From Royalty to Primary Healthcare

Q&A: A Health Coach’s Insights into Working as a Health Improvement Practitioner

Jade Rehu, a qualified Occupational Therapist and former Health and Wellness Coach to a Royal family in the Middle East, shares his perspectives on working as a Health Improvement Practitioner (HIP) within primary healthcare, and running his own Health Coaching business in private practice. He offers insights into the differences between the roles, working in an integrative clinic setting, tips on job opportunities, and the promising future for health coaches in New Zealand (NZ).

What is a Health Improvement Practitioner and their role in healthcare?

A HIP is a registered health professional that supports patients with mild to moderate mental health and lifestyle issues. They support GPs and nurses by taking patient referrals to help with patients’ chronic lifestyle issues that may be affecting their health and well-being.

In a clinical setting, a HIP typically works an eight-hour shift, with each client session lasting 30 minutes, and every second session booked for ‘warm handovers’. This is where the GPs offer same-day referrals to patients who are interested in getting support, and the consultation happens there and then. This helps with flexibility and convenience for the GPs and patients. While no preparation occurs beforehand, it is just a brief chat to get an overview of the patient’s overarching well-being, putting in place a brief plan and support to get them moving forward and then booking them in for a follow-up appointment to build on the health plan.

This is a free service so patients can see HIP’s as many times as they need. This usually consists of three or four consultations, with follow-up appointments occurring every two to four weeks.  

It’s a busy setting, with Jade seeing about 8 – 12 patients per day. He does find working across two GP clinics and running his own health coaching business provides him with plenty of variety, as it can be quite a stressful job dealing with patients at such a high volume. Yet working part-time provides him with the flexibility and work-life balance he needs.

What’s the difference between a HIP and Health Coach?

HIP’s are required to have a health degree and be registered as an allied healthcare worker with a professional registering body, such as a Psychologist, Nurse Practitioner or Physiotherapist. There is additional HIP training offered before commencing the job which includes a training workshop, practicum inductions, and ongoing development. 

While health coaches have no requirement for any underpinning qualification, so you can come from a wide range of different backgrounds such as social work, smoking cessation, or even personal training. Health coach training ranges from six to 12 months and as the field is currently unregulated, membership with HCANZA (Health Coaching Australia and New Zealand Association) is recommended but optional.

Tips for working in the public health system

Jade’s advice is to first gain a credible health coaching qualification, such as the PREKURE Health Coaching Certificate, to give you the confidence and tools to be able to fulfil current population health needs. Next, making sure you have some sort of peer support is vital. PREKURE offers a graduate program, which provides ongoing support in the workforce.

While the public health system follows a different model to preventative lifestyle medicine, Jade is finding across the board that GPs and nurses are starting to see the value in what health coaching has to offer in preventative care, as they simply aren’t trained in lifestyle preventative measures. 

He finds health coaching works well alongside GPs, who often only see patients for 15 minutes, which is not enough time for them to have an overarching conversation about the patient’s overall well-being. Whilst from a patient’s perspective, having an appointment with a Health Coach or HIP, they feel they are being listened to and receive better health care with the extended session time.

Are more health clinics open to health coaching services?

It’s on a case-by-case basis if health clinics are open to incorporating health coaching services into their clinic. This also depends on the practitioner and their level of self-promotion and reiterating the importance of their services. PREKURE provides education on building a health coaching business, and key marketing skills to help support self-promotion and secure job roles. Jade also finds running monthly workshops with the health team in clinics and also presenting client case studies and positive health outcomes works well to maintain a successful level of awareness.

How best to approach GP clinics as a Health Coach?

While it may seem like a challenging step to approach GPs to work together, it’s all about meeting them where they are at. Jade finds that GP practices have metrics, or certain populations and targets that they need to meet, for example, diabetes is a big focus. Therefore, a health coach can offer specific programmes designed for people with specific chronic conditions. So when a patient comes in that has been first diagnosed with diabetes, the GP can then refer them to the health coach for that extra support, designed specifically for that individual. 

This approach helps GPs see the direct benefits of how health coaches can support their patient’s needs and meet clinic targets. Also, the earlier that health coaches can intervene or provide support for a patient, the more of an opportunity they have of improving their health outcomes.

Health Coaches & HIP’s in a clinical setting

All health practitioners in a clinic have access to the patient portal or patient management system to allow collaboration with each patient. The approach is multi-pronged, where a patient with mild-moderate chronic health conditions will first see the GP to diagnose and prescribe, then they are passed onto the HIP who would outline the health plan with the GP. Patients with lifestyle-modifiable diseases such as diabetes, smoking cessation, and weight management are referred to the Health Coach, who works with the patient, helping with changing those behaviours and supporting the path to improved health.

What does the future of health coaching look like?

Jade explains that the government announced funding was being allocated towards primary health care prevention to help with mental health conditions, as depression/anxiety is the number one burden of disease, with one in four New Zealanders experiencing mental distress annually, and the number of Kiwi’s experiencing poor mental wellbeing increasing.

As part of this incentive for health innovation, funding was designated to create two new outcomes, to establish and increase HIP’s and health coaches in primary healthcare. The aim was by the end of 2024 to have a health coach in every single GP clinic throughout New Zealand. There are about 5,000 GP clinics throughout New Zealand, and at the moment there are around 200 health coaches. Therefore there’s a lot of opportunity for more health coaches in the future to meet this treatment gap.

For more information on health coaching:

https://prekure.com/holistic-health-courses/

For more information on Health Improvement Practitioners:

https://healthify.nz/hauora-wellbeing/h/health-improvement-practitioner/

https://www.tepou.co.nz/initiatives/integrated-primary-mental-health-and-addiction/health-improvement-practitioners-in-new-zealand