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Feature Long term conditions

How services for long term conditions could be reborn

BMJ 2011; 342 doi: (Published 22 March 2011) Cite this as: BMJ 2011;342:d1730
  1. Luisa Dillner, head of new product development
  1. 1BMJ Group, London WC1H 9JR, UK
  1. ldillner{at}

Patients with chronic conditions dominate the health service. Luisa Dillner talks to the clinician in charge of overhauling services and listens to the evidence of what might work in practice

Around 15 million people in England have a long term condition, and they take up 50% of all appointments in general practice and 70% of hospital beds. As the clinical lead at the Department of Health for improving the quality and efficiency of long term care, John Oldham is remarkably calm about having to change that. “It doesn’t keep me awake at night because I’m not that sort of person,” he says. “But it doesn’t mean I’m not passionate about making changes. If we continue to manage long term conditions as we do then it’s not sustainable. That’s true for all westernised countries.”

Sir John is also the national clinical lead for quality and productivity at the Department of Health. As such he is at the heart of the coalition government’s health reforms, travelling the country talking to the emerging commissioning consortiums. Last week the department published details of the services that consortiums will need to purchase for their populations.1 The service for long term conditions that Sir John advocates is, he says, based on international evidence, much of it from Kaiser Permanente (a …

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