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Primary careMar 8, 2023

Prevention is the best way to reduce growing demands on the NHS, says Connect Health panel

Health coaching has the potential to reduce the unprecedented pressures facing primary care services, physiotherapist Richard Pell told delegates attending a podcast broadcast by Connect Health on 1 March.

Mr Pell, campaign director of Flippin’ Pain, Connect Health, introduced the session by referring to recent British Medical Association data that highlighted the challenges facing primary care – such as a fall in GP numbers, and recruitment and retention issues.

‘There is now the equivalent of 2,000-plus 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.’

Photo Credit: Connect Health
Smiles better: health coaching can help to improve patients’ self-reported quality of life


Mr Pell added: ‘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.’

Act now to reduce opioid use

Physiotherapist Richard Couch, Connect Health’s service transition manager, tackled the thorny topic of chronic pain and opioid use. ‘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.’

Mr Couch outlined the tenets of a coaching model designed by Tim Williams, which is known as STOPIT.DOIT. 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, Mr Couch explained: ‘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.’

A personalised care approach to pain

Selena Stellman, a London-based GP who acts as lead in musculoskeletal (MSK) and personalised care with the NHS North West London Personalised Care Team, discussed the findings of a year-long pilot project delivered in her practice, supporting patients with chronic pain through 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.

Dr Stellman added: ‘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 MSK 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.’

Coaching in action

Dr Stellman said one patient with fibromyalgia and mental health problems found walking difficult and took taxis everywhere. After taking part in a series of coaching sessions – which focused on the benefits of ‘pacing’ with a walking aid and setting a four-minute goal – the patient '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 Stellman added.

Ollie Hart, a GP and director of Peak Health Coaching, gave insights into his personal 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’.

Dr Hart presented the evaluation of a health coaching service in north east England, using data from patients with conditions including chronic obstructive pulmonary disease, pre-diabetes and low mood. It led to overall health improvements and a reduction in low mobility, self-care problems, pain and discomfort, and anxiety and depression. He said: ‘There was an effective – and cost-effective – improvement in patients’ self-reported quality of life.

Dr Hart added: ‘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.’

The panel event was organised by Connect Health, the largest, independent provider of integrated community MSK and pain services in the UK. It was titled ‘Can health coaching reduce primary care pressure and improve patient outcomes?’

Click to find out more about Flippin’ Pain

Author: Ian A McMillan
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