Chronic disease treatment programme

The chronic disease treatment programme is for people who have one of these chronic conditions:

To be eligible for the programme you must be aged 18 or over and have a medical cardGP visit card or Health Amendment Act card.

Non-cardholders aged 18+ years registered on the CDM Prevention Programe with a diagnosis of Gestational Diabetes or Pre-Eclampsia and who develop Diabetes are eligible for registration on the CDM Treatment Programme.

A chronic disease is a long-term health condition that needs ongoing treatment and management.

The programme is designed so that you can work with your GP on:

  • monitoring your condition
  • identifying early treatment
  • supporting the way you manage your condition

Benefits of the programme

The programme can help you and your GP to manage your condition and prevent hospital admissions through:

  • structured reviews of your chronic disease with your GP or practice nurse
  • a personalised care plan of your needs, preferences and choices developed and agreed with your GP
  • a review of your care plan and medicine by your GP
  • support to self-manage your condition
  • opportunities for structured education and self-management support
  • early detection of any new conditions you may develop
  • early detection of any complications in your condition
  • care in your community, close to your home

How the programme works

The programme includes 2 free reviews in every 12 month period that you are part of the programme.

Each review includes one visit with the practice nurse followed by a visit with your GP. You can see your GP and practice nurse during the same review or separately at different times.

These reviews may be in the GP practice, online or over the phone.

If your review takes place in the GP practice, it will include tests such as blood tests.

There is no charge for any tests carried out as part of your programme reviews.

You can make an appointment for your review with your GP or practice nurse.

You will receive a written care plan after each review.

Care plan

A care plan is agreed between you and your GP or Practice Nurse. It outlines the steps that you need to take to manage your condition and the supports available to you. It can include your concerns, agreed goals between your reviews and advice.

You can continue to visit your GP as normal outside of the scheduled chronic disease management reviews.

Registering for the programme

Your GP or practice nurse will register you for the programme if you want to take part in it and you are eligible.

Your information

As part of the programme, your GP or practice nurse will record some information about you at each review.

This will include your:

  • name and age
  • chronic disease diagnosis or diagnoses
  • medical history
  • details of any symptoms or tests you have had since your last visit

How we use your personal information

Your GP will send information to us at the end of each structured review. This will include your name and address, medical or GP card number, and chronic disease history.

This information will help to improve our understanding of chronic diseases.

It will improve our ability to detect, treat and prevent chronic diseases. It will help us to deliver an improved service to people with these chronic diseases.

Your personal information is stored in line with current data protection regulations. You will have full and open access to the personal information we keep about you. You can ask for it from us at any time.

Read the privacy statement for the Chronic Disease Management Programme (PDF 472KB, 1 page)

Opting out of the programme

It is your choice to take part or not. You can opt out of the chronic disease treatment programme at any time by letting your GP know.

If you opt out, you will no longer receive any reviews and other care planning under the programme from that point. You can always rejoin the programme if you want.

Speak to your GP or practice nurse if you have any questions about the programme.