Our work on (social) prescribing.

For social prescribing to be most effective we also need to sort out patients' 'medical' prescribing.

Here's a two minute description of what we do:

Patient Led Clinical Education and Patient Led Clinical Medicines Reviews

My colleagues and I have been working on ways to put people in charge of their own healthcare. Nowhere is this more important than for people with a variety of conditions or illnesses (the jargon for this is 'multimorbidity').

Only you know what it's like to be you and to have to deal with illnesses that affect you. We are all best experts in our own care. Our work supports this with trusted information, and resources. It links like-minded people together, so we can find the best way to manage our bodies.

Our approach involves people attending a group session on medicines, and then having the option of reviewing their medicines individually in a 3/4-hour session with two health professionals (e.g. a prescriber and a pharmacist).

We provide people with their own notes in the form of a written action plan, which they can share with clinicians. We also give advice on trusted sources of information, on questions to ask doctors and we jointly develop group specific resource pages as a ‘spin off’ to this work. A generic medicines resource www.medsinfo.guru has also been set up. 

Individual support sessions - Our patient led approach.

 Patient Led Clinical Reviews TM - Individual Support Sessions

'In the support session you listened to me, and helped me work out what I needed to say. I gave the notes to my G.P. who changed my meds. and made the referrals you suggested. I now no longer walk with a stick, and feel a lot better. I thoroughly recommend these sessions' Martin, Shepton Mallet, May 2016

‘I’ve made a plan for the pain with my Dr, using

the info and help given...’ Attendee Nov 2015.

‘The course helped me solve a (health) problem I’ve had for ages. Its’ gone now!'

 Attendee March 2015.

This novel approach involves people reviewing their medicines in a 3/4 hour session with two health professionals (e.g. prescriber and a pharmacist).

We provide people with their own notes in the form of a written action plan, which they can share with clinicians.

We also give advice on trusted sources of information including www.medsinfo.guru and on questions to ask their doctors. We ensure people are aware of their rights under the NHS Constitution and the (not so well known) NICE ‘Kindness’ Guidelines.

Benefits identified to date include improved adherence with medicines; improved quality of life; reduced unnecessary medicines; identification and actions on previously unreported patient safety issues; a potential reduction in ‘bouncing’ referrals, less missing information and fewer unnecessary contacts with services.

Because our partnership approach encourages people to trust us, we can discuss whether or not the medicines prescribed are actually being taken (after all 50% of all of us don’t take medicines as prescribed). This can include if any medicines are borrowed, use of any herbal medicines etc., dietary supplements, over the counter medicines, any which have been stopped but the doctor doesn’t know this or any which are bought over the internet, and we can give advice on this. The most important thing being that people share this information with their prescriber.

We don’t take a position on any approach if it’s safe and it works.

This service tackles three key areas:

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Firstly, this starts to address is the fact that specialists in different areas of medicine only ever review the medicines they have prescribed. So people end up with a continuation of medicines they don’t need and often medicines which make things worse. By going through this in some detail, led by the person themselves who is free to ‘tell their story’, we are helping them make changes.

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Secondly, it helps bring out the things people don’t normally tell their doctors (we all do this). In the jargon this is called ‘intentional non-adherence’. This increased trust and openness seems to be because we always deliver these reviews as part of larger project led by users of services, so by the time we see people they have built up a degree of trust in the process.

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Thirdly, we’re finding some unexpected patient safety benefits. We’re learning that, as a result of the way the sessions are carried out, some people feel able to share information on their medicines and treatments with us that they haven’t previously shared with anyone. On a number of occasions we have been able to give advice on medicines safety and signpost people to services they need, but had previously either avoided or been unaware of.

More comments from patients:

'In the support session you listened to me, and helped me work out what I needed to say. I gave the notes to my G.P. who changed my meds. and made the referrals you suggested. I now no longer walk with a stick, and feel a lot better. I thoroughly recommend these sessions' Martin, Shepton Mallet, May 2016

“My counsellor says my anxiety and depression have improved. My confidence levels have gone up a lot. I’m better at talking on the phone, more assertive. I’m more proactive, for example, I dealt with my referral to the pain clinic straight away rather than leave it. I’ve made a plan for the pain with my doctor, using the information and help given by Care Right Now. I was able to be more assertive when booking my appointments and it got the results; I was put on medication for my pain and referred to the pain clinic. Other people have noticed the positive difference in me”. Attendee. March 2016

‘The great thing about the course is that it’s not mandatory and it’s not just given by a couple of people. The trainers were genuine people who listened and who we can trust. You didn’t have a list of things to get through with us you concentrated on what we asked and listened. Once the word gets around everyone will want this.’ Attendee April 2015.

‘You should listen to those guys. You will learn something’ April Attendee 2015.

‘Gives you the courage to question’ May Attendee 2015.

‘We all have different illnesses but we experience the same things and need to talk about it’ May Attendee 2015.

‘…really helpful…you need to think about what you’re going to say to the GP before you get there and make the time count…so I can get my point across’ May Attendee 2015.

This work is written up as a NICE Shared Learning example. Click here to see it.

     It was presented at the NICE Annual Conference 2018.

Click on the here for our presentation PowerPoint

Note:

The names Patient Led Clinical Education ? and Patient Led Clinical Medicines Reviews? and related materials are property of Care Right Now CIC.

We actively promote and encourage this way of working by all appropriate organisations.

Author: Steve Turner

Steve is a nurse prescriber, Head of Medicines and Prescribing for @MedicineGov , Associate Lecturer at Plymouth University and Mental Capacity Asessor for tsf Consultants.

You can follow Steve’s tweets @MedicineGovSte  hashtag #MedLearn

Click on the image to find out more about @MedicineGov and #MedLearn