Practices tell us that as well as presenting challenges, COVID-19 has created opportunities to deliver personalised care and support planning creatively with patients. Many practices who had already implemented personalised care and support planning have developed their processes to continue to meet the needs of people with long-term conditions, thinking about how they can still enable people to be prepared and to participate meaningfully when using remote consultation channels.

We have worked with Dr Sue Arnott at Burnbrae Medical Practice in Scotland to capture the work they have done to ensure they continue to support people with long-term conditions via personalised care and support planning during the pandemic. This has been pulled together into a case study and you can read The Burnbrae Story here.

Year of Care also hosted a webinar in August 2020 on how to adapt personalised care and support planning to include remote methods of delivery. We were joined on the evening by Dr Sue Arnott alongside Dr Graham Kramer and Dr Becky Haines and you can watch a recording of the session here.

For GP practices where LTC care has been paused there is now a need to consider how they restart LTC care and find new ways of working, both to limit one to one contact with the practice and support people to manage the conditions they live with. Year of Care produced this one side paper to help practices begin to think through how personalised care and support planning can help.

Year of Care Partnerships® has developed a suite of resources to support practices to offer remote personalised care and support planning and they available to everyone at the links below - please do not amend the resources.

Introduction to remote PCSP options

We have developed a summary of Year of Care’s learning from around the community of practice during the COVID-19 pandemic. We have a flowchart that walks through the PCSP process from triage to the conversation, and suggests adaptations for remote options. 

1. Background to CSP and remote consultations - learning from COVID-19 V1.0

2. Flowchart for CSP with remote options V2.3

Prioritisation and recall options

This is a suggested guide for practices when triaging for multimorbidity reviews during the COVID-19 pandemic. It also lists the various pros and cons to consider for remote and face to face PCSP. 

3. Prioritisation, triage and recall options V1.0

Information gathering

Here we suggest some considerations for practices when planning information gathering appointments with an alternative to face to face reviews for those who still need to shield. We have also developed a resource to allow people to collate their own self-monitoring results to have to hand for their PCSP conversation. 

4. Information gathering V1.0

5. Self-management info gathering proforma - 1 page V1.0

6. Self- management info gathering proforma - 2 pages V1.0

Patient preparation for remote PCSP

Some people may not need to have a formal information gathering appointment however preparation for their conversation is still equally as important. We have included a resource to help people consider what’s most important to them and things they’d most like to discuss which has been updated following feedback from our community of practice. 

7. Patient Preparation for remote consulting V1.0

8. Preparing for your CSP conversation no information gathering V1.0

PCSP conversations

This section has resources for healthcare professionals to support thinking through PCSP conversations either over the phone or via video. There is a new document on the stages, tasks and skills during the PCSP conversation and some top tips documents based on whether conversations are being held over the telephone or video. 

9. PCSP conversations V1.0

10. PCSP consultations stages, tasks and skills 24.06.18

11. Personalised care and support planning using the telephone 2020 V1.3

12. Personalised care and support planning using video 2020 V1.0


Year of Care remote training and support

Like many of you, Year of Care Partnerships® has adapted the way we work during the Coronavirus pandemic. We have previously delivered a face to face package of training, facilitation and support. This supported GP practices from their early thinking and decision making around personalised care and support planning through to implementation and embedding new ways of working.

We want to continue to support practices evolving and embedding personalised care and support planning into practice and also new practices at the outset, during these unique times so we have designed a remote training offer. This can be delivered to practices in bite-size sessions, tailored to the needs and size of local teams, or to a wider cluster of practices. The sessions are more modular than before and some serve as refreshers to established practice teams

Year of Care remote training and support overview

Please contact us at for more information.