Leading questions: Personalised care expert Dr Samuel Finnikin

Dr Samuel Finnikin, GP and former national clinical specialist advisor in personalised care for NHS England, speaks to senior reporter Beth Gault about how personalised care is fundamentally a culture issue for PCNs.

Beth Gault (BG): What is personalised care and why is it important?

Dr Samuel Finnikin (SF): Personalised care is about focusing on what’s important to the patient as well as clinical experience and the best available evidence to make decisions around someone’s care.

It’s recognising that everybody is an individual with different priorities, values and preferences. There are always options when it comes to healthcare, and unless we understand what’s important to people, they might get care that they don’t want or need – which is not only potentially harmful, but also wasteful.

Personalised care is the mechanism by which we do that – it’s not an add on or an extra. It is fundamental to how we should be practicing healthcare.

BG: How are PCNs generally approaching it? 

SF: PCNs are a relatively new level of organisation within the NHS and they comprise of GP practices, which are extremely varied in their makeup, in values and in their priorities. And so, it’s difficult to generalise how personalised care is being embedded within PCNs.

But, there was an ask that all PCN clinical staff do training on shared decision making a couple of years ago, which put it on the agenda as shared decision making is a fundamental skill that’s required to deliver personal care. Though it may have seemed like a tick box exercise for PCNs, the intention was to try and get people to understand and think about the training that’s available for staff in personalised care.

BG: This training ask was removed from the Network DES in September 2022. Did it still have an impact on practices?

SF: The decision to make the Personalised Care Institute’s (PCI) 30-minute ‘shared decision making’ module mandatory within the PCN Network DES Contract, even if only for a short time, really helped to raise awareness of the importance and value of personalised care.

The great thing was that not only was there a big increase in the number of primary care professionals taking the learning, but the feedback was excellent – with 95% saying that this training would have a positive impact on their day-to-day practice.

That training pointed staff and PCNs to the PCI, a not-for-profit organisation that hosts all the training on personalised care. One of the things about that incentive a couple of years ago was actually showcasing the work of the PCI and making practices aware that the resource exists, which is an important part of the picture. Hopefully PCNs are now aware of that resource.

BG: How many people signed up to this training?

SF: It was 32,701 who signed up to the shared decision-making training. But over 50,000 in total have been trained on personalised care modules by the PCI overall.

Personalised care is not a new concept, but as far as a priority for practice staff and PCNs, it’s probably not a very high priority, so giving people opportunities to get easy access, free training is important to help practices and PCNs focus on this area.

BG: Why is shared decision making important?  

SF: Shared decision making is an individual skill that clinicians need to be working on. It’s fundamental to how we do personalised care. It takes confidence to be able to accept that patients make decisions that we perhaps don’t think are the best ones.

Some practices have blanket decisions about things and don’t give patients options or choices. It’s symptomatic of all the pressure practices are under – we need to try and achieve our goals and aims, but in the most efficient way.

But again, it comes down to the issue of getting it right for the person. And in the long-term, shared decision making makes things more efficient, as it reduces the number of consultations about the same problems and the number of dissatisfied patients.

BG: How have PCNs helped in the development of personalised care?

SF: The main way is the three personalised care additional roles reimbursement scheme (ARRS) roles, the social prescribers, the health and wellbeing coaches and the care coordinators.

The fundamental focus of these roles is approaching problems with a personalised care angle. They add something new and different to the primary care team.

My GP colleagues don’t have the time to invest in people that need help to change behaviours, like those with chronic pain or struggling with weight loss. But health and wellbeing coaches do and can help them to change their health behaviours. This ultimately can help the practice and PCN by taking high frequency users and changing their health needs, reducing the overall requirement for healthcare for that person, helping them self-manage.

Care coordinators can focus on helping individuals who have complex needs to navigate the system and make their care more efficient. There are real gains to be made here because they’re tackling some of the big problems PCNs are facing in terms of access, workload and patient satisfaction.

BG: What about proactive social prescribing, what is this and how does it help?

SF: The idea of proactive social prescribing is using data on our population to target people who we feel could benefit most from social prescribing, whether that be working class men who are at work but don’t come to get their health check, or bringing communities together in a way that helps them use the local resources. It can really reap rewards for practices and help tackle inequalities, which is one of the priorities at the minute.

It’s also the great thing about working at PCN level, because you have that information within your clinical systems and that deep knowledge of the people you’re serving as a PCN.

BG: Do you have any examples of good practice?

SF: There’s a good project in Cheltenham where the social prescribing team worked with young people with mental health problems. A lot of practices around the country struggle with access to mental health services and so the social prescribing team stepped in to provide a forum where people could come together and talk and deal with some of the lower level problems while they were waiting for more intervention.

I can imagine this kind of thing for lots of things – people waiting for orthopaedics who might be struggling with hip, knee or back problems, for example. Health and wellbeing coaches could bring those people together to talk about their problems. Or weight loss, to think about moving better.

We’re helpless to expedite the waits in secondary care, and there’s very little else we can add. But perhaps personalised care roles could help in some ways to plug that gap.

BG: What advice would you give to clinical directors who want to take this to the next level in their PCN?

SF: This kind of care is fundamentally a cultural issue. The PCN and the practice have to agree that it’s something they want to focus on.

PCNs have lots of priorities – it must be difficult to be a clinical director – but personalised care should not be seen as something else to do. It should be seen as a way that people can deliver the things they’ve been asked to do. It’s a mechanism, not an add on task.

But to do that, it requires real understanding of what it is and how it can help people deliver clinical and other priorities.

BG: What do PCNs need in terms of support going forward to develop personalised care?

SF: Some of the asks that come to PCNs don’t embody the priorities of personalised care, and sometimes they can be detrimental to the cause of personalised care. For example, there’s a lot of attention at the minute on how appointments are given and how long patients are having to wait. I know these things are important, but how are we tackling these?

Understanding the interplay between access, continuity of care and personalised care is quite complex, and I think that PCNs could be supported in integrating these priorities. They’ve got so many things they need to do, but they need more time to focus on personalised care.

I’d also like to see more emphasis on training. There will be lots of people who went through training 10, 15 or even 20 years ago and personalised care was not as front and centre as it should have been. It’s the whole team, from nurses to pharmacists, physios and GPs, but also call handlers and receptionists and people who are communicating with our patients all the time.

BG: What does the future of personalised care look like?

SF: We need to continue to support and grow the personalised care roles and not see them as substitute roles for any other aspects of care we’re delivering.

The more we understand and use those roles for their intended purpose, the more we will embed the culture of personalised care within practices.

Dr Samuel Finnikin is a GP in Sutton Coldfield with an interest in personalised care. He was previously a national clinical specialist advisor in personalised care for NHS England and has worked with the PCI to develop training resources on personalised care, which the institute makes freely available to all health and care professionals.

PCNs and ICBs who are interested in receiving training at-scale for their workforce are invited to get in touch with PCI.