Building the House of Care for people with long-term conditions: the foundation of the House of Care framework.

e288 British Journal of General Practice, April 2016 WHAT IS THE HOUSE OF CARE? The House of Care (HoC) is a framework for a coordinated service model that enables patients with long-term conditions (LTCs) and clinicians to work together to determine and shape the support needed to enable them to live well with their condition.1 Based on the internationally well-known Chronic Care Model2 but specifically adapted to fit UK primary care, it uses the metaphor of a house to describe the components that need to be in place to make coordinated personalised care planning a reality.3 Previous articles in this series have described various components of the House.4–7 This article focuses on its foundation. People with chronic LTCs play a key role in managing their own health, but how effective this is depends on their level of confidence and skill to manage tasks that are sometimes quite challenging, especially for those with multiple conditions. They are more likely to feel confident and competent if they are fully engaged in articulating their needs and capacities, deciding on priorities, agreeing goals, and jointly developing a plan for achieving these. The evidence shows that this type of supportive, collaborative relationship can lead to improved health outcomes, especially when it is fully integrated into primary care delivery.8 The care planning conversation (clinicians and patients working together to co-produce health) is at the centre of the House, supported by the right wall (effective teams of healthcare professionals skilled in partnership working with patients), the left wall (engaged, empowered, and wellsupported patients), the roof (appropriate and robust organisational systems and processes), and the foundation (responsive commissioning and support from statutory and voluntary organisations, community groups, and peers).4 The HoC aims to integrate personalised care planning for individuals with commissioning for populations, but it can only achieve this if it is embedded in a clearly defined community strategy. Care planning and the systems, training, and resources needed to support it must be explicitly commissioned, local voluntary and community groups must be actively involved, and a robust approach to outcomes measurement must be in place. These are the foundation stones on which the House is built, ensuring that individual needs and choices identified during the care planning process can be aggregated to inform a commissioning plan that meets the needs of all those with LTCs in the local community.