New personalised care plan for the NHSBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l470 (Published 31 January 2019) Cite this as: BMJ 2019;364:l470
- Anya de Iongh, patient editor1,
- Don Redding, director of policy and partnerships2,
- Helen Leonard, consultant paediatrician3
- 1The BMJ, London, UK
- 2National Voices, London, UK
- 3NHS England Strategic Co-production Group, London, UK
- Correspondence to: A de Iongh
The recently published NHS long term plan1 outlines five large practical changes to the NHS service model, including ambitious plans for personalised care.
The goal is to establish the NHS comprehensive model of personalised care in every local health system. This model consists of six interconnected components: shared decision making; personalised care and support planning; enabling choice; social prescribing and community based support; supported self management; and personal health budgets. Their common aim is to give people more control over their health, care, and support at all stages of life. This can be life changing.
None of these approaches are new, each one has an evidence base,2 and all have been the subject of policy announcements before,3 generally with little effect.4 For many people with long term conditions or complex health and social care needs, the gap between aspirations for personalised care and current reality is stark.5 It is a big ask for any single document to bridge that gap, yet this model includes important differences from preceding examples and gives cause for cautious optimism.
This time there is a delivery plan: NHS England published Universal Personalised Care: Implementing the Comprehensive Model on 31 January.6 This signals a shift from the usual “why” to a more proactive “how”—with a guide for systematic delivery, to ensure that as many people as possible can benefit. NHS England’s delivery plan lists 21 actions to make these approaches standard. Although social prescribing has been making headlines,7 the combined effect of all six components makes this model more than the sum of its parts.
Like most NHS plans, this one focuses on structures, such as emerging primary care networks, and targets, including extending this support to over two and a half million people within five years. But it also recognises the critical human relationships needed to make this happen.
Unlike previous top down initiatives, this model has been co-produced— including as equal partners people with lived experience who understand the changes needed and have driven many of the existing personalised care innovations such as personal health budgets. Professional organisations such as the Royal College of General Practitioners and the Royal College of Physicians have also already embraced this agenda.
Although healthcare professionals across the spectrum often buy into the broad aims of personalised care, changing the culture8 and developing specific skills are challenging. The new plan tries to offer tangible ways to build on existing training initiatives.9 It supports emerging non-clinical roles such as link workers through accredited training.10
The strength of the personalised care model is that it is not condition specific, offering particular benefit to people with multiple conditions, who are often failed by the silo infrastructure of health and social care.11
Making it work
Personalised care is much more than “being nice.” It describes a fundamental shift towards recognising that people who use health services can also help solve problems and take control. Individual professionals, already working in stretched services, cannot realise the full potential of these changes at the proposed scale without widespread cultural transformation. That transformation requires training, new roles, and new infrastructure.2 The plan says there will be extra funding but does not give details.
The momentum of the long term plan, and the tilt in funding towards primary and community care, will ease the implementation of this personalised care model. The changes being made to the mechanisms in England for contracts and quality standards (such as a revised Quality and Outcomes Framework) will also help progress on personalised care.
Voluntary sector leaders welcome the move away from a purely medical model but continue to question whether funding will also flow into the voluntary services and support that are so essential to personalised care.12
The NHS long term plan promises that this comprehensive model will be “rolled out” across England over the next 10 years, but it is more like a parquet floor than a carpet. It has to be shaped and constructed in place, using existing and new materials with local skills.
Universal Personalised Care acknowledges the spectrum of activities that fall under each component, and the balance to be struck between standardisation, local initiative, and personalisation. This balance is important—we need to set quality expectations and remove unfair variation while allowing local systems to flourish in their own way.
This new model provides much to welcome. Its success hinges on two key enablers: adequate funding and our collective engagement as people and professionals. The groundswell of support now needs the details of the funding to be clear to deliver the promised transformation in care.
Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: DR was a member of the external reference group that contributed commentaries to the authors of Universal PersonalisedCare, and a coauthor of the Realising the Value final report and other outputs. National Voices is one of the voluntary sector partners in the Health and Wellbeing Alliance, which is funded by the Department of Health and Social Care to work in strategic partnership with NHS England.
Provenance and peer review: Commissioned; not externally peer reviewed.