Person and Community Centred Approaches – Reflections on Implementation Challenges


My name is Ruth Proudlove, I work in the Person & Community Centred Approaches Team at Tameside & Glossop Integrated Care Foundation Trust. Most of my work is with staff who see patients and members of the public, I spend a lot of my time understanding how they feel the system is working for them and how we can work together to create a system which is focussed on person centred care. 

Following the recent publication of “Universal Personalised Care: Implementing the Comprehensive Model”, I have begun to think about the practical implications of wholescale, system shifts to Person and Community Centred Practice to support people with long term conditions. As I explore with practitioners, the concept of person and community centred practice, I hear more and more the feeling that most practitioners already work in this way, are confused about what person centred approaches would mean for their day to day work or, that the system they work in makes it impossible.

The evidence base is growing quickly to demonstrate that personalised care has a positive impact on people, professionals and the system as a whole. As our national structures respond to the NHS 10 Year Plan around integrated organisations in neighbourhoods, now feels like an exciting time to be working together to support developments in practice for those with long term conditions.

“Universal Personalised Care” describes – “Personalised care means people have choice and control over the way their care is planned and delivered, based on ‘what matters’ to them and their individual strengths, needs and preferences. This happens within a system that supports people to stay well for longer and makes the most of the expertise, capacity and potential of people, families, and communities in delivering better health and wellbeing outcomes and experiences.”

The document highlights six areas which comprise person centred approaches:

1. Shared Decision Making

2. Personalised care and support planning

3. Enabling choice, including legal rights to choice

4. Social prescribing and community-based support

5. Supported self-management

6. Personal health budgets and integrated personal budgets.

Thinking about these in practice provokes some interesting questions.

Taking one area as an example, for shared decision making to become a reality, people will be supported by staff to understand all the care, treatment and support options available to them. They will be able to work through the risks, benefits and consequences of these options and then make a decision about their preferred course of action based on good quality evidence, information and their personal preference.

  • Do we routinely share with a person all their available options when they need to make a decision?
  • Do we share information and evidence which will help them to make a balanced decision about their care, treatment and support?
  • Do we do this with sufficient time for the person to be able to process this and discuss options with people who are important to them?
  • Is the information we provide in a format which is appropriate to the person’s communication needs?
  • Do we have the right skills to support a person in understanding the difference between what is important “to” them and what is important “for” them?
  • Do we respect their chosen course of action?
  • Do we understand how to apply the Mental Capacity Act to support people who lack capacity to make a specific decision?
  • Do we value the person’s input as an equal partner to professional expertise?

We have some fantastic examples of this already happening in Tameside and Glossop so, if you feel that you already do some of this in your practice, share with your colleagues so that they can answer “yes” to these questions too. If your answers would be “no” at the moment, this is ok – we can change together, we need to look at our system with honesty and work out where it is making person centred approaches difficult. Now is the time to begin to think about and really embed these ways of working in day to day practice, considering all of the six areas in turn and in detail – “what could this look like for me, in my role?”

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