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Good Practice Guide and examples
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How to use this guide
This guide should be read alongside the NSF for Long-term Conditions. It is designed to offer practical advice on how to implement the NSF at local level.
This guide and the NSF for Long-term Conditions
The National Service Framework for Long-term Conditions was published in March 2005. It aims to transform the way health and social care services support people with long-term neurological conditions to live as independently as possible.
Although the NSF focuses on people with long-term neurological conditions, much of the guidance it offers can apply to anyone living with a long-term condition. Commissioners are, therefore, encouraged to use the NSF in planning service developments for people with other long-term conditions.
The NSF sets out 11 Quality Requirements to be achieved by 2015. Delivery of the NSF can only be met if significant changes are made at local level.
This Good Practice Guide has been developed with the help of the NSF Implementation Group and various sub-groups. It is designed to offer help and advice, including examples of good practice, that can be used by NHS and social services to achieve the Quality Requirements set out in the NSF.
Implementation of the NSF and its relationship with key policies
Chapter 3 of The NHS Improvement Plan, National Standards, Local Action and Supporting People with Long Term Conditions – an NHS and Social Care Model to support local innovation and integration all demonstrate the high priority that the Government gives to improving the care and quality of life for people with long-term conditions. They also set out the challenges involved for those managing and implementing care.
The NSF builds on the management model described in Supporting People with Long Term Conditions in exploring how person-centred care planning, information and support, self-care, disease management and case management can be put into practice to transform services for people living with long-term neurological conditions. However, it is important to preserve the neurological focus in implementation, and to ensure that this NSF retains its own discrete identity within the broader long-term conditions programme.
Delivering the NSF is, therefore, likely to need a local implementation team with knowledge and expertise in neurological conditions, with its own health, social care and other stakeholders. This would need to be separate from the team responsible for implementing the broader long-term conditions model. It is also likely to involve a different set of health, social care and other stakeholders.
In addition, the Expert Patient Programme should be considered for those people where self-management is appropriate. This programme aims to improve quality of life of people by developing their confidence and motivation for them to use their own skills and knowledge to take effective control over their life with a long-term condition. ‘The expert patient: a new approach to chronic disease management for the 21st century’ can be viewed at the link below.
Chapter 4 of the Long-term Conditions NSF contains information about wider Government initiatives which impact on the NSF. This chapter provides a list of useful websites for further information.
Who this guide is for
This guide is for anyone who is based at a primary care trust, NHS trust or social services department and who has responsibility for planning, commissioning and implementing the NSF for Long-term Conditions locally.
The guide also contains specific advice for service commissioners and providers in the form of three guidance papers in the chapter 'Tackling key issues'.
How to find your way around this guide
It should be straightforward to use the links to move around this guide. The different sections are clearly labelled and each starts with a description and a list of contents.
If you are unsure which sections will be most helpful to you, please check the information summaries that follow.
Getting started
This section is about basic preparation. It discusses the key chapters of the NSF; stakeholder involvement; the need for collaboration between agencies; and the use of service models.
Self-assessment
Self-assessment is a vital part of planning service improvements. This section links to a self-assessment tool developed by the NHS Modernisation Agency and how this might be used for long-term neurological conditions.
Tackling the key issues
This section deals with key issues that will affect implementation. It includes papers for service commissioners and providers on:
- care co-ordination
- provision of information
- service models.
It also has links to the following information resources and guidance that will support implementation:
- integrated care planning
- a workforce competence framework
- medicine management
- equipment services
- electronic care records
- clinical knowledge support - map of medicine®
Examples of innovation and good practice
This section focuses on good practice. It includes information about the Modernisation Agency’s Action on Neurology Programme, evaluated examples of good practice and illustrates how capacity can be released and cost savings can be made based around the 11 Quality Requirements.
Information about the Implementation Group
This section lists their members the Implementation Group who drew up this guide and its terms of reference.
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