Primary care trusts are going to have to bring GPs on board when it comes to working with community matrons to manage long-term conditions. Online learning programmes could be the answer.
Primary care trusts and GPs have a troubled relationship, seemingly at odds at every turn. Bitter recriminations over recent alternative provider medical services contract awards and fights between PCTs and personal medical services contract holders in Suffolk and the North East are symptoms of a relationship where mutual trust has been eroded.
But PCTs must bring GPs on board, not least because they need to convince GPs to work with community matrons to manage long-term conditions - something many will be reluctant to do.
Managing long-term conditions is high on the policy agenda now that the strategic health authority road maps have identified priority areas.
The figures speak for themselves. In the UK, there are more than 2.3 million people with diabetes and around another half a million undiagnosed. Around 2.6 million people are living with heart disease, and there are 700,000 people with dementia. This will rise to more than 1 million people in 2025 and 1.7 million by 2051.
Communitymatrons are already playing a pivotal role in managing long-term conditions in some areas. Take the award-winning Virtual Wards project in Croydon. Virtual Wards use the systems, staffing and daily routine of a hospital ward to provide case management in the community. An experienced, highly qualified community matron leads a team of ward staff including nurses, a health visitor, ward clerk, pharmacist, social worker, physiotherapist and occupational therapist.
Croydon PCT now has 10 fully staffed virtual wards and has established associate community matron posts in the district nurse service to take GP referrals. Maggie Ioannou, director of community health services at Croydon PCT, believes the key to the success of the Croydon project is that each ward works closely with a group of GP practices.
While GPs in Croydon are collaborating successfully with their community matrons, persuading GPs in other areas to engage with community matrons remains a challenge, with some feeling threatened by their presence.
Often GPs take a sceptical view and believe the management of long-term conditions rests entirely with them.
So how do PCTs begin to bridge the gap and convince GPs that they need to work alongside other health professionals?
Targeted online education programmes, already proven to be successful in disseminating messages on issues such as drugs and therapeutics, can play a valuable role in breaking down misconceptions among GPs and persuading them that community matrons really do have a role to play in keeping sick and disabled elderly people out of hospital.
Using video, audio and advanced graphics, modules are usually presented as a series of messages with embedded questions and answers and links to additional information. Short in length - typically a few minutes - they can be easily integrated into a PCT’s existing education programme for clinical staff. Crucially, for time-strapped GPs, they are available online 24/7 and can be incorporated into learning records for appraisal and revalidation.
One PCT that has embraced online education as a means of communicating with its GPs is Buckinghamshire PCT.
Working alongside the local acute trust, the PCT has developed an interactive online presentation for GPs to make sure they offer appropriate falls prevention advice and care to vulnerable patients. The cost of falls to the NHS and social services is estimated at£1.8bn a year, and falls in Buckinghamshire account for 1,500 hospital admissions a year.
With PCTs under increasing pressure to engage their GPs, it makes sense to look at new ways of communicating with them. Targeted online learning modules that help GPs realise the benefits that community matrons bring to their patients would be an ideal place to start.