A revolution is starting to sweep through clinical practice.
Clinicians, exhausted as they are in dealing with a seemingly endless tide of demand, are testing out new ways of working.
Trying to move upstream, developing proactive care plans with the person with long-term conditions and their carer and changing the conversation from “how can I help” to “what is important to you”.
Equally as we see an increase in multi-morbidity including the social and mental health problems, we are slowly moving away from the NHS obsession with single disease specific pathways.
Collaborative Care and Support Planning (CC&SP) is the new paradigm being at the centre of the metaphoric House of Care (figure one)
So what is different?
In the first days of medical school the tradition, paternalistic medical consultation model (figure two) was drilled into our DNA. Some still even remember being examined on it.
This reactive medical model still works in responding to acute illness. The NHS is still very good at responding to “car crashes” but we need a very different way of responding supporting people living their lives with long term conditions as outlined in figure three as the delivery model for Care and Support Planning
This new proactive social delivery model developed by TLAP and endorsed by National Voices is gradually being introduced by Clinical Commissioning Groups while at the same time the Royal College of General Practitioners, is working to mainstream this model into every day clinical practice.
So do we ignore the medical model of care?
Absolutely not. There are times when our clinical skill are critical when we do have to focus on the urine infection, asthma, blood pressure, glucose levels or renal function.
CC&SP is another set of tools in our toolbox. Deciding which end of the spectrum, or a synthesis between the two, requires a professional judgement working with the person and depending on the circumstances.
Neither is right or wrong – but in facing unfathomable medical, social and psychological complexity CC&SP can be liberating for the clinician as well as the person.
How does this work in practice
Currently most of our efforts are focused on those at highest risk.
Intermediate care with services such as community matrons, Rapid Response and community geriatrics have proved their worth for those with greatest need but if we are honest the care plans for these people are more orientated towards the medical crisis plan.
Perhaps we need to think about those people who are at lower risk before they get to that crisis stage.
Working with social services, primary care, the voluntary sector and community staff, systematically proactively working through the population finding out “what is important to you” is at the heart of this new way of working.
The model works in the context of every long term condition be it frailty, end of life care, stroke care diabetes, mental health, learning disability etc. although application may be different.
Up and down the country clinicians are starting to work differently, sometimes trying on their own, but more often within a supportive clinical commissioning group so find out what is happening in your area.
RCGP National Clinical Commissioning Lead and can be contacted on firstname.lastname@example.org
For information about the Clinical Champions network please contact Alison Marsh on Alison.Marsh@rcgp.org.uk