Moving to more self-care will require changes in culture, attitude and behaviour by clinicians. This is particularly true of primary care which is the front line for meeting demand and the gatekeeper to other NHS services. If GP behaviour does not promote self-care, potential benefits will not be realised.
All health professionals need to respect people’s own expertise and to work with them more collaboratively. ‘A commitment by both clinician and patient to shared decision making is considered essential for personalised care planning. The process is unlikely to succeed if either party is reluctant to participate’ (Coulter et al 2015)68. Information about personalised care and support planning can be found at https://www.england.nhs.uk/wp-content/uploads/2016/04/core-info-care-supportplanning-1.pdf.
Skills for Care list seven principles to support self-care stating that anyone promoting self-care:
• Engages, supports, encourages and helps individuals to make decisions that are right for them
• Communicates effectively to assess their needs, and develop and gain the confidence to self-care
• Enables access to appropriate information and the range of options
• Enables access to a range of learning and development opportunities
• Uses new technology
• Enables access to support networks.
Clinicians will need to understand the concept of patient activation and its impact on self management. Motivational interviewing can be used to help start people on the road to change and then to keep on with it. They will also need to be able to access information about the range of resources which can help people (as will people themselves). GPs and general practice teams need to offer people, families and carers genuine alternative options for support and access to help with their health and social problems. Nurse specialists, health trainers and health champions currently working in the community have a potential role in promoting and supporting self-care. They also need to be able to access training.
Altogether Better have brought practice teams together with volunteers from their practice lists who become health champions and all work to improve health and wellbeing in their area. They are currently delivering such a service in Barnet.
Where social prescribing is available, people will be working with a whole range of others to help them to self-manage and make improvements in their own health and wellbeing. The majority of this workforce will be in the voluntary sector, and not under the direct influence of the NHS. Commissioners need to ensure that contracts identify the provider’s responsibilities for ensuring they have a workforce which has the appropriate knowledge, skills and attitudes (including basics such as risk management, information governance & safeguarding - please see separate resource for social prescribing for more information).
There are many providers of training. They include:
• Self Help UK http://www.selfhelp.org.uk/selfcare/#Fundamentals
• DNA Insight: SocialPrescriberPlus - training for Social Prescribers and Link Workers, whether community or Practice based dnainsight.co.uk
• e-learning for Health Care; http://www.e-lfh.org.uk/programmes/supporting-self-care/
• Virtual College; http://www.virtual-college.co.uk/products/self-care.aspx
• NHS Scotland; Supporting Self Management online training resource http://www.nes.scot.+nhs.uk/education-and-training/by-theme-initiative/self-management/supporting-selfmanagement.aspx
• Education for Health https://www.educationforhealth.org/ have more courses for staff
• National Brokerage Network provide training to support disabled people having more control and care more about themselves http://www.nationalbrokeragenetwork.org.uk/training/)
• Connect Link - National Association of Link Workers "Single point of access for relieving link working pain": CIC We are the only membership organisation for link workers and their employers across all sectors. Join us if you are interested in ending link worker professional isolation and would like a single point of access for empowering and supporting the social prescribing workforce in order to help increase positive wellbeing outcomes for themselves, individuals and communities.
Local trainers and services may also be able to provide training
A meta-analysis of disease management interventions for people with chronic illness (Weingarten et al 2002)73 demonstrated the importance of not only educating healthcare providers but also providing them with feedback about the care they provide and outcomes. This was associated with ‘significant improvements’ in both provider adherence to clinical guidelines and disease control.
Integral to the success of social prescribing is the central role of link workers/ community navigators/ support brokers. Some areas employ health and care professionals in these roles. Others recruit local people, based in the community with an excellent insight of local support networks and organisations. Many people who have experienced health conditions and have been helped by social prescribing want to help others themselves. Given the benefits of peer support, this should be encouraged. Whoever is fulfilling the role will need some core skills backed with a good understanding of local communities, voluntary sector providers and informal support networks.
Health Education England has recently released a competency framework for care navigation which will help with this (Health Education England 2016).
Social prescribing also requires GPs and practice teams to work differently. It provides opportunities to develop new roles for general practice staff as a means of offering people, families and carers genuine alternative options for support and access to help with social problems. To be effective the social prescribing system needs to be straightforward and simple to understand, with the whole practice team being able to describe how it works.
Commissioners need to ensure that contracts identify the provider’s responsibilities for ensuring they have a workforce which has the appropriate knowledge, skills and attitudes (including basics such as risk management, information governance and safeguarding).