Health Trainers working in primary care settings take referrals from GPs and other primary care staff has grown a lot across the country over the last couple of years and the GP model runs alongside the community model (see community setting) in many services. Some health trainers are now based in GP practices working as part of primary care teams.
The Primary Health Care Model
The health trainer works in GP practice as part of the primary care team. The health trainer draws up a ’directory’ of local activities – walking groups, leisure centre fitness sessions, befriending groups, and CAB outreach sessions etc. Clients may self-refer or are referred by a member of the primary care team to see a health trainer.
Referral may be part of a care pathway (e.g.in mental health), as an option for those who are identified as at risk after CVD screening, to provide pre operational support (e.g. to lose weight), to help a patient manage a long term condition such as diabetes or to make a life style change (e.g. to stop smoking).
The issue may be pre-determined (e.g. losing weight), but the way the client chooses to do this is up to them- the health trainer is there to support and motivate them
Clients see the health trainer for a varying number of times, depending on their needs (the average is probably 6 times but service models vary)
Health trainers use a coaching model to support the client to set goals and an action plan. They also signpost to local groups and services and can accompany people to these or on other activities like shopping, although often this ‘buddying’ role is undertaken by a volunteer health champion working with the Health Trainer Service. .
Evaluations have been done of some Health Trainer Services working in primary care. Click on the links below to view evaluations from N.E. Lincolnshire and Bradford. The latter is a service which has been commissioned and funded by GPs in which health trainers use a social prescribing model.
- Summary Evaluation of the North East Lincolnshire Health Trainer Service 2007 – 2009
- An Evaluation of Social Prescribing Health Trainers in South & West Bradford 2010
Health trainers are also working closely with nurses in primary care settings. For example in Barnsley where health trainers are part of community development teams based in deprived areas of the district, they are working closely with GP practices and have recently been involved in CVD screening in community venues working in collaboration with community nurses. Health trainers in Barnsley also work closely with the Smoking Cessation Service, particularly seeing clients in the more deprived, rural parts of the district who would not access the service at its base in Barnsley town and have helped boost the services quit rates considerably.
Health Trainers working with nurses to extend the reach of CVD screening
In Barnsley health trainers work closely with both practice nurses and community nurses, Including on the cardiovascular (CVD) risk checks which GPs are incentivised to provide for patients aged 40-74 years. Although risk checks have been in place for over three years GP’s have found it hard to engage some patients, so NHS Barnsley decided to try a different approach – to go out into communities rather than expect patients to come into the surgery, Two venues were identified in one to the most deprived areas of Barnsley and CVD checks were offered as part of events on two days in March 2011.
Practice nurses conducted the checks (blood pressure, cholesterol, random blood sugar and BMI) and collected the other assessment information on hand to provide post-test information, plus lifestyle advice and guidance. Patients were invited to attend, but anyone was able to turn up on the day and provided they met the eligibility criteria could have a risk check. Volunteers were on hand to make people welcome.73 people attended of whom 78% (N= 57) were found to be at risk and referred to their GP for follow-up treatment.
After 4 weeks 6% had taken the advice to make an appointment to see their GP. Evaluation has shown that those screened were very satisfied with the scheme. Health trainers in Barnsley are trained to take blood pressures and provide checks at community events as a way of making contact with people as well as identifying those at risk. Discussions are underway about training them to do initial cholesterol screening and check blood sugar levels. This would make it possible to do far more outreach work into the most deprived communities where many people would not visit their doctor unless they were ill. The potential savings from this approach are recognised and certainly in Barnsley, by working in an innovative and collaborative way, many more people ‘at risk’ have been reached.
GP surgeries are somewhere that many people in our most deprived communities do access and are a good place for health trainers to locate to reach them. But at the same time there are people who do not access their GPs much or are not even registered with one and it’s really important that health trainers continue to work in community locations in order to reach them. For example in Barnsley did at one point recruit 2 health trainers from the gypsy and traveller community who were supporting people one to one in their community to make the lifestyle changes of their choice and who helped some people register with a GP for the first time. Nationally over 7% of Health Trainer clients were not registered with a GP compared to a population figure of 0.44%, which indicates that health trainers are reaching people who are not currently in contact with primary care and linking them into services.