Our records show that it is now time for your Long Term Condition Review.

A long term condition is something that cannot, at present be cured but can be controlled by medicines and other therapies. Examples include Diabetes, Heart Disease, Stroke, Asthma, COPD and High Blood Pressure – you may have other ones not listed and that is why you have been invited to attend the surgery.    


Prior to Covid-19 the practice was changing the way it does these reviews in order to get you more involved and better informed about the changes that may benefit your condition and help you track and understand your condition over time. We feel this remains an important change and whilst the approach needs to be adjusted to reflect the unique circumstances of Covid-19 it is still our intention to help you get more out of these reviews.

How things will work?

Information Gathering

Please arrange a telephone appointment with one of our healthcare team to gather the information needed for your review. What we will need, will depend on your personal circumstances and past results related to your conditions. In many cases information such as weight and blood pressure can be taken at home and submitted over the phone, in some cases blood tests or measures such as blood pressure may be required at the surgery.

If you have access to a blood pressure machine at home please take a series of 3 readings when rested a few minutes apart and record the lowest of the 3. This is best done twice daily for a week, but fewer readings will still be useful, if you can also record your weight, ideally in kg if this is clearly visible on your scales. You will also be asked to complete a questionnaire called the PAM score, this helps the nursing team understand how confident you are in managing your conditions and help identify those who may benefit from extra support.

If you can submit the above information via askmyGP, or email to ahead of your information gathering (part 1) review this would be extremely helpful but if you have this ready for the appointment it can be taken down over phone during your review.

Sharing Information

Your test results and other information will be sent to you before your next appointment with the nurse. We hope this will give you the chance to think about what matters most to you about your health and what you would want to ask and talk through at this appointment.

At your annual care and support planning appointment (Part 2)

·  You will be able to discuss your concerns and what’s important to you. It will also help you plan what to do to manage your health over the coming year. This appointment is approximately 30 minutes.

· You and the nurse will work through your results sharing information focussing on the areas of your condition which are important to you and to make an action plan that reflects your needs and targets.

 · If further information that was not gathered in the initial part 1 is needed to guide treatment changes this may be arranged from this appointment.

Yours Sincerely

Central Surgery Family Doctors