Proactive Care at Chiswick Medical Practice

We are changing the way we organise appointments and provide support for people who have long term conditions by putting in place a new way of working called personalised care and support planning.

If you are a patient with a long term condition, you will be contacted around your birthday month to book your appointment. We may also ask you for more information on your condition and conduct any tests prior to your appointment. Please help us to respond to any messages we send promptly.

Please note: As we are implementing a month of birth system you may be asked to have a test or check before you are due.

What is personalised care and support planning? This way of working aims to give you the opportunity to get more out of your annual review appointments by reorganising the way things happen and giving you more information before you see your nurse or doctor. It should help you to talk about:

  • What is important to you
  • What you can do to look after your health and stay well
  • What support you may need

Who is it for? Anyone with diabetes or long term condition including diabetes, asthma, COPD, atrial fibrilation, coronary heart disease, dementia, hypertension, rheumatoid arthritis, heart failure, learning disabilities, mental health and cancer. We may also call you in if you at risk of conditions such as at risk of diabetes.

Why change things? This way of working is being put into place across a number of surgeries in the area and is nearly always preferred by patients. It will help both you and the doctor or nurse make the best use of the time you have in your care and support planning appointment. Any important tests and results needed at your appointment will be made available to you before the appointment as well as an opportunity to think through what questions you want to ask and identify your key concerns which you want to talk about.

What does this mean for me? This means that your personalised care and support planning review may/will take place over two separate appointments and you will have time to think about what you want to get out of these visits.

What happens at the first appointment? If tests and checks are needed you will be asked to attend the surgery to have them done (e.g. blood tests, breathing tests) with a healthcare assistant. The healthcare assistant will book your next appointment which will be with a doctor or nurse.

What happens if I don’t need tests and checks for my condition? You will be invited to the personalised care and support planning appointment only but will receive some information to help you think about what is important to you and what you would like to discuss at your care and support planning appointment.


Please see the video for more information.