2025 was a significant year for the Universal Care Plan, including the major milestone of expanding the UCP use cases. As we move into 2026, we’re excited to build on the strong progress across health, social care and the voluntary sector to continue supporting systems to deliver more coordinated, compassionate care.
Greenwich Complex Case Management Team: Use of the UCP
This month we’re highlighting the Greenwich Complex Case Management Team, a proactive service supporting care home residents with complex health and care needs who are at high risk of unplanned hospital admission or frequent users of urgent GP services. Leianndra Dinnall and Helen Michel, Complex Case Managers for Greenwich Care Homes, shared more about the team and their work:
“As part of a modified Comprehensive Geriatric Assessment (CGA), care plans are agreed at a multidisciplinary team meeting with a Consultant Geriatrician. Advance care planning discussions are routinely carried out by Complex Case Managers (CCMs) with residents, relatives, and next of kin. Previously, CCMs did not have access to document the information directly into the UCP, requiring conversations to be revisited and recorded by GPs which led to delays in formalising patient wishes.
To improve this, we presented a case and Standard Operating Procedure (SOP) to our trusts’ Clinical Effectiveness Group meeting requesting authorisation for CCMs to enter information directly into the UCP. This aimed to reduce delays, prevent unplanned hospital escalations, and improve patient outcomes. Following a series of reviews and approval, this change was implemented.
At the time of approval, there was already a significant increase in UCP completion by GP teams. As a result, our focus naturally shifted from completing UCPs to reviewing their quality and ensuring consistency and completeness across all entries.
As a service we’re very proud with the progress we’ve achieved and the collaborative work that we continue to do to support residents across the older adult care homes in Greenwich.”
Free online Advance Care Planning and Universal Care Plan Training Module For SEL healthcare professionals
A free online training module is now available for all South East London healthcare professionals. It aims to increase understanding of advance care planning (ACP) and build confidence in holding and recording ACP conversations. It includes different approaches to advance care planning, such as the UCP.
The module takes around an hour to complete and provides a certificate of completion. You can find more information here.
UCP Report
Use of the UCP increased significantly in 2025 compared to 2024, reflecting wider adoption across health and care settings. Overall care plans accesses rose by 30%, with particularly strong growth in care homes (75%) and urgent care services (62%), including a 39% increase in access by the London Ambulance Service. GP practices also saw a 52% rise in use, while independent providers increased by 39% and NHS trusts by 12%.
Thank you for continuing to use the UCP to support the people you care for and enable its growth!
Consultation on New Regional CPR Guidance for Adults
The London Palliative and End of Life Care Clinical Network has developed draft regional guidance on Cardiopulmonary Resuscitation (CPR) recommendations in adults. The aim is to support the use, best practice and transferability of CPR recommendations across organisational boundaries, so they accompany a person and apply in all settings. The guidance is intended to complement, rather than replace or duplicate, existing relevant local healthcare policies and procedures.
The draft guidance is currently out for consultation. Once this guidance is finalised, the UCP CPR form will be reviewed to ensure it supports the new guidance. If you would like to share your feedback on the draft guidance, please complete the Microsoft form. More information can be found here.
Dates for the Diary
18th February – Learning Disability UCP Champions meeting. NHSE’s Learning Disability, Autism & SEND team have introduced a champions group to bring people working in LD services together to discuss the UCP. If you would like to be involved, get in touch here.
5th March – UCP Champions Meeting. The Champions help to raise awareness and adoption of the UCP locally. If you’d like to find out more or join, get in touch.
19th March – People with Lived Experienced Group (PLEG). Our PLEG group help to keep people at the centre as the UCP evolves.