of PAM and the coaching service to other areas within Primary and Community care, led by our improved outcomes and feedback from our patients on what they want to see, that is “care focused on people and their individual needs at the centre”.

Dr Karen Eastman

Dr Karen Eastman is a Clinical Director for NHS Horsham and Mid Sussex CCG and a GP Partner at The Brow Medical Centre in Burgess Hill, West Sussex. She also enjoys a role as a GPwSI in Pain Management.

With a passion for high quality, person centred and innovative patient care and services provided in local community settings, Karen became involved in Practice Based Commissioning in 2005 and remained active in representing frontline patient and clinician experience right through to the formation of Clinical Commissioning Groups (CCGs) in April 2013.

She is now a Clinical Director for the CCG formed of 23 GP Practices, responsible for the health and wellbeing of more than 225,000 people. She also leads the clinical input into Long Term Conditions and Planned Care for the CCG and feeds into NHS England’s Person Centred Care Working Group, and is a RCGP Champion for Care and Support Planning and sits on the NHSE PAM Learning set.

Karen has been a GP for 19 years, having trained at The Royal London Hospital Medical College.

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  1. Mike says:

    This is the dozy NHS at work. Most of the time my GP is obedient but this has not been the case recently. I’ve now started legal proceedings against my GP for not prescribing Vitamin D – on the day new recommendations for Vit D came out. I suspect the ‘PAM’ tool is there to cope with the complete inadequacies of the people in the NHS.

  2. Sue Wilkinson says:

    Hi, this looks fantastic! I am very interested in PAM, but particularly when used in conjunction with the health coaching model mentioned by Dr Eastman. Could I have more information on the project please including the background of the health coaches. Here in NHS Leeds West CCG our Public Health Clinical Lead is interested in developing a similar approach employing health coaches from the third sector. Are you able to send me more details please as we would be keen to learn from your project( I have read the interim report)

    kind regards


    • NHS England says:

      Hi Sue,

      Many thanks for getting in touch.

      If you contact the Person-centred Care Team on, we will be able to send you more details about Horsham & Mid Sussex CCG’s health coaching service specification. It also seems sensible to link you with colleagues at Leeds City Council, who are using the PAM tool across three different programmes so that you can link up.

      Kind Regards
      NHS Engand

  3. Lynne Craven says:

    Really like this!