Enhancing Primary Care......Adding a New Dimension

I wanted to follow up on my last article on Linkedin to focus in on those three new personalised care roles. They represent such an important change. Bringing in Social Prescribing Link Workers (SPLWs), Health Coaches (HCs) and Care Co-ordinators (CCs) has opened a whole new set of capabilities for primary care, enabling us to offer a new dimension of support to people.

I’ve been a Clinical Director (CD) of our Primary Care Network (PCN) for five years now. One of the key levers for networks to have positive influence has been through the new additional roles. Initially there was a small budget to fund 2 roles – a SPLW and a Pharmacist. As we all had to have a SPLW it catalysed the Social Prescribing revolution. As the budgets increased and more roles came on board, we have the choice to employ HCs and CCs and grow numbers of SPLWs. Now there are over 12,000 people occupying one of these three roles in the NHS across England. The Workforce Plan aspires for 36,000 by 2034. What an achievement, we have grown a whole new branch of Primary Care.

I have seen first-hand in our PCN and through hearing from fellow GPs Dr Ayan Panja Hussain Al-Zubaidi and CDs across the country how much impact they have had. These roles bring in specific capacity and skills we’ve not had before. They allow us to support people in ways we’ve always wanted to but not been able, certainly not consistently and at scale. It's led to astonishing and life changing outcomes for so many people, staff and patients.

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We’ve known for decades that the wider determinants of health are crucial, issues like isolation and loneliness, poor housing and work, poverty. SPLWs directly focus on these issues. They use their skills to help people find solutions, and often generate opportunities in communities where they don’t exist. They create stories like Rachel who joined a woman’s climbing group low in confidence and struggling with her mental health. Learning new skills, being quietly supported by the group leaders, consistently building her self-confidence and belief, led to a new job, reduction in meds, and a sustained turnaround of her life. Julia Hotz wrote a whole book about these sorts of stories!

?HCs are experts at building people’s self-management and self-coping skills. They focus on discovering what matters most to people and helping them to grow confidence and skills to improve their health and their quality of life. When it comes to people living with long term conditions that depend on these self management skills like eating well, moving more, managing stress and sleep well, this support is game changing. Every HC has 100s of tales of people take back control of their lives. People like Deepak who with coaching support reversed his diabetes by changing his diet, and then supported his mum to do the same, and then contributed to peer support for others like him.

CCs offer a range of crucial support functions, often for the most complex, or marginalised patients. One CC told me ‘we catch those that fall between the cracks’. A while back the family doctor might have held this role, but with multimorbidity, and hugely more complex medical interventions, and many more older people GPs struggle to keep up. These specifically trained staff add in capacity to help people navigate, make sense of, survive the burden of treatment. They support and compliment the GP role.

There is much overlap between these three roles. Coaching skills are essential for relationship building and care planning that many CCs do. SPLWs use coaching skills to understand peoples need and make the right connections. HCs often seek inout from SPLWs for onward connections in their local community to help maintain behaviour changes. In the best of systems these roles collaborate closely, share wisdom and support for each other and the communities they jointly serve.

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I wrote of the importance of compassion. For me these 3 roles are the ‘ambassadors of compassion’. They bring in capability and capacity for our primary care teams to recharge our caring vocation. ?We know that stimulating this sort of person-centred approach, reinvigorates the rest of the team. GPs and Nurses want to work with compassion, it makes the days worthwhile. Having a dedicated team like this to collaborate with is a welcome boost.

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It is still early days, and as I wrote before there are vulnerabilities. Often these roles are the last to be allocated a room. Often no-one can spare time for supervision or debrief. I can understand why, primary care has been under resourced and stretched for so long. Often there is little energy left for anything but firefighting. A big risk to any new approach is the rest of the team being so burnt out they can’t embrace anything new. Despite being brand new, and coming into a very challenging and unwelcoming landscape, people stay in these new roles because they believe in them. I heard a health coach say last week ‘I’ve found my happy place’. I hear that sort of thing a lot from all three roles.

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I’m optimistic that more NHS resources will be redirected to primary care. We are great value and a little goes a long way. We are already seeing new investment (￡82 million for new GPs). It was a brave ambition to pursue personalised care through such challenging times for primary care. I have huge respect for the teams that have managed to forge such value adding services despite the lack of support adequate for such a huge change. ?Let’s hope as the core of Primary Care is re-resourced, and pressure eases, recognition of the value of these roles will spread, and every community will benefit from this much needed new dimension.