CARE PLAN

ITEM: 	GP Management Plan  ____ 721	
	TCA    ____ 723                                                     

PATIENT DETAILS: | GP DETAILS:
[Patient Demographics:Full Details] | [Doctor:Full Details]
DATE CARE PLAN PREPARED: [Miscellaneous:Date]
PROBLEM LIST:
[Clinical Details:History List]

ALLERGIES:
[Clinical Details:Allergies]

CURRENT MEDICATIONS:
[Clinical Details:Medication List]

[Clinical Details:Smoking]

[Clinical Details:Measurement BP]

[Clinical Details:Measurements]

CARE PLAN TEAM MEMBERS or if GPMP - SERVICE PROVIDERS:
NAME | TYPE OF CARE | if developing a TCA CONTACTED/ COPY SENT | if developing TCA AGREED?
[Doctor:Name] | GP (details above) | yes | yes
[Addressee:Full Details] | [Addressee:Specialty] | yes | yes

GP MANAGEMENT PLAN  chronic tension headache

Patient problems / needs / relevant conditions | Goals - changes to be achieved (if possible) | Required treatments and services including patient actions | Arrangements for treatments/services (when, who, and contact details)
1. General | | |
Patient's understanding of chronic tension headache | Patient to have a clear understanding of chronic tension headache and the patient's role in managing the condition | Patient education | GP

Diagnosis of chronic tension headache

Patient to undergo clinical assessment

Positive diagnosis made

Demonstration of the following Key features

Recurrent featureless headache which does not interfere with activity

Headache

Constant (not throbbing or pulsating)

Bilateral

No sensitivity to noise light smell or movement 

Able to work through headache.

Activity does not worsen headache

GP / other specialist

Exclusion of red flag factors in the diagnosis of primary headache syndrome

Patient to undergo appropriate clinical assessment  and if appropriate subsequent neuro-imaging

Red flags to exclude
redflags 
	
pressure symptoms 
vomiting positional change 
acute vertigo
sharp pain on coughing sneezing straining or laughing or stooping
  
headache 
worst ever / sudden onset
maximum intensity within 5 minutes of onset 
new onset  / unusual 
unilateral migraine that never occurs on the other side 
	
past history 
malignancy 
head trauma in the last 3 months 
immunosuppression HIV 

triggers 
exercise coughing /sneezing posture 

systemic features 
weight loss 
fever 
diarrhoea 
skin rashes 
malaise 
vomiting without known cause 

associated features 
neck stiffness 
local tenderness 
focal neurology 
higher cortical dysfunction 
change in personality 
impaired consciousness

GP / other specialist

2. Lifestyle | | |

Nutrition

Healthy eating pattern, low fat diet

Patient education

OR 
As per Lifescripts action plan

GP
Patient to implement
Dietitian

Weight

Your target:
BMI £ 25
Men waist £ 94 cm
Women waist £ 80 cm

Monitor
Review 6 monthly

Patient to implement
GP to monitor
Physio / dietician to advise

Physical Activity

awareness of the positive benefits of physical activity on stress in general and secondarily on tension headaches

Your target:
At least 30 minutes walking or equivalent 5 or more days per week

Patient exercise routine

Patient to implement
GP to monitor
Physiotherapist to advise

Smoking

Complete cessation

Smoking cessation strategy:
Consider:
- Quit
- Medication

Patient to manage
GP to advise / monitor
smoking cessation advisor  to advise

Alcohol

Your target:
£      standard drinks per day
Ideal:
£ 2 standard drinks per day (men)
£ 1 standard drinks per day (women)

Reduce alcohol intake
Patient education

Patient to manage
GP to advise / monitor

2. Biomedical | | |

Cholesterol / Lipids

Your target:
Cholesterol £ 4.0 mmols/L
Triglycerides £ 2.0 mmol/L
LDL-C £ 2.5 mmol/L
HDL-C ³ 1.0 mmol/L

Annual check

GP

Blood pressure

Your target:
< 140/90

Check every 6 months

GP

3. Management | | |
3 / A Non-pharmacological interventions

Acupuncture / manipulation

Understanding of the role that acupuncture and manipulation play in the prophylactic treatment of chronic tension headache

Provision of acupuncture / manipulation  for the management of chronic tension headache

Physiotherapist to perform 
Gp to monitor

Stress

Awareness and understanding of the role that stress plays in the aetiology of chronic tension headache.

Reduction in stress

Assessment.
Medication
Talking therapies to address stress / anxiety and mood disorder
cognitive behaviour therapy

GP to assess and initiate management

Psychologist to provide sress / pain  reduction talking therapies

3./ B Medication | | |

First line therapies – simple analgesics – over the counter

Regular oral paracetamol / NSAIDS / aspirin

Patient education 
Review medications

GP and pharmacist to review and provide education

Gp to review at 6 monthly intervals or more frequently if indicated

Pharmacist to review opportunistically at each dispensing.

Pharmacist to refer back to prescribing clinician (or GP) as appropriate in the event of any issues arising.

Second line therapies

Amitriptyline

Patient education 
Review medications

GP and pharmacist to review and provide education

Gp to review at 6 monthly intervals or more frequently if indicated

Pharmacist to review opportunistically at each dispensing.

Pharmacist to refer back to prescribing clinician (or GP) as appropriate in the event of any issues arising.

Pharmacist role in TCA

pharmacist to be aware of underlying disease process which merits pharmacological intervention

pharmacist to review the indications for therapy , assess the side effects of therapy and monitor compliance with therapy

GP and Pharmacy to reconcile prescribing and dispensing records

pharmacist to monitor the progress of symptoms and or complications and provide appropriate advice to patient which may include advice to return to see the prescribing clinician and or general practitioner

4. Psychosocial | | |

Social isolation

Reduce social isolation

Improve social support 
eg referral to support group

GP to advise and monitor

Copy of GP Management Plan offered to patient?  y

Copy / relevant parts of the GP Management Plan supplied to other providers?  y

GP Management Plan added to the patient’s records?  y

Date service was completed: | Proposed Review Date:

I have explained the steps and any costs involved, and the patient has agreed to proceed with the plan. YES