Main Report of the National Review of Primary Care Out of Hours Services

13 Promoting Person-Centred Care

Delivering person-centred care is a strategic priority for NHS Scotland and the Scottish Government, and essential to the delivery of our 2020 Visionfor Health and Social Care.

Recommendation 25 refers to promoting person-centred care

The Review stated that person-centred care was true for both those who received care and those who deliver it. The Review has had a key thread running through it of valuing professional health and social care, administrative, support, third and independent sector, other statutory agency staff and voluntary workers - often working in difficult circumstances, with complex cases in the OOH period. This section focuses on the optimal care, support and wellbeing of the people of Scotland

Optimising Person-Centred OOH and Urgent Care

The Review gives an opportunity to develop OOH and urgent care services that are responsive to the relational care, self-management and health literacy needs of people, particularly as health literacy is at the heart of our commitment to delivering a safe, effective and person-centred healthcare system.

Evidence

Individual quality improvements by themselves do little to support self management and there is a growing understanding that a whole system approach that promotes the process of partnership working to plan and coordinate care (care and support planning) is required. Key ingredients include:

• Helping people and their carers to be informed and engaged through education, information sharing, addressing health literacy needs, emotional and psychological support.
• Helping the professionals to be enabling and collaborative, through leadership, communication skills, training and reflective practice.
• An organisational infrastructure that promotes continuity, ease of access, customises time according to need, IT support and service design.
• Rich social support, relationships and sustained resources in our communities that keep people well.

The evidence for these elements comes from the work on the Chronic Care Model which has been redrafted into the House of Care. Embedding these elements into an integrated health, care and community setting is a key piece of work supported by Scottish Government and the Alliance (HCSAS), which aims to promote the adoption of care and support planning, particularly within primary care, for people living with long term conditions. It is also a policy commitment by RCGP (UK) and part of RCGP Scotland's strategy blueprint for Scottish general practice.

• Promoting the integration of all these elements in to health and care settings requires transformational change. Where this has been adopted there is also evidence of improved biomedical processes of care and by inference this should have a positive impact on unscheduled care, hospital admissions and effective discharges. It's important to recognise that gains occur when all the elements are in place. Individual interventions, such as a self-management or anticipatory care plan, whilst important, on their own are likely to prove limited.
• The key message is that improving our health and care system that embraces enabling, empowering approaches and promotes collaborative, personalised care and support planning will have a mutually positive effect for people using out of hours services and for those providing their care.

The House of Care Model in itself can be used as an integrative framework to map and checklist many areas of policy and service improvements, such is required for developing OOH services. However, we need to be mindful that at its core is a productive interaction between people and their professional carers.

What can OOH services do to promote self management and be responsive to people's health literacy needs?

• As professionals, whilst we may wish to be enabling and empowering, we may unwittingly and unintentionally dis-empower people and perpetuate learned helplessness and dependency. Certainly when someone is acutely ill such as a stroke, heart attack or severe pain they willingly and appropriately submit to being passively cared for.

• However, for many OOH contacts our professional responsibility is to help people make sense of their health problem, the health service, and then support them to cope with the demands and expectations that any treatment or further management at home entails.

There is an opportunity to develop OOH and urgent services that are responsive to the self-management and health literacy needs of people. The rationale and recommendations for these are set out in Scotland's national health literacy action plan Making it Easy. For this the following elements are suggested:

• Organisational management and leadership committed to these aspects of person-centred care
• Enthusiastic health literacy and self-management clinical champions
• Training and support for staff to recognise and cater for people's health literacy needs
• Involvement in design and delivery by service users
• Clear, unambiguous, intuitive processes to access and navigate OOH services
• Clear jargon- free communication
• Accessible to people with different language needs, speech, sight or hearing difficulties
• Checking understanding
• Sharing of personalised and meaningful information, such as results and correspondence (including shared medical record)
• Tailored educational information that is literacy and numeracy sensitive

Summary

Promoting person-centred care was the opening guiding principle of the Review and is appropriate now that we return to it. OOH and urgent care services should not just be about supply and demand but rather we should be seeking to respond optimally and compassionately to care needs and to support self management and improve health literacy. The Review supports Scotland's national health literacy and action plan, Making it Easy, and the integrative framework of the House of Care. This is assimilated as Recommendation 25 (see also Recommendations 5,6,7).

Primary care out of Hours Team, Hamilton NHS Lanarkshire clinical support worker, driver, GPs nurse practitioner, senior charge nurse