As the government encourages every one of us to put forward suggestions on how to improve the NHS in the 10-Year Plan consultation change.nhs.uk, I started to think about some of the issues that my colleagues and I face as we try to navigate a convoluted system in an effort to both deliver and access high quality care.
This consultation comes at a time when many colleagues right across the NHS are still impacted from the pandemic. They are quite rightly prioritising their own wellbeing without losing sight of the reason they chose to work in the health service, and the desire to deliver the very best care. The consultation comes at a good time to refresh and reimagine how we deliver the right care in the right place at the right time, free at the point of need. Central to this will be finding ways to restore joy at work for the 1.5 million people working in over 350 different roles.
As professionals we are motivated by self-direction, mastery and a sense of common purpose. These are all components of the National Association Primary Care (NAPC) CARE programme (Connected, Authentic, Resilient, Empowered). CARE, supports and encourages participants to seek innovative solutions to problems that they can see need fixing. CARE aims to radically improve population health and reduce health inequalities by connecting and empowering the whole health and care workforce, alongside their local communities, it’s a win, win. Participants are building personal resilience and rediscovering joy in their work; they are more likely to remain in post and are designing and delivering services that appeal to their patients. Patients in turn begin to understand and see the benefits that becoming more active as partners in their care can bring. They feel more in control of their health and consequently experience improved outcomes and a better user experience.
The basic principle of activation is simply giving the health care profession permission and support to seek and apply innovative solutions to improve the experience and outcomes for their patients. Achieving small successes results in a snowball effect, colleagues are in turn more likely to find ways to simplify pathways and work with patients to take more control of their health and well-being.
A workforce that is more invested in improving the support and care offer results in significant improvements in population health, patient experience and value for money.
We know that the NHS spends approximately £10 billion a year on diabetes care. People with diabetes typically requires twice as many GP visits and three times as many hospital admissions as people without diabetes. It comes as no surprise that colleagues who have been through the CARE programme are seeking solutions to improve the experience and outcomes for patients with diabetes, in addition to increasing their job satisfaction and streamlining costs. Some of the benefits and impact from the following results of CARE participant innovations and success stories include:
- Nurse led text nudges: Text support reduced diabetic HbA1c by 9 mmol/mol between reviews
- Group support: Virtual care and goal setting cut HbA1c by 28% and BMI by 4%
- Telephone outreach: Calls to disengaged patients reduced GP contacts by seven appointments annually, while improving HbA1c and BMI.
It’s clear that the outcomes for these patients are improved and we know anecdotally, their experience of receiving care is improved too.
CARE participants have embarked in hundreds of population health improvement projects
- Supporting patients: Over 70% of diabetes projects took a multidisciplinary approach to help patients overcome barriers in self-management and to facilitating lifestyle changes
- Addressing Inequality: Approximately 25% of projects strove to bridge health inequities by connecting underserved populations with healthcare and community resources
- Digital Engagement: A significant number of projects utilised text nudges, digital tools, and virtual group consultations to provide support more efficiently
- Clinical Care Protocols: Several initiatives focused on developing standardised care protocols and optimising medication for diabetes management.
Most CARE projects (72%) are expected to reduce NHS demand by enabling people to take a greater role in their own health.
It is possible to calculate the financial benefits associated with this. A 1-point rise in activation (on a 4-point scale), is correlated to a saving of up to five GP contacts per patient per year and primary and secondary care demand savings of £327 per patient per year.
In the areas where we have seen these glimpses of what a successful future could look like, they are typified by a culture that supports a shared ambition to improve health outcomes and patient experience in addition to encouraging and allowing staff to innovate and be given the support and time to do so. This bottom-up approach keeps the focus on the needs of the community and recognises that one size does not fit all.
As we think about submitting our evidence to the Secretary of State for Health, on what needs to change to improve the experience for both patients and staff, activation will be very high on the list.
