Chronic conditions now account for 60% of deaths worldwide and are imposing an increasing burden on society and health services.1 Self management programmes are commonly used to help patients learn the skills to manage their own conditions better.2 The NHS in the United Kingdom, and countries in Europe (especially Scandinavia), Australasia, and North America have chosen specifically to use courses tutored by trained lay leaders, rather than health professionals such as nurses.3 Considerable resources have been allocated to support and run such programmes. A major attraction for healthcare planners has been the expectation that such courses will reduce use of health care and will deliver long term cost savings.4 More debate about the impact of lay led, self management programmes is needed. This article opens up this debate and examines the evidence that “expert patients” consume fewer healthcare resources, with particular reference to data from trials in the UK.