The Chronic Disease Management Programme has now been rolled out to all patients over 18 years of age, who hold a Medical Card or GP Visit Card.

The practice will be inviting you to register for the Structured Chronic Disease Management Programme. The cost of the assessment visits will be covered by your Medical Card or GP Visit card. You may also contact the surgery yourself to make an appointment

 

You are eligible to join if you:

    • Have a medical card or a GP visit card
    • Are you aged over 18 years
    • Have a specific chronic disease(s) as listed below
    • Can attend your GP surgery

 

The conditions included in the Chronic Disease Management Programme are:

  1. Type 2 Diabetes
  2. Asthma
  3. Chronic Obstructive Pulmonary Disease (COPD)
  4. Cardiovascular Disease including
    • Heart failure
    • Heart Attack/Angina
    • Stroke
    • Irregular Heartbeat (Atrial Fibrillation)

 

How will I benefit by being part of the Chronic Disease Management Programme?

The Chronic Disease Management programme has been developed in line with international best practice and research. This evidence shows that regular structured reviews of chronic medical conditions leads to improved patient outcomes through better condition management.

The Chronic Disease Management programme can improve your ability to manage your condition and support you by providing:

    • Structured reviews of your chronic disease with your GP and practice nurse
    • A personalised care plan developed and agreed with your GP
    • Regular reviews of your care plan and medication
    • Opportunities for structured education and self-management support
    • Early detection of any new conditions you may develop
    • Early detection of complications in your condition(s)
    • Care in your community, close to your home.

How will the programme work for you?

There will be 2 structured reviews in the Surgery each year as part of the Chronic Disease Management Programme. This amounts to a total of 4 visits per year. Each structured review includes 1 visit to your GP and 1 visit to your practice nurse at the Surgery.

 

How do I arrange a structured review?

Once you are eligible for and confirm your participation, your GP will sign you up to the programme. You can make an appointment for a structured review directly with the Surgery. You may see both your GP and practice nurse during the same review or separately at different times, as appropriate.