Description of the Community Matrons service
The Community Matrons service is provided by experienced autonomous practitioners, who proactively manage high risk patients with complex long term conditions using case management techniques to coordinate care and services.
Community Matrons are responsible for the management of care and service provision for individual patient pathways across the primary and secondary interface, preventing hospital admission and reducing length of stay by facilitating hospital discharge.
Community Matrons will assist patients to remain at home for as long as possible, facilitating choices in healthcare and social care including end of life choices.
Who can access the service?
Age 65 and above (younger patients will be considered on an individual basis). Patients must be registered with ALW GP.
Patients must be suffering from two or more Long Term Conditions and be willing to enrol in a Case Management Programme.
Patients who will benefit from a Case Management Programme include: Taking 4 or more medications, two or more attendances to Accident & Emergency in the preceding three months. High Risk for readmission or any unplanned admissions. Three or more falls. Social isolation.
Wigan Health Centre
Frog Lane Wigan
Telephone: 01942 482113