Long Term Condition Reviews

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Clinical Terms
Structured assessments in primary care that monitor, evaluate and manage chronic health conditions to improve patient outcomes and quality of life.

What are Long Term Condition Reviews?

What is ?

Long Term Condition Reviews are systematic clinical assessments conducted in primary care settings to monitor and manage chronic health conditions such as diabetes, asthma, COPD, hypertension, and heart disease. These reviews typically follow evidence-based protocols and involve comprehensive evaluation of the patient's condition, medication effectiveness, lifestyle factors, and overall wellbeing. They aim to optimise treatment, prevent complications, reduce hospital admissions, and improve quality of life for patients living with long-term health conditions.

Long Term Condition Reviews Best Practices

What is ?

  • Implement a structured, condition-specific template approach to ensure comprehensive assessment
  • Utilise multi-disciplinary teams including GPs, practice nurses, pharmacists, and healthcare assistants to deliver reviews
  • Schedule reviews at clinically appropriate intervals based on condition severity and national guidelines
  • Incorporate patient-centred goal setting and shared decision making
  • Establish robust recall systems to ensure patients don't miss regular reviews

Use Long Term Condition Reviews in a Sentence

What is ?

  1. The practice nurse conducted a thorough Long Term Condition Review for Mrs Johnson's diabetes, checking her HbA1c levels and discussing her medication adherence.
  2. The Primary Care Network has implemented a standardised approach to Long Term Condition Reviews to ensure consistent quality across all member practices.
  3. During his annual Long Term Condition Review, Mr Smith's blood pressure medication was adjusted after reviewing his home monitoring readings.
Frequently Asked Questions about
Long Term Condition Reviews

What does Long Term Condition Reviews mean?

Long Term Condition Reviews are structured clinical assessments conducted in primary care settings to monitor and manage chronic health conditions such as diabetes, COPD, asthma, and heart disease. They involve evaluating symptoms, medication effectiveness, lifestyle factors, and overall health status to optimise treatment plans, prevent complications, and improve patients' quality of life. These reviews are typically conducted by GPs, nurses, or other healthcare professionals within a Primary Care Network at regular intervals determined by clinical need and national guidelines.

How often should Long Term Condition Reviews be conducted?

The frequency of Long Term Condition Reviews varies depending on the specific condition, its severity, and national guidelines. Generally, most long-term conditions require annual reviews at minimum, with some requiring more frequent monitoring. For example, patients with diabetes typically need annual reviews, while those with unstable COPD might require reviews every 3-6 months. The NHS frameworks such as the Quality and Outcomes Framework (QOF) often provide guidance on recommended review frequencies. Primary Care Networks may also implement risk stratification to prioritise more frequent reviews for patients at higher risk of complications.

Who conducts Long Term Condition Reviews in a Primary Care Network?

In a Primary Care Network setting, Long Term Condition Reviews are typically conducted by a multidisciplinary team. This may include practice nurses with specialist training in specific conditions, GPs, clinical pharmacists, healthcare assistants, and sometimes condition-specific specialists employed across the network. PCNs often develop condition-specific pathways with designated healthcare professionals leading different aspects of care. This team-based approach enables skill-mix optimisation, with appropriately trained staff conducting reviews according to their expertise, while ensuring more complex cases receive input from GPs or specialists.

What typically happens during a Long Term Condition Review?

A typical Long Term Condition Review follows a structured format that includes several key components: review of symptoms and disease control; medication review for effectiveness, adherence and side effects; physical assessments relevant to the condition (e.g., blood pressure, peak flow, foot checks for diabetes); review of test results (e.g., blood tests, spirometry); discussion of lifestyle factors affecting the condition; psychological wellbeing assessment; and collaborative care planning. The healthcare professional will document findings, update the care plan, arrange necessary referrals, and schedule follow-up appointments or investigations as needed. Many reviews now use condition-specific templates to ensure comprehensive coverage of all relevant aspects.

How do Long Term Condition Reviews benefit patients and the NHS?

Long Term Condition Reviews offer numerous benefits for both patients and the NHS. For patients, these reviews provide regular monitoring that can detect complications early, optimise medication regimens, improve symptom control, enhance self-management skills, and ultimately improve quality of life. For the NHS, effective reviews help reduce emergency admissions, decrease costly complications, optimise medication use, and ensure appropriate use of resources. Studies show well-structured review programmes can lead to better clinical outcomes, reduced hospital admissions, and cost savings. They also support the NHS Long Term Plan's focus on preventative care and management of long-term conditions in community settings.

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