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Exclusive: Netherlands nurse-led community model to be tested in UK

  • 9 Comments

A community nurse-led care model that sees management functions shared between staff and ensures at least 60% of time spent is with patients is being tested in the UK, following success in the Netherlands, Nursing Times has learnt.

The Buurtzorg – or “neighbourhood care” – model uses teams that have a maximum of 12 district nurses to deliver care in people’s homes.

“There is a huge pent-up desire of nurses to work in this way because they want to be treated as professionals, with responsibility and freedom”

Brendan Martin

The typical caseload for a team is 40 to 60 patients in the local area, although most nurses in Holland work part-time under this model.

Nurses are self-managed and co-ordinate care with other healthcare professionals, such as GPs and allied health professionals.

They work within guidelines including the requirement to have an office that is in a prominent place in the neighbourhood, to use 3% of their turnover for training, have a diversity of nurse specialisms, and to share eight defined management and administrative responsibilities between them.

Nurses must also spend at least 60% of their working time with patients and no more than 40% on other activities such as meetings and travelling.

They have access to coaches for wider support and a central back office that processes their billing, but are responsible for their team’s own finances and use of time.

In Holland there are now 850 teams, with more than 10,000 nurses since the model was devised in 2006 by former nurse Jos de Blok.

Research and patient surveys have suggested the model has improved outcomes for people, with patient satisfaction in particular having increased, according to those behind it.

“There is absolutely no reason why the fundamental ethos of Buurtzorg.. can’t be applied very successfully to other settings, including acute”

Brendan Martin

In the Netherlands the social enterprise model is estimated to run at around 30% less cost than conventional hierarchical health and social care systems in the country.

Meanwhile, nurse job satisfaction is high due to the autonomy of the role according to Brendan Martin, managing director of consultancy organisation Public World, which is the official partner for delivering the Buurtzorg model in the UK.

“In terms of job satisfaction, it speaks for itself. There’s a lot more nurses wanting to join Buurtzorg than Buurtzorg is able to provide jobs for,” he said.

“There is a huge pent-up desire of nurses to work in this way because they want to be treated as professionals, with responsibility and freedom at the frontline,” he added.

However, he acknowledged there were some challenges to address in adaptation for the UK, due to the model’s requirement for frontline nurses to have additional management responsibilities.

“One of the issues Buurtozorg is grappling with is, because nurses are providing care in this way, it can be difficult to manage their work/life balance,” he said.

”One of the issues Buurtozorg is grappling with is…it can be difficult [for nurses]  to manage their work/life balance”

Brendan Martin

“We don’t want to swap one type of burnout for another. We are trying to solve that problem of stress at the frontline, rather than producing another kind of stress,” he said.

Around a dozen organisations in the UK – including one that provides home care – are currently looking at how the Buurtzorg approach could be adapted for this country.

Two are due to pilot versions of the model later this year – Guy’s and St Thomas’ NHS Foundation Trust in London and a consortium of health and social care providers and commissioners in West Suffolk.

The Netherland health service is funded by insurance – compared to the UK’s free and means-tested health and social care services – which has allowed the model to grow at a slow pace by taking on gradually increasing numbers of patients.

Public World

Netherlands nurse-led community model to be tested in UK

Brendan Martin

But Mr Martin said he believed it was possible to transfer it to UK organisations quickly based on the success of similar, large organisations adapting the approach in Holland.

He referred to one private health and social care provider – Zorgaccent  which has more than 2,000 staff, but switched to the Buurtzorg model within 18 months.

Mr Martin also said, although the care model had been designed for community nursing, he believed some aspects could be applied to acute settings in the future.

“There is absolutely no reason why the fundamental ethos of Buurtzorg – in terms of enabling frontline care givers to exercise their vocation and to be supported to be nurses rather than be controlled from above – can’t be applied very successfully to other settings, including acute,” he said.

  • 9 Comments

Readers' comments (9)

  • michael stone

    I listened to a very interesting BBC Radio 4 programme about this method of community nursing perhaps a year ago.

    What was highlighted most by the radio programme, and this doesn't seem to be so obvious in the NT piece, was that the nurses were what I would describe as 'self-tasking' in terms of deciding how much time particular patients actually needed, etc, so the patient's were effectively more in control of the visits they received (because the nurses were responsive to the patient in front of them, as opposed to the nurses being 'tasked from above' re their 'time allocation'). Both the patients and the nurses, seemed to like the system.

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  • Having read the reports on this model it's good to know it is being tested. As I understand it the teams are all qualified nurses showing again that their use is a key factor adding to the large body of similar evidence . it would be good to see a trial of a similar approach in acute settings.

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  • Heard the founder of this system in Adelaide a couple of years ago - Yes it is entirely nurse led in self managing teams - very interesting model!

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  • michael stone

    Why did I write 'so the patient's were' ? - my brain is showing signs of wearing out.

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  • Good to read the positive reactions and the way you implement our working/ organisation home care model in the UK. I am working now withmuch pleasure for more than three years as a nurse in a Buurtzorg team in Almere/ Netherlands. It is a great chalenge to keep the team in a continues state of self organisation . This demands skills such as selfreflection, feedback , and professional quality methods f.i. Intervision en teamcoaching. I can asure you that no one of my colleageus want to switch back to their " old hierarchical " organisations.

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  • michael stone

    Hi Hemmo, thank you for giving NT 'an insider's view'.

    The NT article did include:

    '
    5 COMMENTS
    Full screenDistrict community nurse home visit carer
    A community nurse-led care model that sees management functions shared between staff and ensures at least 60% of time spent is with patients is being tested in the UK, following success in the Netherlands, Nursing Times has learnt.

    The Buurtzorg – or “neighbourhood care” – model uses teams that have a maximum of 12 district nurses to deliver care in people’s homes.

    “There is a huge pent-up desire of nurses to work in this way because they want to be treated as professionals, with responsibility and freedom”

    Brendan Martin
    The typical caseload for a team is 40 to 60 patients in the local area, although most nurses in Holland work part-time under this model.

    Nurses are self-managed and co-ordinate care with other healthcare professionals, such as GPs and allied health professionals.

    They work within guidelines including the requirement to have an office that is in a prominent place in the neighbourhood, to use 3% of their turnover for training, have a diversity of nurse specialisms, and to share eight defined management and administrative responsibilities between them.

    Click here!
    Nurses must also spend at least 60% of their working time with patients and no more than 40% on other activities such as meetings and travelling.

    They have access to coaches for wider support and a central back office that processes their billing, but are responsible for their team’s own finances and use of time.

    In Holland there are now 850 teams, with more than 10,000 nurses since the model was devised in 2006 by former nurse Jos de Blok.

    Research and patient surveys have suggested the model has improved outcomes for people, with patient satisfaction in particular having increased, according to those behind it.

    “There is absolutely no reason why the fundamental ethos of Buurtzorg.. can’t be applied very successfully to other settings, including acute”

    Brendan Martin
    In the Netherlands the social enterprise model is estimated to run at around 30% less cost than conventional hierarchical health and social care systems in the country.

    Meanwhile, nurse job satisfaction is high due to the autonomy of the role according to Brendan Martin, managing director of consultancy organisation Public World, which is the official partner for delivering the Buurtzorg model in the UK.

    “In terms of job satisfaction, it speaks for itself. There’s a lot more nurses wanting to join Buurtzorg than Buurtzorg is able to provide jobs for,” he said.

    “There is a huge pent-up desire of nurses to work in this way because they want to be treated as professionals, with responsibility and freedom at the frontline,” he added.

    However, he acknowledged there were some challenges to address in adaptation for the UK, due to the model’s requirement for frontline nurses to have additional management responsibilities.

    “One of the issues Buurtozorg is grappling with is, because nurses are providing care in this way, it can be difficult to manage their work/life balance,” he said.'

    which is obviously alluding to your:

    'It is a great challenge to keep the team in a continues state of self organisation'

    But, if both patients and nurses 'tend to prefer' the method to 'the older hierarchical models', then it looks good to me !

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  • michael stone

    The comment that appeared from me yesterday, isn't what I thought I'd posted !

    Anyway, what I INTENDED to post was:

    MICHAEL STONE 19 JULY, 2016 2:08 PM

    Hi Hemmo, thank you for giving NT 'an insider's view'.

    The NT article includes:

    “One of the issues Buurtozorg is grappling with is, because nurses are providing care in this way, it can be difficult to manage their work/life balance,” he said.'

    which is obviously alluding to your:

    'It is a great challenge to keep the team in a continues state of self organisation'

    But, if both patients and nurses 'tend to prefer' the method to 'the older hierarchical models', then it looks good to me !

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  • Michael.
    The management of the work/life balance is a HRM challenge in almost every knowledge and care intensive organisations. This is not unique for Buurtzorg. A high quality of patientcare starts with the sense op responsibility of care for your own teammembers / colleagues. This is an essential attribute of the teamculture at Buurtzorg .

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  • michael stone

    Hemmo,

    One of the problems with the NHS, is that it is a 'structured and hierarchical' massive organisation, and as a result there is a lot of 'top-down instruction' 'inside the NHS'. I see this all the time, for end-of-life (the thing I'm interested in).

    So while you are of course absolutely correct, the aspect of the Buurtzorg model which I like, is the greater freedom of the nurses from 'operational instructions from above'.

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