What is proactive and personalised care?
Proactive and personalised care is an approach to health and wellbeing that identifies and supports people’s needs before they reach a point of crisis.
It focuses on early identification and intervention to keep individuals well, independent, and connected to their communities for as long as possible.
Proactive and personalised care works best when delivered in partnership with communities and tailored to local needs, using data, relationships, and community assets to identify and support those at risk.
To deliver proactive and personalised care effectively, we need to place the individuals at the centre of decisions about their health and wellbeing, understanding what matters to them.
Proactive and personalised care also considers the wider social determinants of health, such as housing, employment, and education, to promote long-term wellbeing and reduce health risks.
Why is it important?
Proactive and personalised care is particularly important in Greater Manchester as it underpins the region’s ambition to create a sustainable, person and community-focused health and care system.
It aligns closely with the Greater Manchester Primary Care Blueprint and the Greater Manchester Live Well model, which emphasises supporting people to live healthier, more independent lives through early intervention, prevention, and community-based support, recognising that many of the factors influencing wellbeing sit outside of clinical settings.
Proactive and personalised care is not only vital to helping individuals lead healthier, longer lives, but is also key to the long-term sustainability of our healthcare system by reducing avoidable demand on overstretched services, as advocated in the Darzi Report and more recently in the NHS 10 Year Health Plan.
Delivering proactive and personalised care at a neighbourhood level is crucial, as it allows interventions to be tailored to the unique needs of local populations and leverages local strengths, assets, and community networks.
This place-based approach builds resilience, tackles inequalities, and supports a more sustainable, person-focused health and care system.
About the Greater Manchester Proactive and Personalised Care Programme
The Greater Manchester Proactive and Personalised Care Programme was designed to help Primary Care Networks (PCNs) develop ways of improving patient care and health outcomes.
It equipped them with the skills to proactively tackle long-term conditions in their localities and ultimately reduce demand on primary and secondary care.
Participants chose one condition to focus on and were supported to develop person-centred approaches based on the specific needs of their local population.
Phase one of the programme focused on dementia, frailty and high-intensity users, while phase two featured cardiovascular disease (CVD) and diabetes.
Through a mixture of face-to-face workshops and online sessions, they learned how to interpret local data, shared learning with other PCNs, and understood how to adapt their workforce, including how to maximise the roles under the Additional Roles Reimbursement Scheme (ARRS).
They also received a range of quality improvement (QI) tools and templates, and benefited from health coaching principles to help maintain structure and focus for their individual proactive and personalised care projects.
The programme was delivered by Greater Manchester Primary Care Provider Board (GMPCB) and NHS Greater Manchester (NHS GM) in partnership with Peak Health Coaching.
In addition, Made By Mortals, a company that brings lived experience to life, delivered a theatrical interactive audio workshop called Stuck.
