Intended for healthcare professionals


How effective are expert patient (lay led) education programmes for chronic disease?

BMJ 2007; 334 doi: (Published 14 June 2007) Cite this as: BMJ 2007;334:1254
  1. Chris Griffiths, professor of primary care,
  2. Gill Foster, senior research fellow,
  3. Jean Ramsay, senior research fellow,
  4. Sandra Eldridge, reader in statistics,
  5. Stephanie Taylor, senior clinical lecturer in health services research
  1. Centre for Health Sciences, Barts and The London, Queen Mary's School of Medicine and Dentistry, London E1 2AT
  1. Correspondence to: C Griffiths c.j.griffiths{at}
  • Accepted 28 April 2007

Considerable hyperbole has surrounded the UK expert patient programme, and it has received considerable funding—but will its impact meet expectations?

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.

Involving patients in health care

Two main arguments drive the shift towards increasing patients' involvement in health care.5 Firstly, it is unethical for patients not to be involved in decisions about their health and, by extension, for the public not to be involved in how care is organised. Secondly, greater patient involvement in the consultation may lead to greater satisfaction, and perhaps more importantly to better health. Patients' involvement has been championed by organisations like the Picker Institute (, which monitor patients' experience of care and highlight deficiencies. Systematic reviews show that interventions can promote patients' involvement and possibly greater satisfaction, but the jury is still out on whether this leads to better health.6

Against this background, the UK government has promoted the idea of a patient centred NHS, with …

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