Your Chronic Disease Management Programme
Information for patients registered on our long-term condition recall register — each serving its own community, all part of the same practice.
You don't need to do anything right now. When it's time for your review, we will contact you directly by text message with booking instructions. Please wait to hear from us — you don't need to call the practice.
What is the CDM programme?
The Chronic Disease Management (CDM) programme is a structured NHS service that ensures patients living with long-term conditions receive regular, planned care. Barclay Medical Practice maintains a register of patients with conditions such as diabetes, asthma, COPD, and cardiovascular disease, and uses this to proactively contact patients and arrange annual health reviews.
These appointments help us monitor your health, check your test results, review your medications, and support you to stay as well as possible — all as part of your normal NHS care, at no cost to you.
How it works
Your practice identifies you as living with a long-term condition and adds you to the relevant CDM register.
You'll receive a personalised text from your practice nurse with the reason for your recall and how to book.
Book into a 10-minute hub appointment with the practice nurse at a time that suits you.
The nurse records your key health readings, reviews your medications, and updates your care plan.
When will I be contacted?
We run recalls quarterly — each condition group is contacted during a specific three-month window each year. Find your condition below to see when you can expect to hear from us.
- Type 2 Diabetes
- Asthma
- Respiratory conditions
- Cardiovascular disease
- Kidney disease (CKD)
- High blood pressure
- Atrial fibrillation
- Stroke / TIA
- Thyroid conditions
- Epilepsy
Learn more about your condition
Trusted NHS and charity information about the conditions covered by the programme.
Common questions
How will you contact me?
You will receive a personalised text message from your practice nurse. It will explain which condition the review is for and include instructions on how to book your appointment.
Do I need to contact the practice myself?
No — we will reach out to you during your condition's quarterly window. If you have urgent concerns before then, please contact us as normal or call NHS 24 on 111.
What happens at the appointment?
You'll have a 10-minute appointment with a practice nurse. This includes recording key readings such as blood pressure, weight, or HbA1c (depending on your condition), reviewing your questionnaire responses, and updating your medications and care plan. If anything needs further attention, we'll arrange a follow-up.
What if I don't respond to the first text?
If we don't hear from you, we'll send a reminder message towards the end of the quarter. If you're finding it difficult to attend, please get in touch and we'll do our best to find a suitable time.
Will my information be kept private?
Yes. Your information is held securely within our clinical system in line with NHS Scotland data protection policy. It is used only to plan and deliver your care.
I'm on the register for more than one condition — will I be contacted separately for each?
Possibly, as each condition has its own quarterly window. Where we can, we'll try to combine reviews into a single appointment to save you time. We'll explain this when we contact you.
Need to speak to someone sooner?
If you have concerns about your health before your review, please contact Barclay Medical Practice directly. For urgent medical advice at any time of day or night, call NHS 24 on 111.