Sheinaz Stansfield - In God we trust, everyone else must bring data

“IN GOD WE TRUST – EVERYONE ELSE MUST BRING DATA”

By Sheinaz Stansfield, July 2023

Sheinaz Stansfield’s award-winning work in reshaping the primary care workforce has helped embed the use of social prescribing link workers within modern general practice. In this new Perspectives blog for Optum, she describes how her passion for population health data and evidence-based decision-making has guided her career.

Looking back, I’ve spent an awful lot of time in the NHS, but my early professional experiences, as a black woman and as a nurse, weren’t very good – and my experience as a patient was even worse. Many years ago, when I was having bowel problems, my GP said to me, “Black women have a low pain threshold, you've got IBS”. I was 24 years old. I had bowel cancer.

As a nurse, I didn’t feel able to care for patients the way I wanted to care for them. As a health visitor, I wasn't allowed to do the health intervention and prevention I passionately cared about. I spent some time in commissioning roles too – becoming one of the first black commissioning managers – but the constant cycle of organisational change wore me down.

And so, for the last 15 years I’ve worked as a practice manager. And they’ve been the most rewarding years of my career. Why? Because general practice is one place where we have the power to do the things we want to do if we gather the right data and do the right things for our patients and our staff. And that’s what I’ve tried to do in my work.

Understanding demand

Soon after I became a practice manager, I decided to do a quality improvement development programme. I learnt the importance of collecting the right data to help us make the right decisions. I then started to get people in my practice thinking about measurement for improvement – embedding the discipline of making sure we capture baseline data to understand the problem before we put effort into solving it.

One of the first things we looked at was demand. And we quickly found we didn’t collect data on demand in the fullest sense of the word. We would look at patient demand but what we didn't look at is all the other things that take time: personal training, management meetings, staff appraisals, other administrative tasks and so on.

We began to build that fuller picture. And what becomes clear when you do that is that demand is entirely predictable. Furthermore, by analysing what the demand is made up of you can start to redesign your team around what your population’s health needs really are. And that’s when the real benefits can be seen.

Challenging conventions

We started with our partners and salaried GPs first: leaders must exhibit the right behaviours for change to stick and be sustainable. Then we looked at demand and capacity within our nursing team. Back then, the nurses kept saying to me, “We don't know what to do, we're really, really busy”. They were always there at seven, eight o'clock at night. So I started to look at what the nurses were actually doing. I found that they'd never measured what they did. When we did, we found that 22% of the appointments were Did Not Attends because they were having to wait so long.

Huge amounts of their capacity were being wasted in different ways. For example, the nurses would arrive at work at eight o'clock in the morning, and then they'd undertake tasks that others in the team could have done better.

So, we began to challenge all these behaviours and assumptions. We ringfenced and protected nurses’ time in a stricter way. And – crucially – we started to think about how we should be using this resource more effectively to support our patients, based on what the evidence said rather than what conventions dictated. The ambition was also to make sure that staff felt safe and were able to adhere to their professional code of conduct, working at the top of their license.

Creating the care navigator role

One of the first things we discovered was that many patients were requiring home visits that didn't necessarily need a doctor but didn't meet the criteria for community services. So, we employed a frailty nurse, a lady called Karen who came from secondary care. Within six months of Karen doing comprehensive geriatric assessment, we reduced GP home visits by 81%.

We also carefully measured Karen’s workload and found around half of her patients had complex needs but did not require highly skilled clinical care. In other words, because social services weren’t available to these people, Karen was having to carry a caseload of people requiring social care. This sparked the next idea. We developed the care navigator role to help people with these wider social needs access the services that could help them.

We trained two of our receptionists to become the first care navigators, partly because they saw and knew and understood so much about our patients. We didn’t really start out with a clear idea of what the role would entail. We just played around, tested different approaches and measured all the way through.

Three months later, when we tracked 86 people discharged as emergencies from hospital, not one of them needed to see a doctor or nurse, because they were all then ‘care navigated’ to social prescribing routes. And that's really where the concept of social prescribing came from. Now it’s everywhere. All because of population data, combined with the staff in the practice having courage to experiment and learn, enabled and empowered by leaders, who wanted to create new interventions to meet population need.

Occupational therapist

Next, we got a community-based occupational therapist working alongside our frailty nurse.

This came about because I had a bit of money and I said to Karen, “If I could give you a present, what would you want?” And Karen said, “I'd want an occupational therapist.” So I spoke to our local hospital’s OT department, we pulled together a proposal and we secured the OT.

The NHS Confederation and The King’s Fund, at the time identified this as a ground breaking intervention to manage urgent care for older people in primary care. These interventions were featured on national BBC, won several awards and were to later feature in the PCN contract.

And, oh, the things our OT is doing in general practice now! Helping people with frailty and long-term conditions. Supporting patients while they are in hospital. Pulling them through and helping them back on their feet at the other end. It’s simply amazing

Pride and passion

And so last month, after 43.5 years of working in the NHS, I finally retired. I’ve had the most amazing career in general practice. I came into my practice to do three things: to sort out our premises, sort out our workforce and sort out access. It's taken me 15 years, but I feel like I've done what I set out to do, though there will always be new challenges as population needs and the model of general practice change.

I’m immensely proud to have had this opportunity and so privileged to have such a dynamic, innovative team, brave enough to test new things, some of which – like social prescribing link workers – are now established elements of the primary care workforce. For me, this is a marker of how powerful population health management can be.

One of my favourite expressions has always been, “In God we trust – everyone else must bring data.” It sums up how important this principle has been in my career. Data has been instrumental in helping me do what I’m truly passionate about, which is caring for people. And for that I’m incredibly grateful.

And, even as I end my own career, what’s exciting for me is that this is only really the beginning for PHM. With the right data, the right skills, the right leadership and the right partnerships, there’s so much more we can – and must – do to support our patients and our staff. And I look forward to watching it happen.

We would love to hear from you. Please get in touch.

This article was prepared by Sheinaz Stansfield in a personal capacity. The views, thoughts and opinions expressed by the author of this piece belong to the author and do not purport to represent the views, thoughts and opinions of Optum.