Care Plans

Care Plans

ID

C36

Version

1.3.0

Type

Capability

Category

Patient care management

Status

Effective

Effective Date

Feb 26, 2026

Contracting Vehicle(s)

Description

Enables Health or Care Professionals to manage Care Plans for a Patient/Service User.

Outcomes

For a Patient/Service User:

Collects information relevant to the effective and coordinated care of Patients with long term conditions or needs into a single location.

For a Health or Care Professional:

Enables the ability to deliver care to a Patient/Service User according to the agreed plan, by providing easy access to a Patient/Service User’s information.

MUST Epics - Describes the minimum functionality required to deliver a Capability. Solutions MUST be successfully evaluated against each Epic and Acceptance Criteria via Capability Assessment in order to be associated with this Capability

E00485 - manage Care Plans

As a Health or Care Professional

I want to manage Care Plans for Patients/Service Users

So that Care Plans are managed

Acceptance criterion 1: create a Care Plan

Given the Health or Care Professional is permitted to manage Care Plans for Patients/Service Users

When the Health or Care Professional selects to create a Care Plan for a Patient/Service User

Then the Care Plan is created for the Patient/Service User

Acceptance criterion 2: view a Care Plan

Given the Health or Care Professional is permitted to manage Care Plans for Patients/Service Users

When the Health or Care Professional selects to view a Care Plan

Then the Care Plan for the Patient/Service User is displayed

Acceptance criterion 3: amend a Care Plan

Given the Health or Care Professional is permitted to manage Care Plans for Patients/Service Users

When the Health or Care Professional selects to amend a Care Plan for a Patient/Service User

Then the Care Plan is amended for the Patient/Service User

Acceptance criterion 4: close a Care Plan

Given the Health or Care Professional is permitted to manage Care Plans for Patients/Service Users

When the Health or Care Professional selects to close a Care Plan for a Patient/Service User

Then the Care Plan is recorded as closed for the Patient/Service User

E00485 - Supporting Information

  • Examples of Care Plans MAY include, but are not limited to:

    • End of Life Care Plan - contains a Patient/Service User's preferences and wishes for their end of life care

    • Urgent Care Plan - contains a Patient/Service User's preferences and wishes in an urgent care setting

    • Transitional Care Plan - contains anticipated changes in a Patient/Service User's health status, helping them to manage key transition periods in their life and their care trajectory

    • Advanced Care Plan - contains a Patient/Service User’s preferences and wishes regarding their care, to be enacted if they are unable to express a preference in the future

    • Escalation Plan - contains the support the Patient/Service User would receive when managing potential future events relating to their condition(s). It may cover what to do when a Patient/Service User's condition deteriorates and may include instructions for emergency care professionals (e.g. paramedics)

MAY Epics - Describes additional functionality associated with the Capability. Suppliers should consider all MAY Epics as part of their User Research. Suppliers can choose to map their Solutions to these Epics and they will be evaluated via Capability Assessment. Contracting Authorities or purchasing organisations may require these Epics as product qualification or requirements criteria

E00487 - search for Care Plans

As a Health or Care Professional

I want to search for Care Plans for Patients/Service Users using defined criteria

So that I can access the relevant Care Plan details

Acceptance criterion 1: search for Care Plans

Given the Health or Care Professional is permitted to search for Care Plans

When the Health or Care Professional selects to search for Care Plans using defined criteria

Then the search results are displayed


E00762 - share Care Plans for Patients/Service Users to Health or Care Professionals in other Health Services

As a Health or Care Professional

I want to share Care Plans to Health or Care Professionals in other Health Services

So that Care Plans for Patients/Service Users can be shared across multiple Health Services

Acceptance criterion 1: share Care Plans for Patients/Service Users to Health or Care Professionals in other Health Services

Given the Health or Care Professional is permitted to share Care Plans for Patients/Service Users to Health or Care Professionals in other Health Services

When the Health or Care Professional selects to share a Patient/Service User's Care Plan to a Health or Care Professional in another Health Service

Then the Patient/Service User's Care Plan is shared

E00762 - Supporting Information

  • Examples of Health Services MAY include, but are not limited to:

    • Chiropractic services

    • Occupational therapy

    • Physiotherapy

    • Podiatry

    • Speech and language therapy


E00767 - view Patients/Service Users requiring Care Plan reviews

As a Health or Care Professional

I want to view Patients/Service Users that require Care Plan reviews

So that I can view Patients/Service Users that require Care Plan reviews

Acceptance criterion 1: view Patients/Service Users requiring Care Plan reviews

Given the Health or Care Professional is permitted to manage Care Plan reviews for Patients/Service Users

When the Health or Care Professional selects to view Patients/Service Users requiring Care Plan reviews

Then the Patients/Service Users that require a Care Plan review are displayed


E00768 - schedule Care Plan reviews for Patients/Service Users

As a Health or Care Professional

I want to schedule Care Plan reviews for Patients/Service Users

So that Care Plan reviews for Patients/Service Users can be conducted

Acceptance criterion 1: schedule Care Plan reviews for Patients/Service Users

Given the Health or Care Professional is permitted to manage Care Plan reviews for Patients/Service Users

When the Health or Care Professional selects to schedule a Care Plan review for a Patient/Service User

Then the review for the Patient/Service User’s Care Plan is scheduled

E00768 - Supporting Information

  • Where there are multiple Care Plan reviews that require scheduling, these MAY be scheduled in bulk


E00488 - manage Care Plan templates

As a Health or Care Professional

I want to manage Care Plan templates

So that I can improve efficiency by using locally defined templates to create Care Plans

Acceptance criterion 1: create a Care Plan template

Given the Health or Care Professional is permitted to manage Care Plan templates

When the Health or Care Professional selects to create a Care Plan template

Then the Care Plan template is created

Acceptance criterion 2: view a Care Plan template

Given the Health or Care Professional is permitted to manage Care Plan templates

When the Health or Care Professional selects to view a Care Plan template

Then the Care Plan template is displayed

Acceptance criterion 3: amend a Care Plan template

Given the Health or Care Professional is permitted to manage Care Plan templates

When the Health or Care Professional selects to amend a Care Plan template

Then the Care Plan template is amended

Acceptance criterion 4: delete a Care Plan template

Given the Health or Care Professional is permitted to manage Care Plan templates

When the Health or Care Professional selects to delete a Care Plan template

Then the Care Plan template is deleted


E00489 - use Supplier implemented Care Plan templates

As a Health or Care Professional

I want to create Care Plans for a Patient/Service User using a Care Plan template created by the Supplier 

So that I can improve efficiency by using Supplier defined templates to create Care Plans

Acceptance criterion 1: use Supplier implemented Care Plan templates

Given the Health or Care Professional is permitted to manage Care Plans for Patients/Service Users

When the Health or Care Professional selects to create a Care Plan for a Patient/Service User

Then they can select to use a Care Plan template provided by the Supplier

And the Care Plan is created for the Patient/Service User


E00490 - view Care Plan reports

As a Health or Care Professional

I want to view Care Plan reports

So that reports relating to Care Plans for Patients/Service Users can be viewed

Acceptance criterion 1: view Care Plan reports

Given the Health or Care Professional is permitted to view Care Plan reports

When the Health or Care Professional selects to view a Care Plan report

Then the report results are displayed

Roadmap

Items on the Roadmap which impact or relate to this Capability