Who are we?
We are highly experienced Senior Nurses who work closely with patients who have serious Long Term Conditions, and their carers.
We act as case managers, a point of contact for education support and health promotion and advice.
Who do we work with?
Patient’s registered with a Bassetlaw GP, people who have long term conditions or with a complex range of conditions.
These will be people who have had several hospital admissions or frequent GP visits and are at risk of having to leave their home and independence due to their long term condition.
Who is in the team?
The team consists of nine Community Matrons, working alongside GP Surgeries and Bassetlaw Hospital with the support of Health Care Support Workers.
How can we help?
We will organise care, and plan and co-ordinate your health and social needs. Above all your Community Matron is someone who is there for you to make sure your views are heard, so you can feel in control when decisions are being taken about your health, well being and life.
How will you benefit?
The Matron will make sure your care is properly co-ordinated. This will mean less duplication and fewer unnecessary trips to the GP or hospital.
The Matron will make sure you understand how your medicines help you and may prescribe you new ones.
Often people with long term conditions find themselves admitted as an emergency to hospital because their symptoms have suddenly been out of hand. A Community Matron can prevent such emergencies happening in the first place by spotting difficulties early and have medications in the home ready.
We will offer you education to recognise the signs of deterioration or crisis and tools to step in to self manage wherever possible.
If you are admitted, we will plan to visit you on the ward and help the ward staff to get you home as soon as possible.
Who can make a referral?
Patients, family members, and other Health and Social workers or carers. Referrals can be made through Single Point of Access on 01777 274422 or on the Hospital Ward or ask at your GP Surgery.
