Value based health and care action plan: measurement framework

Action 9

The Scottish Government and delivery partners, including NHS Education for Scotland, Professional Bodies, NHS Boards and Health and Social Care Partnerships, will continue to develop a multi-professional community of practice to foster a culture of stewardship.

Progress to date and future priorities

In alignment with Scotland’s commitment to VBH&C and Realistic Medicine, a national Community of Practice (CoP) was launched in May 2024. This initiative is open to all and brings together professionals, policy makers, and stakeholders to foster collective learning. The CoP provides a pace to share best practice, explore challenges, and co-create solutions.

Since its establishment, the CoP has achieved national reach across territorial and special Health Boards with members actively contributing to discussions and campaign activities. The CoP includes representatives from the Realistic Medicine Network and the Scottish Government policy teams and has delivered on initial actions such as supporting the re-run of the “It’s OK to Ask” campaign and linking members to resources. Recent feedback from CoP members highlighted strong desire to continue with the group, helping sustain a culture of learning, innovation, and person-centred care. Next steps include expanding membership to ensure broader system engagement, reviewing and updating ways of working based on member feedback, and using ongoing input to evaluate impact.

Monitoring metrics

The monitoring metrics for Action 9 are based on survey data from health and care professionals. They describe levels of engagement with a range of RM and VBH&C networks and events. These metrics provide insight into awareness, participation and the reach of these networks and activities which support the spread and adoption of Realistic Medicine and Value Based Health and Care.

Metric 9.1: Nearly one-in-five health and care professionals surveyed had engaged with the Community of Practice very often (3%), often (5%) or occasionally (10%). Around half (53%) were not aware of the Community of Practice.^[12]

Metric 9.2: Around a third of health and care professionals surveyed had engaged with the Realistic Medicine Network very often (6%), often (10%) or occasionally (17%). Around three-in-ten (31%) were not aware of the Realistic Medicine Network.

Metric 9.3: Nearly four-in-ten health and care professionals surveyed had engaged with their local Realistic Medicine Team very often (7%), often (14%) or occasionally (16%). Around three-in-ten (30%) were not aware of their Realistic Medicine Team.

Metric 9.4: Nearly four-in-ten health and care professionals surveyed had engaged with local or national events related to Realistic Medicine very often (5%), often (11%) or occasionally (22%). A quarter (25%) were not aware of such events.

Supplementary case study: Case studies showcasing integration of shared decision making and person-centred practice enabled by community of practice engagement:

1. Enhancing Patient Communication through Community of Practice Collaboration

Participation in the CoP directly influenced NHS Lothian’s approach to patient communication. Discussions within the CoP prompted a re-evaluation of how outpatient letters were shared with people, leading to a cultural shift towards more transparent and inclusive communication practices aligned with Realistic Medicine and Value Based Health & Care principles.

A key outcome of the CoP engagement was the initiation of an audit to assess the current state of Patient-Facing Letters (PFL) across NHS Lothian. With approximately 130,000 outpatient appointments per month, understanding the scale and quality of patient communication was essential. Conducted in November 2024 across two major hospital sites and including 123 outpatient clinics spanning 13 specialities, the audit findings highlighted both successes and areas for improvement, for example 48% of the letters sent lacked an explanation of medical terminology and 43% used patient-friendly language.

The audit provided a baseline for future enhancements and informed ongoing work with digital teams to explore cost-neutral, sustainable solutions for sharing PFL electronically.

2. Advancing Shared Decision Making in NHS Fife through Community of Practice Engagement

The NHS Fife Realistic Medicine team joined the CoP seeking a collaborative space to share, inspire, and spread innovative approaches to VBH&C and Shared Decision Making (SDM). Participation in the CoP has been instrumental in shaping NHS Fife’s approach to embedding VBH&C and Realistic Medicine.

Inspired by a CoP presentation from NHS Lothian about how they had used collaboRATE in outpatient setting, the Fife team introduced the tool as a quality improvement project with ScotGEM (Scottish Graduate Entry Medicine) students from St Andrews University.

A recent CoP session saw a Music Therapist share insights into creative therapies, sparking meaningful dialogue and facilitating connections that may not have otherwise occurred.

The CoP has served as a collaborative hub for accessing and co-developing SDM resources, tools, and training. Regular meetings and use of Teams channels have kept members informed about the latest frameworks and evidence-based tools, while peer-led sessions have contextualised SDM within local settings. The Fife team learned how others had overcome barriers to training uptake through integrating TURAS modules into corporate induction and personal development plans.

Looking ahead, the CoP can further support NHS Fife to improve by facilitating targeted workshops, spotlight sessions, offering mentorship, and creating space for open dialogue about challenges and solutions. Next steps for Fife are to explore with others the approach to developing roles using the finance value-based health and care toolkit.

The Community of Practice has been a catalyst for change in NHS Fife, accelerating the adoption of Realistic Medicine and VBH&C principles, supporting workforce development, enabling cross-sector collaboration, and generating actionable insights.