Providing services in different ways

When people with long term conditions and their carers play a more active role in managing their own health, how they engage with services and the support they want and need can change.  These changes are often not about providing more, but about working differently.  Working with people to understand the changes that will best support them and to co-design the changes will ensure that your service is working in the most effective way to support people.

Some of the ways that services can be developed include:

  • Provide rapid follow-up after patients have had their appointment.  Research shows that people need rapid follow-up and support if they are to implement and sustain behaviour changes they have talked about in their consultation.  You can support people by changing the way your service provides follow-up.  This might include:
    -  Using different approaches to follow-up such as phone calls, email and text messages, rather than face-to-face appointments.
    -  Having different team members follow-up – for example the diabetes specialist nurse might follow-up after a consultant appointment – or even different agencies – for example a health coach based in the voluntary sector might follow up after a GP appointment.

    Most of the sites working on the Health Foundation’s Co-creating Health programme have redesigned the way they follow-up with patients and now offer a choice of time of follow up and also a choice of mode, face to face, telephone or email.
    For example, one of the GPs in Islington uses the nhs.net account for the practice to send texts to patients two weeks after they have agreed goals with the patient at their appointment.  This has proven popular with patients and a powerful method of follow-up.
  • Provide appointments in different ways, for example by holding group consultations, or replacing face-to-face follow-up with telephone follow-up, or using telehealth.
    For example, in Newham patients are able to have Skype consultations with their Diabetes Specialist Nurse.  Teresa O’Shea, Diabetes specialist nurse, says:

    "Not only is it practical for lots of people as they don't have to come to an appointment, but it also changes the dynamic within the consultation. We have run a lot of focus groups about it, and people always tell us that they feel more like equals in a Skype consultation and are less anxious and more comfortable sharing information. It's different for me too – I feel privileged that I am invited into their space."
     
  • Use technology to enable people to self-monitor.  For example, Florence (Flo) is a very simple healthcare system provided via the patient’s own mobile phone being used in a variety of NHS services.  It’s primarily an SMS (text) based system that clinicians use to send reminders to patients and collect their health readings.  All health checks are automated and monitored and readings are presented on graphs that help identify and track long term health issues and trends. Health tips and reminders are sent to patient help them follow recovery plans, or manage long term conditions.
     
  • Provide different opportunities for people to have face-to-face contact, such as group consultations, support groups, and reunions for patients who have attended self-management training.  At the Whittington Hospital, in Islington, people with diabetes who have attended the Self-Management Programme not only go to re-unions but also Weight Watchers classes.