Case Management

1
Case Management

• Central strand of West Care Plus admission
  avoidance programme
• Rapid development/implementation
• System redesign?

2
Case ManagementWhat worked well

• Recruitment of 4 highly motivated nurses range
  of skills and experience
• Service is established 3 GP practices c.70
  patients
• Evaluation of services impact on
  admissions/highly valued

3
Case ManagementChallenges

• Implementing a changing model
• Castlefields
• Community matrons
• Holistic model of health
• Systems and processes
• Patient identification
• Documentation
• Referral pathways
• Management of expectations
• Impact model
• Unrealistic assumptions re takeon
• Timescales re impact?