Developing a peer-to-peer coaching service

Health Connect Coaching is a peer-to-peer coaching programme to build self-management skills and confidence among people with long-term health conditions. 

The trained volunteer coaches start by intensively coaching two peers once a week each for two months. When this moves to fortnightly calls, the coach takes on another coachee. When these three conversations reduce in frequency the coach takes on two more people. 

This approach has two benefits

• Tapering the conversations over six months is an evidence-based approach to ensure the coaching is a catalyst, not a crutch.
• The coaches are not overburdened, but the numbers of people who can be supported by the programme are kept up. 

The programme aims to increase supported self-management of long-term conditions so people can safely move onto the patient initiated follow-up (PIFU) pathway.

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, talked to Q peer interviewers Suzanne Wood and Chris Pavlakis about the programme.

Hear about the programme from Helen Davies-Cox in the video below.

Designing a robust volunteer training and management programme that takes account of individual needs, learning styles and clinical and information governance is complex.

A co-design approach enabled the team to use the lived and learned experience of patients and professionals to navigate challenges and iterate improvements. 

Initially, the training programme for volunteer coaches was taught over four weeks, 1.5 hours twice a week. 

This presented barriers for people with long-term conditions, so now much of the training is online. People can access it at their own pace, alongside participating in live practice sessions and rich discussion. 

This means the coaches need digital capabilities, so the project team have connected with voluntary organisations who can help individuals to access digital devices. 

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 posed a challenge for funding. 

External funding from Q Exchange, having senior champions within their organisation and sharing learning externally have helped to alleviate this challenge. 

Being agile has also allowed the team to respond to opportunities by offering the service to people on elective care pathways.

The service has been rolled out in six outpatient pathways so far and is designed for growth. One staff coordinator can safely manage 50–100 volunteer coaches as they increase in competency and move to group-based supervision.

The programme has attracted wide interest due to its evidence-based and co-design approach, and Helen was awarded an NHS Clinical Entrepreneur Fellowship as a result.

While the time taken to establish and evidence the programme has affected the team’s ability to secure funding, co-design is nonetheless a strength of the project. 

The time and effort spent on this has strengthened the design and is potentially improving people’s lives.

The team are designing for scale 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, in terms of the usage licence fee. 

So, as part of a randomised control trial (RCT) feasibility study, they are testing it alongside other free-to-use measures shown to be equally effective.