ACP tools and resources

Anticipatory Care Planning (ACP) is a process that requires support from health and social care professionals. It is comprised by a number of steps, and there is a range of tools and resources that you can use to support individuals in ACP.

Our tools and resources are grouped and presented here based on four steps that health and care professionals should consider when undertaking ACP conversations. These were developed through discussions between health and social care professionals who are working on the ground and having Anticipatory Care Planning discussions. The four steps are also based on previous ihub work on ACP in Scotland.

 

Four steps to ACP

visual - to be developed by comms

Preparation and planning

Health and care professionals must spend time planning how they will support ACP within their workplace. This involves dedicating time and resources to undertake ACP effectively. Staff need to be well-prepared, with the appropriate knowledge and skills to support ACP conversations. It is helpful to develop a system for identifying and prioritising people who would benefit from an anticipatory care plan.

Find tools and resources to support you in planning for ACP and help you identify who will be involved in the process.

Meaningful conversations

ACP is based around a conversation between an individual and those who are supporting them. These conversations are not always straightforward and can involve discussing challenging or sensitive issues. It is essential that health and care professionals have the skills and confidence to conduct these discussions in a supportive way.

Find tools and resources to support you in having ACP conversations.

Documentation and sharing

There are many different tools and resources that support the documentation of an ACP conversation. Using a particular tool to support an ACP conversation can be useful, but completion of the document should not be the focus of the conversation. Experience has also taught us that no single form or document suits every person or care setting. However, the recording of decisions and priorities can help us to share information with all those that need to know.

Find some tools and resources that support the documentation and sharing of information in an ACP.

Review

ACP is not a one-off exercise. It is important that discussions, decisions and priorities are reviewed regularly over time, particularly when health conditions or social situations change. Reviewing an ACP should include the updating of any relevant documentation, such as the Essential ACP, ReSPECT or the Key Information Summary.

Find tools and resources on reviewing ACP.

 

We continue to develop and share new resources. We welcome any suggestions you may have for further resources and feedback to improve existing resources. If you have tools or resources that have supported you in preparing for and undertaking ACP, or you want to provide feedback, please get in touch by emailing us at his.pcpteam@nhs.scot.