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Developing the Evercare pilots

From Dr Richard Smith, chief executive, and Nancy Williams, director of operations, both of UnitedHealth Europe

Your coverage of community matron-led long-term care schemes such as Evercare (News, 28 September) fails to acknowledge the limitations inherent in any early measurements of these pilot schemes.

The infrastructure that needs to be in place to ensure the Evercare processes or similar programmes can successfully reduce unplanned admissions is demanding. We have identified some 18 essential components.

One essential is GP involvement. The programme does not substitute for GPs but rather helps them improve care for frail, elderly patients.

An effective information system for identifying those most at risk, intense mentoring for community matrons, 24/7 cover, and access to intermediate care services are also all essential to implement this kind of proactive case-management system.

These crucial components did not exist until recently in many primary care trusts – and still don't in many.

The Evercare pilots therefore could never have had all these elements in place. Despite this, the evaluation by Picker Europe showed considerable improvement in patient and carer satisfaction. Importantly, we also measured improvements in staff satisfaction.

Case management plus a redesign of primary care can be an effective way to reduce unplanned hospital admissions. The question now is what further action is needed to improve these pilot systems.

It's because primary care trusts involved in the Evercare pilots have realised the importance of these essentials that their programmes have moved on. It was always anticipated that developments would be necessary.

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