A “rapid response” home nursing service, which features the expertise of community matrons, has helped reduce GP callouts and emergency hospital admissions in South Tees.
The service, which is delivered by community staff from South Tees Hospitals Foundation Trust, was initially set up to provide assessments by nurses in patients’ homes.
“The GPs have a lot of confidence in the community matrons”
However, it has since evolved to incorporate the expertise of community matrons.
The move has led to big increase in referrals from GPs, explained Val Gair the trust’s head of nursing for integrated care.
“The GPs have a lot of confidence in the community matrons, as they can offer advanced clinical skills and nurse prescribing as well as being able to put in place a management plan for the patient,” she said.
“It’s easing the pressure on the system as GPs don’t have to be called out or admit the patient to hospital. Previously around 75% of these patients would have ended up going to hospital,” she added.
Since the community matrons came on board, GP referrals have increased from about three to 16 per month.
Meanwhile, South Tees Clinical Commissioning Group has seen a 3.9% reduction in emergency admissions over last year, which compares to a 3.9% increase nationally.
“The additional expertise brought to the team by community matrons enables more of our patients to be supported at home”
The service runs from 8am to 11pm seven days a week, taking referrals from GPs and the 111 non-emergency number.
In total, 18 community matrons cover the Middlesbrough, Redcar and Cleveland area, working closely with the integrated community care team for patients with long-term conditions.
All referrals are responded to within two hours and patients are then monitored for 72 hours before being discharged or placed under the care of their local community matron.
The changes to the service were introduced as part of a wider CCG programme to improve care for vulnerable and elderly patients.
“The additional expertise brought to the team by community matrons enables more of our patients to be supported at home rather than being admitted to hospital unnecessarily,” said programme lead Dr Ali Tahmassebi.