Care and support planning (CSP) is a systematic process which replaces current planned reviews for people with long-term conditions and is focussed on creating the opportunity for a ‘better conversation’ between the person with LTC/s and a care professional, enabled by preparation.

The CSP process begins with an information gathering appointment in which tasks and tests are collected ahead of the CSP conversation. The results of any information gathered together, with reflective prompts, are sent to the person 1- 2 weeks before the CSP conversation (preparation). 

The CSP conversation itself has a solution focussed and forward looking approach which acknowledges the experience and expertise of the patient. It brings together traditional clinical issues with what is most important to the individual, supporting self-management, coordinating complex care and sign posting to social prescribing.



Organisational processes, care pathways and staff/team roles and support are redesigned to achieve this. These principles apply in any planned care setting and are appropriate for all people with LTCs however many conditions or issues they live with.


In a general practice CSP often looks like this:


The underpinning philosophy of care and support planning using our approach is:

  • People with long-term conditions (LTCs) are in charge of their own lives and self-management of their condition/s, and are the primary decision makers about the actions they take in relation to their long-term conditions management.
  • People are much more likely to take action from decisions they make themselves rather than decisions that are made for them.

This means the healthcare professional has a new role. Instead of doing things ‘to’ and ‘for’ patients, care and support planning is about doing things ‘with’ people. This enables people to identify their own information needs, goals and action plans and supports them to be more effective problem solvers as they live day-to-day with their LTCs. This often requires healthcare professionals to learn new skills as well as new ways of working.

Download a summary of 'CSP in a nutshell' here.