Putting it into practice: workforce development

Self-management support involves a cultural shift in how we understand the roles, responsibilities and relationship between people living with long-term conditions and the health and social care professionals and others who support them.

All practitioners can use the skills and approaches of self-management support in their practice. For health professionals, it means not only providing clinical care, but helping people to think about their strengths and abilities, identifying their information needs and the changes they can make in their lives to take control, reach their goals and maintain their health and wellbeing.

The tools that provide a structure to achieve this are as follows:

  • Care and support planning: helps people set their own aims, then plan the support and care needed to achieve them.
  • Collaborative agenda setting: at the start of the consultation, the practitioner and the person talk about and agree the health issues to explore and the problems to solve.
  • Recognising and exploring ambivalence: practitioners can explore people’s readiness to change, then respond accordingly.
  • Goal setting, action planning and follow-up: the practitioner supports the person to identify a goal they want to achieve and break this down into small achievable actions. Following up goals later involves developing problem-solving skills and exploring solutions to barriers, as well as positive affirmation of progress and effort.

All of these approaches are underpinned by the use of core communication skills that build relationships of trust and rapport. These skills include: open-ended questioning; reflection; empathy; affirmation and normalisation; summarising; signposting; active listening and non-verbal communication. Further skills include health coaching approaches and helping people to explore the importance to them and their confidence of making changes.

Approaches can also be adapted to reflect each person’s level of knowledge, skills and confidence around managing their health condition.

Organisations have an important role in supporting their practitioners to develop and use these skills and embed them into practice. This means providing training and ongoing support and adapting systems and processes. Elements of self-management support are now part of revalidation criteria for doctors.

All members of a team (such as GPs, nurses and practice receptionists) can benefit from training. Training whole teams or workforce groups together is key to:

  • ensuring common understanding of self-management support and core tools and techniques
  • creating a common language and culture
  • creating a critical mass of trained practitioners within a team or service to put the skills into practice across a service or organisation
  • improving the ease with which self-management support can be tested and adopted
  • enabling practitioners to support each other through the training and later when using the skills in practice.

A combination of face-to-face, role modelling and e-learning teaching methods can be used. Ongoing support to maintain new skills and behaviours within a team can include action learning sets, community interest groups and refresher training, having a senior lead or champion, and building it into supervisions and team meetings. Train the trainer programmes and including elements in organisation induction programmes for new staff can help the sustainability of training schemes.

Further reading

Example case study: Cambridgeshire NHS Trust training

This sets out the experiences of one NHS organisation delivering training in self-management support http://personcentredcare.health.org.uk/sites/default/files/resources/sms_case_study_care_planning_training_cambridge.pdf

Practitioner Development Programme. Health Foundation.

This distils evidence about what works into a clear set of practical tools that clinicians, health coaches and others can learn and use to support people to self-manage http://personcentredcare.health.org.uk/resources/practitioner-development-programme

Agenda setting sheets. Health Foundation person-centred care resource centre

A range of sample agenda setting sheets for people with long-term conditions before appointments http://personcentredcare.health.org.uk/resources?search_api_views_fulltext=agenda&f[0]=field_area_of_care%3A364

Practitioner development. Health Foundation person-centred care resource centre

Collection of resources from a range of sources supporting practitioner development http://personcentredcare.health.org.uk/person-centred-care/self-management-support/implementing-self-management-support/practitioner

The Health Coaching Experience in NHS Midlands and East Health Coaching Review

Review of evidence of large-scale training in self-management skills for health care professionals http://pcc-cic.org.uk/sites/default/files/articles/attachments/dr_penny_newman_the_health_coaching_experience_in_nhs_midlands_and_east_0.pdf

Sustaining and spreading self-management support. Health Foundation.

Lessons from the evaluation of the second phase of the Co-creating Health project www.health.org.uk/sites/default/files/SustainingAndSpreadingSelfManagementSupport.pdf

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