Combined Chronic Disease Reviews
in Primary Care

Anna Hargreaves, Nurse Practitioner, Primary Care

Primary care is my passion, an area of nursing that I really felt settled in. However, over the years I have noticed the amount of duplication that occurs within our chronic disease management. Mainly down to nurses having set roles, such as respiratory nurse or diabetic nurse. Not only does this mean the patients see two different practitioners but also two appointments if there can’t be aligned on the same day. As we know when it comes to chronic diseases, they mainly affect the elderly frailer population. Those that find it difficult to get transport or generally struggle due to ill health or have poor mobility.

Looking at diabetes and Chronic Obstructive Pulmonary Disease (COPD) specifically, there is already proved research behind protecting the cardiovascular system for our diabetic patients but more recently the same has been found for our COPD patients. It would seem sensible to combine all three aspects of the review, diabetic, COPD and Chronic Heart Disease (CHD) as one review. The key overlapping element here being the heart, this being said, a person’s weight could impact not only the heart but the lungs. So, conversations around weight for our diabetic patients would be suitably combined within there COPD review when discussing how best to manage their symptoms of breathlessness. Diabetic annual blood tests are just another example, eosinophils that are found within the full blood count can be useful when assessing our COPD patients and if they may benefit from an inhaled steroid early on. We use the eosinophil trend to help make this decision along with other relevant clinical history.  

So why don’t we combine these reviews?

Some surgeries have started doing just that, others may find it more of a challenge due to training in certain areas and staff shortages.  Upskilling is certainly an area which can be developed, a practice nurses’ role can focus on all co-morbidities, to avoid this duplication of work. Provide continuity of care for the patient and reduce appointments. 

The Con's

Some nurses really have a passion for their area of chronic disease management. Some patients can be very complex and require a high level of knowledge in that area to fully assess and carry out the review. 
Many practice nurses are also getting ready to retire and are unlikely to want to start any new training or upskilling. 

In conclusion, I feel like combined reviews are the way to manage our chronic disease patients in practice to create more time and minimise duplication, but it will take time. It’s not something that can happen over-night, it may also mean that where practice nurses became almost specialists in one area that they go back to being a ‘trick of all trades’ and then refer on when they have reached their level of competence. I myself enjoy a variety within my clinic days, but i have always had more knowledge around respiratory than anything, so appreciate that change can be difficult. The ever-changing NHS and pressures on time and staff call for change. Which may mean adapting the way we work in primary care.

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