By Dr Ollie Hart, GP, PCN Clinical director, and Director of Peak Health Coaching
I have been involved in training and supervising many hundreds of social prescribing link workers and Health Coaches in the last year. I have done this in my local capacity as a Primary Care Network Clinical Director, and as part of a team of trainers at Peak Health Coaching offering PCI accredited support and training across the country. We have a few take-home messages to share.
Firstly, we notice people in these roles are almost universally proactive and positive minded. They appear very motivated to support people and excited by the potential of their roles. They have often come from other areas of psychology or mental health support, personal training, or community development, but see opportunity in the personalised care vision of the NHS. They are excited by the NHS policy articulating the value of social prescribing and health coaching, and the opportunity afforded their new roles to support people in a different way.
There are however clear challenges on the ground. Many people are working in systems where the local staff and clinicians don’t fully understand or appreciate the role they can play. There is confusion about how health coaching and addressing social determinants of health fits in with the current day to day workings of clinical care.
We hear mixed reports of how well-prepared patients are and how realistic their expectations are. They emphasise that when the people they see come having had a realistic introduction to the value of their support, it makes a big difference. They engage people more easily and realise benefits more quickly.
We also very commonly hear link workers and health coaches worry about the knowledge they have (or don’t have). People say things like “I really need to know more about diabetes….. or eating disorders”, for example. We spend much of our time instilling confidence in the people we train of the significant value of the skills they do have. Good coaches don’t need much clinical knowledge (that’s rightly the realm of doctors and nurses, or trusted websites or books). What they need is the knowledge and skills to support people to apply the knowledge they already have in their real lives.
Doctors and nurses rarely have the time (and often the skills) to explore safely and compassionately what is really going on in peoples lives. To be honest that’s often not the best use of their time, training, and skillset. Health Coaching training gives people the skills to do this really well. This can be employed in brief interventions, but often it’s best enacted by dedicated coaches with more time. Health coaches and link workers connect patients with how they can take a role themselves to manage their health and wellbeing in a way that works for them.
Research and commentary from independent bodies like the Health Foundation, Kings Fund and Nesta repeatedly reveal that this community orientated, coaching function is incredibly important’’. The NHS continually puts high value in the personalised approach. Yes, it needs to be coupled with relevant medical assessment and information, personalised for that person, but what makes the real difference to their outcomes is how people make sense and apply that information.
We’d even go as far as to suggest that if coaches try to build their health knowledge too much, they risk focusing on information giving, which detracts from their more important function as coaches.
We need mutual understanding of the value of each staff members role. People using coaching skills need to value what they do. The current health care teams need to value the important role they play to add significant value to patient care. Service evaluations personally communicated to us by the National Associated of Primary Care, suggests the return on investment of coaching approaches for the NHS is consistently between 6:1 and 12:1. That’s huge, and very valuable to the NHS.
Primary care networks are new, with potential for a wide range of new additional roles. It can be tempting to lean towards roles where their additional benefit is more easily understood like pharmacists, first contact physios, or mental health workers. The new roles focussed on personalised care may be seen as a less obvious ‘quick win’. It will take time to establish slick systems that know how to take advantage of new skills and new approaches. We think teams do best when they understand how to make best use of everyone’s time and skill sets and work as a co-ordinated team. This is exciting new territory, with much to be gained.