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Transforming the provision of long term conditions services

At the recent QIPP summit national coach for the long term conditions workstream set out three drivers for delivering efficient and patient-centred services

Transforming the provision of long term conditions services

Russell Dunmore presents the outputs of the Long Term Conditions workshop to delegates at the QIPP summit

Improving care for people with long term conditions

 One of the key breakout sessions at the recent QIPP summit was the long term conditions workshop led by Workstream National Coach, Russell Dunmore. He began by laying out the stark challenge posed by long term conditions: that demand for care in the UK was projected to increase 60% by 2015 and 252% by 2050.

QIPP - delivering efficient and patient-focussed services 

To help cope with this demand, QIPP seeks to reorganise services to become more local, more efficient and more patient-focussed - with a strong emphasis on managing conditions responsively and in a way that prevents costly, distressing hospital admission.

 To achieve this, the workstream is promoting three key drivers:-

  •  Risk profiling of patients: so that their conditions can be continually monitored and changes responded to with prompt, effective interventions that prevent admission.
  • Integrated care teams: treating and supporting the person, rather than the condition, thereby delivering holistic, joined up, productive care.
  • Patient self-care and management: viewing patients as experts in their conditions and empowering them to access the care and support they need, when they need it.


Russell Dunmore pointed out that organisations are already getting good results in these areas and that the drivers were proving to be effective catalysts for redefining pathways and services. At the same time however he suggested that whilst it is relatively simple to identify new pathways, adopting the mindset for change is considerably more challenging. 

Overcoming the obstacles


The second part of the session saw delegates identify obstacles to change and means of overcoming them. Below is a summary of their conclusions:-

 Lack of patient and carer empowerment

 The traditional culture of ‘the doctor knowing best’ has created dependency among service users. Patients and carers often lack quality information that could help them make choices, access support and shape services.

 Action points: promote the conversation about user empowerment with patients, clinicians and carers.

Systemic obstacles

 The wide variety of organisations involved in pathways can create silos in relation to diagnostics, care planning / delivery, budgets and workforce. As a result, resources don’t flow readily in support of change.

 Action point: acknowledge these tensions but hold mature conversations across boundaries, focusing on best care. Consider an independent person or body to chair these discussions.

 The fear of the unknown

 The 19th century, hospital-dominated model of healthcare is deeply ingrained in the minds of the public and health professionals. The move to a very different model still under development creates anxiety, as does the fear of ‘loss’ created by potential closures.


Action point: work across silos to develop and communicate a virtual model that clearly demonstrates benefits and how things will ‘look and feel’ in the new system.

 Extending local pilots

Delegates pointed out that translating local pilots into large scale initiatives often creates strain on the system in terms of the changes demanded from it.

 Action point: continue to innovate locally but make use of all data available that helps frame changes, outcomes, approaches and standards. Above all, share ideas and experience of what works..

 Risk averse culture

 The NHS is fundamentally risk averse in its culture. This is vital in clinical care but suppresses innovators seeking news ways of planning, organising and delivering services.

 Action point: seek out your ‘disruptive innovators’ and use their input to identify opportunities and bring about change.