Sam Scott
sgcscott.bsky.social
Sam Scott
@sgcscott.bsky.social
Academic GP Registrar.
Overall, the plans sets out a vision that aligns with what many have said years when it comes to the care of people with MLTCs. That said, details are both crucial and absent.

Enablers are identified, with a significant bet on tech. Cultural silos and attitudes must continue to shift for impact.
July 8, 2025 at 10:31 AM
Measuring success:

- Patient reported outcomes and feedback will be amongst the measures used in a new value-based approach that shifts from activity to outcomes.
- This is another mechanism by which a holistic approach may be prioritised, encouraging improvement of the feel of care.
July 8, 2025 at 10:31 AM
A holistic approach:

- The need for care plans, that people have control over (using the app, of course), is a reasonable mechanism to encourage patient-centeredness. A goal of 95% is set for those with 'complex needs', but it is not clear who this applies to and how it will be encouraged.
July 8, 2025 at 10:31 AM
The burden of navigation:

- Patient-facing teams in neighbourhood health services could ease this. It is not explicitly stated, but it should be a core component.
- There is a huge bet on the NHS App to make this all easier for people. Details and examples are light. Co-design is key.
July 8, 2025 at 10:31 AM
Fragmented care:

- Neighbourhood health services are offered as a solution to convene professionals, but practical details are light.
- A single patient record should aid inter-professional communication. Cultural factors and clear responsibilities will still matter.
July 8, 2025 at 10:31 AM
This is just one of the issues encountered by people with multiple long-term conditions. It is fixable.

Further threads coming, do read the piece.

www.kingsfund.org.uk/insight-and-...

(4/4)
Improving Clinical Coordination Of Multiple Long-Term Conditions | The King's Fund
More people have multiple long-term conditions, but care pathways focus on single conditions. What do clinicians and commissioners need to improve the experiences of those with multiple long-term cond...
www.kingsfund.org.uk
May 27, 2025 at 10:26 AM
If left alone, this would have been three separate days spent travelling to the hospital.

More school missed, more parent/guardian time off work, increased travel costs.

Intentional or not, there is an in-built disrespect of people's time (3/n)
May 27, 2025 at 10:25 AM
I'm currently working in paediatrics. Different population but similar challenges.

Multiple times last week I spent ~30 minutes changing appointments and arranging scans so that they could happen on the same day. (2/n)
May 27, 2025 at 10:22 AM