Research has evidenced the benefits of using information and communications technology (ICT) in chronic disease management including improving information availability, communication methods and raising individual patient's self-awareness of their own conditions. Extending ICT use to support patients in the community through online services draws attention to the complex task of how to meaningfully acquire input from all potential users of such systems and to balance their competing interests. This paper explores these issues across system analysis, specification and design for a community based patient support system. The paper highlights user-centred design challenges in a situation where the patient-users were not able to be included during the planning stage and explores how this impacted on the subsequent development.