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Community matrons failing to hit caseload targets

By Lilian Anekwe

Community matrons are failing to hit caseload targets set by the Department of Health for the number of patients, with some struggling to manage caseloads of just ten patients.

A new analysis has found community matrons are working on such a small scale that they are unlikely to have an impact on patient outcomes.

They were expected to manage a caseload of between 50 and 80 patients, as a key plank of the drive to reduce inpatients emergency bed days by 5%.

But a study across six PCTs carried out at the National Primary Care Research and Development centre, funded by the DH, found that ‘few community matrons in any of the six sites had been able to achieve or maintain the 50-patient target.'

Researchers found community matrons were ‘anxious' that their caseloads did not exceed 50 patients, feeling they would struggle to manage high-risk patients who required more complicated, time-consuming care.

The research, involving interviews with 46 community matrons working with older patients or those with long-term conditions in six PCTs in England, also found that the greater the caseload, the more community matrons shifted from proactive to reactive, unplanned and episodic models of care - contrary to government guidance.

Many matrons admitted that when this occurred ‘quality of care provided to patients decreases and hospital admissions may increase.'

The research report, published in the January issue of the Journal of Nursing Management, urged the Government to revise the 50-patient case load target.

Professor Ruth Boaden, professor of service operations management at the Manchester Business School and an author of the research, said: ‘The findings indicate that community matrons are struggling to achieve and maintain Department of Health targets to case manage 50 patients with long-term conditions.

'That target currently lacks an evidence base and the research also suggested that large caseloads reduce the level of care provided to individual patients and distort models of case management away from their intended design.'

Dr Donal Hynes, a GP in Bridgwater, Somerset and PECtchair of Somerset Coast PCT, set up a successful service fun by medical nurse practitioners in a local community hospital that is reducing admission rates and is planning two more.

He said: 'There is little doubt that the concept of community matrons will work but the limitations of putting principle into practice are highlighted here.

'Where they have fully engages with local practices and community staff, they become a very effective force. But when they are used to either repair local deficits in nursing numbers or are excluded from integration into practices it is easy to see why they fail to deliver their expected outcomes.'

Community matrons

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