Improving the care of people with long term conditions is a key priority for the NHS, and a central part of UK Department of Health's Improvement Plan.1 Just 2% of patients with chronic conditions account for 30% of unplanned hospital admissions and 80% of general practitioners' consultations. Chronic disease now accounts for 78% of all spending on health care in the United Kingdom, and this percentage will rise with an increasingly ageing population. The process of case management (or care management) lies at the heart of the government's plans for the care of people with long term complex conditions. An NHS case manager—a new type of specialist clinician, usually a nurse comfortingly designated a community matron—will identify suitable patients, assess their needs, and then work with local general practitioners and primary care teams to develop tailored personal plans to prevent worsening of the condition and, where possible, to prevent unplanned admission to hospital.2

By 2008 all primary care trusts will have developed their own case management approaches, and more than 3000 community matrons should be working to reduce unplanned admissions by 10-20%. Case management is intended to work alongside initiatives such as the expert patient programme,3 enabling patients to make better …