Patients with a Chronic Condition
We are changing the way we deal with patients with any of the following conditions:
- Chronic Obstructive Pulmonary Disease
- Coronary Heart Disease
- Heart Failure
- Chronic Kidney Disease
- Peripheral Arterial Disease
- Atrial Fibrillation
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.
One you have received your notification, contact the practice after 10:00 in order to make your appointments. We code all of our letters H1 to H8 depending upon the condition(s) that you have. Tell the Clinical Administrator which ‘H’ letter that you have been sent – they have instructions with whom you are to see, as well as the precise timings of your appointments.
The first appointment. The Information Gathering appointment will be with the Healthcare Assistant, and may include blood pressure, weight, blood tests, foot checks (Diabetes) and/or Health Questionnaires. During this appointment we will ask you to consent to having your results either: posted to you, e-mailed to you, or by notification for you to collect it from the Practice. You can withdraw consent or change your mind about how the information gets to you at any time – just keep us informed about how you’d like us to communicate with you.
Sharing information. After your first appointment, and once all the results are available, they will be sent to you in advance of your second appointment. It is important that you have the same information as the Practice Nurse or GP who sees you for that appointment. Having the results beforehand will help you think about what they mean to you and what you might like to discuss. You might like to talk about your results with a family member or close friend.
The second appointment. The Review Appointment is about Care and Support Planning, and will be with the Practice Nurse or GP 2-3 weeks later. It is to discuss your results with you, and is also the opportunity for you to discuss any concerns that you may have. Our Clinical Administrators will have the specific requirements for your appointments and will advise you when you call. You’ll be able to discuss your results, other things that are important to you and what you would like to do to manage your long-term condition over the coming year. Please bring your results with you on the day.
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.
Additional information. We have enclosed a leaflet with more information and if you have any concerns or questions regarding this please do not hesitate to contact us. We do look forward to seeing you soon, but please remember that it is important that you advise the practice if you are unable to attend any of your appointments; and please feel free to contact any of our Clinical Administrators if you have any further questions.
 Our preferred option because of the administrative efficiencies.
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