Universal Care Plan (UCP)

What is the Universal Care Plan?

The Universal Care Plan (UCP) is a digital personalised care plan available across all of London. 

It captures what matters to the patient, their care preferences, and clinical updates.

It is visible in real time to London Ambulance Service, GPs, community, OOH teams and A&E departments.

It is a vital tool to enable the right things to happen especially in a crisis.

Who is it for?

Any patient who would benefit from proactive, coordinated planning.

Prioritise patients on your palliative / end of life register, frailty register, care home list, or those with frequent unplanned admissions. 

Where do I find it — do I need a separate login?

No separate login is needed for most NWL practices. Access it directly from your clinical system:

  • EMIS Web - launch via the UCP widget within the patient record

  • SystmOne - access via the integrated UCP link within the patient record

  • Web portal access - ucp.onelondon.online

How do I identify patients and create a plan?

Use the EARLY toolkit (available in EMIS and SystmOne) to flag patients who may benefit from a care planning conversation.

Then open the UCP from within the patient record, search by NHS number, and work through the template.

Save at any point — the plan is immediately visible to other services.

What are the key fields to complete

The minimum information should include CPR status, professional and family contacts plus key symptom management plans e.g. what if pain or breathing deteriorates

Who can see it and does the patient need to consent?

Yes, verbal consent is needed. ''Are you happy for me to complete an electronic care plan to keep everyone involved in your care up to date?''

It can be accessed by the London Ambulance Service, NHS 111, OOH GPs, community nursing, and hospital teams - and patients can view it themselves via the NHS App. 

When should I update it?

After any hospital or hospice admission, on significant clinical change.

Keeping it current is what makes it useful in a crisis.

 

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Related Services

Hospices

24 hour Advice Line Michael Sobell Hospice
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24 hour Advice Line Michael Sobell Hospice

T. 0203 824 1268

Offers support and advice on palliative care issues to GPs, Care Homes, District Nurses and hospital doctors.

It is also an Advice Line for patients and families who live in Hillingdon and need advice on any aspect of palliative care. 

The Advice Line is answered by hospice nurses in the Inpatient Unit and queries are escalated to the on-call palliative medical team if needed.

Harlington Hospice
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Harlington Hospice

T. 020 8759 0453

W. https://www.harlingtonhospice.org/

Harlington Hospice provides a wide range of palliative care services to the residents of Hillingdon and surrounding areas.

The Hospice hosts a Wellbeing Service (shared with Michael Sobell Hospice), complementary therapies, counselling, lymphoedema service and the CABS team supporting children and adolescents.

The Hospice also hosts Harlington Hospice@Home team, mainly providing night sits, plus inpatient beds based at Michael Sobell Hospice (MSH) in Northwood.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)
Hospice UK
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Hospice UK can help find a hospice, provide infromation and support about end of life care and guidance to plan ahead.

Michael Sobell Hospice Inpatient Unit (MSH)
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Michael Sobell Hospice Inpatient Unit (MSH)

T. 020 8106 9201

W. https://www.harlingtonhospice.org/michael-sobell-house/

The Michael Sobell Hospice provides a range of palliative services for people with advancing illness.

The Hospice has 10 beds in its refurbished inpatient unit and looks after people with complex symptoms as well as those close to the end of their life.

Many people have a short admission and get back home agian.

The Hospice hosts the 24 hour Hillingdon advice line  on 020 3824 1268

The Hospice is part of Harlington Hospice, and shares the Wellbeing Service with the Harlington team, and hosts the Harlington Hospice@Home team

Please use the referral form below.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)

Rapid access services

24 hour Advice Line Michael Sobell Hospice
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24 hour Advice Line Michael Sobell Hospice

T. 0203 824 1268

Offers support and advice on palliative care issues to GPs, Care Homes, District Nurses and hospital doctors.

It is also an Advice Line for patients and families who live in Hillingdon and need advice on any aspect of palliative care. 

The Advice Line is answered by hospice nurses in the Inpatient Unit and queries are escalated to the on-call palliative medical team if needed.

Michael Sobell Hospice Inpatient Unit (MSH)
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Michael Sobell Hospice Inpatient Unit (MSH)

T. 020 8106 9201

W. https://www.harlingtonhospice.org/michael-sobell-house/

The Michael Sobell Hospice provides a range of palliative services for people with advancing illness.

The Hospice has 10 beds in its refurbished inpatient unit and looks after people with complex symptoms as well as those close to the end of their life.

Many people have a short admission and get back home agian.

The Hospice hosts the 24 hour Hillingdon advice line  on 020 3824 1268

The Hospice is part of Harlington Hospice, and shares the Wellbeing Service with the Harlington team, and hosts the Harlington Hospice@Home team

Please use the referral form below.

Community Specialist Palliative Care Referral Form V4.2 (DOCX)

Adult social care services

Adult Social Care Hillingdon
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Adult Social Care provides practical support to people to stay safe and well.  These services are usually provided in people's homes, care homes or in the community. Thre is also support for people who are caring for an adult family member or friend, access to personal care and home care services.

Carer's groups

Carers Trust
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Carers Trust works to transform the lives of unpaid carers through its network of local carer organisations. Carers can access to support, advice and resources to help them manage their role as carers.

Carers Trust Hillingdon
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Carers Trust Hillingdon offer support and guidance to unpaid carers of all ages throughout the London Borough of Hillingdon.

They provide information, advice, training and support and a range of Fact Sheets on their website.

Telephone advice centre open every day 10am to 4pm or email with enquiry to email address above.

Benefits and legal advice also available.

They have a team specifically to support young carers.

Carers UK
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Carers UK

T. 020 7378 4999

W. https://www.carersuk.org/

Carers UK offers information and support to carers across the UK. There is an online forum and local support groups for carers. 

Friendship and support

Compassionate Hillingdon
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Compassionate Hillingdon is a collaborative project that supports people who might need support in Hillingdon. Their work revolves around a commitment to those living with a life limiting illness, older people and those suffering from isolation. They do this by facilitating reciprocal friendships between like minded people who live close to one another across Hillingdon.

This project is part of the ‘Compassionate Communities’ movement. Compassionate Communities is built on a combined ethos of a Public Health Approach to Community Development, Palliative and End of Life Care.

Compassionate Neighbours
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Compassionate Neighbours can support by:

  • Visiting weekly for a cup of tea and a chat, offering friendship and a listening ear
  • Helping you do the things you like doing
  • Helping you stay connected to your friends and the community
Wellbeing Hub
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The Wellbeing Hub is an online tool and resource hub developed to empower Hillingdon residents’ and improve overall feelings of wellbeing. 

It provides modern, hospice wellbeing information alongside other types of wellbeing support. The wellbeing hub empowers people to enhance feelings of wellbeing in a holistic way. The online tool provides support with information to better support each person's own, unique wellbeing journey, by encouraging the setting of personal goals and accomplish tasks that align with individual wellbeing aspirations. Goals such as completing tasks (by creating and sharing a bucket list) and documenting wishes such as an advance care plan can take place.

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