Long Term Conditions: Annual Reviews

Do you have a long term condition? Do you have annual reviews at the surgery for your condition?

General Practices was instructed to stop all routine annual reviews at the start of the Covid-19 pandemic. This was to protect our patients and staff, as per the government guidance on ‘Stay at home, save lives and protect the NHS’.

Our nursing staff had to completely change the way they were working, to meet the care needs of our shielded and most vulnerable patients. Our clinicians opened a Red Site, which is still in operation, to review patients with COVID suspected symptoms, isolating them from other more vulnerable patient groups. 

image of a patient getting blood pressure review

As the risk level has reduced and our shielded patients are now able to return to our surgeries for care, we are now starting to focus on restarting the routine annual reviews recalling by month of birth.


What do I need to bring to my annual review?

  • Asthma – ACT Questionnaire (this will be sent to you via text or letter)
  • COPD – CAT Questionnaire (this will be sent to you via text or letter)
  • Hypertension, Chronic Heart Disease (CHD), Diabetes, Stroke/TIA – Height, Weight and BP readings at least a day before your appointment and a urine sample on the morning of your appointment in a sterile container from one of our surgeries.
  • Non-Hyperglycaemic Diabetes (NHD) and Chronic Kidney Disease (CKD) – Nothing unless you have another condition listed above.

How will the recall process for routine reviews work this year?

Routine Long Term Condition Annual reviews are there for many reasons, to check you are doing well with your condition, for health education and monitoring ongoing health care. In these unprecedented times we need our patients to be responsible for their condition and to work with us to achieve the best health outcomes we can for all our patients. 

If you are unwell or symptoms of your condition are worsening you need to contact us where we can take the appropriate action to ensure you are looked after. 

Patients will be invited to attend in the month of their birth. Once a patient has received the letter they may call the practice for an appointment on our main telephone number 01524 511999 and pressing option 1 for our dedicated annual long term conditions review team. Please do not call the practice if you have not received this letter.


My birthday is in September why have I not had a letter?

If you have not received your letter in your month of birth, this is something that one of our recall team can look into for you. If you would like to give us a phone on 01524 511999 and press option 1, this can be looked into for you.

If you are concerned your health is deteriorating or symptoms worsening please do NOT wait for your routine long term condition annual review and call the surgery where we can assess how we can help you on 01524 511999, selecting option 5 on the phone line.


What do I do if my condition is worsening?

It was never the role of a long term condition review to treat deteriorating conditions, it is even more vital that you contact the practice regarding any deterioration in your condition when it happens selecting option 5 on the phone line. Our Patient Advisors will forward your details to our review nurses who will either contact you to discuss of refer you to our urgent care team who with assist you.


How can you help us help you?

There is certain information that our nurses need to assess a patient’s progress when carrying out a review. Patients would normally be able to have their weight, height and also have their Blood pressure taken in the surgery with current restrictions we would ask our patients try to acquire this information . We have Blood pressure machines at each surgery for this to be done before entering your appointments. 

It is as important to monitor blood pressure as it is to monitor weight.

A list of valid blood pressure monitors for use at home can be found by clicking here


The REACT Service

The REACT service is a delivered by an independent company called National Services for Health Improvement Ltd and is paid and provided for by Chiesi Ltd. Chiesi Ltd is as a pharmaceutical company. Please ensure that you have all your medicines with you for the review. By phoning the practice or booking via the Self Booking link on the text message, this confirms that you accept the following privacy statement that can be accessed by the following the link: https://www.nshi.co.uk/reactppp/