Dr David Paynton is the National Clinical Lead for the RCGP Centre for Commissioning. David is a practising GP from Southampton.
Within my practice we have been working to implement personalised care and support planning using the ‘House of Care‘. Over the past year we have been attempting to identify the top 10% of people who may benefit from this approach.
One of the mechanisms for doing this, has been to look at those people who attend GP appointments more than ten times each year. We find that these patients may or may not consume secondary care, but they do attend the surgery frequently. Each of those ten minute slots accumulates to quite a considerable amount of time in total but it is not used very productively in many of these cases.
The short consultation works when you are reacting to what a patient is presenting and dealing with it via prescription or referral, but it is not so suitable for more complex cases. When people are attending frequently with a long term condition, we often find that there is a hidden underlying element.
Identifying that hidden element is almost impossible during such a brief, reactive conversation.
But identifying people who you think would benefit from a more holistic approach, and providing them with information prior to a couple of lengthier consultations at the beginning, paves the way for a very different conversation and, ultimately, quite a different relationship. Enabling access to information is empowering for the individual and it allows for a more informed conversation. That information also helps to level out what can sometimes be perceived as a power imbalance between the patient and the healthcare professional. Health literacy is such a vital part of this approach.
In these cases, non-statutory agencies have a lot to offer. We really need to think more broadly about our approach and utilise what is available in our communities to full effect. We have trialled having volunteers working alongside us as ‘care navigators’ which can be very beneficial.
This model is fundamentally about a shift from reactive to proactive care planning, where we can support people to become more fully in command of their condition. The Personalised Care and Support Planning Handbook helps outline practical guidance for doing this, but we also need to be thinking about training all parts of the system to understand this approach more fully. We should be encouraging this through our commissioning and changing our systems in order to support the requirements of this approach. It is whole system change which will take time but the impact of doing so could be hugely valuable.