In this blog, NAPC Chair Dr Nav Chana reflects on a recent talk he gave alongside James Sanderson, Director of Personalised Care at NHS England.
It was a great pleasure to find ourselves on the same platform at the recent Westminster Health Forum: The future of health commissioning in England. It was one of those rare occasions where there seemed considerable alignment in our thinking and approach even though we have travelled along different paths to this point.
As a GP in South London for 26 years and having occupied a variety of healthcare roles, I have tried over many years to grapple with the implementation of care models embracing the concepts of population health management, value and integrated care.
However, what’s been missing is a much better understanding of delivering truly personalised care and it was great to hear James talking through the latest vision and delivery programme for NHS England’s Personalised Care programme, as well as presenting the latest Comprehensive Personalised Care Model, which brings in all the key personalised care programmes together under one umbrella for the first time.
My own issues of late have been in the design and delivery of new models of care built around the principles of primary health care, which places person-centred care at the heart – that is care that is respectful of and responsive to individual preferences, needs, and values, whole-person care: biological, emotional, social and cultural (WONCA 2013).
NAPC’s primary care home model referring to the ‘home’ of care for a place embraces the principle of personalised care with a whole population health management approach. This is one of the founding characteristics of the model. Implicit in this is the notion of ‘value.’ Professor Sir Muir Gray effectively describes the triple value ambition for healthcare systems, recognising ‘personal’ value of equal importance as allocative and technical value.
As we think of population health management, we need to remember that, beyond understanding populations, we need to engage them and the people within them and co-design approaches through the triple value based framework with a significant focus on personalised care.
As James rightly pointed out, the focus on personalisation includes drawing out the assets and the knowledge that individuals bring to their own health and wellbeing, because clinicians will always be experts in a condition or a disease, but people are experts in themselves, people are experts in their own bodies, and people are experts in what works for them. We’ve all lived with ourselves, since before we were born. You think about that for a second.
So how can we change that conversation, how can we ensure that people are at the heart of the planning process?
James recounted that a lot of people say to him, well the problem is the NHS is a bit too paternalistic. But this is not the case because we rely on the NHS at times of need to support us. We rely on the NHS sometimes to give us that expert view, to guide us in how to better manage our health and wellbeing, but that’s not to say that it doesn’t work best all the time, especially for people who are living with a long-term condition. Surely there’s a better approach.
If you are knocked over by a car you don’t necessarily want the paramedic leaning over you and saying ‘what matters to you’ or ‘what does a good day look like to you?’ You know there’s certain times and place for this approach, but if we can start releasing the assets that people bring to their own care and from their surrounding community, then surely that’s quite an important thing.
He went on to articulate that there are lots of approaches to personalised care that exist across the country. There’s some really good work being down in health coaching, personal health budgets, on patient activation measurement and on social prescribing. But, up until now, a lot of this has been fragmented. While, as ever, we need locally tailored services, there are some standard models that we should learn from and hopefully, start to adopt.
So this is what he and his team has started to do with the comprehensive personalised care model. It articulates an all age, whole population approach to personalised care, and how different parts of the population can be targeted by different interventions which support them to experience a more personalised approach and, ultimately, gives them more choice and control as well as benefits their health and well-being.
This means that people living with long-term conditions and mental and physical health conditions, can be supported through more proactive means, through self-care and self-management. We can also support the whole population, through elective choice and shared decision making and those with more complex needs through personal health budgets.
Key to making this happen is we need to look at what’s available to support them in the community and this is especially relevant to colleagues in primary care.
I know that many are already working on this and I would encourage more of my fellow GPs to think what community-based assets are already available to their patients, but what else is there that can support them to better manage their health and care?
We also need to work with them, to ensure that they have the levels of activation; that they have the levels of skills and confidence, and knowledge to support themselves with the condition that they’re living with. And how they can get that through health coaching which can start to improve the choice and control they have over conditions and the system serving them.
Finally, James emphasised that we also need to ensure that we put all of this into practice, through approaches to commissioning, payments and incentives that align with population health and personalised care goals.
Working through models such as the primary care home model, we hope to be able to demonstrate both how to deliver the wider comprehensive personalised care model in practice, but more importantly, demonstrate the impact we can deliver to ensure that these approaches are both sustainable and able to spread across the country. Exciting times ahead!