Establishing new nursing roles: a case study of the English community matron initiative

Authors

  • Vari Drennan,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Claire Goodman,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Jill Manthorpe,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Sue Davies,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Cherill Scott,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Heather Gage,

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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  • Steve Iliffe

    1. Authors:Vari Drennan, PhD, RN, FQNI, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, London; Claire Goodman, MSc, PhD, RN, Professor of Health Care Research, CRIPPAC, University of Hertfordshire, Hatfield; Jill Manthorpe, MA, Professor of Social Work, Social Care Workforce Research Unit, King’s College London, London; Sue Davies, BSc, MSc, RN, Research Associate, CRIPPAC, University of University of Hertfordshire, Hatfield; Cherill Scott, BA, MSc, RN, Senior Research Fellow, School of Health and Social Care, University of Greenwich, Greenwich; Heather Gage, BA, MSc, PhD, Reader in Health Economics, Department of Economics, University of Surrey, Guildford; Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Department of Primary Care and Population Studies, Centre for Ageing Population Studies, University College London, London, UK
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Vari Drennan, Professor of Health Policy and Service Delivery, Faculty of Health and Social Care, Kingston University and St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK. Telephone: 020 8725 2339.
E-mail:v.drennan@sgul.kingston.ac.uk

Abstract

Aim and objective.  To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented.

Background.  Improving health services for people with chronic diseases (long-term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved.

Design.  A realist, pragmatic evaluation of the introduction of community matron posts.

Method.  The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi-structured interviews in three primary care organisation case study sites.

Results.  National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to ‘bolt on’ nursing roles in primary care.

Conclusions.  The implementation of the community matron role is an example of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes.

Relevance to clinical practice.  There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.

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