Collaborative Care and Support Planning (CCSP) review

Lead: Leeds South & East

Area: Leeds South & East

Period: 1st Jun 2017 - 30th Nov 2017

The CCSP offers patients with long-term health conditions the opportunity to have an annual review at their GP practice. The aim of the review is to offer ongoing support and coaching to enable patients to look after their own health.

We know that many patients attend the first appointment and have their results sent to them.  However, many patients do not attend the follow-up appointment a year later. We wanted to understand why this might be.

We spoke to patients who have long-term health conditions and are under annual review at the following practices: Lofthouse surgery, Nova Scotia Medical Centre, The Manse Surgery, Church Farm Close Medical Practice, Church View Surgery, Shaftsbury Medical Centre. We asked why patients may not return for their review appointment. We also asked how we can we make the review appointment easier to attend.

We have asked practices in this year’s scheme to consider how they can have a better conversation with patients about their follow up appointments. We have asked clinicians to clearly outline the benefits of follow up appointments.

We have asked practices to explore how they can use suitable technology to encourage people to attend their follow up appointments. We will ensure that face-to-face appointments are available to people who are uncomfortable with other technology.