Growing pressure on NHS services could be eased if the ‘new mindset and new skillset’ of health coaching was more widely adopted across patient care. This was the prevalent point debated by a panel of esteemed healthcare professionals during Connect Health’s latest Change event, ‘Can health coaching reduce primary care pressure and improve patient outcomes?’
Event chair Richard Pell, Flippin’ Pain Campaign Director, Connect Health introduced the session, outlining data from the British Medical Association showing the current challenges facing primary care, exacerbated by declining GP numbers and recruitment and retention issues.
There is now the equivalent of 2,000+ fewer qualified full-time GPs compared to 2015, despite practices delivering 29.6 million appointments in January alone – with seven in 10 of those being face-to-face,” Richard explained.
It is recognised that health coaching has the potential to reduce demand on primary care; supportive self-management intervention can guide and prompt people to change their thoughts and behaviour, so they can make healthcare choices based on what matters to them.
Health coaches aim to develop people’s motivation, knowledge, skills and confidence around a variety of issues and conditions, including weight, diet, mood and persistent pain. They support people to become more active in the management of their own health and care.
Jag Mundra, Population Health Lead, National Association of Primary Care (NAPC) discussed ‘how health coaching can reduce demand for primary care appointments’, arguing that “prevention is the best way to reduce growing NHS demand.”
Describing the top four health needs of the national population – obesity and diabetes or prediabetes; anxiety and greater mental health issues; frailty; respiratory conditions such as asthma, COPD, smoking and air pollution – and the correlation between patients with such needs seeking increased time with GPs, Jag encouraged healthcare professionals to avoid “hurdles” and to “get started” with health coaching.
He presented significant results from a controlled study undertaken by a PCN in South West England. The study revealed just two health coaching sessions resulted in better outcomes for patients, including an average BMI decrease of 0.3, the need for one less GP appointment and more than six fewer primary care appointments each year.
Jag explained:
As activation [of health coaching] rises, it’s only a matter of time before physical health improves and contacts fall – a one point rise in activation is linked to a reduction of four GP appointments per patient per year, and primary and secondary care demand savings of £173 to £538 per patient per year.
Health coaching works. Done well, with the right model, it may well pay for itself in short term demand reduction alone, that’s without counting the benefit to other providers and the benefit of better health and wellbeing in patients.
Health coaching is a great example – probably the best example – of population health improvement in action. The interventions that have the biggest impact on our populations are those that help us move, eat better, sleep and connect with ourselves and others. What we really want to see here is for this to represent a way of working that ultimately the whole health service, and outside of the health service, enter.
Dr Selena Stellman, GP Lead – MSK and Personalised Care, NHS North West London Personalised Care Team and GP at North End Medical Centre discussed the findings of a year-long pilot project delivered in her practice, supporting chronic pain patients with a multidisciplinary team (MDT) approach – which included health coaching.
These patients were high frequency users of primary and secondary care services…often dissatisfied with the care they were receiving, and lacking both an understanding of their condition as well as the self-competence and resources to be able to make changes themselves.
The pilot focused on a self-supportive personalised care approach to pain, working in primary care and community settings, with MDT support.
Patients had an initial appointment to explore symptoms and discuss the impact of pain on daily life. They were signposted to community groups and appropriate resources, including health coaches, and individually referred to relevant services. A follow-up appointment a few months later reviewed their progress, goals and outcomes.
Selena explained:
We went into it thinking that patients wanted to talk about their pain or their medications or physio, but actually, the vast majority wanted to discuss social issues and challenges and how they could self-manage their conditions. And they wanted to understand what their condition was, and focus on mental health. So it was very little about the medical, and more about how they could address wider factors in their lives – and how they could do it themselves.
Very few patients were referred to secondary care, or musculoskeletal services; most were referred to social prescribers and mental health services. Working in this way, using health coaches and other members of the team – we expect this translates into reduced appointments, referrals and costs.
Telling the story of a patient with fibromyalgia and mental health problems, Selena said:
She found walking difficult and took taxis everywhere. Her coaching sessions focused on pacing, with a walking aid, giving her just a four-minute goal to try. She gradually increased the duration and found her mood improved. A key part of the coaching for her was having a plan when things went wrong. She started to use public transport because she felt more confident, which meant she could go and see friends. This illustrates how just helpful health coaching can be.
Dr Chloe Stewart, Health Psychologist, National Specialist Clinical Advisor in Personalised Care/MSK, NHS England, discussed the drivers for change and why health coaching should be used more.
She explained.
There are growing numbers of people living with long term conditions [with many] living with multi-morbidities – two or more chronic conditions.
Reinforcing the points that these patients require the largest number of GP appointments and inpatient beds, Chloe reiterated:
Only 20% of health outcomes are attributed to health care, and in fact it is socioeconomics and health behaviours that account for 70% of health outcomes. As healthcare professionals, we have a huge part to play in supporting people to develop their own agency, to build their knowledge, skills and confidence in managing long term conditions.
Consistently since 2010, only approximately 50% of people feel as involved as they want to be in decisions about their care and treatment. This includes responses from 73,000 people annually. We know that in the 2022 primary care survey, 31% of people asked, didn’t have an agreed plan with a health care professional from their GP practice in place to manage their condition and 6% of people didn’t know if they had one or not. Of those that have a plan in place, 95% find it helpful.
Dr Ollie Hart, GP, Director, Peak Health Coaching gave an insight into his own journey into health coaching. He started as a GP with special interests, running a pain clinic and looking at “how you can help people to live well for themselves and take control.”
Discussing a paper he co-published in the British Journal of Pain in 2014, Ollie said:
We concluded that a health coaching programme promoting self-management in chronic pain can be successfully implemented in primary care. And it can be instrumental in helping clients to actively participate in identifying their own problems, setting achievable goals and managing the challenges of everyday life.
He presented the evaluation of a health coaching service in North East England, using data from patients with conditions including COPD, pre-diabetes and low mood. The findings revealed overall health improvements and a reduction in low mobility, self-care problems, pain and discomfort and anxiety and depression. He added:
There was an effective – and cost-effective – improvement in patients’ self-reported quality of life.
This type of approach is a new mindset and a new skill set [for healthcare professionals]. It’s opening the doors to a new workforce and adding an additional capacity to us that we didn’t have before. It is improving patient self-management and quality of life, which is a sustainable way of reducing demand. People are coping better and doing well. They demand less from the system. It’s setting them up to achieve things for themselves.
Richard Couch, Service Transition Manager, Connect Health, discussed chronic pain and opioid use best practice, beginning with three statements:
Managing pain is very difficult both for the clinician and for the patient. Opioids are not effective for the majority of people with long term pain. Reducing opioids is quite challenging or very challenging, especially if you’ve been on them for quite a long time.
He outlined Tim Williams’ STOPIT.DOIT® coaching model, considering the perspectives of two people – a clinician thinking about reducing opioids, and a patient talking about their pain and opioid use.
Explaining how each letter in the model relates to an action: S for signs, T for tell, O for outcome, P for prevent, I for ideas and T for time, Richard said:
We know that if you put a date in the diary, it’s much more likely to happen – we set ourselves up for success. So there’s no time like the present, to reduce opioid use, get better outcomes, have a positive impact on the wider community and to consider coaching conversations.
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