Once the use of the tools becomes easy and the ‘default’ position, the tools are more consistently and reliably used.

System changes may be as large as a redesign of how you run your clinics eg diabetic clinic redesign or as small as developing weekly email reminders to partners to remember to use a specific service tool.

Several sites working with the Health Foundation’s Co-creating Health programme used templates within their clinical systems to increase reliable and consistent use of the self management tools:

• EMIS Prompts have been developed to automatically alert the clinician to refer to the Self management programme whenever a patient with a diagnosis of COPD is seen and referral letter produced. (Ayrshire & Arran).
• SystmOne templates developed to enable the goals set with community teams to be seen by other clinical professionals (Calderdale).
• SystmOne templates developed to prompt the clinician to agenda set with their diabetic patients (Whittington), or to use the skills taught in the Advanced practitioner programme (Torbay, or use a post consultation reminder for patients (Torbay).

Other system changes used to promote self management include service redesign of hypertension monitoring and cystitis management both putting patients more in control of there illness (Torbay).

Several sites have redesigned their systems to send patients their blood results (with interpretation) prior to their review visit with the clinician (Cambridge, Whittington).

Significant redesign of the way follow up is conducted has involved most sites offering patients a choice of time of follow up and also a choice of mode, face to face, telephone or email.

Benefits:

• consistent use of self-management support by all team members
• enables self-management support to be embedded and mainstreamed
• increases likelihood of sustainability
• able to link self-management support with other team processes.