Report says matrons ease GP workload
By Gareth Iacobucci
The debate over the value of the Government's community matrons scheme has taken a new twist after a national audit made dramatic claims for its effectiveness.
An analysis by NHS Employers found community matrons had successfully cut emergency bed days, costs and GP workload across the UK.
Some 80 per cent of 26 chronic disease management pilot sites reported reductions in inappropriate admissions and emergency bed days. One pilot, at Solihull PCT, found a 14.3 per cent saving in GP time.
But the report did not wholly contradict two recent audits finding matrons were failing to have the anticipated impact on admissions.
An analysis of one pilot site revealed the bulk of predicted cuts in hospital bed days came from reductions in length of hospital stay rather than admissions – provoking concern that patients were being moved out of hospital too quickly.
Cathy Devonport, assistant national lead of the large-scale workforce team at NHS Employers, insisted matrons were offering real benefits. 'People don't want to be in hospital if they don't need to be – community matrons can provide that care and prevent admissions.'
Professor Rod Sheaff, one of the team on the national evaluation of the Evercare community matrons scheme, questioned whether the apparent cuts in bed days meant quality of care had improved.
He said: 'By itself, I would not regard the number of emergency bed days as an indicator of quality of hospital care. A lot of other information would be needed – faster recovery, better-organised discharge or worse care, premature discharge.'
Professor Sheaff, professor of health services research at the University of Plymouth, said the reported reductions in hospital bed days seemed 'fairly credible' but questioned the failure to include control groups.
'The bed days for existing patients have to be offset against increased numbers of any new patients who are often found.'
Dr Martyn Walling, a GP in Boston, Lincolnshire, said he had doubts over the claims made for matrons. 'It's an expensive exercise – another person involved and another mouth to feed at the PCT. I haven't seen any evidence that they help reduce workload.'
Dr Prakash Kawar, a GP in Walthamstow, north-east London, also expressed surprise at the positive results. 'It might be different in some practices, but at the moment we haven't seen any difference at all.'
Key bed day savings
Dacorum PCT and Watford and Three Rivers PCT
• 470 bed days saved over
• Cost saving of £36,700
Kingston PCT and The Royal Borough of Kingston
• 565 bed days saved over
• Cost saving of £127,000 over
Swindon PCT and Swindon Borough Council adult care
• 483 bed days saved over four weekends
• Cost saving of £41,500