In the 2008 NHS next stage review, ‘High quality Care for all‘, the government set a target that everyone with a long term condition should have a care plan to manage their condition. The process of Care planning offers people active involvement in deciding and agreeing how their diabetes (piloted in year of care) will be managed through a partnership approach with health professionals. Lofty aims to be sure but what is the basis for the care planning consultation and how can it be delivered?
The care planning consultation represents a change in style both for health care professionals (HCPs) and their patients. The principal is that the patients and HCPs ‘stories’ are shared, discussed and ensure a holistic, patient centred approach to diabetes management. The patient ‘stories’ cover living with diabetes, managing diabetes and health beliefs whilst the HCPs cover clinical aspects and biomedical indices, all of which the patient is notified of prior to the consultation. These stories are then used to identify priorities and then set goals for future care. This goal setting (action plan) is agreed by both the patient and HCP.
A care planning consultation may seem very different to a traditional one and training is usually required for the HCP. Furthermore, time may become an issue as it seems that a care planning consultation requires more time than a traditional annual review. However the use of other staff may help this, including information gathering of biomedical indices and dispersal of the information (at its crudest, sending HbA1c, lipids, blood pressure etc results to the patient in advance of the consultation along with information about what each reading means and the targets desired.
The year of care programme, a collaboration between the Department of Health, NHS Diabetes and Diabetes UK revolves around the redesign of routine care through the use of care planning and then commissioning the appropriate local services. This can be demonstrated visually by a ‘year of care house’ consisting of a foundation of commissioning, walls consisting of an engaged informed patient and a committed HCP with a ‘roof’ of the organisational process with the care planning consultation in the centre.
Although these seemingly major changes to the consultation process may seem daunting, results from the pilot sites have shown that they can be flexibly adapted at a primary care level although translating this to secondary care still remains a challenge.
Dr. Mark Freeman