This paper is an update of the paper previously published by the King’s Fund in 2011. It argues that health care commissioners will need to deliver a sustainable system in the face of the most challenging financial and organisational environment seen in decades

It outlines the need to shift the current emphasis on acute and episodic care towards prevention, self-care and integrated and well co-ordinated care to cope with an aging population and increased prevalence of chronic diseases. And they will need to direct resources to the patients with greatest need and redress the ‘inverse care law’ by which those who need the most care often receive the least.

It identified a number of common themes across the ten priotirites and the need for commissioners to help to drive:

• more systematic and proactive management of chronic disease
• the empowerment of patients
• a population-based approach to commissioning
• more integrated models of care

Supporting self management is the first priority set out in the paper, and it reports recent work conducted by the Richmond Group of Charities and The King’s Fund (2012) calling for patients to be offered the opportunity to co-create a personalised self-management plan which could include the following:

• patient and carer education programmes • medicines management advice and support
• advice and support about diet and exercise
• use of telecare and telehealth to aid self-monitoring
• psychological interventions (eg, coaching)
• telephone-based health coaching
• pain management
• patient access to their own records