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Long-term conditions
We ask patients with long-term conditions such as asthma, coronary heart disease and diabetes to attend annually for review. We take a team approach to our chronic disease monitoring with the doctors, pharmacy and nursing teams working together.
It is important to attend your annual review, to ensure your condition is as well-managed as it can be. After any physical checks have been completed we will ask you to book a phone appointment with the clinical pharmacist to complete a medication review, so that your prescriptions can be reauthorised for the following year.
Our goal is to move both long-term condition reviews and medication reviews into your birthday month, to help you and us remember when they are due.
Online reviews
We are endeavouring to make access and medication reviews easier and safer for all patients by offering you the facility to carry out your annual review for some common conditions online - please see links below.
| Condition | Frequency of follow up | Detail | Flu jab recommended |
|---|---|---|---|
| Asthma | Yearly | Complete asthma review form online; clinical staff will review form and you will be contacted if your asthma is not well-controlled. | Y |
| Chronic obstructive pulmonary disease (COPD) | Yearly | LTC (COPD) review with the nursing team | Y |
| Coronary heart disease | Annual review +/- 6 monthly bloods | LTC (CHD) review with the nursing team | Y |
| Diabetes | Yearly | LTC (Diabetes) review with the nursing team | Y |
| Hypertension | Yearly | LTC (Hypertension) review with the nursing team | Y |
| Serious mental illness (schizophrenia, bipolar disorder, psychosis) | Yearly | SMI review with commissioned mental health practioner | N |