Long Term Condition Review Appointments

Many of our patients are living with long term chronic health conditions such as diabetes, heart disease and asthma.

The team at Bourn Surgery have always managed each individual condition according to best practice.  However, we now recognise increasingly people are living with multiple conditions, which can lead to multiple appointments and disconnected care.

We want to continue to provide the best care and support for our patients:

  • Care which focuses on the individual.
  • Care which empowers patients to feel in control of their own health conditions.

We have therefore decided to trial some changes to how we call patients in for ongoing health reviews.


We will proactively contact patients once a year to invite them to book an initial health review appointment.  For most patients the invitation will be sent in their birthday month.  If you would prefer to be recalled at a different time of year, we can arrange this (please contact reception).  People with a birthday in March are likely to be called at a different time (as the NHS requires us to have final results each year by the 31st March).

This initial appointment will be made with one of our nurses or healthcare assistants.  They will undertake all necessary blood tests and physical health examinations (such as weight and blood pressure).


Once the results of these initial tests are available, your GP will review them.  If all is going well, you will not have to come into the surgery for a further appointment.  Your medication review date will be updated and you will receive the results letter by your preferred method of communication (email, SMS or post).   You will of course still be welcome to book an appointment with a clinician if you wish.

Patients where the initial test results suggest treatment needs to be adjusted or optimised, will be contacted to make a review appointment.  These may be made remotely via telephone or video consultation, or as a Face to face appointment in the surgery.

At this review appointment, you will have an opportunity to discuss your long term conditions and make a plan for your ongoing care with the clinician.


We hope this new approach will be easy to understand and provide more flexible care for patients.  We would love to hear any feedback you might have.