Dr Anita Sharma explains how delegating responsibility to her community matron has freed up practice time and improved the care of her patients
The community matron scheme was a part of five-year national plan announced by the then health secretary John Reid in 2004, and since then I have had a community matron attached to my practice.
A community matron is a senior experienced nurse who has minimal five years post registration experience and an in depth knowledge of long term chronic illnesses. Most have a diploma/degree in nurse prescribing and it is worth thinking how they can be used more effectively.
My patients and practice have benefited a lot from our community matron's good problem solving, negotiating and communication skills. Here is how.
1. Flu vaccinations: Our practice is currently very busy immunising at-risk groups, we have asked our community matron to help with immunising older and house-bound patients and this will help us achieve the target of 75% this year.
2. Managing chronic disease: Our community matron is trained to diagnose, treat and monitor patients with COPD and I have no problem with her prescribing inhalers because I know she prescribes cost effectively (I was her mentor!). Print out a list of all your house-bound patients with COPD and heart failure and discuss their management plan with a community matron. Make her in charge of their management and if they are a trained prescriber, take advantage of his/her skills.
3. Home visits: If a patient, who happens to be on our community matron's list, rings for a visit, (e.g. because of an acute exacerbation of COPD) we direct the visit to her. They will assess whether the patient warrants an admission and the patient is happy to see a familiar face.
4. Coordinating input from other agencies: As a hard-pressed GP, you are not always the best person to coordinate social services, housing benefits etc etc. Community matrons have good problem-solving and negotiating skills and can do this more effectively than a GP can.
5. Medication reviews and needs assessments: A community matron has the ability to do physical, mental and social care needs assessments in patients with chronic illness. We delegate this job to them and ask them to carry out compliance checks and conduct medication reviews. Our community matron ensures patients are using the correct technique with inhalers, monitors blood pressure and orders regular blood tests. This saves my time as a GP and also our practice nurse's time.
6. Follow-up checks: A patient discharged from hospital after an acute exacerbation needs a follow-up visit. Our community matron does this for us and then feeds back to us.
7. Educating patients: Community matrons are good at health promotion, educating patients and carers about the disease process, and preventing complications, such as exacerbations. They have more knowledge of what health promotional activity is going on locally and can refer patients for smoking cessation advice, alcohol counselling and counselling for anxiety and depression. They are also good at making sure that the appointment is kept – saving us the trouble of re-referring.
8. Educating students: Our community matron takes medical students on home visits of house-bound patients. This is a really useful learning experience for them and gives them an insight into how patients and carers live and manage at home. It also gives them a clearer picture of the roles and responsibilities of different team members working in primary care.
9. Keeping you informed: Our community matron attends PHCT meetings and updates us about each and every patient on her list. She is an important part of the team even though we do not see her daily.
Dr Anita Sharma is a GP in Chadderton, Greater Manchester
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