We need strategic national direction to achieve a single, holistic view of people’s health information

Adopting PRSB’s information standard to support person-centred care planning would be a ‘pragmatic’ step in the right direction for trusts, integrated care systems and suppliers. By Dr Nilesh Bharakhada

Six years ago, Professional Record Standards Body (PRSB) embarked on the development of an information standard to support a holistic, person-centred care planning approach. Professor Martin Severs, then chief medical officer of NHS Digital, said that if we could crack care planning – taking an integrated approach to care across multiple professions and settings supported by digital records – it would be a huge achievement.

We developed the Personalised Care and Support Plan Standard in 2018, through extensive consultation and collaboration with the Personalised Care Team at NHS England and others, a landmark accomplishment. Since then, we have gone on to develop a suite of standards that enable personalised care including standards for shared decision making, social prescribing and palliative and end of life care.

Our aim was to overcome the problem that people routinely encountered of having many care plans for multiple conditions with multiple health and care professionals, in which their voice, preferences and needs were peripheral, not central. Person-centred care planning (as opposed to condition-specific or profession-specific care planning) enables what is important to the person, and their goals for their health, to be the focus with condition-specific information built around it.

Avoid duplication of effort

The PRSB Personalised Care and Support Plan Standard, is a generic care planning standard for recording person-centred care plans and is flexible enough to accommodate plans for a person who has multiple long-term conditions. It can be used with a person’s shared care record and draws on existing information about the person, to avoid duplication of effort.

We are delighted to hear that this is becoming a priority for the NHS England Shared Care Record team and a focus for integrated care systems (ICSs) and their work on shared care records.

However, the need exists for strategic direction to develop a single, holistic view of people’s information that includes shared care records, care plans and appointment bookings through patient engagement portals (PEPs). There are concerns among system leaders that PEPs are being developed separately and that would result in a lost opportunity to ensure people can view – and in some cases amend – bookings and appointments. A truly joined-up approach would allow people to see their care history, current care plans and future appointments with providers that would go a long way to putting the person at the centre of care.

Ensure quality and consistency

For trusts, ICSs, and suppliers currently puzzling over the architecture for integrated care records, care plans and patient portals, a pragmatic early step would be to adopt the PRSB Personalised Care and Support Plan Standard which ensures the quality and consistency of data across all the necessary systems, regardless of the interoperability solutions deployed. For suppliers, testing conformance against the standard through the Standards Partnership Scheme is fundamental and a powerful lever to deploy with ICSs and trusts to demonstrate your solution will support the standard and give your customers confidence that you are moving in the right direction, towards interoperability. PRSB is already assessing conformance of all the adult social care suppliers with the Personalised Care and Support Plan Standard as part of the national digital social care programme.

Better and One London is a good example of joined-up thinking and we are hoping to work with Better to test conformance with the Personalised Care and Support Plan and learn from their experience. They have developed the Better Shared Care Planning Application to provide a generic care planning capability to London’s health and care system, comprising five ICSs, 40 trusts, and 1,400 GP surgeries serving more than 9 million people.

At a national level there is an urgent need to provide a strategic view and guidance on how shared care records, patient portals and care plans should join up. Until the wider system has that strategic direction, we risk repeating the same mistakes we have made in the past and getting no closer to removing fragmentation, with all the implications that entails for professionals’ working lives and people’s care and outcomes.

Dr Nilesh Bharakhada is a GP and executive clinical director for health and care at Professional Record Standards Body