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Home > Long term conditions > Managing Long Term Conditions (Chronic Disease Management) - home page

  Supporting people with Long Term Conditions Homepage


News Update 

Useful Documents

NHS Examples

US Models


Working with Data


Practice Based Commissioning

National Primary Care Development Team (NPDT)

 Workforce Change in Long Term Conditions Programme


Contact Us

In Supporting People with Long Term Conditions, published in January 2005, the Government introduced a model designed to help improve the care of people with long term conditions.  This followed the setting of a national Public Service Agreement (PSA) target for improving outcomes for people with long term conditions by offering a personalised care plan for vulnerable people most at risk, and reducing emergency bed days by five per cent by 2008 through improved care in primary and community settings.

For this to be carried out, the NHS will have to learn to work in new ways, and to develop cooperative plans for patient care that involve primary and secondary care, GPs, consultants, social services, nurses and pharmacists.

This website has been put together by the Long Term Conditions team in NatPaCT, part of the NHS Modernisation Agency.  It aims to help all those in the NHS involved in introducing this new way of working with people with long term conditions.  It is for managers in Primary Care Trusts at all levels, but also for clinicians, pharmacists, practice managers and people in social service.

It contains basic information about the management of long term conditions, in the overview, and more detailed background in the useful documents section.This section particularly is frequently updated as new pieces of work are done to help those working in this area.

There is a section where NHS Trusts share their experiences and successful new ways of working, and another section which looks at care in the US models.

The website contains information about Department of Health policy, and specialist information around nurses and practice based commissioning.

There are also separate sections for the Workforce Change in Long Term Conditions Programme, which is looking at new ways of working across the NHS, and the National Primary Care Development team (NPDT) which works particularly with GPs.

Finally, the website brings regular news of developments in the management of long term conditions, and news of events.You can also contact the team with your questions and contributions.

Top Download

Supporting People with Long Term Conditions -
An NHS and Social Care Model to support local innovation and integration
 (DH publication)

Click here to download PDF

Featured Event(s) 



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