Throughout the 20th century the health service has shifted from work on minor illnesses and care of relatively young healthy people to the care of chronically ill older adults.

Evidence suggests the best care for people with chronic conditions is delivered when resources and services are integrated and focused on empowering the patient to provide effective self-care.

But this is not in general how the NHS is organised - studies show that good quality management of chronic conditions is patchy and that support for patient self-management of disease has to date received little attention.

GPs and primary care services have often been the focus of attention when improvements are called for in this area. However it is a wide issue that needs to draw in financial and structural incentives as well as new ways of working to make a difference managing chronic diseases. The NHS system needs to change.

Issues that FHN explored include:

• New clinical models that systematically assure all patients receive recommended care; embrace new ways of working and new enhanced professional roles such as GPs with a special Interest (GPSIs); and change the way clinical encounters are defined from one-to-one management through to ICT enabled services.
• Expert patients programme: Given shortage of health workforce and since most chronic conditions are heavily impacted by patient actions, emotions and lifestyle choices, the movement towards patients involvement and concordance in care should provide benefit for patients and the NHS.
• Information infrastructure: ICT is a critical component of success - not only does every member of the clinical team need information to make the correct and timely clinical decisions but they also need decision support. The technology now allows a significant increase in home monitoring/care.

As FHN is now closed, these pages will no longer be updated.