News and Comment

Patients in control: ‘assume it’s possible’

Friday 1 May 2015

By:

Imagine walking into a GP surgery. For most of us, the first thing we normally face is a reception desk with overworked staff fielding phone calls in front of long queues of waiting patients.

What would happen if you took the reception desk away? Can you picture the waiting room as a place to talk to healthcare advisers, to find out about different wellbeing programmes without needing to necessarily even see a GP? The experience might feel something like going into an Apple Store and being greeted with a friendly smile and an iPad to search for options.

This is one of the latest ideas from the Bromley-by-Bow centre – reimagining the waiting room as a space to actively engage with patients, rather than a space where people are passively processed.

Operating in one of the most deprived areas of Tower Hamlets, BBBC is a pioneering community organisation – a vibrant hub with a café, arts workshops, offices, a nursery, garden, GP surgery and officers from the local housing association. The programmes that they run include helping people with long term conditions to take control of their lives, learn new skills, supporting people to find work and establishing social enterprises. The GP surgery (along with five others in the local area) refers patients to BBBC programmes through social prescribing.

 

BBBC

Bromley-by-Bow Centre

 

The philosophy underpinning this approach is not necessarily new or unique – The Marmot Review into health inequalities emphasised a social understanding of health, and more recently Dr Atul Gawande dedicated one of his Reith lectures to the importance of medicine shifting from a focus on health to wellbeing. There is also evidence from social prescribing pilots elsewhere in the UK of the success of the approach. But the BBBC has put a wellbeing approach into practice and made it sustainable – based on an unswerving belief in the power of stronger, and more networked communities, and people’s capacity to achieve their goals and raise their aspirations.

OPM worked with the Bromley-by-Bow Centre (BBBC) to create a commissioning simulation as part of the South East CSU Person-Centred Care project. This aimed to explore the tools and knowledge that CCGs might need to confidently commission programmes and services that put patients in control.  Participants had to imagine they were at a Commissioning Challenge event for a fictional CCG – although not dissimilar to what some CCGs are already doing. At our event, commissioners, patients, local authority representatives, clinicians and voluntary sector providers had come together, to work up an idea on how to reduce Type 2 diabetes and heart disease through a living well programme.

Simulations always risk being slightly contrived, but the aim was to go beyond commissioners’ usual environments, draw inspiration from the setting and think about how to join the dots between different organisations in local areas – all of whom could have something to contribute to a wellbeing approach that puts patients in greater control of their health.

What did we learn?

Creating the space for CCG commissioners to come together with local organisations and patients is essential to understand what each has to offer. Patients in control programmes will rarely sit in isolation – they are part of a menu of options, and commissioners need to think across the local system.

We found many examples and case studies of programmes that could be described as putting patients in control. But commissioning these are not yet the norm.

Participants talked about the importance of CCGs being less risk averse – finding ways to challenge entrenched cultures, and influence others internally and externally. This is not an easy task in a time of tight budgets and long lists of priorities.

Within this context, being able to demonstrate impact and outcomes is vital – we have blogged about measuring impact in the context of commissioning earlier on in this blog series on person centred care.

Despite these challenges, overall, we found that there is real desire amongst CCGs to use the commissioning process to ensure that there are person centred approaches in place. As one participant in the simulation said: ‘The aim should be for a Bromley-By-Bow Centre in every local area…’

In the words of the Centre itself: ‘assume it’s possible’.

______________________

This is the third in a series of blogs to be published following the development of a set of online tools and resources by OPM in support of the person-centred care agenda for South East Commissioning Support Unit. The first is entitled: Person-centred care: putting patients in control and the second: Person-centred care: measuring impact.