Implementation examples / innovations
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The Year of Care (YOC) Programme (UK)
‘Working together for better health care and better self-care’
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A section from the executive summary is below. Access to the full report is available here: www.diabetes.org.uk/upload/Professionals/Year%20of%20Care/YOC_Report.pdf.
The YOC Programme has demonstrated how to deliver personalised care in routine practice for people with long term conditions (LTCs), using diabetes as an exemplar. The approach puts people with LTCs firmly in the driving seat of their care and supports them to self-manage. It transforms the diabetes annual review into a constructive and meaningful dialogue between the health care professional and the person with diabetes. It has two components. Firstly, it enhances the routine biomedical surveillance and Quality and Outcomes Framework (QOF) review with a collaborative consultation, based on shared decision-making and self-management support, via care planning. Secondly, it ensures there is a choice of local services available to support people wanting to improve their health, wellbeing and health outcomes.
YOC provides practical evidence and support to implement the white paper Equity and Excellence: Liberating the NHS proposals for personalised care ‘no decision about me without me’ and locally-driven flexible commissioning for people with LTCs and the QIPP agenda. Care planning is included in the NICE Quality Standard for diabetes. YOC has worked closely with the Royal College of General Practitioners (RCGP), who are developing professional standards for care planning to be incorporated into training.
YOC makes available:
a tested National Training and Support Programme to support delivery of care planning in primary and specialist care. This includes quality-assured ‘training the trainers’, facilitation of delivery, and links with unique IT templates to record patient goals, action plans and service needs
the Royal College of General Practitioners’ (RCGP) report ‘Care Planning – Improving the Lives of People with Long Term Conditions’. This is a practical guide for clinical teams on putting the YOC care planning model into practice (Diabetes UK, NHS National Diabetes Support Team, Department of Health, and Health Foundation 2011).
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