It is clear a ‘one size fits all’ approach to health and care simply cannot meet the needs of users of the health and care system."
Personalised care is not an add on, a tick box exercise or an afterthought. It is a way of creating health that goes beyond prevention or treatment of illness and disease and looks at possibilities for creating genuine care. Personalised care is driven by looking to understand what matters most to people, and ensuring actions or interventions are fit for the person, their life and their community.
Personalised care puts the person at the centre of their health decisions and gives them choice and control over the way their care is planned and delivered. One of the core foundations of personalised care is shared decision making. This ensures that people are supported to make the decisions that are right for them, and this decision making is collaborative. It brings together the clinicians’ expertise in treatment options, evidence-based diagnostics, risks and benefits and the person’s own knowledge of their own circumstances, experience, values, beliefs and objectives.
At Practice Unbound, we have focussed on creating products which free up practitioners to have the right conversations about what matters. This has been achieved through the safe delegation of low-risk clinical correspondence and Pathology processing, freeing up over 1 million hrs of clinician time across the UK to enable these conversations and work on transforming services to put people at the centre. We continue to develop programmes and partnerships that deliver patient centred care. Whilst we continue this work, we are also focussing our attention on changing the conversations themselves.
Our newest programme, Prescribing Lifestyle Medicine (PLM) is helping practitioners change the conversation, understanding what a person’s typical day looks like, co-creating lifestyle prescriptions, and building people’s confidence in their abilities to manage their own conditions and symptoms. PLM is focussed on shared decision making, personalised care, enabling choice and supporting self-management. It enables practitioners to empower patients through prescriptions focussed on lifestyle interventions.
Focusing on biological systems rather than symptoms, PLM offers practitioners a new set of immediately implementable, safe tools which will increase job satisfaction and deliver better patient outcomes. PLM introduces a unique, easy to use framework that is applicable to practitioners within a standard appointment system. PLM uses shared decision making and personalised care and supports people to reflect on and change their behaviour to enable them to access health interventions, PLM does not purport to fix health inequalities, but it does recognise the impact that health inequalities have on a person’s ability to make changes. PLM ensures that clinicians are co-creating lifestyle prescriptions that reflect what matters to the person using their services and that fit into their life.
Our Group Consultations programme is helping change the conversations by putting people’s stories and peer support at the heart of health and helping patients become more activated to self-care. The programme enables choice and supports shared decision making. Patients report increased confidence to self-manage and become more connected with their communities with a more integrated approach to personalised care and support planning. Group consultations are an efficient and person-centred way of focusing on priority areas and healthcare challenges. Group consultations enable clinicians to proactively and collaboratively manage and support high risk patients preventing the need for acute admissions and tackling health inequalities.
Practice Unbound is a division of Here, a not-for-profit social enterprise. Through partnerships with primary care and providers in health and social care, we create health services and solutions which are shaped around the needs of the person. We support clinical service design and delivery across physical and mental health services. Our approach is based on an analysis of how value is added for the patient at every contact point, enabling services to focus on their core purpose and delivering care that effectively responds to the person’s needs.
Personalised care within the Sussex MSK Partnership has been a prime focus for our service over the past 7 years. In 2016 we recruited a supported self - management lead, Dr Chloe Stewart a health psychologist, who championed person centred care and led a major programme of work to enable clinicians to improve their skills in ‘shared decision making’, which is a collaborative partnership where clinicians work together with patients to support choice and control over options for their management.
Another shift in our process in MSK has been to engage patients in their health journey through the development of a patient outcome letter to outline individualised care plans. We have seen improvements in patient experience measures and there has been a significant reduction in referrals to secondary care since 2015 suggesting patients are opting for conservative management over surgical intervention which is also reflected in a reduction in secondary care spend.
Since then, we have trained new clinicians to our service in all components of personalised care in skills such as using health coaching and motivational interviewing techniques to improve our conversations and ensure consultations are patient centred. Our most recent project was to call patients early after their referral to the MSK service and ensure they reached the right place, first time as well as to establish their concerns and expectations of the MSK service. We found that with a health coaching conversation and the right support, many patients had the knowledge, skills and confidence to self-manage. Of 568 patients we spoke to, 118 were able to self- manage and only 10% of these patients have needed to re-access our service 1 year on. We are striving to continue to make our work in MSK person centred and equitable, in particular addressing health inequalities which have become more apparent during the Covid pandemic.
It is clear a ‘one size fits all’ approach to health and care simply cannot meet the needs of users of the health and care system. Personalised care will enable the NHS workforce to work in a person-centred way using shared decision making, personalised care and support plans. This will give people choice over their mental and physical health. This approach means that both the clinical and non-clinical aspects of care are addressed.
What the Covid 19 epidemic has taught us is that life can change at a moment’s notice. We need to create a world where it is normal to ask each other what’s important and what matters. We need to create a truly integrated healthcare system that has the person at the centre This isn’t just about healthcare. This is about the people using the service and the people delivering the service.
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