Implementing personalised care and support planning (PCSP) doesn’t happen by chance and is best achieved in three stages - set up, initial implementation and maintenance.

Year of Care has worked with organisations at a strategic level to plan, support and deliver the wholescale adoption of PCSP. This case study based on the work carried out across Thames Valley illustrates what’s involved, the critical success factors and the impact.

The key activities are listed below and more detailed guidance can be found in the Year of Care implementation guidance document

Set up

Deciding to implement PCSP using the Year of Care approach requires teams and organisations to work together to transform how individual care is delivered. 

  • Begin by having an exploratory conversation with a member of the Year of Care team to discover the support they can offer and if the values and aims of the programme align with local aspirations and thinking
  • Identify local champions, user involvement and early adopters
  • Set up a local steering group and develop an initial plan of work (use the Year of Care House as a checklist)

Initial implementation

This stage focuses on the initial introduction of PCSP into clinical care 


Maintaining new habits and ways of working can be difficult. The steering group may wish to think about some of the following ideas:

  • Ensuring PCSP is happening and ensuring fidelity to the approach
  • Ongoing support for practices e.g. training for new staff members
  • Identifying if there is a need for local trainers or facilitators
  • Supporting work to extend the scale or scope of PCSP following initial implementation