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By 2035 it is estimated that more than two thirds of people aged 65 and over will have multiple long-term conditions. 

The impact of living with long-term conditions has a profound impact on individuals, affecting their quality of life, and is associated with an increased use of emergency care, hospital admissions and increased mortality.

As one of the commitments within the NHS Long Term Plan, Proactive Care provides personalised community-based coordinated care that starts with what matters to the individual, and approaches care based on the individual’s strengths.

By providing more proactive support to individuals, Proactive Care aims to offer early identification of people at risk of future deterioration, e.g., those living with multimorbidity, frailty, or complex needs, and to work with them to stay well and independent for longer through structured Proactive Care.

Health and care professionals are using an electronic data system called ‘HealtheIntent’ to identify local groups of people who have chronic illness or are at risk of ill-health. Over time, multiple data sources will be brought together to help build a better understanding of a person’s health and care needs and the circumstances they live in. We are currently developing tools to support Proactive Care with a focus on frailty, and these tools will support the delivery of the Proactive Care programme.

Through a series of workshops, multiple professionals are coming together to develop Proactive Care models which would design and consider how we deliver care in Coventry.

Key learnings will be shared from the areas who have been piloting this and will help us to design how we deliver Proactive Care across Coventry.  

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