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Government rushed through care plans without evidence say DH advisers

By Nigel Praities

Government plans to insist all patients with long-term conditions have a personal care plan have suffered a major blow - after key advisors admitted the plans were rushed out with little evidence they would improve health.

Members of a Government working group on diabetes said they were pressured to make recommendations after analysing 22 systematic reviews into personal care planning in asthma, cancer and diabetes and finding ‘little robust evidence' to show improved outcomes.

They concluded patients were more engaged to self-manage their condition, but there was evidence care planning might distract GPs from addressing clinical problems.

Lead author Dr Jonathan Graffy, a GP in Waterbeach, Cambridgeshire and senior clinical research associate at the University of Cambridge, said care plans had to be integrated into other initiatives if they were to be successful.

‘These findings lend support to the view that "patient-centeredness" alone may not be sufficient to significantly improve on health outcomes, and integration with interventions to promote self-management is required.

‘They also suggest there is a risk of practitioners paying lip service to an initiative that may not have been adequately thought through,' he said.

The team of researchers also admitted their review of evidence had been compromised by pressure to fit in with the Government's policy announcements.

‘The working group was under pressure to report speedily, so that policy on care planning for diabetes could fit in with other initiatives … we are aware that as a result we may have missed some relevant work,' they said.

Their analysis was published early online in the Primary Health Care Research and Development Journal.

Personal care plans for every patient with a long-term condition by 2010 was a key pledge in Lord Darzi's review of the NHS and is due to be fully rolled out by June 2010.

The roll-out has proved controversial, with an impact assessment published in March revealing that practices would have to spend 10 hours a week to implement the scheme and employ new staff to run the scheme.

Dr Colin Kenny, a GP in Dromore, County Down, and a committee member of the Primary Care Diabetes Society, said although promoting self-care was important the care plan scheme were unlikely to succeed unless properly resourced.

‘There is concern about the time involved in motivating patients to take part in care plans. There is nothing wrong with the concept, but unless it incentivised by QOF it is not going to happen, ‘ he said.

By By Nigel Praities

npraities@cmpmedica.com

BOX: Personal care plans, a timeline

Mar 2006 - 'Our Health, Our Care, Our Say' policy paper commits the Department of Health to supplying care plans for all patients with a long-term condition

Jun 2008 – Lord Darzi's NHS Next Stage Review reiterates the promise, pledging all patients will be offered a personal care plan in two years

Mar 2009 – Pilots launched and the Department of Health issues an impact assessment, estimating the average practice will have to spend 10 hours a week to implement the scheme

June 2010 – Deadline for all patients to be offered a personal care plan

Prickly subject: Government advisers say care plans for diabetes were rushed Prickly subject: Government advisers say care plans for diabetes were rushed

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