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Community matrons - the shape of things to come

Marilyn Eveleigh
Consultant Editor

There have been suggestions about new ways of providing community nursing care for the last year, often based on an American model whereby holistic case management of patients with multiple needs is provided to avoid hospital admission. Nine PCTs in the country have been piloting the use of advanced nurse practitioners for a small number of patients who account for a large number of hospital admissions.
Since the publication Supporting People with Long Term Conditions: Liberating the Talents of Nurses who Care for People with Long-Term Conditions,(1) in January 2005, the term "community matron" has been hailed as the new leader and advocate for patients with more than one chronic disease and high-intensity needs. The role is intended to avoid hospital admissions by proactively identifying patients with complex requirements, assessing their physical, psychological and social needs, and coordinating a proactive case management plan for them. Each community matron will have around 50 patients in their caseload at any one time, ensuring 24-hour, seven-day a week support from a variety of health, social, family and voluntary sector providers.
The Health Secretary announced that 3,000 community matrons are to be appointed by 2007. There is little doubt that the majority of these posts will come from existing community roles in district nursing, practice nursing and older people health visiting disciplines. However, hospital nurses who are experienced in discharge planning and coordinating a wider range of support agencies will be well suited to the role. It requires experienced, mature and skilled practitioners. They need to have the confidence to push out traditional boundaries, join up existing services, challenge poor practice and coordinate agencies. They will have the imagination and capacity to support patients in making personal choices about their care, including decisions that allow them to remain at home until the end of their life.
It is just the sort of care package that you would want for your own loved ones. It is just the sort of care you have always wanted to be able to give as a nurse - but barriers such as workloads, hierarchies and bureaucracy daunted your confidence. These roles will unblock such blockages - so watch out hospital consultants, rigid nurse management and elusive social services.
It is clear that a community matron must be a nurse. It is unclear where the nursing staff will come from when we have a continual shortage, despite new returners. New posts are already in place, but roles and skills appear very variable. Many are skilled in advanced physical assessment and prescribing, but it is not at all uniform nationally. Titles are inconsistent, and pay grading/banding is interesting. Yet does it matter? The successful coordination of care is the key - getting the best person at the right time.
I'm anticipating great opportunities ahead for patients and the profession. If you have not read Supporting People with Long-Term Conditions, make it a priority - it is about us! It is about how we can make a future of ill-health more healthy.

Reference

  1. Available from www.dh.gov.uk/cno, or tel: 08701 555 455, or email dh@prolog.uk.com