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With a need to reduce the number of unnecessary attendances to Emergency Care from the care homes in Liverpool, improve equity and health outcomes for older people, Liverpool PCT (LPCT) began a phased roll out of Care Home Support across its 71 older people’s homes from January 2006. This was a two-pronged initiative utilising MDT support and case management.

Since January 2006, 15 care homes in North Liverpool have phoned a single point of access for all non-999 calls (UCD - Unplanned Care Direct, which has the facility to offer GPs alternatives to hospital admission) 24 hours a day instead of contacting GP surgeries. A further 31 care homes joined this system in November 2006 with the remaining 25 care homes in February 2007. The call to UCD is triaged by a nurse advisor and triaged through to the most appropriate member of the multi-disciplinary team (MDT). Members of the MDT supporting this initiative include GPs, district nurses (DN), community matrons, emergency response team, physiotherapists and the medicines management team.

District nursing teams have been aligned to care homes thus giving each home a named nurse and team responsible for all residents within that care home. The rationale for this was to encourage partnership working and relationship building between LPCT and care home staff, to improve the DN knowledge of both the home and its residents, as well as any unique issues facing particular care homes. For nursing home residents the DN is available for advice and support and is pivotal in referring residents to other services within the community as required.

District nurse contact within each home has varied depending on resources and need, but examples of input include a weekly clinic and daily early morning triage to minimise unplanned calls.

Community matrons are allocated to the same care home as the DN team they are linked to. Calls are allocated to the community matrons by UCD within the given protocols for a “reactive” visit to a care home resident, they also pro-actively manage residents with long term conditions within the care home setting. Those who have attended emergency care are followed up by the community matron or district nurse. Community matrons can also support those discharged from Departments of Medicine for the elderly on discharge.

There is excellent support and liaison from the Departments of Medicine for the elderly from both local University Teaching Hospitals, with a daily rota for access to a consultant if advice is required and agreement for outreach as necessary.

“Teaching rounds” in care homes are planned for the near future with a consultant geriatrician, nurse consultant, community matron, district nurse and care home staff involvement. Care home staff report they feel supported and benefit from the closer links with LPCT’s multi-disciplinary team. This initiative has allowed care home staff to have issues raised and addressed by LPCT.

To date Liverpool has seen a reduction in attendances to emergency care across two hospital sites. The care home with the highest rate of attendances to emergency care has shown a significant reduction with targeted community matron/case management and district nurse support. Collaborative working with Liverpool City Council, to address ways of improving standards within the care home settings through contractual measures, is ongoing.

David Jones,
Nurse Consultant for Older People,
and Susan Norbury, Care Homes Implementation lead, Liverpool PCT