Personalising Realistic Medicine: Chief Medical Officer for Scotland's Annual Report 2017-2018

Appendix 1

Realistic Medicine Survey 2018

In 2016, I wrote my first Annual Report recognising that current models of healthcare do not always suit the aspirations of the workforce and need to change. The six principles of Realistic Medicine emerged through my conversations with staff about how they wanted to practise healthcare. In the three years since then, I have continued these essential conversations and have received a wealth of staff feedback in person and through letters, emails and social media. All of this has been invaluable in informing the Realistic Medicine agenda.

Our shared vision for Scotland is that all health and care professionals will be practising Realistic Medicine by 2025 and how we achieve it will continue to be shaped and delivered by our workforce. Last year, I decided to ask people working across health and care for their views on where we need to focus our efforts to support people to practise Realistic Medicine. In October 2018, a survey was conducted to explore staff views on Realistic Medicine: its concept; its impact to date; the perceived barriers to its successful delivery; and priority areas for where it should go next. The survey was distributed widely across Scotland: to NHS Board Chief Executives and Directors of Medicine, Nursing, Pharmacy, Public Health and Finance; as well as Chief Officers of Integration Authorities – with a request for the survey to be shared with all of their staff.

Survey Population

In just 3 weeks, a total of 2,464 responses were received. 51% of respondents were doctors, 15% were nurses, 13% were Allied Health Professionals and 11% were pharmacists. The remainder of respondents were dentists, healthcare service managers, finance staff and those working in the ambulance service.

Concept of Realistic Medicine

Ninety five percent of respondents fully or somewhat agreed that the principles of Realistic Medicine matched their own personal beliefs and values about how healthcare should be practised in Scotland. Only 5% felt that there was little or no alignment with their own ideals.

Impact of Realistic Medicine

When considering the extent to which Realistic Medicine has influenced the practice of healthcare in Scotland over the last 3 years, 61% of respondents felt that it had had a positive influence, with 37% believing that Realistic Medicine was yet to have a meaningful influence.

Barriers for Realistic Medicine

People were also asked to consider the barriers to practising Realistic Medicine (Figure 1). The three biggest barriers they identified were:

• insufficient staff time (36%);
• lack of formal training (16%); and,
• lack of local leadership (16%).

Figure 1: Greatest barriers to making changes and improvements aligned to Realistic Medicine [base: 2388 respondents selected their biggest barrier]

Future of Realistic Medicine

People were also invited to prioritise the importance of each of the Realistic Medicine principles over the next 5 years (Figure 2). Their top three priorities were:

• building a personalised approach to care (37%);
• reducing harm and waste (23%); and,
• tackling unwarranted variation in practice and outcomes (14%).

Figure 2: Top priorities for Realistic Medicine over the next 5 years [base: 2362 respondents selected their top priority]

In terms of the future direction of Realistic Medicine, the top three priorities were:

• wider engagement with the general public to improve understanding of Realistic Medicine (28%);
• a focus on how Realistic Medicine can be applied to specific areas of healthcare (26%); and,
• a focus on optimising the wellbeing of the health workforce to enable the delivery of Realistic Medicine (13%).

Nearly 500 respondents provided additional free-text comments which offered a valuable range of insights into how people experienced Realistic Medicine in practice.

The results will be available in full on the Realistic Medicine website.

Reflections

I am truly delighted to have received almost 2,500 responses to our survey and I am most grateful to all who took time to share their views. It is heartening to see the extent to which staff feel that Realistic Medicine matches their own personal beliefs and values about how healthcare should be practised. It is also reassuring that so many people believe that Realistic Medicine has had a positive impact on the way they practise already. I recognise that it will take time to fully embed Realistic Medicine across our health and care system but we are off to a great start and I remain wholly committed to achieving this.

It is perhaps not surprising that just over half of all respondents were doctors given that much of our engagement on Realistic Medicine has focussed primarily on the medical profession. But I firmly believe that Realistic Medicine principles and values are for all health and care professionals, not just doctors. That’s why I am particularly pleased to have received such valuable feedback from all of the nurses, Allied Health Professionals, pharmacists, dentists, managers and finance staff who took part in the survey.

It has been particularly helpful to elicit people’s views on the barriers to implementing Realistic Medicine and to understand their priorities for the future. Already, work is underway to address them. The Realistic Medicine Leads in NHS Boards were newly in post at the time of the survey but are now well placed to provide the local leadership on Realistic Medicine that some people felt was lacking. An NHS Education for Scotland Education Lead for Realistic Medicine was also appointed in January 2019 and will support the national development and coordination of training in Realistic Medicine. And the Citizens’ Jury has given us valuable insight into the public engagement needed to promote and support shared decision-making.

The survey and Jury findings give us a clear indication of where we must now focus our efforts. They will inform a new national delivery plan which will set out the action we will take over the next three years to further support professionals, and the public, to practise Realistic Medicine.

It is also clear that Realistic Medicine is a vision shared, shaped and delivered by not only those working in health and social care but also the public. I am therefore convinced that it has been worthwhile to use my Annual Report this year to address some of the themes emerging from the survey and the Jury and to focus on our most important priority – ‘Building a Personalised Approach to Care’.

Please note: not all respondents answered every question in the survey and so the percentages presented in this section are based on the number of responses to each question [this base number varies slightly between questions].