Universal Care Plan: making personalised care a reality

The Universal Care Plan is a dynamic integrated care planning solution that enables every Londoner to have their care, health status, and support wishes digitally shared with healthcare professionals across the capital.

• The UCP programme currently supports pathways for urgent and end of life care but has plans in place to extend to other areas of care. This includes, but is not limited to, supporting people with sickle cell disease, dementia, frailty, children and young people, asthma, mental health needs, learning disabilities, autism, and others.
• The solution shares real-time data across primary, secondary, urgent care, and community health care settings and geographies across the region, whilst enabling the relevant technical capability to provide interoperability with the existing health and care IT systems.
• The Universal Care Plan has integrated with the NHS App and the NHS National Record Locator, establishing nationwide access to care plans.

What is the Universal Care Plan for London?

The Universal Care Plan is a conversation between a healthcare professional and the citizen in their care, where the professional will listen, understand, and make notes on their care and support wishes such as what is essential in day-to-day life, care preferences, information about personal contacts involved, and urgent care key information such as diagnosis, prognosis, symptom management.

It is a platform that serves the entire London region and ensures that care is tailored to personal needs and delivered as close to home as possible. It supports a collaborative and data-first approach to improving technology, information governance, and how health and care services are provided and experienced across London.

The Universal Care Plan brings together multiple electronic patient records, personal health records, or electronic palliative care coordination systems in standardised data fields and is accessible to all urgent care services. It is based on the openEHR standard that enables information and data sharing.

Key features of the Universal Care Plan

Platform approach
Taking an openEHR platform approach with persistent data layer that is separated from applications, combined with low-code development, enables faster pace of change, local flexibility, and reduces dependencies on application vendors.

Improved accessibility
Users accessing the UCP via interoperable electronic patient records do not need separate log-in credentials. The solution is accessible via a standalone portal or via context launch with a single sign on from a users’ local EHR, including GP systems (EMIS, EMIS Community, and TPP SystmOne), emergency care systems Adastra and Cleric, and secondary and acute systems such as Cerner.

Reduced duplication
Care plans can be pre-populated with relevant information from the patient’s GP record. Specified SNOMED codes can be written back to GP records.

Use case development
The technology underpinning the Universal Care Plan enables multiple care plan use cases to be created, thus supporting a greater variety of clinical pathways.

NHS App & NRL integrations
The Universal Care Plan has integrated with the NHS App and the NHS National Record Locator (NRL). This is an important step towards nationwide healthcare accessibility and revolutionises patient care coordination, providing access to vital health information regardless of geographical location within the UK.