We spoke to Isabel Hodkinson – a GP in Tower Hamlets, in east London – about the benefits of person-centred care for clinicians and their patients.
What makes you so passionate about person-centred care?
I was the diabetes clinical lead in Tower Hamlets from 1993-2011. With a big Bangladeshi population and high levels of deprivation, our service was struggling. Then in 2007 our diabetes nurse specialist talked us into signing up for the ‘Year of care’ pilot project.
I can remember sitting in the meeting room with the team and saying (and I feel embarrassed to tell you this), ‘our patients won’t get this... it isn’t going to work here.’ I cringe now to think of my paternalistic, patronising tone. Because of course our patients got it. Person-centred care respects the fact that people have all sorts of skills and resources that can input into improving their own health. And this brings about better results, which is why I believe so passionately in this approach.
What have you done to make care more person-centred in your area?
Well, Tower Hamlets became one of three pilot sites for the Year of Care project. This involved transforming consultations with diabetes patients to make them truly collaborative, using care planning to set goals and giving patients the tools and confidence to manage their condition.
Tower Hamlets then embedded this approach in 2009 in a new enhanced package of care for people with type 2 diabetes. This was delivered by networks of practices and supported by realtime data benchmarking and feedback. We allocated a lot more time to care planning encounters with patients, extending appointments to half an hour or more. We also put a lot of work into identifying resources out in the community and providing self-help materials.
Because diabetes was such a problem in Tower Hamlets, our PCT was brave enough to put money into primary care. As commissioners this was a bold move as they knew they wouldn’t see an immediate return. But now we’re really starting to reap the rewards. For diabetes, Tower Hamlets has had the best blood pressure and cholesterol results in the country for the last two years, which is amazing.
How is person-centred care different from what the NHS does now?
I’ll give you an example. With some patients with a long-term condition it used to feel like we were having the same consultation again and again. You think the patient’s being ‘non-compliant’ and it’s very frustrating.
I remember one man with diabetes who was very overweight and could be quite difficult. I’d tried many times to make him see that he needed to lose weight, but he wasn’t interested.
Then one day he came into his care planning session, looked me in the eye and said ‘I really need to do something about my weight’. It was such an incredible moment because we were suddenly in a completely different place – not me going on at him, but him asking me to support him to make a change. From then on we were able to have a completely different conversation which was about problem solving together.
What needs to happen in order to make NHS care more person-centred?
The health service is a big monster and the trouble is, to make this happen, you have to change the whole system.
Take diabetes for example. We know that 30-40% of people with diabetes are depressed, an issue which often doesn’t get addressed. Why, when mental and physical health are so interconnected, is our provision of care so siloed? It just doesn’t work for the person on the receiving end.
The other big cultural barrier is that lots of doctors think they’re doing it already, when really if they asked their patients, they’d realise they aren’t.
How do clinicians need to adapt?
Developing clinicians' consultation skills is key. Person-centred care hinges on our ability to build quality relationships with people.
At the heart of it we need to learn to listen better, and to trust patients to make their own choices. When we first spoke to colleagues about working in this way we got comments like: ‘they won’t make the right choices, they won’t take their statins...’. But just because you tell a patient to take a statin, doesn’t mean they will.
It’s better to make the interaction with the patient more honest, so they can say ‘actually I really don’t want to take that’. I say ‘fine, it’s an informed decision’. Then we can go on to have a conversation about the other things they could do instead. So it doesn’t get the antlers locked.
I hope through our work in Tower Hamlets we’ve helped to prove it’s worth taking a leap of faith and changing how you deliver and commission health services. For me, the overwhelming feedback we’ve received from clinicians says it all:
‘This is so much better, I never want to go back to working the old way again. It’s better for patients and it’s better for staff.’