Creative Collaboration in Primary Care
“Luton practices have been working together in groupings covering 30-70,000 patients… Practices have been looking at how they can staff differently… We now have a workforce that can see hope. They can see a possibility of working differently and of being in charge of their own destiny, managing their own workload.”
Dr Pearson identifies the generational shift which is currently taking place in Primary Care, from symptom-led care to ‘whole person’ healthcare. Innovative and creative collaboration in Primary Care is one of the ways the NHS Long Term Plan aims to achieve the “move from treating illness, to identifying and helping people as soon as they notice something isn’t quite right.”
Different Staffing Models for GP Practices
The traditional idea of a local practice comprising a number of GPs and a team of nurses, is shifting to accommodate a more holistic, and preventative approach to health. Practices now employ a much greater range of healthcare staff including pharmacists, paramedics, social prescribing link workers, and physiotherapists.
This expanded team is able to consider both the physical and mental health of patients; they’re also expanding the range of treatments available. Prescriptions continue to provide medicine, but they also include social prescribing, personalised care, support for conditions related to ageing, and medicines optimisation.
A Changing Experience of Health for Patients
“National surveys tell us that over 40% of people want to be more involved in decisions about their care, and similarly 40% of people living with LTC want more support to manage their health and wellbeing on a day-to-day basis.”
- NHS England
Asking a patient to describe their symptoms gives a partial and imprecise view of their condition. Primary care is now moving from asking ‘What’s the matter?” to discussing with patients how healthcare resources can best be deployed to increase their wellbeing and alleviate their symptoms. This collaborative approach to care increases the value experienced by patients, and encourages a more long-term, productive use of funding.
Examples of Creative Collaboration in Primary Care
The integrated care system for whole person health is supported by the rapid innovation of digital technologies in healthcare that make collaborative practices in primary care easier and more efficient.
- National Innovation Collaborative for Digital Health. This is a support system that brings together health and social care professionals in order to grow their knowledge and share their experiences of using technology to care for people in their own homes. Over the past two years this initiative has been involved in 100 projects in England allowing 360,000 patients to be treated via remote monitoring.
- North Central and East London Provider Collective. This is a collaboration between 5 trusts and their service users. They commission and provide child and adolescent inpatient mental heath services in London practices. The approach has improved the outcome for patients and made significant savings for healthcare budgets.
- Ways to Wellbeing in York. Social prescribers are embedded in a range of services across York. People can be referred, or self-refer, and this leads to an informal discussion in which they’re asked ‘what matters to them’ and any ‘gaps’ they’ve identified in health provision. A plan is then made, collaboratively to determine ways to improve their wellbeing, utilising available primary care and voluntary services.
Patient-Focused Case Study – Pain Management in Milton Keynes
Celene has back pain caused by an accident she had a number of years ago. It is a chronic condition and she was finding it increasingly difficult to manage. The pain was initially treated at her local GP practice for pain medication, and by an MSK consultant.
“I was put on some painkillers, which had a number of debilitating side effects, and also referred for hydrotherapy, and physiotherapy. I was hoping that the therapies would eventually help me to lower my pain medication, but this wasn’t the outcome. I found it too painful to do many of the exercises and ended up feeling that I’d failed.”
- LDA Research Interview
Celene was then offered a referral to a Pain Clinic in Milton Keynes:
“It was here that I got real help. A change of pain medication, a thorough consultation with the lead specialist, and a designated pain management nurse.”
- LDA Research Interview
The Pain Management Course in Milton Keynes is run by Milton Keynes University Hospital and is a multi-disciplinary service which employs the expertise of pain consultants, health psychologists and an advanced nurse practitioner in chronic pain.
“It’s a course of 6 sessions running continuously on a Monday. It’s 3 hours of very intense therapy, and you’re given work to do in-between sessions. It’s something you really have to commit to if you want to get the most out of it. I’ve learnt what pain actually is, how to manage it, accepting it and our ongoing relationship with it.
It was really interesting, re-engaging with communication and listening skills – we talked about how we discuss our pain, whether we are passive, aggressive, or assertive. We also were given exercise bands and new exercises to start doing daily. Last week we learnt a little Tai Chi.”
- LDA Research Interview
Whilst the course is now complete, Celene still has access to her pain nurse who checks in with her every 6 months, and she’s able to request steroid injections for the damaged areas of her back.
“I think the course will continue to help me in the long run. I have realised that it’s about me finding out what helps me, changing my thought processes and having more positive thoughts about pain and living with it.
I would totally recommend this course. I’ve met some other interesting patients that have made this course worthwhile for me. It’s about interacting with each other and the course leaders and information. It would be nicer if it was more sessions but as it’s run by NHS obviously it’s limited time wise.
It didn’t work for everybody, some of the participants said that they didn’t learn anything they didn’t already know. Fair enough. I think that patients need to be open to this approach, to be ready to participate in their own management of pain, and to see it as part of their treatment.”
- LDA Research Interview
The point Celene makes about patients needing ‘to be ready to participate’ in the management of their pain, or condition, is an interesting one. There is clearly a need for clear communication between patients and HCPs about:
- the role of self-management in their wellbeing
- the opportunity to develop skills and confidence in relation to their condition.
- the potential benefits of patients becoming experts in their own health.
As primary care shifts into a new relationship with patients, it’s more important than ever that the goals, benefits, and long-term potential for this shift is clearly articulated to patients who are being asked to change their perceptions of care, and of the role the GP plays in that care.
Working With LDA Research
For over a decade, the LDA Research team has been recruiting participants globally for medical market research projects. We have a reputation for being able to source ‘hard-to-reach’ patient groups, and this is largely down to our dogged tenacity, and a willingness to work extensively with secondary sources.
We employ a mix-and-match approach to our wide-ranging methodologies, which include online focus groups and interviews, video diaries, ethnographic studies, in-depth phone interviews, surveys, and questionnaires.
We have dedicated healthcare panels in the UK and US and have developed an extensive network of partners with international panels. Currently our field partners span Europe, the US, Canada, South America, South Korea, China, Mexico, Japan, the Middle East, and the South Pacific.
Would you like to talk to a member of the LDA Research team about working with us? Call us today on 01525 861436
