Background and introduction: The management of chronic diseases now represents a major portion of health service provision accounting for over 10 million hospital visits per year and a significant share of the primary care budget. Three-quarters of all illness episodes are managed by individuals without recourse to healthcare professionals and there is evidence that people want a greater role in the management of their health including requests for more information, a role in medical decision-making and participation in disease management. The development of guided self-management regimes in the treatment of asthma and diabetes has shown that partnerships between patients and healthcare professionals in the management of these diseases can reduce morbidity and decrease healthcare utilisation. Chronic diseases tend to ran a relapsing/remitting course, and routine clinical review may not be the most efficient method of management because 1) clinic visits rarely correspond with disease activity and 2) there is frequently a delay between symptoms and treatment. The intervention: The purpose of this study was to assess a new approach to the management of ulcerative colitis. This is a chronic inflammatory bowel disease affecting over 100,000 people in Britain causing abdominal pain, diarrhoea and rectal bleeding. Like other chronic diseases, the symptoms are intermittent with periods of disease activity punctuated by episodes of relative quiescence. Instead of conventional treatment and follow-up, patients were offered the following package of care: 1) a personalised, guided self-management regime agreed in partnership with patients and based on their individual symptoms and circumstances, 2) hospital visits on request instead of routine pre-arranged appointments and 3) a telephone helpline for advice and to arrange clinic appointments. The new system was assessed in a randomised, controlled, multi-centre clinical trial. 203 patients were randomised to receive either standard treatment and follow-up or the new system of care. The trial lasted 14 months. Results: There was a highly significant reduction in the number of hospital visits and visits to the G.P. by patients in the intervention group compared to controls. Hospital visits: 88 by subjects, 297 by controls. G.P. visits: 26 by subjects, 77 by controls. The delay between symptoms and treatment was also reduced from a mean of over 3 days to less than 24 hours. The majority of patients preferred the new system of care and only four out of 101 subjects wanted to return to the original system. The new package of care resulted in financial and time savings for patients and a highly significant reduction in healthcare provision. There was also a significant but clinically very small improvement in quality of life scores for patients in the intervention group. Conclusion: Guided self-management and follow-up on request is a new approach to the management of colitis which is acceptable to patients, provides more effective healthcare and reduces the demand on health service provision.