ABSTRACT

The commonest cause of the deaths of most people alive today will be a chronic illness. In most cases this illness could have been postponed, at least, if not prevented. Most chronic illnesses should be better managed. The key to improving chronic illness management lies in systematic structured care or what has been proposed as the Chronic Care Model (Wagner et al., 2001). The risk of ill-health or death from chronic illness varies amongst different groups in a population. The risk is often greater amongst those who are more

socio-economically deprived. It makes sense, therefore, to target efforts to improve the care of diseases such as ischaemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease as closely as possible to those at greatest risk. Chronic illness care presents a dilemma for gen-

eral practitioners (GPs) and primary care teams. Can the ethos of personal care, which has been at the core of general practice throughout the twentieth century, be maintained in an environment that also demands precise disease management skills and the delivery of national strategies to local populations (van Lieshout et al., 2011)? A tripartite approach to the care of chronic illness

Most chronic illnesses present the patient with a tough challenge. Usually the challenge can be lived with; less often can it be overcome. The task that faces the doctor is also challenging. It requires technical expertise, a personal partnership with the patient, and more recently acknowledgement of the need to deliver a service to the whole population. For the modern general practitioner this implies a responsibility to all registered patients.The treatment of chronic illness is helped by a keen grasp of the complex effects the illness has on the individual. It also requires a clear structure within which effective and predictable long-term care can be provided.