Annual LTC (Long Term Condition Review Process) – Guide for Patients
A ‘Long Term Condition’ is any medical condition for which a patient takes regular medication or receives regular monitoring in order to ensure their condition is well controlled. This can include:
-Asthma/COPD
-Diabetes
-Hypertension (high blood pressure)
-Chronic Kidney disease (CKD)
-Heart Failure
-Dementia
-Mental Health
As well as the above we also invite patients in on a ‘Best Practice’ basis which includes a variety of conditions such as cardiovascular risk where we will offer an appointment for cholesterol bloods and blood pressure or thyroid conditions for example. There are also many more.
How does the process work at Chillington Health Centre?
Invitation
Every year around your birthday month you will receive an initial text message from us inviting you into the surgery. If you do not have access to a mobile phone, we will call you. Please do check your contact details are up to date. This will be booked routinely, and we do have specific slots available to book. We will send out a total of three reminders, following this a letter if we have not heard from you. Our GP’s strongly encourage patients to attend to adequately and safely monitor your condition and/or your medication.
Part 1 – LTC initial Review
This appointment will be with one of our healthcare assistants and will be either 20 or 30 minutes in duration. Diabetic patients and those over 80 years will be allocated 30 minutes. Throughout this appointment you may be asked some questions on your lifestyle, blood tests, Blood pressure, weight/height and urine (these tests are determined by the monitoring required for your condition so will vary). If you need to bring a urine sample in we will advise you of this. For diabetic patients you will be offered a diabetic foot check within this appointment.
Following this your results will be reviewed by our advanced nurse practitioner, and you may or may not be invited back in for a follow up appointment depending on your results and medication.
Part 2 – Follow up appointment
This stage of the process will be your opportunity to discuss your results, check and review your medication and to answer any questions you may have. You will be invited back in for either a 20 or 30 minute appointment. All patients over 80 will generally be allocated a 30 minute slot. This part will be undertaken by either our practice nurse or advanced nurse practitioner. You will be invited via text message or phone call if you do not have access to a mobile.
LTC Interim Reviews
As well as the above some patients will be invited in at intervals throughout the year for monitoring. This will usually be six monthly. This will comprise of a 20 minute appointment with a healthcare assistant as below:
-Chronic Kidney Disease – Bloods, blood pressure and urine
-Heart Failure – Bloods, blood pressure and weight
-Diabetes – bloods, blood pressure and weight
The results of the interim review will be reviewed in the same way and followed up if required.