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GPs sceptical of community matron value


Community matrons could become a casualty of the latest NHS reforms due to the low opinion in which the role is held by GPs, latest research suggests.

Many GPs are sceptical about the impact of community matrons and see them as a danger to traditional services, according to a study published in the British Journal of General Practice.

This is despite nurse-led case management of long term conditions increasingly being championed as one of the main alternative service models to hospital care.

The Royal College of Nursing said the findings – based on interviews with GPs, nurse case managers, and community service managers across three primary care trusts – were concerning.  

The researchers investigated views on nurse case management, including the specialist role of community matrons in dealing with complex cases, ahead of the transfer of most NHS funding decisions to GP-led clinical commissioning groups in April 2013.

The study authors said: “The dominant mood [among GPs] was scepticism about the ability of nurse case managers to reduce hospital admissions among patients with complex comorbidities. Community matrons in particular were seen as staff who were imposed on local health services, sometimes to detrimental effect.”

They said many GPs considered the “current model of community matron as resource intensive” and questioned whether the “resources financing it might be used to greater effect in other ways”.

In addition, the authors added that managers “all reported that their organisation and the wider commissioning community were questioning the value of the community matron posts as currently configured”.

Royal College of Nursing primary care advisor Lynn Young warned that “quite a few community matrons were already losing posts, or having to reapply for them”.

She said the community matron role worked well in some areas, but had suffered from “unsatisfactory” introduction and development in others, often when district nurses were “shoved” into a community matron role overnight.

“There’s a lot of work to do in these areas of nursing. The whole conglomeration of nurses in the community is as messy as it’s ever been.”


Readers' comments (10)

  • This is the problem when nursing roles are left to be moulded by different trusts according to whatever is the current political fashion. It is the NMC and RCN that should be inforcing a structured career path in nursing (whether it is leading into secondary or primary care) that is standard across the UK. Then roles can be clearly defind... At the moment "matron" can mean different things in different trusts.

    I think this variance makes for a lack of unity amoung nursing making for a weak workforce that is an easy target for (possibly) by GPs feeling threatened. Because lets face it, what they say goes unfortunately.

    This article to me illustrates perfectly this desire to down dumb nursing by some GPs/doctors and most politicians. For some reason they don't like us being educated, nevermind benefits to patients.

    I really do exasberate and pull my hair out with the NMC and RCN because they should be dealing with this issue!

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  • The comment above illustrates a general problem of 'team working'. Everyone sees things from their own perspective, and this means that nobody will ever entirely agree about where 'a sensible balance' is.

    As healthcare is supposed to be primarily about the best outcome for the patient, but different sorts of professionals can be involved in that care, the correct test is not 'what do nurses think would be better ?', or 'what do GPs think would be better ?' but 'what gives the patient the best outcome ?'.

    If different approaches are tried, and one clearly works better for the patients, that one is best - but even that will tend to be disputed, if the objective outcome does not suit a particular profession.

    The RCN and BMA are not really 'partner organisations' ! And politicians are very rarely true 'partners' with anybody !

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  • This is a fundamental problem isn't it, GPs will not see any value in ANY role within our profession, certainly not any advanced role! So what do you think will happen when they get control? We may as well kiss our profession goodbye now!

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  • Mike I disagree. The lead GP for the nursing home in which I work is pushing for me to able to do my ANP & Nurse Prescribing course - he has even offered to part fund it from the Surgery budget.

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  • Following on from what Anonymous | 26-Sep-2011 5:50 pm said....

    Could this mean that nurse roles will vary area to area according to what GPs want as well as what trusts want....?

    Everywhere I look nurse roles are being created, dissolved, recreated, reinstated, nurses redeployed etc etc. But patient needs are constant and still need to be cared for.

    We nurses should be taking control of our own profession, not just for our own sake but for the stability of good patient care across the country... would anyone dream of messing around with GP role? I think not.

    Hope I make sense.

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  • I also disagree with Mike. I am a District Nurse, on the whole GP's really value District Nurses and I think that they, and we, see it as a real kick that instead of developing DN teams, who are the experts in their communities and care in that community they side line us and put in a few 'matrons'. I think GP's who themselves are Generalists know that Primary Care needs generalists at its core. Too often the specialist role is at the expense of the generalist. In my trust the long term condition nurses are duplicating our work, confusing patients and do not provide the holistic comprehensive 7 day a week service that patients in the community need. I hope that GP's can influence community nursing because I am confident that they will support the role of the District Nurse and maintain the tradition that we have in adapting to the needs of the practice population.

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  • Whilst I agree there are individuals who - as some of you have pointed out - do support our profession and its progression, my point (although not well defined in my first post) is much more of an overall one, as I do not believe GPs as a whole, as a professional entity in a way, will support Nursing as a whole. Furthermore, why should it be up to another profession whether our own progresses and advances or not? We are a professional body in our own right, we should be stating clearly that community Matrons, or any other Nursing role, is a vital one, and WILL be part of the overall health service whether GPs want to support them or not, because WE believe them to be a vital part of our profession. Anonymous | 26-Sep-2011 6:07 pm makes an excellent point, if some GPs support the role and some don't, will this lead to massive inequalities and a fragmented profession dependent on where you are in the country? Surely it would be better if the decisions came from within our own profession?

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  • A recent case of nurse consultants being downgraded by a private healthcare supplier, now GP a sceptical about the value of community matrons. Nurses beware... know your place! I don't doubt that the current Government, and many GPs, feel that nurses should not bother themselves with clever stuff and just stick will the repetition of menial tasks, while looking glassy eyed and smiling brainlessly while mopping brows, and ensuring all bed wheels face the right way.
    Time will tell, as we enter the mire of increased private healthcare provision and GP commissioning.
    Quite frankly I would love to be able to drop anything medical related to my practice and just soley concentrate on basic care provision (nothing that could be considered once the preserve of the medical profession) no obs, no health promotion, no blood taking, no answering of question relating to medical treatment or illness pathology. Nothing, just the very, very basics... everything pig ignorant Daily Mail readers think we should be. How quickly would services fall apart if this was to happen across the board?

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  • So how do we go about regaining control of the reigns?. . . seriously! because I've only been qualified a year, about to embark on my top-up, and I'm thinking whats the point if we're just going to be down gradded and my skills aren't going to be utilised or recognised? I don't want to go through what my mum went thru . . .

    The role of the district nurse is something I feel quite personally for. My mum did her 2 years post grad diploma to become an actual district nursing sister at band 6. But then some of her case load was going to be taken away to the band 7 community matrons who were being trained up only for the PCT to change their mind, redeploy the band 7s and mean while my mum is doing the community matron role as well as community nurse role all at a band 6 pay. Just before she left her title was changed from district nursing sister to senior community staff nurse. I mean what a bloody cheek!!

    I wish she had told them to bloody stick it a long time ago! To name and shame it was Hampshire PCT!

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  • L Stephens

    The DNs v Community Matron argument simplifies the debate about the CM role massively. I am a community matron and practice nurse and feel I work pretty well with my DN colleagues, who I feel at band 6 are undergraded and overworked.
    Theres no shortage of people with long term conditions to look after we don't need to fight over caseloads...
    GPs may unfortunately often see things from a practice perspective-which is fair enough in some ways as they have large lists and responsibilities and if it isn't something that affects their practice budget then they will not value it. The future for any nurse in the community does not look great if GPs are to manage services-terms, conditions and wages for practice nurses are way worse than for their community colleagues despite many practice nurses doing specialist roles. I think that CM roles will be easy targets for trusts looking to make savings and studies like this will not help....

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