Local GPs and Yeovil NHS Trust worked together to design and setup their Enhanced Primary Care Service to deliver better outcomes for people living with long-term conditions and manage demand on healthcare services. Initiated and managed by Symphony Healthcare Services the service involved having a broader ‘skill mix’ in primary care, including Musculoskeletal (MSK) and mental health practitioners to focus specifically on people with long-term conditions.
A key role within this service was the addition of health coaches. They try to understand patients’ lives holistically, use personalised coaching techniques to build up their motivation to change, and then supporting them to realise their own goals. To better enable this, health coaches have a good knowledge of local resources, and help to identify gaps and develop resources for individuals, such as peer support groups.
As part of this approach, they use the Patient Activation Measure (PAM) questionnaire to identify peoples’ levels of knowledge, skills and confidence (‘activation’). After patients have been working with health coaches and taken actions identified in their conversations, a second PAM survey is carried out. If the patient’s score has improved it means there has been a positive impact on their confidence, knowledge and skills. Evidence shows that a patient’s activation score has a direct link to reduced service usage and improved health outcomes.
Across 17 GP practices in South Somerset, the vanguard employed 50 health coaches. By December 2017 they had supported 12,508 patients, completed 1,591 personalised care and support plans, and administered 2,523 PAMs. Of those, 167 have had a second PAM and 65% improved their activation score, having worked with the health coach. Though some more analysis of the matched control cohorts is needed, patterns in the data suggest a decrease in the number of emergency bed days, excess bed days, length of stay, and outpatient appointments for patients receiving health coaching. In addition, a qualitative evaluation showed the positive impact of health coaching on diabetes, weight loss and mood, as well as on the wider determinants of health such as social isolation.
Beyond the positive impact on patients, GPs have also experienced a positive change. One practice reported a decrease of appointments with a GP from 70% to 50%. This was directly linked to the introduction of health coaches, key workers and MSK practitioners. As a result, they were able to dedicate more time to planned and proactive care. It also led to improved morale, greater job satisfaction, and reduced work-related pressure.
A South Somerset GP has said of the impact of health coaching:
What’s different is probably the perception of what is possible and permissible. We feel in control rather than being an island under attack retreating from the relentless onslaught of demand on one side and reduction in provision on the other.