Developing a peer-to-peer coaching service

Health Connect Coaching is a tapered, peer-to-peer coaching programme1 for people to access support to self-manage their long-term health conditions and move onto the patient initiated follow up (PIFU) pathway.2 Patients without the knowledge, skills or confidence to effectively manage their own health (ie low activation levels) – ​‘who… possibly don’t know their early warning signs [or] have a plan of what to do are much more likely to end up in crisis.’ – are matched with people who know when and how to access the information and support they need to live well with their conditions. The peers have similar symptoms or experience in terms of background.

Tapering the coaching conversations over six months is an evidence-based approach to ensure the programme is ​‘a catalyst and not a crutch’. Volunteers start by intensively coaching two people once a week each for two months. When those two move to fortnightly calls the coach takes on another person, and when those three lots of conversations reduce in frequency at the next stage, the coach takes on two more people. ‘[So] we are valuing the coach, not overburdening them, but at the same time keeping the numbers of people who can be supported coming through.’ 

Helen Davies-Cox, Head of Personalised Care at Torbay and South Devon NHS Foundation Trust and project lead, and Krystina Bones, one of the two coordinators for the service, spoke with Q peer interviewers Suzanne Wood and Chris Pavlakis.

Co-design through patients’ and professionals’ lived and learned experience has been essential for enabling the team to navigate challenges and iterate their approach. The initial four-week taught programme (1.5 hours twice a week) presented barriers for people with long-term conditions. Now much of the training is online for people to access at their own pace alongside live practice sessions and rich discussion. This means the team need to recruit volunteers with digital capability, so they have ‘[created connections with] voluntary organisations who would… be able to help individuals… [borrow] equipment.’

It has taken longer than expected to develop the approach and test it enough to give confidence that the model works and enable a sound business case.This poses a challenge for funding (including for the coordinators) despite the substantial interest in the work. The external funding from Q Exchange, having senior champions within their organisation and sharing learning externally have helped to alleviate this challenge. Also, being agile and moving more quickly than they would otherwise to has allowed them to respond to opportunities by offering the service to people on elective care pathways.

The evidence base underpinning the programme design/​embedded co-design instils confidence, with ​‘wide interest’ from external organisations. Helen applied for, and was awarded, an NHS Clinical Entrepreneur Fellowship5 on the back of this work. The service, currently rolled-out in six outpatient pathways, is designed for growth. One staff coordinator can safely manage 50–100 volunteer coaches as volunteers increase in competency and move to group-based supervision.

While the time taken to establish and evidence the programme is affecting the team’s ability to secure funding, co-design is nonetheless a strength of the project. The time and effort spent on this has been well rewarded for how it has strengthened the design and is potentially improving people’s lives.

The team are designing for scale6 and will train people to run a similar programme in their own areas:

A potential conflict with scalability is their use of the Patient Activation Measure (PAM) to identify people as either coaches or peers,7 in terms of the usage licence fee. So as part of a randomised control trial (RCT) feasibility study,8 they are testing it alongside other free-to use measures shown to be equally effective.