Hi All
I am just letting you know there will be an article in the December issue of 'Network' about the sometimes contentious subject of Care Planning. The NTA is promoting Care Planning as a means to enhance treatment effectiveness, and I am keen to open up a dialogue about this and get an idea of people's experiences. I have asked for feedback at the end of the article, and this is to let you know I really mean it! I know it's often a highly debatable topic. I'm really keen to know all thoughts on Care Planning - do you think it's just a waste of time? is anyone doing it in primary care already? Is it any use? Have you got a template that includes care planning? did the NTA's Care Planning practice guide help? etc etc,

looking forward to hearing from you all!

Hi susi,
I don't work in pc but do do care planning in my work, at least in essence. My experience of trying to get clients in to the idea that this is their plan and it's effective use isn't positive I'm afraid. Often the clients I see just want prescriptive care e.g my script and 'what do you think I should do about....' and have never had a client who wanted a copy of their plan.. that doesn't mean thay haven't done some good work or the treatment isn't effective, they often feel it's something they don't understand and therefore see little relevance to them directly "that's your job isn't it, to plan my care?" which I suppose it is in a way. Can we impose this on them? I don't think so because how would it be done without the data collected (e.g numbers of clients without copies of their plan) suggesting we as services don't actually do it as advised...hope that makes sense?

Hi Susi

A couple of GPs and myself wrote an article last year for Network that touched on care planning: http://www.smmgp.org.uk/html/newsletters/net012.php#Connecting

True, it was more about patient access to electronic records but the concept of patient ownership seems central to both to me.

I see practitioners who construct book-length care plans for their patients. Technical terms and phrases jostle inside the various substance, health, and social domain headings each of which has 4, 5, 6 or more goals. Detailed contingency plans for unmet needs spill off the other page. Patient identifiers (which already appear in umpteen other places in the patient's file) get labouriously re-entered. Etc etc. And with this kind of approach, no wonder some practitioners fall back on pulling out off-the-shelf, one size fits all, here's something I prepared earlier care plans.

It's clearly unhelpful nonsense.
And whose perceived needs are getting met here -provider or patient?

OK, you're asking about care planning in primary care and there are electronic substance-specific packages (e.g. RESULT, rest-in-peace!) which could take some of the hard-work and repetition out of the administrative side.

The GP practice systems are not substance-specific so are very unhepful in regards of integral care planning templates.

But (and at the risk of returning to the substance of previous thread), it often comes down to how the laudable aims of a national policy directive (involve patients in their own care and help them avoid 'drift' into an exit-less treatment) can be given monolithic and concrete interpretation at the grassroots.

A lot - most - primary care based treatment is happening in collaboration with statutory mental health Trust providers.

And they really do seem to me to run the risk of falling into the micro-detailed and paternalistic kind of approach I've suggested above.

Anyway, look forward to the article.
Will repsond again then.

Cheers
Simon


Whose needs are these suiting?

Hi Susi,

It is a little out dated, and mental health specific, but Direct Power has kept me in good stead when developing care plans. Direct Power is published by MIND (I think!) and offers a model whereby service users write and prepare their own care plan. May be slightly too radical (albeit 10 years after the mentyal health field!) but does offer a model whereby service users are at the centre of any care planning process, which is surely where we want to be heading towards?

Hope this is of some use.

Look forward to reading your paper.

Regards

Hi Susi.

I've read your article and it's an excellent summary of the whys and wherefores.

But I am still of the view that there is a tremendous amount of over-description by workers that is burdensome for them, and which creates care plans that are effectively unreadable by and meaningless to the patients themselves.

I suspect that this over-description is often about workers feeling they have to cover their backs in case there is a future serious incident.

Anyone who has been involved in the aftermath of a death in service (and not just in drug services - I was a witness in a Mental Health Act Commission investigation many years ago) will know that the risk departments of large provider organisations can often appear to be less intersted in 'learning from mistakes' than in 'finding a fall guy'.

But I liked the optimism about GP based electronic templates. That's got to be a good way forward.

What do we want: Electronic templates on demand!
When do we want them: As soon as is feasible within the overall constraints of the NPfIT project!

Simon

Thanks for the feedback Simon. I agree totally about mistranslation/oversimplification of good ideas when they get to frontline level. Its definitley something to watch out for - I think the idea behind the NTA e-careplanning guide was in part to disseminate adequate training to address this. But user involvement surely has to be the way to go to guard against meaningless box-ticking. Joes experience I'm sure will be similar to otheres, in finding it hard to get that to haoppen.
Scooby I'm therefore very interested in the mental health package you describe - will see if I can get to it by simple search, if not I'll ask for more details!