For many years the NHS has talked about the need to shift towards a more personalised approach to health and care. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations.

The NHS Long Term Plan is clear the time has come to give people the same choice and control over their mental and physical health that they have come to expect in every other part of their life. Chapter one of the NHS Long Term Plan makes personalised care business as usual across the health and care system.

To support this in practice, NHS England has recently published the Universal Personalised Care: Implementing the Comprehensive Model, which sets out the details of the six, evidence-based standard components, and 21 actions to achieve its systematic implementation, right across the country. Implementation will be guided by delivery partnerships between NHS organisations, local government, the voluntary and community sector and people with lived experience.

The six components of the Comprehensive Model for Personalised Care are:

1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets and integrated personal budgets

The personalised care operating model

The personalised care operating model shows how all the various components work together to deliver a joined-up approach around the needs of each individual. The model seeks to deliver:

• Whole-population approaches to supporting people of all ages and their carers to manage their physical and mental health and wellbeing, build community resilience, and make informed decisions and choices when their health changes.
• A proactive and universal offer of support to people with long-term physical and mental health conditions to build knowledge, skills and confidence and to live well with their health conditions.
• Intensive and integrated approaches to empowering people with more complex needs to have greater choice and control over the care they receive.

What good social prescribing looks like

The Social Prescribing Summary Guide outlines what good social prescribing looks like for people, communities and systems, and includes a link worker job description, a check-list for commissioners, and a Common Outcomes Framework.

On 30 July, NHS England Personalised Care Group published a new Social Prescribing Reference Guide for PCNs.  This guide has been created for practice managers and clinical leads within primary care networks (PCNs), for social prescribing link workers, commissioners and local system partners, including voluntary, community and social enterprise (VCSE) leaders, public health leaders, people with lived experience and patient groups.

It should be read in conjunction with the technical annex that accompanies the guide covering:

• Checklist for introducing social prescribing link workers into PCNs
• Working with partners to create a shared local social prescribing plan
• Recruiting social prescribing link workers
• A framework for social prescribing link workers
• What to include in a link worker induction
• Supervision and learning for social prescribing link workers
• Creating personalised care and support plans
• Quality assurance for social prescribing
• Social prescribing referral systems
• Measuring impact: people’s wellbeing
• Measuring impact: on community groups

Healthy London Partnership’s Proactive Care team is working closely with colleagues at NHS England and London’s Sustainability and Transformation Partnerships (STPs) and Clinical Commissioning Groups (CCGs) to help support the deployment of the model in London, building on current developments and existing good practice, particularly around social prescribing and supported self-management.

Please contact hlp.proactivecare@nhs.net if you have any questions or would like further information.

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