‘Patient centricity’, the process of designing a service or solution around a patient’s wants, needs and preferences, is a key aspiration for the NHS. But what does it involve and how can it be enabled?
The NHS recognises that many factors can affect health and wellbeing, hence it plans to integrate health, social care and other services, such as housing and the voluntary sector, around an individual by ensuring that all areas of England are covered by an Integrated Care System (ICS) by April 2021.
These place-based services aim to bring care closer to patients’ homes, allowing more people to be treated in the community by specialist nurses, rather than in hospital outpatient departments. Specialists will be able to view patient records remotely to determine if and when they need to see them and many of these appointments will be conducted online.
“The NHS can no longer afford to take a paternalistic approach to patient engagement”
The NHS also aspires to make personalised therapeutic options more widely available. For example, last autumn, the NHS became the first national health system in Europe to give the go-ahead to a breakthrough cancer treatment based on modifying a patient’s own CAR-T cells.
However, patient centric care is not just about changing the way services are designed and delivered. With an ageing population and growing burden of diseases, many of which are preventable, the NHS can no longer afford to take a paternalistic approach to patient engagement.
A King’s Fund paper argues that most people already take responsibility for their health and care but that more could be done to reduce overdependency on services and draw on people’s own expertise. In the paper, published in November 2018, and titled ‘Shared responsibility for health: the cultural change we need’, the King’s Fund says: ‘The cultural change we would like to see affects staff as well as patients because it requires staff to work differently in order to fully involve patients and the public in decisions about their health and wellbeing. By staff, we mean both clinicians who provide care and support and others working in public services.’
As part of a wider move towards shared responsibility over the next five years, the NHS Long Term Plan promises that the NHS will ‘ramp up support for people to manage their own health’. This will start with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support, as well as online therapies for common mental health problems.
The NHS has developed a Comprehensive Model of Personalised Care in partnership with more than 50 stakeholder groups and it is now being implemented across a third of England. Personal Health Budgets (PHBs), which are already in use in some parts of the NHS and give people more control over the services and care they receive, are a key aspect.
According to the NHS Long Term Plan, up to 200,000 people will have a PHB by 2023/24 and this will include provision of bespoke wheelchairs and community-based packages of personal and domestic support. Social prescribing will also be included in the personalised care model.
What is pharma’s role?
The importance of diet for disease prevention and management is already being recognised and acted upon by the NHS in diabetes management. For example, the Long Term Plan explains how medical research has shown that some people with type 2 diabetes can achieve remission by adopting a very low-calorie diet. Consequently, the NHS plans to test a programme supporting very low-calorie diets for obese people with type 2 diabetes.
In line with this, pharma needs to think beyond the pill and consider the implications of the wider determinants of health, such as diet and fitness. It also needs to define how relevant preventative interventions fit into patient pathways and how it can support the NHS in tailoring preventative interventions for particular cohorts of patients.
For example, pharma could review patient care around diabetes and other conditions. This could provide valuable insights for population healthcare management programmes and lead to a quicker uptake of appropriate drugs for appropriate patients, resulting in improved outcomes.
Pharma also needs to ensure that it gathers feedback on the patient’s overall experience of a drug and their ability to resume a normal life. This could involve creating an app through which patients can record data and this, in turn, could support services and forums that are already enabling patients to record information as well as the NHS’s National Patient Reported Outcome Measures (PROMs).
Industry also needs to review its activity around medicines optimisation and monitoring adherence, since this too is becoming increasingly personalised.
Patient centricity is manifesting itself in many ways in the NHS – from service design and delivery to the development of personalised treatments and the ambition to form a new relationship with patients.
While this is unlikely to lead to a reduced reliance on drugs in the short-term, there will be an increased emphasis on more holistic ways of improving the nation’s health. Pharma needs to define where its products fit into the new integrated care pathways that are emerging and think beyond the pill in helping the NHS to achieve its vision.
Steve How is part of Wilmington Healthcare’s Consulting Team.