Living well with multiple morbidity

INTERVENTION: CARE Plus, Exploratory cluster RCT to test feasibility of carrying out complex intervention in high deprivation setting; Follow Up Length: 12 months Randomisation at practice level will then take place after baseline measurements are completed, with four practices randomised to control group and four to intervention. The CARE PLUS Intervention: core components The CARE Plus consultation is the core of the intervention. The ?ingredients? are an empathic person‐centred approach, a holistic assessment, and a specific and agreed plan of action. It will be based on a simple model, called the CARE Approach.1 The CARE Approach consists of; 1. Connecting with the person (not just the patient or the diseases) 2. Assessing issues holistically (using a bio‐psycho‐social framework) 3. Responding empathically and positively (validating suffering, identifying individual strengths) 4. Empowering and enabling (making a SMART plan of action based on patient?s priorities) The CARE Plus consultation is not designed as a ?tick box? exercise, though there will be required documentation of what was discussed, prioritised, and planned. An essential component will be the formation of an agreed list of priorities based on the patients needs and views, and a documented plan of action (which may include things that the practitioner will do in addition to the patient) with SMART objectives (Specific, Measurable, Achievable, Realistic, Time‐bound). As much as possible, practitioner will be encouraged to link patients with relevant local resources and community services, including the third sector. However an essential component of the intervention is also follow‐up, to review progress against the plan, help problem solve, and to repeat the process of the CARE Plus Consultation, moving prioritised items up the agenda to be tackled in the revised plan of action. The number of longer consultations that each patient will receive will be agreed between the practitioner and patient, but we env CONDITION: Generic Health Relevance ; Not Applicable PRIMARY OUTCOME: 1. Health‐related quality of life (Euro‐Qol 5D‐5L); 2. Well‐Being (W‐BQ12); ; Measured at baseline, 6 months, 12 months INCLUSION CRITERIA: For participating practices, the inclusion criteria are: NHS Greater Glasgow and Clyde general medical practices serving socio‐economically deprived populations that have previously registered interest in the study. For participating patients, the inclusion criteria are: 1. Males and females who are aged between 30 and 65 years 2. Who have two or more long term conditions 3. Whose healthcare provider believes are likely to benefit from and participate in the intervention for the duration of the study SECONDARY OUTCOME: 1. Hospital Anxiety and Depression Scale (HADS); 2. Self‐efficacy; 3. Self‐esteem: The questionnaire will also include demographic and socio‐economic status items, self‐rated multimorbidity burden; 4. Self‐rated general health; 5. Compliance with medication; 6. CARE measure and Patient Enablement Instrument (PEI) will be used at the first consultation in both groups, and then retrospectively at 6 and 12 months on the participating patients (n=200). Practices will also collect 100 such measures on consecutive adult patients not in the study at baseline, 6 months and 12 months to ascertain any effects of the intervention on consultation quality in general.; ; An economic analysis will also be carried out, based on the EQOL utility scores, and health service utilisation in control and intervention groups.