Chronic care in the English National Health Service: progress and challenges.

One of the aims of the English National Health Service (NHS) reform program has been to give higher priority to chronic care. Chronic care policy has focused on self-management, disease management, and case management, alongside a number of related initiatives. A start has been made in implementing these initiatives, and some are beginning to demonstrate benefits, like the new pay-for-performance contract for family physicians. However, investment in the chronic care policy has been modest, and the emphasis on case management appears to have been misplaced, when it is the cumulative effect of different interventions that is likely to have the greatest impact.