Long Term Health Clinics

These clinics are for patients with long term “chronic” conditions and are run by our multi-skilled team of Health Care Assistants and Nurses. Examples of chronic diseases we manage are:

  • Diabetes
  • Pre Diabetes
  • Asthma
  • COPD
  • High blood pressure
  • Heart Disease

Once a person has been diagnosed with a chronic condition, they are included on a register and will be invited yearly for review of their condition/s.  This review maybe done virtually by remote monitoring, using emails, texts, video consultations, group sessions or face to face consultations. You may find that you will be asked to provide more information yourselves rather than to attend the surgery as often.

Some people may have more than one chronic disease so we will try to manage all conditions in one appointment if possible.

Our aim is to:

  • Educate and enable people to manage their own health, where possible.
  • To monitor and identify progression of their condition/s so that active steps can be taken to step treatment up or down.

If you have been sent a message to fill in our “long term condition questionnaire” please click on the link below to access it:

LTH Questionnaire


Once this form is completed please either drop into the surgery or email it to us at:


  • Asthma Clinic

    This nurse-run asthma clinic provides advice and ongoing support for newly diagnosed and established asthmatics. All aspects of care are provided including assessing symptoms, triggers and treatments as well as self-management plans. Adjustments to medication and devices may be made if appropriate and prescriptions issued in liaison with GPs.

    All new patients with asthma registering with the practice are invited to attend the asthma clinic and annually thereafter if well controlled.

    If you think that you might have missed your routine annual asthma review, or feel that you would like to update us on your asthma symptoms and management, please complete and return the form below. Once completed you can email the form to sehccg.swansurgery@nhs.net, or post it to us at the surgery address on the form. Alternatively, please contact the surgery for an appointment for your annual asthma review. After returning your form it will be reviewed by the team and you may be contacted to discuss your asthma or invited to asthma clinic. We aim to review submitted forms within 5 working days.

    Asthma Questionnaire
  • Diabetic Clinic

    If you are someone living with diabetes you will require regular monitoring and occasionally additional support to help care for yourself.

    You will receive a letter inviting you to attend for this review in the month of your birthday. This initial review will be performed by our trained Health Care Assistants who will liaise with our Diabetes Specialist Nurses and your GP to ensure you receive the best care. Our service offers one to one personalised care both face to face, by telephone or email and some group sessions, both real and virtual to enable individuals with diabetes to take responsibility for their day to day needs and provide you with the opportunity to discuss your condition.

    Patients who also attend hospital specialist diabetes services will receive an invitation to attend the surgery to complete their annual diabetes review.

    Below are some links that you may find helpful:

    Why do I need the checks?

    What do my results mean?

  • Hypertension

    What is hypertension?

    High blood pressure, or hypertension, rarely has noticeable symptoms. But if untreated, it increases your risk of serious problems such as heart attacks and strokes.

    The following NHS link is a good explanation and I think appropriate to be on the SMG website. It answers many questions and offers the individual the chance to put in their BP and see what their risk is and how to manage it:


    How is SMG managing the monitoring of people with hypertension?

    Most people with established hypertension are not unwell, but they do need to have an annual review and an annual blood test.

    We are now offering patients the opportunity to complete a form with such information as their Blood Pressure, weight, smoking status etc.  and return it to the surgery at the same time as having their routine yearly hypertension monitoring blood test done. This ensures that the checks needed are completed without the patient having to make a booked appointment with a HCP. All results are reviewed by their GP who will contact the patient if anything needs changing.

    If however, an individual would like to have help with this or wants to speak to a HCP, they may attend a small group session where all this can be done and there will be time to ask relevant questions about their condition at this time.

    If someone also has diabetes or prediabetes they do not need to attend a specific hypertension review as all the checks will be included in their diabetes and prediabetes assessments, which we encourage them to attend.

    The process for the hypertension groups is

    • Letter of invitation will be sent to the patient including a blood request form and a form with the relevant questions.
    • The patient gets a blood test done and the GP will review the results
    • The patient can then either attend group or complete form and return to the surgery. High BP readings will trigger further action by the HCP and change in medications may be discussed with GP or prescribing nurse.
    • Any concerns re blood pressure can be addressed on the day in the group if the individual is happy to do this or directly with the nurse running the group at the end of the session.
    • Once the patient has provided all the required information they can leave.

    We are also pleased to announce that we can now sell patients their own home use BP monitor if you wish, this is a British Heart Foundation approved model and only costs £15, please ask at reception for full details.

    For patients who are carrying out home blood pressure monitor readings, please see this LINK to our guidance and instructions, once these results are submitted to the practice we will average these results and add to your medical record, if any issues with the readings are identified a HCP will be in touch.

  • Chronic Obstructive Pulmonary Disease Clinic

    This chronic lung disease, primarily caused by smoking, can be very debilitating. The clinic aims to improve quality of life for patients and control symptoms. An annual check provides an opportunity to assess lung function and monitor disease progression, address lifestyle issues and give support and advice.