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
Health Educator | Health Education | yes | yes

GP MANAGEMENT PLAN

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 | | |
Skin condition | Increase patient's understanding of skin condition. | Patient education. Support. | GP, HE

Self-management

Develop self-management routine

assess patient's way of self-monitoring: support, educate.
•	Use of cleansers and moisturizers
•	Identifying and avoiding triggers

GP

2. Lifestyle | | |

Nutrition

Healthy eating pattern, low fat diet

Patient education

GP
Patient to implement
Dietitian

Weight

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

Monitor
Review 6 monthly

Patient to monitor
GP

Physical Activity

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

Patient exercise routine

Patient to implement
GP

Smoking

Complete cessation

Smoking cessation strategy:
Consider:
- Quit
- Medication

Patient to manage
GP

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 monitor

3. Biomedical | | |

Cholesterol / Lipids, BP, Vit D - check up

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

4. Medication | | |

Medication. Correct use.

Correct use of medications, minimise side effects

Patient education
Review medications
Encourage feedback

GP to review and provide education

4. Psychosocial | | |

Psychological burden of chronic skin condition

Manage depression

Assessment.
Consider medication or/and  behaviour therapy

GP to assess and initiate management

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