Realistic Medicine: Survey Highlights

Executive Summary

This report shares the main survey findings, our reflections on what they mean, and what we must do to support you to practise Realistic Medicine.

Realistic Medicine is having a positive influence on the way we practise

Three in four of you (75%) said that you understand Realistic Medicine and 70% of you said that it has had a positive influence on your practice. The majority of you also recognise the positive influence that Realistic Medicine has had on healthcare in Scotland over the last year. This is significant given the challenges our system continues to face. Realistic Medicine is clearly making a positive impact on the way we deliver care.

However, the number of you who believe that Realistic Medicine has had no positive influence on the practice of healthcare in Scotland in the last year last year (42%), makes it clear that we have more to do to support you to practise Realsitic Medicine routinely.

We understand some of the barriers to practising Realistic Medicine

The biggest barrier to practising Realistic Medicine is insufficient staff time (53%), perhaps not surprising given the pressures our system is experiencing. However, the consequences of not taking time to understand what matters to the people we care for are significant. We cannot afford to waste resources and time – our own time and that of the people we care for. We cannot afford to deliver low value, or futile care. Shared decision making and consent are fundamental to good practice. We must understand both the biology and their biography of the people we care for, find out what matters to them so we can deliver the care people value. Employer organisations should consider what more they can do to help you make time for these meaningful conversations. I would encourage you to read my reflections on lack of time to practise Realistic Medicine (page 22).

Realistic Medicine: Taking Care - Chief Medical Officer for Scotland Annual Report 2023–2024

Lack of formal training on Realistic Medicine is a perceived barrier

Just 13% of you said that you had completed any Realistic Medicine and/or Value Based Health and Care training. However, NHS NES has developed excellent training resources on Realistic Medicine available on TURAS. Scottish Government and its delivery partners including NHS NES, NHS Boards, HSCPs and our professional bodies must do more to raise awareness of the excellent training available and do more to ensure that you are supported to complete it. Why? because of those of you who have completed Realistic Medicine training, 76% of you feel more confident in your knowledge and ability to practise Realistic Medicine as a result.

Through shared decision making we can deliver care that people value. By identifying and tackling unwarranted variation in health, treatment, and outcomes we can reduce waste, ensure equity of access for those who need our help the most and ultimately, a fairer more sustainable system. If we really wish to achieve the outcomes that matter for people, completing the training available on TURAS will help.

Public Engagement

In terms of future priorities, many of you are keen to see more engagement with the public on Realistic Medicine. We understand your desire to involve the people we care for. That is why there has been extensive engagement with the public and the recent Citizens Panel 14 (November 2024) results tell us much of what we need to know. An overwhelming majority of respondents wanted to be actively involved in decisions about their care, with 93% agreeing that people should be encouraged to ask their health and care professionals the BRAN questions. My reflections on the Citizens Panel findings (page 26) underscore the importance of understanding what matters to the people we care for if we are to achieve the outcomes that matter to them.

Respondents also said that NHS Scotland needs to take action to prioritise initiatives aimed at resource optimisation and waste reduction. Reducing wasted prescriptions was highlighted by the Panel. Implementing 7 step medicines reviews and guidance on medicines of low or limited value would be a great place to start.

Senior leaders across our system must consider the recommendations that accompany the Citizens’ Panel 14 findings and reflect on how our current and planned activities contribute to delivering them. At an individual level, I encourage you to consider how you can help take the Panel’s recommendations forward.

You want to understand how Realistic Medicine can be applied to specific areas of healthcare

You have identified the need for a detailed focus on how Realistic Medicine can be applied to specific areas of healthcare as a future priority. The Realistic Medicine Casebook contains a variety of excellent case studies that demonstrate how teams across Scotland are achieving the outcomes that matter for people. My thanks go to all teams who were willing to share their stories, including the positive impact that practising Realistic Medicine is having on the people we care for, and how practising Realistic Medicine is contributing to a more sustainable system. We should celebrate their success. I very much hope that these excellent examples of good practice inspire you to innovate, adopt these approaches and deliver careful, kind, better-value care.

More support from senior leaders and professional bodies is needed

50% of you feel that you have received limited or no support from leaders and peers to practise Realistic Medicine.

Interestingly, where Realistic Medicine is promoted by employers, professional bodies, or peers and leaders, you are more likely to:

• have completed Realistic Medicine and VBH&C training;
• feel confident in your understanding of Realistic Medicine principles;
• feel that Realistic Medicine has positively influenced your practice;
• identify fewer barriers to practising Realistic Medicine; and,
• report that practising Realistic Medicine has led to positive outcomes.

There is clear association between the level of local promotion of and support for Realistic Medicine and more positive findings. It is also clear that as the level of promotion of Realistic Medicine reduces, people are less likely to feel confident practising Realistic Medicine and identify more barriers to practising it.

Practising Realistic Medicine delivers better value care, for the people we care for and for our system

I would encourage you to read the section on the benefits of practising Realistic Medicine (page 40). 38% of you said that some positive outcomes have been achieved in improving health equity, reducing harm, and/or achieving the outcomes that matter for people.

Practising Realistic Medicine clearly has huge benefits for people and for our system. By practising Realistic Medicine, you are delivering Value Based Health and Care. It is truly inspiring to hear about the positive difference that Realistic Medicine is making to people lives and the services we provide.

Please take the time to consider the key findings and my reflections on what we must do to ensure every healthcare professional in Scotland is supported to practise Realistic Medicine.