We know that implementing care and support planning is a challenge, but we have also shown it can be achieved following the Year of Care approach and will reap significant benefits.  

Our experience has shown that, before embarking on the implementation of Year of Care, asking some key questions can contribute to the development of a robust strategy and clear plan:  

  • What do you hope to achieve by implementing care and support planning?
  • What is the current quality of care being delivered?
  • How does care and support planning fit with your local model of diabetes/long term condition (LTC) care to improve it?
  • How does this link and fit with your commissioning strategy for LTCs?
  • In what clinical settings do you hope to implement care planning?
  • How are you going to stratify your population of people with LTCs to receive a care and support planning approach?
  • How engaged are your local clinical teams and who would be a good local GP champion?
  • How is the implementation of the care and support planning going to be coordinated, supported and monitored?
  • What funding do you have to support the delivery of training and do you need to develop local capacity by training local trainers and facilitators?
  • How are individual practice teams going to be supported after training delivery?
  • How are you going to ensure that there is a ‘portfolio’ of services to support people in the community that they can link with following individual care and support planning?