If you have a long-term condition, you know better than anyone what it is like to live with day to day. That’s why we are helping local GP practices move towards a new way of helping patients manage long-term conditions. It’s called care and support planning.
Information for patients
With this new way of working, everyone with a long term condition should expect a yearly review in your General Practice to monitor your condition and help you manage it. This will include a review of any medications you take.
If your practice is using the care and support planning approach, this is what to expect when it is time for your annual review:
First you will have any checks or tests to help you monitor your condition. Your results will be shared with you, with an explanation, so you can think about anything you’d like to discuss before meeting your GP or practice nurse. You will then have time to talk about what is important to you and plan your healthcare together.
This could include discussing what could help you live better with your long-term conditions, anything else in your life which affects your health, like social or financial issues, and deciding together what support you need.
This means you can work more closely with your doctor or practice nurse to agree a clear plan for managing your condition together. Your doctor or practice nurse will still be on hand when you need their help at other times.
Many GP practices are now working in this way with patients who have long term conditions like diabetes, heart disease, COPD, asthma and circulatory disease.
To find out more about care and support planning, speak with your practice team.
Information for health professionals
We initially developed this approach in Gateshead, with funding from the British Heart Foundation as part of the national House of Care programme, plus support from the Year of Care Partnerships. The majority of practices in Newcastle are now also working in this way.
The focus of the project was to implement a new approach to the management of long term conditions – the year of care approach. The aim was to enable patients and their carers to be engaged, informed and empowered to better care for themselves, and to enable health professionals and the voluntary sector to support self-management.
The project has used a partnership approach across Gateshead with support from local stakeholders, and we are grateful to all involved for their hard work and support.
Useful information
- Care and support for multi-morbidity – making it routine in general practice
- Why implement care and support planning?
- Care and support planning – learning from our experience in Gateshead
- Gateshead House of Care – evaluation report 2018
- Our experience of the Gateshead House of Care project – April 2018
- Year of Care Gateshead – case study by the Richmond group of charities
- Care and support planning in Newcastle Gateshead – patient survey 2019
- Richmond Group of Charities Multiple Conditions Guidebook- 2020