Making Every Contact Count

How NICE resources can support local priorities

The MECC approach

Making Every Contact Count (MECC) is an evidence-based approach to improving people’s health and wellbeing by helping them change their behaviour. The approach enables health and care workers to engage people in conversations about improving their health by addressing risk factors such as alcohol, diet, physical activity, smoking and mental wellbeing. 

Public Health England and Health Education have worked with organisations in health and social care to produce a range of practical resources to support this approach. They align with our guidelines on behaviour change.

This approach is a requirement of the NHS standard contract. It also supports the emphasis on prevention that's part of the Five Year Forward View. This includes:

  • increasing the support available to help people to manage and improve their own health and wellbeing
  • ensuring that behavioural interventions are available for patients, service users and staff.

MECC uses brief and very brief interventions, delivered whenever the opportunity arises in routine appointments and contacts. Very brief interventions take from 30 seconds to a couple of minutes. The person is encouraged to think about change and offered help such as a referral or further information. A brief intervention involves a conversation, with negotiation and encouragement, and may lead to referral for other interventions, or more intensive support.

Developing your MECC approach

Supporting people to take action to improve their lifestyle is central to MECC. We have guidance and quality standards on this, which you can find by browsing the lifestyle and wellbeing area of our website. The behaviour change topic page is particularly relevant.

The guidelines that'll help you develop an approach for your STP or integrated care system are:

Quality standards help you prioritise areas to improve on. See how to use quality standards.

To see how all the guidance and advice fits together, visit the NICE Pathway on behaviour change. The following video explains how to use NICE Pathways.

Support for improving quality

You can find tools to help with putting our guidance and quality standards into practice by clicking on the tools and resources tab for any guidance or quality standard. They include:

  • baseline assessment tools to check whether your services are in line with our guidelines, such as the guideline on stop smoking interventions and services
  • resource impact reports and templates to allow you to calculate costs of implementing our guidance in your area
  • tools produced by other organisations that we've endorsed
  • shared learning case studies showing how organisations have used the guidance in practice.
  • For the guideline on behaviour change: general approaches, the shared learning case studies include:

    • reducing health inequality and supporting people to make healthier lifestyle choices in Blackburn and Darwen
    • tackling heart disease by raising awareness of the risks and how to have a healthy lifestyle in West Belfast
    • developing a whole-system approach to MECC across NHS North.

    Helping people stop smoking

    You can find all our guidance, advice and other products about stopping smoking on our smoking and tobacco topic page.

    Guidance

    Our guideline on stop smoking interventions and services includes recommendations about brief interventions. Other guidelines cover support for specific groups, such as women who are pregnant or have recently had a baby.

    The topic page also lists NICE Pathways. These are a series of interactive flowcharts showing how all our guidance and advice on a topic fit together. The pathway on smoking includes recommendations on offering advice to people who smoke.

    Quality standards

    The quality standards listed on the smoking and tobacco topic page will help you identify areas to prioritise for quality improvement. For example, smoking: supporting people to stop provides:

    • information about identifying people who smoke and offering brief advice
    • structure and process measures to ensure that people are asked if they smoke at every contact with a healthcare practitioner, and offered help if they do.

    The tools and resources for this quality standard include the quality standard service improvement template, which you can use to see how services in your area are meeting any of our quality standards. 

    There’s more information on how to use quality standards on our website.

    Improving diet and losing weight

    You'll find our guidance and advice on diet and obesity on the diet, nutrition and obesity topic page.

    Guidance

    The 2 most relevant pathways for making every contact count are:

    Public Health England’s collection of guides to commissioning and delivery of tier 2 weight management services will support putting these recommendations into practice in your area. You can also use the baseline assessment tool for the NICE guideline on preventing excess weight gain to get a picture of how services are doing in your area.

    Quality standards

    We have several quality standards on obesity to help you identify ways to improve services, including:

    Endorsed resources

    We've endorsed an introductory certificate in obesity, malnutrition and health, which has been produced by the Royal College of General Practitioners. This resource supports recommendations in several of our guidelines that are relevant to MECC.

    Increasing physical activity

    Our topic page on physical activity has all our guidance and other products on this subject.

    Guidance

    The NICE guideline on physical activity: brief advice for adults in primary care has recommendations that will help with giving brief or very brief advice to encourage people to increase their physical activity.

    There are several tools to help with putting the guideline into practice, including a baseline assessment tool to get a picture of the activity in your STP area. It also helps with planning activities to meet the recommendations.

    There's also a shared learning case study that shows how one organisation implemented brief interventions to encourage physical activity.

    Quality standards

    Our quality standard on physical activity: for NHS staff, patients and carers has 3 statements about giving advice. In particular, statement 1 refers to opportunities to give advice on physical activity during NHS health checks, in line with making every contact count. The tools and resources tab has a link to a guide for commissioning services to encourage physical activity, which includes issues to think about.

    The interactive flowchart on encouraging people to be physically active in the NICE Pathway on physical activity shows how all our products on brief advice fit together.

    Reducing alcohol consumption

    Our topic page on alcohol has everything we’ve published on preventing and managing harmful drinking.

    Guidance

    Our guideline on alcohol-use disorders: prevention has recommendations on brief advice. The tools and resources tab has tools to help with putting them into practice. These include shared learning case studies showing how organisations have put the guideline into practice.

    Quality standards

    Quality statement 2 in the quality standard on alcohol-use disorders: diagnosis and management covers opportunistic screening and brief interventions. You can use this as a focus for quality improvement in your area.

    To see how all our guidance and advice on brief interventions fits together, see the interactive flow chart on screening and brief interventions for harmful drinking and alcohol dependence in the NICE Pathway on alcohol-use disorders.

    Improving mental wellbeing

    To see everything we’ve published on mental wellbeing, go to our topic page on mental health and wellbeing.

    Guidance

    We have guidelines covering mental wellbeing in children and young people, adults at work and older people.

    Mental wellbeing in over 65s: occupational therapy and physical activity interventions has recommendations about improving people’s mental health by giving them opportunities to increase their physical activity. There are tools and resources to help with putting them into practice, including some shared learning case studies showing how other organisations have done this.

    You can also visit our topic page on mental health and behavioural conditions. Our guideline on common mental health disorders: identification and pathways to care includes screening questions for depression. The tools and resources to support this guideline include case scenarios showing how the recommendations can be applied in primary care.

    Quality standards

    The quality standard on mental wellbeing of older people in care homes includes quality statements that may help you develop your approach in line with MECC. The tools and resources tab has videos on how the quality standard can help with improving standards and with CQC inspections.

    Shared learning case studies

    Supporting inpatients with mental health issues who misuse alcohol

    South London and Maudsley NHS Foundation Trust has increased the number of inpatients with a mental health condition who can get support for alcohol misuse by introducing new staff training and a new system for recording the results.

    The aim is to train 60% of qualified nurses and team them with dual diagnosis leads to carry out alcohol screening, deliver brief advice and offer referral to specialist substance misuse services. New nurses will also attend the half day course as part of their preceptorship programme.

    By the third quarter following the introduction of the training, 37% of eligible patients were screened, 29% were offered brief advice and 45% were referred for specialist support.

    Image of a man pouring alcoholic drink into a glass. Image of a man pouring alcoholic drink into a glass.

    Physiotherapists offer physical activity advice to inactive people attending musculoskeletal outpatient clinics

    Allied health professionals at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust have developed the skills and confidence to incorporate public health messages into routine practice.

    During a pilot project, physiotherapists used a physical activity screening tool to identify inactive people attending musculoskeletal outpatient physiotherapy services. They then offered brief advice on the benefits of – and local opportunities for - physical activity.

    All the physiotherapists felt confident about identifying people they could help. Many (85%) felt confident about delivering a brief intervention - and 69% said they often did this. More than half (61%) were confident about signposting people to local opportunities to help them become more active.

    Image of a physiotherapist examining a patient. Image of a physiotherapist examining a patient.