So what is Care
Planning anyway?
Care Planning Support Pack 2014
1
So what is care planning anyway?
Why?
Care Planning meets UK national standards, policy and guidelines:
• 2011 NICE Quality Standard 3 ‘people with diabetes participate in annual care
planning which leads to documented goals and an action plan’
• 2010 DH White Paper there was a commitment to ‘shared decision making’ and
‘choice’ as part of the care planning process
• 2001 National Service Framework for Diabetes Standard 3 encourages
participation in the decision-making process
• 2008 Darzi High Quality Care for All advocates use of jointly agreed personalised
care plans
• 2006 Department of Health and Diabetes UK provides theoretical basis for care
planning
Translates into real self care behaviour change
Professionals report greater job satisfaction, improved skills and time efficiency
So what is care planning anyway?
What?
‘A "road map" of sorts, to guide
all who are involved with a
patient's care’
‘A written means of planning
patient care and discharge’
‘A comprehensive plan of medical
care insurance’ (in Labrador)
‘The NTA expects all service users
to have a written care plan which is
developed and reviewed on a
regular basis with them’
‘A 12 page Medicare document
for residents’
‘Under Petshealth Care Plan …
incidents relating to the consumption
of contaminated pet food are
covered’
So what is care planning anyway?
What?
Care planning is a way of making sure time spent between patients and
healthcare professionals is used in the best possible way, so that when
they come together they can:
• Set goals
• Have a record of these
• Follow up and talk about progress
These are what we are calling the minimum standards of care planning.
This means that every adult living with diabetes in Lambeth and
Southwark should receive these at every diabetes appointment.
So what is care planning anyway?
Is this Care Planning?
I really don’t
want to go on
insulin
This patient
needs to go on
insulin
“Hello, nice to
see you again.
I hear you’ve
been told you
need to start
insulin.”
“Hello, oh
have I?”
So what is care planning anyway?
I wonder when’s
the best time for
the patient to
take the insulin?
“So we need to
talk about what
insulin might
suit you.
Do you eat your
meals at about
the same time
every day?”
I really don’t want to go
on insulin. I don’t
always eat meals at the
same time every day. I
wonder if that matters?
“Yes, I
eat my
meals
usually at
the same
time.”
So what is care planning anyway?
Another
successful
consultation!
“Good, we can
start you on two
injections a day
on Monday.
Does that sound
OK with you?”
I’m sure I’m
busy with
something else
on Monday…
“Well I’m not
really that
keen but 2
injections is
better than 4
I guess.”
Care plan template
CARE PLANNING TEMPLATE
Codes
 Goal identification
67L
 Identifying barriers to goal achievement
67R
Free text box
 Goal achieved
 Goal not achieved
67L0 (zero)
67L1
Free text box
Not appropriate
for first care plan
drop down
 Follow up arranged drop down
 Follow up in 1 month
 Follow up in 2-4 months
 Follow up in 4-6 months
 Follow up in 1 year
8H8
8H87
8H88
8H89
8H8B
 Personalised Care Plan completed
8CMD
Comments
My Health Plan