Community Matrons Research Articles

Community matrons - an exploratory study of patients’ views and experiences

The aim of the study was to explore patients' views and experiences of the community matron role in one primary care provider organization. Community matrons manage the needs of people living with long-term conditions in the community and aim to improve patient self-management and education, and enhance co-ordination between in primary and social care. A purposive sample of 14 service users (ten women, four men; aged 45-89 years) with a range of chronic conditions took part in interviews in 2007. A grounded theory approach was the framework for data collection and analysis. The role of the community matron appeared to have a positive impact on patient care mainly in three areas: access, patient advocacy and psychosocial support. Patients thought that they had easier access to healthcare services and that the community matron acted as an advocate by helping them to understand medical jargon and supporting them at hospital appointments, thereby providing a link to secondary care. Some patient perceptions differed from those about other primary care staff. There is evidence that community matrons may have a beneficial effect on patients' perceptions of their care, psycho-social support, access to services and advocacy. The impact of this role on the patient experience needs to be taken into account when evaluating this nursing role and services, as benefits may not be captured by relying solely on quantitative evaluations of hospital readmission rates.

Inter-organisational communication for patients being case managed by community matrons.

Background Poor communication between community matrons (CMs), in-hours and out-of-hours (OoH) general practitioners (GPs) causes uncertainty and inefficiencies. Setting A practice-based commissioning group in West London and the associated CMs who case manage high users of hospital services. Question What helps good communication between CMs, GPs and OoH services to ensure that the right patients are case managed and hospital admissions are avoided? Methods Whole system participatory action research, with four stages: 1) identify communication problems as perceived by a wide range of stakeholders; 2) draw a diagram of the existing communication system, and with stakeholders redraw this to overcome its weaknesses; 3) pilot the changes proposed; 4) gain consensus among stakeholders about policy. Results Stakeholders agreed that standards should be adopted to improve communication for the care of patients who are case managed by CMs. Routine passage of information between GP, CMs and the OoH services would achieve this, and is feasible. Specifically: routine information (termed Special Patient Notes) should be sent to the OoH service about vulnerable patients, including those who are case managed by CMsclear information about CM attachment to general practices and how to refer to them should be easily accessibleGPs and CMs should meet quarterly for mutual learning and to discuss patientsthe OoH service electronically should cascade information to GPs, CMs and others named in the Special Patient Notescommissioners should routinely gather data to compare clusters of general practices for i) referrals to CMs, ii) posting Special Patient Notes, iii) unscheduled consultations and hospital admissions of all patients including those being case managed. Discussion This project revealed system-wide communication problems for the care of patients being case managed by CMs, and ways to overcome these. Commissioners could insist that these are adopted locally, and gather data to prompt compliance and evaluate the consequential cost savings.

Support networks for community matrons

Reflective practice helps professional development.

Collaborative working in end-of-life care: developing a guide for health and social care professionals

This article describes a project to develop collaborative working between palliative care nurse specialists and community matrons for patients with a non-cancer diagnosis. Pathways to clarify decision-making in end-of-life care were created as part of the project and were subsequently developed into a guide for use by health or social care professionals caring for any patient, irrespective of diagnosis. The guide is designed to facilitate best practice in end-of-life care, by identifying the key questions which need to be addressed and the appropriate responses at different stages of the patient journey. The project was supported by the Help the Hospices' Care Beyond Cancer programme, funded by the St James's Place Foundation. The programme is designed to identify models of effective, replicable end-of-life care provision for patients with a non-cancer diagnosis, and to widen access to specialist palliative care.

Community palliative care: role perception

Community nurses play a key part in palliative care for patients and their families, yet there is relatively little research examining how their role is understood by nurses themselves. This paper presents findings from a qualitative study exploring how district nursing teams and community matrons (CMs) understood their own and each other's roles in palliative care. Twenty-four district nurses (DNs), 15 CMs and seven other key stakeholders were interviewed. DNs saw themselves as having a pivotal role, often coordinating other services as well as providing hands-on care. CMs agreed with the importance of the DN role, but had doubts about whether DNs had the capacity or skills to provide genuine case management. Both sets of nurses varied in their views of the CM role in palliative care, from seeing it as negligible to extensive and valuable. Organizational change contributed to the defensiveness of many DNs about their role, and to CMs' experiences of suspicion towards theirs.

Community matrons and long-term conditions: an inside view

This paper sets out to assess the impact of the community matron as perceived by those undertaking this relatively new nursing role. With the incidence of people living with long-term conditions continuing to rise and subsequently the costs of care set to increase, the role of community matron was identified as one approach to improve the management of these individuals living with chronic conditions. This included anticipating, coordinating and joining up care of specific high intensity patients with complex long-term conditions while supporting new ways of working to reduce unplanned hospital admissions and contain costs. Local primary care trusts (PCTs) were given guidance for the development of the community matron role with supporting frameworks for competency expectations and the use of case management techniques along with targets to achieve and a minimum case load criteria. Following the implementation of this role in 2005 a small scale study was conducted to evaluate the role using nine community matron participants working across NHS South of Tyne and Wear PCTs. Following in-depth interviews results were analysed and findings suggestive of many positive aspects of the role and areas still requiring further support and development.

Face to face

Sam Boobier spent several years working in acute cardiology and coronary care before moving into the community to become one of the first advanced primary nurses in England, a role which evolved into that of community matrons. In 2007, Ms Boobier became community matron lead for Bristol Community Health and has just been appointed deputy director of nursing and allied health professionals at Wiltshire Community Health Services. She spoke to Ruth Williams

Exploring the role of the community matron

The introduction of the community matron (CM) is important for the management of long-term conditions (Department of Health (DH), 2005b). However, the role is relatively new in the UK and evidence is limited as to how CMs perceive their role. This study has therefore examined CMs' perceptions of their role. The objectives of the study are to understand how CMs perceive and practice their roles. Furthermore, to analyse the affect of influencing factors on the CMs role and understand the perception of the role in light of Governmental policy. Two focus groups were held to which twelve CMs from a range of PCTs attended. Data were manually transcribed and an analytical approach was used to index the data. Six main themes emerged which are explored in the article. CMs perceived their role to be highly valued by their patients. The perception of their role by other professionals varied and anxieties about role recognition, support and dual roles were raised. Similarly, support from managers and PCTs varied. Training and developmental needs were highlighted to be paramount for their role. CMs were generally optimistic about their role, especially the positive effects it has had on their patients. However, the concerns raised.

Practice question.

Sam Boobier, community matron lead, Bristol Community Health Community matrons case manage a group of predominantly housebound older patients with long-term conditions, who are at high risk of emergency hospitalisation. They are experienced registered nurses trained in the management of long-term conditions and have advanced practice skills in holistic history taking and physical examination. They are able to assess, diagnose and treat people, including prescribing medications for a range of clinical situations that often affect people with long-term conditions.

An analysis of the impact of the NHS and social care model on patients with multiple sclerosis

This article analyses the impact of the Department of Health's policy document Supporting People with Long Term Conditions: An NHS and Social Care Model, on those who have multiple sclerosis. The application of a US managed care model to the UK is discussed, and the importance of effective commissioning in the success of the model highlighted. The impact of payment by results on the application of the model and the resulting impact on those with multiple sclerosis is analysed. Workforce issues, predominantly the recruitment of community matrons, and the reduction of multiple sclerosis specialist nurse posts are examined for the serious and unintended impact that they may have on the care and support that those with multiple sclerosis receive.

Developing a community matron service:a neighbourhood model.

NHS Blackburn with Darwen Provider Services Unit has adopted an innovative team approach to improve patient access to its community matron service. This article reviews the national picture and local development of the community matrons role.

Developing a community matron service: a neighbourhood model

NHS Blackburn with Darwen Provider Services Unit has adopted an innovative team approach to improve patient access to its community matron service. This article reviews the national picture and local development of the community matrons role.

Community matrons: primary care professionals’ views and experiences

This article is a report of a study exploring how the role of the community matron is progressing and any barriers or facilitators to performing the role. Long-term conditions are distressing for patients and costly for healthcare services. Government policy in western countries has increasingly focussed on more integrated and pro-active management of patients with multiple long-term conditions to maintain the ability of the aging population to function independently. The role of community matrons has been introduced in England in an attempt to address these issues. A purposive sample of 31 health and social care professionals participated in five focus group discussions. Reported experiences of the community matron role by community matrons, district nurses, social workers and general practitioners were analysed according to the principles of grounded theory. Data were collected in 2007. The community matron role was seen as effective in meeting the medical and social needs of patients. This was achieved through patient education, developing patients' self-management of their health conditions and monitoring their social needs. Potential barriers to success of the role were associated with lack of role definition prior to its introduction. It is unclear whether the role is financially viable in its current form. Further research is required to examine differing models for implementing the role and judging its effectiveness in bridging the primary-secondary care interface.

Providing an integrated admissions avoidance service

The long term conditions agenda is a national agenda which was introduced in 2004 as part of the NHS Improvement Plan. The plan highlighted long term conditions as one of the top three priorities for PCTs to deliver on. Initially the key element in providing the long term condition agenda was the community matron role providing care to patients who were considered to be very high intensity users of healthcare services. This article describes the integrated model of provision that Bassetlaw PCT adopted and goes on to explain the planned initiatives to enhance the model. The article explores the debate for an integrated approach and the issues associated with implementing that model. In particular the paper details the vision to provide a consistent service across the 24 hour period in order to reduce avoidable admissions to acute care. Finally, the article highlights the perceived outcomes of the model and the PCT’s future plans for expanding it.

A before and after study of the impact of Specialist Workers for Older People

Case management of vulnerable older people by Community Matrons has been introduced into the UK. A locally designed case management approach, The Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here we report an evaluation of this service. Before and after study of 418 people (207 before; 211 after) aged > or =75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, coordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload. There was a non-significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine GP surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001). Case management might reduce hospital admissions and is potentially a cost-effective service. However, not all case management schemes are successful. With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.

Service developments for managing people with long-term conditions using case management approaches, an example from the UK

This research has considered current developments in the provision of services for people with long-term conditions within the NHS of England. Community Matrons are being employed and by adopting a case management approach they are aiming to improve patient care and reduce their demands for acute hospital care. Qualitative research was undertaken to explore experiences of community matrons and service leads on the development, implementation and provision of services for people with long-term conditions. This research provides evidence of what is being done to meet the challenge of long-term conditions and provides lessons for similar challenges and service development for different areas of care and in other countries. Continual system and role change has had effects on service delivery and on the whole care. These effects relate to; defining the role of community matron and structure of service, training staff, identifying patients, providing infrastructure, demonstrating benefits, identifying gaps in services, ability to reduce avoidable admissions and identifying the advantages and difficulties of the role. All of these aspects should be used to inform future development.

Evaluating the role of mentor for advanced practitioners: an example from community matrons in England

AbstractThis study evaluates the role of mentor for the new community matron role in England and identifies the implications for others in advanced practice roles. With the introduction of 3000 community matrons in England by March 2008, a national pilot education programme was introduced to prepare them for their role. Given the recent requirement by the UK Nursing and Midwifery Council to introduce support at the advanced level of nursing practice, a purposely developed mentorship module was introduced for those supporting the new community matrons.A mixed‐method approach to data collection was used. This involved documentary analysis of a range of sources and, during July 2006, a self‐administered postal questionnaire was sent to all community matrons undertaking the pilot education programme (n = 70) with a response rate of 67% (n = 47). Individual telephone interviews were conducted with 17 students, and 6 mentors on the purposely developed mentor module. A focus group interview was undertaken with the education programme development team (n = 5). Quantitative data were analysed using spss and qualitative data analysed using content and thematic analyses.Despite some initial problems, 96% (n = 45) students had access to a mentor during the programme. Overall, the findings reinforce the value placed on individual support for the role and identify the problems associated when support was absent or unsuccessful. For those who had support, there were different expectations of the mentoring role, variation in the quality of their relationship and the perceived value of education to support the mentors in their role.The study concludes that supporting pioneers to develop new roles when neither party is clear about its strategic direction, nor fully aware of its impact on service, requires risk taking by both parties, and a genuineness, openness and commitment by both in forging the new pathway.

Community matrons and case managers: who are they?

In 2005 John Reid, the then Secretary of Health, announced the need for 3?000 community matrons to be appointed to coordinate the care of the growing numbers of people living with long term conditions. Although by the date agreed there were only 1?348 in post, according to Snow (2007), some PCTs have decided not to recruit further community matrons. Following the first evaluations of the role there also appears to be some confusion as to the title used by professionals who case manage this client group. The title of community matron has been used interchangeably with case manager, and therefore requires some clarification. This paper attempts to review the role of community matron and case manager, identify the professionals who take up these posts, and the professional qualifications and preparation required for the roles.

Recognizing the importance of palliative care skills for community matrons

Caring for people at the end of their lives is an important role for many health and social care professionals. One of the key aspects of this role is to discuss with individuals their preferences regarding the type of care and the location of that care. These discussions need to be handled with skill and sensitivity and the outcomes of such discussions then need to be documented, reviewed and communicated to other relevant people subject to the patient's agreement. The community matron is well placed to handle this planning. Several audits have demonstrated that end-of-life planning and palliative care are crucial aspects of the community matron's role. Training, development and support are therefore key to ensuring effective and efficient care planning to ensure positive outcomes for patients at the end of life.

A before and after study of the impact of Specialist Workers for Older People

Case management of vulnerable older people by Community Matrons has been introduced into the UK. A locally designed case management approach, the Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here, we report an evaluation of this service. Before and after study of 418 people (207 before; 211 after) aged >or=75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, co-ordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload. There was a non-significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine general practitioner surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001). Case management might reduce hospital admissions and is potentially a cost-effective service. However, not all case management schemes are successful. With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.