Health coaching system improves results at Leicester GP practice


Totally Health solution leads to 100% reduction in attendances at A&E, 80% reduction in home visits, and a 57% reduction in attendances at out-of-hours surgeries

A clinical health coaching programme for patients with long-term conditions has shown dramatic results in enhancing patient care, quality improvements, and activity reduction for the NHS.

Interim results from the project, which launched in September 2015, show a 100% reduction in attendances at A&E, an 80% reduction in home visits, and a 57% reduction in attendances at out-of-hours surgeries.

Commissioned by Parker Drive Practice & Manor Medical Centre and Leicester City CCG, the service is provided by Totally Health to registered patients at the Parker Drive GP practice and its branch practice, Manor Medical Centre.

A total of 68 patients with long-term health conditions including chronic obstructive pulmonary disease (COPD), diabetes, and heart failure, were recruited within the two practices, with patients aged between 61-70.

The Totally Health clinical team undertook a review of clinical records for the period and condition within the service and the comparative period prior to the service starting.

Overall results included:

  • A 50% reduction in unplanned admissions
  • A 47% reduction in secondary care outpatient appointments
  • A 39% reduction in contacts with all health professionals in local services
  • A 30% reduction in GP/practice nurse appointments
  • A 22% reduction in community healthcare appointments

Ensuring patients were better educated about their condition and had a greater insight into the access to specialist medical support was a key part of the work and patient improvements from the project included:

  • 95% of diabetes patients showed an improvement in latest HbA1C results
  • There was a 95% increase in the number of ‘Medication Rescue Packs’ prescribed, meaning patients are now more pro-active with exacerbation medication, resulting in disease complication prevention
  • A 47% increase in the number of patients with a documented Long Term Condition (LTC) review
  • A 44% increase in the flu vaccine for patients who prior to enrolment had not had a flu vaccination
  • A 23% increase in podiatry and retinal screening

Dawn Denison, clinical programme analyst at Leicester City Clinical Commissioning Group, said: “Totally Health’s clinical health coaching has given us some great results for our patients, including increasing patient satisfaction, confidence, motivation and compliance, as well as having a positive impact on the practice by improving interaction with available health services and reducing the time and cost impact on resources.

“We’re especially pleased to see the improvement in HbA1C and increase in the amount of Rescue Pack Prescriptions. This highlights for us a much-greater understanding and willingness from patients to commit to and progress with their self management.”

Lead GP at Manor Medical Practice in Leicester, Dr Jawahar, added: “The evaluation report clearly demonstrates the effectiveness of clinical health coaching. It enables patients with long-term conditions to be a major partner in managing their condition very effectively and helps the NHS to achieve valuable healthcare outcomes.”

And Emma Jane Roberts, chief operating officer at Totally Health, said: “Our Clinical Health Coaching services aim to help individuals make positive changes in their lives, which address long-term health conditions and wider wellness issues.

Patients with long-term health conditions who struggle to manage their condition can often find it difficult to navigate the healthcare system, putting pressure on time and resources by over using services such as A&E.

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“We provide tailored one-to-one clinical health coaching to enable patients to gain the knowledge, skills and confidence to become active participants in their own health and healthcare, reducing their reliance on both primary and secondary healthcare services.”