We’ve invited you for an annual review of your long term condition. The review is for your benefit so we can ensure your condition is well controlled and that you stay well. Please attend or let us know if you want to decline the invitation so we can record this.
I don’t feel ill, why do I need an annual review?
You won’t always feel ill or notice any symptoms from your long term condition. However, there can be changes happening in the body that may lead to your condition becoming worse and which will make you ill if we don’t know about them. The changes could be a result of the condition you have or from the medications we prescribe you to treat it. We can detect some of these changes by monitoring your blood pressure, blood tests and asking you about your condition. Our aim is to detect and act on any problems before they make you ill. We hope you agree that popping in to see us once a year for a check-up is better than spending weeks in hospital because we were unable to catch any problems early.
I have more than one long term condition, why can’t I have them all reviewed at the same time?
Looking after your long term conditions requires some specialist knowledge from our doctors and nurses and they don’t all have the same skills. For example, some of our nurses have expert knowledge in managing breathing problems like asthma and COPD, and others are experts in cardiovascular conditions like diabetes and heart disease. We’d like you to see the relevant expert which is why you may be asked to attend more than one appointment. We will keep the number of appointments to a minimum.
What is the review actually for?
The review allows us to check your general health, some physical checks and maybe a blood test. The blood test and blood pressure checks help us to see if your body is having any problems from your condition or the medications we prescribe for you. They check if your organs such as heart, kidneys and liver are functioning properly and allow us to take action early if things don’t look quite right.
The checks also allow us to review the medications you are prescribed and that they are controlling your condition in the way we’d like, without giving you unnecessary side effects. The results of the checks help us decide if we need to change the dose of your medications, or consider alternatives.
What happens if I don’t attend?
We really hope you’ll choose to attend your annual check-up. If you don’t attend then you may become ill because we’ve not been able to detect any problems early and your condition has become worse. Long term conditions are usually with you for life so it is important to manage them well so you remain symptom free for as long as possible.
If we are prescribing you medication then we have a duty to ensure we are doing this safely. To ensure the prescribing is safe we need to do regular blood tests to check your liver and kidneys are working OK. If we can’t prescribe safely then we might not be able to prescribe at all so please help yourself and us by attending your review.
What complications might I experience if my condition is poorly controlled?
The complications depend on what isn’t well controlled. Many of the cardiovascular conditions have symptoms or problems in common and can affect each other. Cardiovascular conditions are those that affect the heart and circulation, for example high blood pressure, diabetes, heart problems and stroke.
Respiratory conditions are those that affect your lungs and breathing, usually asthma and chronic obstructive pulmonary disease (COPD). COPD is a general term that includes conditions like emphysema and bronchitis which obstruct airflow and make it difficult to breath.
High blood pressure
This can put extra strain on your heart, blood vessels and body organs. It can lead to kidney damage and it increases the risk of stroke if it is consistently high. At least half of all heart attacks and strokes are associated with high blood pressure. It can also lead to problems with your vision. You can help to control your blood pressure by eating a healthy diet and taking regular exercise. You can learn more at https://www.bloodpressureuk.org/.
High blood sugar levels
Having consistently high levels of sugar in the blood can cause many problems and eventually lead to diabetes. We usually measure something called HbA1c rather than glucose. HbA1c levels give an indication of how much sugar there has been in the blood over the past three months or so. A high HbA1c means you are eating too much sugar and the body is not controlling sugar levels well. If you are diagnosed with pre-diabetes or diabetes then it is important that you control your sugar levels to avoid further complications. These can include problems with your vision, numbness in your hands and feet and seizures. You can read more at https://www.diabetes.org.uk/about-diabetes/complications.
Irregular pulse
Your pulse is something that can be felt around various parts of the body and is directly related to how your heart is beating. It is caused by the expansion and contraction of the blood vessels as the heart pumps blood around the body. Your pulse should normally be between 60 and 100 beats per minute and regular. Regular means the beats happen about the same distance apart. A pulse that is too slow, too fast or irregular can indicate problems with your heart that can be life threatening. If you have a known problem with your heart such as atrial fibrillation, heart disease or heart failure then it is important that we check your pulse so we find any problems.
Breathing problems
If you have a respiratory condition then it’s really important that you use your inhalers as directed. This is the best way to avoid severe attacks where you have difficulty breathing, which can be scary. We invite you for a review each year so we can assess your symptoms and ensure you are on the best treatment, and to check you are using your inhalers correctly.
What does good look like?
This is usually different for each patient. However, there are a few guidelines to aim for.
Blood pressure
This should be below 140/90 mmHg for patients aged below 80, or below 150/90 mmHg for patients 80 and older.
HbA1c
This should be below 42 mmol/mol.
A value between 42 and 47 mmol/mol indicates pre-diabetes or non-diabetic hyperglycaemia.
A value consistently 48 mmol/mol or higher indicates diabetes.
The aim for those with pre-diabetes and diabetes is to reduce their HbA1c back to the level for healthy people.
Cholesterol
There are different types of cholesterol which have different target values. These are collectively referred to as lipids.
A total cholesterol below 5 mmol/L is considered to be good if you have no long term conditions.
If you have a cardiovascular or kidney problem then your LDL cholesterol should be below 2 mmol/L.
If your lipid values are above the target values then you may be offered medication to help lower them. High levels of lipids can lead to blocked blood vessels and cause heart attacks and strokes.
Can I decline or opt out?
We’d obviously like to ensure you are keeping well and that we are prescribing safely for you. However, you can decline the invitation for a review. Depending how we invited you, use the link in the message or contact reception to let us know.
Please be aware that certain medications that we prescribe must have blood tests to ensure they are not causing side effects. You will still need to attend for blood tests or we may not be able to prescribe for you.
Does this affect your funding?
Before we answer that question, we’d like to stress that our primary aim is to look after you and provide the best clinical care possible. We hope you appreciate that in order to do that, it costs money for staff, premises and equipment.
The way we are funded by the NHS is complex. We receive a core level of funding, but large amounts of the money we can receive are based on achieving targets or doing certain things. We can only provide the level of service that we do if we are successful in earning the additional money related to targets.
Carrying out an annual review for you is not directly a target that we have to hit. However, some of the things we measure or try and control as part of the annual review are subject to target related income. For example, keeping your blood pressure at or below the recommended target of 140/90 mmHg is a target for many long term conditions. We have to ensure that at least 40% of our patients have a blood pressure below the target before we receive any payment for this work. That means we do a lot of work for no payment at all before we start to earn any income!
We’d like to stress again that our aim to provide you with the best care possible. We have provided this information about funding to be transparent and explain how you can help to support us maintain our funding and the service we offer.