The Shift in Public Health Nursing to the ‘Universal in Reach – Personalised in Response’ model

Shifting from the previous service design and delivery model

The Universal, Universal Plus, and Universal Partnership Plus model has been at the forefront of service design and the delivery of Public Health Nursing services across the UK for the last 5 years. Recently, however, a new model has emerged: The ‘Universal in Reach – Personalised in Response’ model, that is broken down into 4 levels – community, universal, targeted, and specialist services. This new model, which now supersedes previous models for health visiting and school nursing such as the ‘4-5-6’ model, aims to provide a greater emphasis on the proactive assessment of children, young people, and families’ needs, with an agile skill mix that can seamlessly respond to unique requirements.


Why was a Change Required?

This revised model has been developed with various stakeholders to reflect changes in how services are commissioned and provided locally. The new model aims to capture the full extent of both the Health Visitor and School Nurse offer – as many local services were offering significantly more than the ‘5’ contacts, outlined in the ‘4-5-6’ model. The model suggests opportunities for further contacts or opportunities to provide support; for example, within early years contacts at three and six months, to support breastfeeding, mental health, healthy diet, and higher quality sleep. The model will enhance accessibility enabling young people to receive proactive, early, and bespoke interventions to build their resilience and embed lifelong, healthy habits, so they can have the best start in life.


The ‘Universal in Reach – Personalised in Response’ Model

The new model consists of four distinct levels, shown in Figure 1. The level chosen is entirely dependent on the individual’s and family’s needs:


  • Community – Health Visitors and School Nurses will lead the Healthy Child Programme within schools and the community, proactively engaging with children, young people and allied services, and acting as the go-to for healthy lifestyles information. As leaders of the Healthy Child Programme, Health Visitors and School Nurses should work together to form multi-professional care pathways and integrate services to support a healthy pregnancy and children aged 0-19 years. and up to age 25 for children with SEND.


  • Universal – Relates to the delivery of effective public health interventions via the evidence-based Healthy Children Programme to all children up to age 19/25. Utilising local community assets is fundamental to the universal aspect of the model. A key role of school nurses is to signpost children and their families to other appropriate healthy lifestyle services , who will then provide bespoke care in co-located premises to build familiarity, trust, and comfort.


  • Targeted – Health Visitors and School Nurses will proactively identify children that need support through regular, robust health needs assessments, using well-established relationships with the local provider network, and by adopting Making Every Contact Count principles. Early, targeted interventions will be delivered to those at risk of ill health to provide timely care and support that contributes to long-term positive outcomes and empowers behaviour change.


  • Specialist – Utilising multi-agency and multi-disciplinary approaches, School Nurses will help vulnerable children and families (e.g., those experiencing/witnessing domestic abuse) through specialist, long-term support.



Figure 1 – The overarching elements of the ‘Universal in Reach – Personalised in Response’ model


High Impact Areas

As part of the ‘Universal in Reach – Personalised in Response’ model within Public Health Nursing services, the High Impact Areas should be at the centre of service design. These areas outline where Health Visitors and School Nurses can have a significant impact on children’s health, wellbeing, and outcomes. Below, Figure 2 shows the High Impact Areas for early years children and Figure 3 shows the High Impact Areas for school-age children.


Figure 2: the High Impact Areas for early years children


Figure 3: the High Impact Areas for school-age children


There are many reasons to be optimistic about Public Health Nursing provision under this new model of care. The model and High Impact areas have been designed exclusively to support local Commissioners and providers to deliver an evidence-based Healthy Child Programme, that prioritises accessibility, prevention first, and early-intervention to ensure children and families are safe and are empowered to live long, healthy lives.

Written by Dan Illingworth, Bid Manager

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