Year of Care for Long Term Conditions

Year of Care is a model to support people with long term conditions to self-manage.

The model has been tested in diabetes care as part of a national pilot and it concluded that there were three component parts to the Year of Care approach. However, not all three components have been successfully tested in one site.

This project aims to take all three component parts and implement them within three diverse GP commissioning consortia across North of Tyne, extending the approach to all long term conditions. The components are:

1. Workforce development - embedding care planning in practice by rolling out a comprehensive training and support programme across all 46 GP practices within 3 commissioning consortia localities North of Tyne
    
2. Commissioning intentions - capturing individual patient need for local services to support self-management through systematic informatics data capture
    
3. Market development - implementation of a tested non-traditional provider model (HealthWORKS Newcastle) to develop local services to support self-management.

 
The project will be based in primary care and 3 local Pathfinder GP Commissioning Consortia will be involved:

• Care First North East (North Tyneside)
• West Northumberland PBC Group (Tynedale)
• Newcastle Bridges (West Newcastle)

The team will also work collaboratively with Northumbria Healthcare NHS Foundation Trust as part of this project. 

To find out more about how Year of Care has been tested and implemented in Diabetes, please click here.