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Patients with a Chronic Condition

Appointment Process

We are changing the way we deal with patients with any of the following conditions:

  • Diabetes
  • Cardiovascular
  • Asthma
  • Chronic Obstructive Pulmonary Disease
  • Coronary Heart Disease
  • Stroke
  • Heart Failure
  • Chronic Kidney Disease
  • Peripheral Arterial Disease
  • Hypertension
  • Atrial Fibrillation

The Process

About your Annual Check Up.  There have been some positive changes to how we are planning to help you manage your long-term condition(s).  We call this Care and Support Planning and we want to help you be more involved in the decisions that affect you.  You will be invited to attend, for a review, in the month of your birth every year; and this is how things will work:

You are invited to arrange two appointments in the month of your birth, these will consist of:

  • An Information Gathering appointment with our Healthcare Assistants requiring:
  • Blood test – you must not have consumed any meat within 12 hours prior to the blood test. Taking blood can be made easier if you have a good drink of water about an hour before the test; and by keeping your hands warm.
  • Urine sample taken first thing in the morning of the blood test if you are a Diabetic or CKD patient
  • You may be required to bring your inhalers with you.
  • A Review appointment.  Generally this will be with the Practice Nurse, but you will be informed by our Clinical Administrators if it is to be with the GP.

When you receive your letter, contact the practice to make your  appointments.  Please inform staff when making your appointment which chronic condition you suffer from to ensure you are booked in with the most appropriate clinician.

The first appointment.  The Information Gathering appointment will be with the Healthcare Assistant, and may include blood pressure, weight, blood tests, urine test, foot checks (Diabetes) and/or Health Questionnaires.   

The second appointment.  The Review Appointment is about Care and Support Planning, and will be with the Practice Nurse 2-3 weeks later.  This appointment is to discuss your results and is also the opportunity for you to discuss any concerns that you may have. 

Housebound patients.  Please let us know if you are currently housebound so that we can make alternative arrangements for your care and support planning.  Our Clinical Administrators have been advised of those patients who may require a home visit.