• Embedding self-management support through the three strands of the Co-creating Health programme.
  • Focused on working with chronic obstructive pulmonary disease (COPD) patients.
  • The first phase ran from September 2007 until August 2010. The second phase ran from January 2011 until November 2012, broadening the focus to people with other long-term conditions.
  • The project began with embedding the approach in secondary care, before moving on to involve GP practices.

Overall, the aim was to introduce positive benefits from efficient self management thereby improving people’s quality of life, helping avoid emergency admissions to hospital, and reducing the burden on the NHS. To achieve this they rolled out the three elements of the Co-creating Health programme:

  • Self-management Programme (SMP) for people with long-term conditions
  • Advanced Development Programme (ADP) for clinicians
  • Service Improvement Programme (SIP) to redesign services.


Evidence gathered during a monthly casenote audit showed that individuals and clinicians were jointly setting an agenda and together agreeing goals and follow-up. Feedback demonstrated that the majority of service users felt they had the information they needed to manage their condition well and were supported by their clinician to manage their condition.

Other evaluations also showed that clinicians had changed their consultation behaviours and were enabling people to be more in control.

The trust also tested a combined COPD and diabetes programme, which was a success with good attendance and retention of participants.

Some of the specific actions the team took to ensure this success were:

  • Promoting SMP as part of the ADP course encouraged clinicians to refer to the programme.
  • Ensuring engagement and commitment from influential people within the organisation enabled CCH to become embedded as an important dimension of several organisational work streams.
  • Integrating self-management support activities into systems and pathways wherever possible ensured sustainability.
  • Collecting evidence to show that supporting self-management had a positive impact (by limiting emergency hospital admissions and reducing length of stay) to secure ongoing investment.
  • Working on making clinician training flexible to suit need, including introducing an e-learning module, enabling time-pressed clinicians to take part.
  • Adapting SMP and ADP, making them locally relevant and sustainable.

This project was twinned with the Co-Creating Health project at Cambridge University Hospitals NHS Foundation Trust.

Further reading

Research report

Co-creating Health: Evaluation of first phase

April 2012
Research report

This report gives the findings from an independent evaluation of phase 1 of our Co-creating Health...

About this programme


Co-creating Health


This programme ran between 2007 and 2012 and involved eight projects that aimed to embed...

You might also like...

Press release

NHS England statistics show hard work and dedication of NHS staff

Press release

Health Foundation response to the publication of NHS England's monthly performance statistics...

Press release

Growing concern about shortfall in social care workforce

Press release

Health Foundation response to the Skills for Care annual report, State of the adult social care...

Press release

Over a million more health and care staff needed in the next decade to meet growing demand for care

Press release

New report from the Health Foundation’s REAL Centre highlights huge scale of workforce shortfall.

Kjell-bubble-diagramArtboard 101 copy

Get social

We believe we have a responsibility to act on climate change and environmental breakdown. We're taking steps to re… https://t.co/bEZx8NYPsS

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more