Care in the community

Until the start of this year, patients with long-term health problems had to rely on their GP or social services to co-ordinate all aspects of their care. This involved several hospital visits a week, explaining their condition over and over again to different consultants - or being left to deal with their conditions alone.

After the Government introduced a policy of preventing people unnecessarily attending hospital, Barnet Primary Care Trust (PCT) launched its community matron scheme in January.

Six community matrons - experienced senior nurses trained in diagnosing, prescribing and managing medicines - have been brought in to work closely with the patient and their doctor to organise care.

Typically these will be people who have had several emergency hospital admissions or are at risk of having to move from their own home into a nursing home because of conditions including lung disease, diabetes and heart failure. Recently, two additional matrons were brought in specifically to help patients with cancer and HIV.

The community matrons' aim is to look at the treatment patients receive as a whole and provide support and advice on medication, use of and ordering of equipment, such as special beds or mattress, and the referral to support services.

Patients are referred to a community matron by their GP, and matrons have started approaching GP practices to ask if any of their patients would benefit from their support. Matrons have a computer programme, specially created by Barnet PCT, to identify which patients are at risk of unnecessarily going to hospital. They also teach patients to contact them when their condition worsens, so the matron can visit and give advice and support.

Margot Stevens, a community matron since January, said: "Research showed that people with long-term conditions weren't getting the support they needed to manage their conditions and were attending hospitals more often, having lots of problems with their medication but not enough support from social workers or with their social care."

Reducing hospital out-patient attendances and the length of patients' hospital stays means more money is being saved by the health service. Barnet PCT estimates having saved £52,000 between April and July this year, compared to the same period last year. During this period, matrons were undergoing training and therefore were not fully operational, so the amount of money saved is likely to grow.

But Ms Stevens is keen to stress that it's not just about the money. She said: "It's about improving people's quality of life and that's what we are focusing on. Patients were reaching crisis point and calling ambulances and then being sent back home again from hospital. That costs the health service a lot of money and it was very distressing for them. There was a lack of support and direction to help them with the management of their condition.

"Most of the patients I have been working with say they don't want to be going to hospital - where there is the risk of secondary infection, such as MRSA - and they feel much more supported now. We can speak up and ask questions for them. We have been educating them to recognise triggers to their condition and it reduces the number of crises with their health."

Carol Thompson, clinic manager for adult and older people's services and community matrons, added: "Some patients have been supported extremely well by their GP or district nurses. But there are others who do not want to bother their GP and then get, for example, an acute chest infection and end up in hospital and stay there much longer than expected, for days or weeks. And then there would be this anxiety, how are they going to cope? For them it's making a difference, and the nurses are even meeting them before they go into hospital."

The Government wants there to be 17 community matrons in Barnet by 2008, and a total of 3,000 across the country.