The Long Term Health Conditions team runs alongside the community nursing service for all patients registered within Freshney Pelham Federation practices.
The service manages patients with 1 or more chronic or long-term condition across their illness trajectory. The patient whilst able will continue to visit the practices for management of their condition by G.P or Practice Nurse. During this time the patient will also be known by the long-term condition team manager and any episodes of acute exacerbation and the patient being housebound, the L.T.C Team manager would assess and manage acute episode of care.