North Central London Integrated Care System is a partnership of NHS, councils, and voluntary sector organisations, working together to improve health and care in Barnet, Camden, Enfield, Haringey, and Islington, which includes supporting people living with long-term conditions.

As part of a new service for people living with long-term conditions, North Central London Integrated Care Board (NCL ICB) is using MYCaW®, provided by Meaningful Measures Ltd., to record the individual's health and wellbeing needs throughout the care planning journey. MYCaW will be used to support around 300, 000 people across north central London.

How is NCL ICB using MYCaW® to deliver personalised care?
Since 1st October 2023, General Practice surgeries in North Central London have started to offer a new way to treat and support people with certain long-term conditions, inviting them to a new service called Your Yearly Health Check. This new annual service is person-centred and can help people manage their health and wellbeing.

Each person invited to a Your Yearly Health Check will be asked to complete the MYCaW® First form (the Care Plan), helping to record their top one or two concerns before discussing with a clinician what is most important to them and identifying the next steps to help support them. There will be another opportunity for people to discuss their Care Plan with a clinician, a few months later in the Yearly Health Check. At this point, as part of reviewing progress made and initial goals, the MYCaW® Follow-Up form (the Care Plan Follow-Up) can be completed.

How does MYCaW® support NCL ICB's personalised care approach?
The new service allows people to discuss their top one or two concerns that affect their ability to self-manage their long-term conditions. These may not necessarily be medical concerns. Clinicians will support people to agree on priorities and goals and help identify appropriate services (health or social care) for the person to connect with.

MYCaW® supports a holistic approach to care planning, helping to capture the concerns in the person's own words, giving them more choice and control in how their needs are met through a shared decision-making conversation which leads to agreeing outcomes or goals for the person to work towards.

The Your Yearly Health Check service provides appointment time over 12 months for people with long-term conditions to discuss and review concerns that impact their ability to optimise self-management of their health. This could include employment, housing and mental health concerns and these conversations are complementary to the medical services that continue to be provided.

As the MYCaW® forms are simple questionnaires, written in easy-to-understand language that takes just a few minutes to complete, it supports the Your Yearly Health Check service by offering a consistent way for all General Practice surgeries in North Central London to capture a person's concerns. MYCaW® enables appointment time to focus on what the person's goals and priorities are and what support they require.

The data captured in the MYCaW® forms is anonymous, allowing the data to be analysed to identify gaps in the provision of health or social care services across North Central London which could lead to the prioritisation of which future services should be established.