David Colin-Thome. National Clinical Director for Primary Care GP, Castlefields, Runcorn Honorary Professor, M.C.H.M, Manchester University Honorary Professor, School of Health, University of Durham. Benefits of a first contact in primary care. (Starfield).
“The predominant acute disease paradigm is an anachronism. It is shaped on a 19th century notion of illness as a disruption of the normal state produced by a foreign presence or external trauma, e.g. infection or injury. …..Under this model acute care is that which directly addresses the threat. ….
In fact, modern epidemiology shows that the prevalent health problems of today (defined both in terms of cost and health impact) revolve around chronic illness. Kane (2002)
“While the global disease burden has been shifting towards chronic conditions, health systems have not evolved to meet this changing demand. Care is fragmented, focused on acute and emergent symptoms, and often provided without the benefit of complete medical information” WHO (2002) 
Quality (What Patients’ Value)
Prof Al Mulley,Harvard
The annual review and routine interval appointments
A conveyor belt of checking and prescribed actions?
New view? The Diabetes NSF
‘A care plan is at the heart of a partnership approach to care and a central part of effective care management. The process of agreeing a care plan offers people active involvement in deciding, agreeing and owning how their diabetes is to be managed’Systematic care - A change in style?
Highly complex members
or Case Management
High risk members
Assisted Care or Care Management
Usual Care with Support
70-80% of a CCM pop
Population Management:More than Care & Case Management
Measurement of Outcomes & Feedback