• Commissioners could use a new operating model and commission a service specification to improve support from primary care to self-care.
• Based on agreed criteria, practices could identify people who meet those criteria and invite them in for a review appointment (which would be a double appointment to allow extra time).
• The conversation should be based on the personal care and support plan principles with the objective of agreeing on personal goals and agreeing on the next steps.
• This might involve the person using a range of services e.g. an Expert Patient Programme, but also possibly seeing a social prescribing link worker who can have a further and longer conversation and support them to use an appropriate range of community based resources, which can help with social issues where they exist (see separate social prescribing resource).
There are a lot of different ways that self-care developments could be funded or influence new funding. Some are described below.
Best Practice Tariffs
Designed to encourage delivery of best practice. They are currently being developed and not likely to be ready till 2018-19 commissioning round. Subject to development they may be a good vehicle for supporting the implementation of self-care.
The planning guidance for 2017-19 includes a CQUIN to incentivise secondary care providers to use the PAM and train their staff in the use of personal care planning.
A CQUIN template for promoting self-care for long-term conditions is available at the self-care forum website - http://www.selfcareforum.org/wp-content/uploads/2011/07/CQUIN-Self-Care.pdf
QOF/Local Incentive Scheme
Outcomes relating to self-care might be included, but QOF is under review and may come to an end (replaced by New Care Models contracts). A more likely option to influence primary care activity is to include it in the core contract or any locally agreed incentive schemes with federations/care networks.