Experts urge commissioners to invest in self management courses for patients with chronic disease

BMJ 2012; 345 doi: (Published 19 November 2012) Cite this as: BMJ 2012;345:e7857
  1. Tessa Richards
  1. 1BMJ

Clinical commissioning groups in England should recognise the value to patients and the potential cost savings to the NHS of increasing investment in self management courses for patients with long term conditions, a meeting convened by the Expert Patients Programme agreed last week.

The programme (, which was set up and financed by the Department of Health 10 years ago and contracted out to a social entrepreneur in 2004, is now run by a not for profit community interest group that deploys a large number of volunteers with experience of living with long term conditions. The self management courses aim to build the confidence and resilience, particularly of disadvantaged patients, to cope with daily living and to use health and community services appropriately. Feedback from them, well illustrated by personal stories aired at the meeting, has been very positive, meeting participants were told.

“The courses have supported patients to be fully engaged and decreased their dependence on health services,” said Liam Donaldson, former chief medical officer for England.

But although the strengths of the programme were “admired internationally,” he said, primary care trusts had been “very varied in their willingness and enthusiasm to take them up.” Self management courses for patients with chronic disease should become “a major part of healthcare in the UK in the future,” he said.

The courses are led in conjunction with health professionals and volunteer patients. Most of the courses so far have been generic self help courses based on a model developed at Stanford University in California. Groups of up to 16 people attend sessions weekly for six weeks. Patients from ethnic minority groups can attend courses in their favoured language. Disease specific courses are also available for people with mental health disorders, alcohol and substance abuse, chronic pain, and chronic obstructive pulmonary disease; and others have been developed for use in prisons and for children.

The cost to commissioners of running a course was around £5000 (€6225; $8000), the BMJ was told. But recent independent evaluations of their effects on patients’ use of health services and the accrual of broader social rewards—including improved lifestyles and ability to continue education, stay in employment, and contribute to the community—indicated that they could be highly cost effective.

Despite this evidence, several speakers at the meeting expressed misgivings about whether the new clinical commissioning groups would see support of self management as a funding priority, given their imperative to cut back on costs. Because of this, the programme has developed online courses and just launched a new “expert patient community” where patients are being encouraged to post self management stories and video diaries.

Renata Drinkwater, chief executive of the programme, said, “We are in a challenging environment. Most of us do or will live with a chronic long term condition or care for people with a [combination] of chronic illnesses.” She added that for the benefit of the community as a whole, “We need to connect expert patients and harness their skills as volunteers.”


Cite this as: BMJ 2012;345:e7857

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