Care planning and advance care planning
A series of conversations in which a person sets out what matters to them and how they would like to be cared for, now and in the future, so their wishes are known and can be respected if they later become unwell.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Advance care planning is the person's own voice — it records what they want, and is never about 'giving up' or withdrawing care.
- It can include an advance statement, an advance decision to refuse treatment, a Lasting Power of Attorney and an emergency plan such as ReSPECT.
- A decision not to attempt CPR (DNACPR) only relates to CPR — all other treatment and care continues as needed.
- Plans can be changed or cancelled at any time while the person has capacity; choosing a trusted decision-maker now is often the most useful step.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Keeps the person in control of decisions about their own care
These conversations should never be rushed or pushed on someone who is not ready; planning is voluntary and led by the person.
The person talks through what matters to them and the options for recording their wishes, with time to think and ask questions.
A clear, plain-language plan that genuinely reflects the person's wishes.
The person talks through what matters to them and the options for recording their wishes, with time to think and...
Any agreed plan or document is drafted, and the person decides what they want to record now and what to leave for...
The plan is finalised, the person keeps a copy, and it is shared with the GP and other services who may need it in...
The person can revisit and change the plan at any time while they have capacity, and is encouraged to review it as...
What is care planning and advance care planning?
Care planning is a conversation between a person and their clinicians about what matters to them and how they want to be looked after. Advance care planning looks further ahead: it records a person's wishes for their future care, in case there comes a time when they cannot speak for themselves.
It is important to be clear about what advance care planning is — and is not. It is the person's own choices, set out in their own words. It is not about giving up, and it is not someone else deciding to do less for them. It is a way to make sure that, whatever happens, the person stays in control of decisions that matter to them.
Planning ahead can cover several things: an advance statement of wishes and values; an advance decision to refuse a specific treatment (which can be legally binding); choosing someone to make decisions through a Lasting Power of Attorney; and recommendations for emergency care, such as a ReSPECT plan, which may include a decision about attempting cardiopulmonary resuscitation (CPR).
None of this fixes anything in stone. Plans can be revisited and changed at any time while the person has capacity, and they sit alongside all the other care and treatment the person continues to receive.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Different ways to plan ahead
| Tool | What it does |
|---|---|
| Advance statement | Records wishes and values; guides but is not binding |
| Advance decision (ADRT) | Refuses specific treatment; legally binding if valid |
| Lasting Power of Attorney | Names someone to decide if you cannot |
| ReSPECT / DNACPR | Recommendations for emergency care, including about CPR |
These can work together. A Lasting Power of Attorney made after an advance decision may take precedence, so it is worth getting advice on how they fit.
Preparing for your appointment
- Think about what matters most to you — your priorities, what you value about daily life, and what you would and would not want.
- Consider who you trust to speak for you, and whether you want to set up a Lasting Power of Attorney for health and welfare.
- Gather information about your health conditions so the conversation can be realistic and specific.
- Note any treatments you feel strongly about accepting or refusing, and any spiritual, cultural or family considerations.
- Decide who you would like to be involved — family, carers or a friend — while remembering the plan is about your wishes.
- Look at any plans or documents you have made before, so they can be reviewed and kept up to date.
- Remember you can take your time, ask questions, and change your mind at any point.
What happens
Advance care planning is usually a series of unhurried conversations rather than a single event. A clinician — often a GP, geriatrician, specialist nurse or palliative care professional — talks with the person about their health, what matters to them, and how they would like to be cared for, now and in the future.
They explain the different ways of recording wishes, and help the person decide which, if any, are right for them. This might lead to writing an advance statement, making an advance decision to refuse a particular treatment, naming a Lasting Power of Attorney, or agreeing a ReSPECT or emergency care plan.
Where decisions about emergency treatment or CPR come up, these are discussed honestly and compassionately, in plain language, and always with the person (and, with their agreement, those close to them).
The agreed plan is written down and shared with the people who need to see it — such as the GP, out-of-hours services and, where relevant, the ambulance service — so that the person's wishes can actually be followed. The person keeps a copy and can change it whenever they wish.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- These conversations should never be rushed or pushed on someone who is not ready; planning is voluntary and led by the person.
- Advance care planning is not a way for others to decide to do less for someone — it must reflect the person's own wishes.
- If the person is acutely unwell or distressed, urgent care and support come first, and planning can wait.
- An advance decision is not the right tool if the person actually wants treatment decisions made flexibly at the time — an advance statement or attorney may suit better.
Delay or rearrange if…
- The person is acutely unwell, in crisis or too distressed to take part meaningfully.
- A reversible problem such as severe depression is affecting the person's outlook and should be treated first.
- Important information about the person's health or prognosis is missing.
- The person needs more time, or wants to involve family or seek legal advice before deciding.
Alternatives to discuss
- Starting with an informal conversation about wishes, without formal documents yet.
- Naming a Lasting Power of Attorney so a trusted person can decide flexibly in future.
- An advance statement of wishes rather than a binding advance decision.
- Leaving decisions to be made at the time with the clinical team, if that is what the person prefers.
- Involving palliative care or a specialist nurse for support with difficult decisions.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Keeps the person in control of decisions about their own care
- Makes sure wishes are known and can be respected if the person later cannot speak for themselves
- Reduces the chance of unwanted or distressing treatment in an emergency
- Eases pressure on family, who are not left guessing what their relative would have wanted
- Helps care be more joined-up across the GP, hospital and out-of-hours services
- Can be revisited and changed at any time, so it grows with the person
Risks & complications
- The conversations can be emotional and may bring up difficult feelings
- It can take more than one appointment to think things through
- Family members may have different views from each other or from the person
- A plan may not be found or shared in time during an emergency if it is not properly recorded and circulated
- An advance decision that is unclear or out of date may not be followed as the person intended
- Discussions about CPR or end-of-life care may be distressing if handled without enough care and time
- Conflict between an advance decision and a later Lasting Power of Attorney, or disputes that need legal advice
- A poorly explained DNACPR decision being wrongly understood as a decision to stop all care
The most important things to get right are honesty, time and clarity. A DNACPR or ReSPECT recommendation must be explained properly: a decision not to attempt CPR does not mean other treatment, comfort or care will stop. Make sure any plan reflects your own wishes, is written clearly, is shared with the people who need it, and is reviewed as your health changes. Ask who will be able to see the plan in an emergency, and how to update it.
Published figures to discuss
Care planning and advance care planning are conversations and decisions, not procedures, so there are no complication rates to quote. The real risks are about quality: plans that are unclear, out of date, or not shared so they cannot be followed; or emergency decisions explained without enough care. These are addressed by good practice rather than measured as percentages.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Emergency admission without a shared care plan | Common in advanced frailty, dementia and multimorbidity | Plans only help if they are visible to out-of-hours, ambulance, hospital and care-home teams. | Guide sourcesClinical context |
| Preferences changing over time | Expected rather than rare | Advance care planning should be reviewed after major diagnoses, admissions, functional decline or a change in living situation. | Guide sourcesClinical context |
| DNACPR being misunderstood as 'do not treat' | Common communication risk | A resuscitation decision is separate from active treatment, symptom control, antibiotics, fluids or hospital transfer decisions. | NHS — Advance decision to refuse treatment (living will)nhs.ukSource-linked context |
| Loss of capacity before planning is completed | A practical risk in dementia, delirium-prone illness and advanced frailty | Earlier conversations preserve choice and reduce pressure on families during crises. | NHS — Advance decision to refuse treatment (living will)nhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from these conversations. "Afterwards" is about the plan: what was agreed, where it is recorded, who can see it, and knowing you can change it whenever you wish.
- Feeling emotional or reflective after talking about the future
- Wanting time, and perhaps another appointment, before finalising anything
- Discussing the plan with family and sometimes changing your mind
- Reassurance that nothing is fixed and the plan can always be updated
Aftercare
- Keep a copy of any plan or document somewhere accessible, and tell those close to you where it is.
- Make sure the plan has been shared with your GP and, where relevant, out-of-hours and ambulance services.
- If you have made a Lasting Power of Attorney, check it is registered and that your attorney knows your wishes.
- Review the plan after any major change in your health or circumstances.
- Tell your clinical team straight away if you change your mind about anything.
- Make sure family understand that a DNACPR decision, if you have one, does not mean other care will stop.
- Ask who you should contact with questions about the plan.
- Thoughts about what matters most written down
- A trusted decision-maker considered or named
- Information about your health conditions to hand
- Any previous plans or documents gathered for review
- Family or carers informed if you want them involved
- A note of any treatments you feel strongly about
- Knowledge that you can change the plan at any time
⚠ Get urgent help if…
- A sudden change in health where you are unsure what your plan covers — contact your clinical team for advice
- An emergency plan or DNACPR decision that no longer matches your wishes and needs updating urgently
- A plan that cannot be found or has not been shared with the services who would need it
- Feeling pressured into any decision, including about CPR or refusing treatment
- Being told, or fearing, that a DNACPR decision means other care will be withdrawn — this is not the case, so seek clarification
- Distress or low mood after these conversations that does not ease
- Any thoughts of self-harm or that life is not worth living
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is a clear, up-to-date plan that genuinely reflects the person's own wishes, that the people caring for them can find and follow, and that the person feels in control of. It can bring real peace of mind to the person and their family.
Planning ahead cannot predict exactly what will happen, and it does not bind a person to choices they may later change. Its value is in making sure the person's voice is heard, especially at times when they might not be able to speak for themselves. It never reduces the care and comfort someone receives.
An advance care plan is a living document. Wishes can change with time, new diagnoses or different circumstances, so plans should be reviewed regularly and after any significant change in health. An advance decision remains valid until the person changes or withdraws it, but it should be kept clear and current. A Lasting Power of Attorney lasts until cancelled or the person dies.
Related tests, treatments or support
Care planning often sits alongside a comprehensive geriatric assessment, treatment of long-term conditions, and conversations about capacity. It works closely with palliative and end-of-life care where relevant, and with legal advice for Lasting Powers of Attorney and advance decisions. A ReSPECT plan brings emergency-care recommendations together in one place.
Follow-up & long-term care
Plans should be reviewed regularly and whenever health or wishes change. The clinical team makes sure documents are shared with the GP and emergency services, and that the person and their family understand them. Any update the person makes is recorded and re-shared so the most current wishes are always available.
- Review the plan regularly and after any major change in health or circumstances
- Keep documents accessible and make sure trusted people know where they are
- Check a Lasting Power of Attorney is registered and your attorney knows your wishes
- Make sure any updated plan is re-shared with the GP and emergency services
- Tell your clinical team promptly if you change your mind about anything
Repeat, follow-on and what comes next
- Plans should be expected to change over time as health and wishes change.
- An advance decision may need rewriting if it becomes unclear or out of date.
- A later Lasting Power of Attorney can affect an earlier advance decision, so the two should be kept consistent.
- Emergency-care recommendations such as ReSPECT are reviewed and updated, not fixed once and forgotten.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, plain-language plan that genuinely reflects the person's wishes.
- The plan shared with the GP and, where relevant, out-of-hours and ambulance services so it can be followed.
- A named contact for questions, and a clear way for the person to update or cancel the plan.
- Regular review, especially after changes in health, with the person always in the lead.
- Honest, compassionate handling of CPR and end-of-life decisions, making clear other care continues.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The experience and profession of the clinician leading the conversations
- How many appointments are needed to think things through
- Whether visits are at home, in clinic or by phone or video
- The complexity of the person's health and the decisions involved
- Any written documents prepared and shared
- Separate legal fees for registering a Lasting Power of Attorney
- Any follow-up reviews to keep the plan current
- The clinician's fee and their experience in this area
- How many appointments are likely to be included
- What documents will be prepared and shared, and with whom
- Whether sharing the plan with the GP and emergency services is included
- That legal costs for a Lasting Power of Attorney are separate
- Whether review appointments are included or charged separately
- The cancellation policy
On the NHS? Care planning and advance care planning are a normal part of NHS care for people with long-term conditions or frailty; private support is also available, but the documents and decisions are the same.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Pressuring someone into a DNACPR or advance decision rather than letting them lead.
- Failing to explain that a DNACPR decision does not stop other treatment or care.
- Not making clear that plans can be changed or cancelled at any time.
- Making an advance decision so vague it cannot be followed, or so rigid it no longer fits.
- Not sharing the plan with the services who would need it in an emergency.
Marketing red flags
- Selling a one-size-fits-all document without a genuine, personalised conversation.
- Implying advance care planning is about 'saving resources' or doing less for the person.
- Bundling unnecessary legal services or pressuring people into decisions.
- Treating a DNACPR form as a tick-box exercise rather than a careful, explained conversation.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which kinds of plan would suit my situation, and what does each one mean?
- If I make an advance decision or a ReSPECT plan, who will be able to see it in an emergency?
- If I choose not to have CPR, what other care and treatment would still continue?
- How do an advance decision and a Lasting Power of Attorney fit together?
- How do I review or change my plan if my wishes change?
- Who do I contact if my health changes or I have questions about the plan?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is advance care planning the same as giving up?
Does a DNACPR decision mean doctors will stop treating me?
Can I change my mind after making a plan?
What is the difference between an advance statement and an advance decision?
Should I set up a Lasting Power of Attorney?
Is this only for people who are dying?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Advance decision to refuse treatment (living will) Compassion in Dying — Planning ahead Resuscitation Council UK — ReSPECT for patients and carers GOV.UK — Make, register or end a lasting power of attorney SCIE — Mental Capacity Act and advance planning British Geriatrics Society — End of life care
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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