Your doctor has invited you to attend a longer appointment to discuss any concerns or issues.  These are some of the things other people have found it helpful to talk about.   Please put a cross on the line to show how much of a problem each item is for you.  
		Not a                                                                 Big                                                                        Problem                                                            Problem                                                            	
	Being tired / No energy / Fatigue	  -----------------------------                                           	
	Stress and worry	  -----------------------------                                           	
	Feeling low or tearful	  -----------------------------                                           	
	Shortness of breath	  -----------------------------                                           	
	Pain	  -----------------------------                                           	
	Sleep problems	  -----------------------------                                           	
	Managing to work	  -----------------------------                                           	
	Money / benefits	  -----------------------------                                           	
	Housing / where you live	  -----------------------------                                           	
	Family / friends / relationships	  -----------------------------                                           	
	Having children	  -----------------------------                                           	
	Support from the NHS	  -----------------------------                                           	
	Learning about your condition	  -----------------------------                                           	
	Being able to relax	  -----------------------------                                           	
	Doing exercise	  -----------------------------                                           	
	Walking / climbing stairs	  -----------------------------                                           	
	Getting out and doing things that you enjoy	  -----------------------------                                           	
	Sexual problems	  -----------------------------                                           	
	Eating a healthy diet	  -----------------------------                                           	
	Stopping smoking	  -----------------------------                                           	
	Managing your medicines	  -----------------------------                                           	
	Measuring your symptoms at home	  -----------------------------                                           	
	Any other problems	

Now please put a cross beside the 3 items you feel that you would most like to talk about 
Time to Talk
“Time to talk” is aimed at people with two or more long term conditions.  The aim of the service is to offer them an extended consultation with their GP or practice nurse to discuss wider issues they may not normally have time to address such as worries, depression, lifestyle and family issues.

Research shows that the use of a patient “prompt” sheet acts as memory aid; provides a focus for the consultation; gives patients “permission” to discuss certain things and helps provide greater tailoring for the patient.  Overleaf is the prompt sheet currently being used for this service in City and Hackney. 

Care Plans
Your doctor or nurse may also want to discuss what goals and wishes you have and help you record them in a care plan. You may be sent your results.  Please think what you might want to change, and how, and what help you would want. For example, many people may want to set goals around getting more exercise, changing their diet or stopping smoking.  You might want to do activities in your local community. This will be your chance to find out what is available and what support you can get.  

Please make a note of any changes or new goals you are thinking about:

Feeling Low

If you feel low, it would be helpful if you could fill out the questionnaire below about how you are feeling 

(PATIENT HEALTH QUESTIONNAIRE-4)

Over the past 2 weeks have you been bothered by these problems? 	Not at all 	Several days 	More days than not 	Nearly every day 	
Feeling nervous, anxious, or on edge 	0 	1 	2 	3 	
Not being able to stop or control worrying 	0 	1 	2 	3 	
Feeling down, depressed, or hopeless 	0 	1 	2 	3 	
Little interest or pleasure in doing things 	0 	1 	2 	3 	

The thought of harming myself has occurred to me (circle one) 		No		Yes
Name: ____________________________________
Today’s Date: _____________________________