Netherlands nurse-led community model to be tested in UK
Nursing Times, by Nicola Merrifeild
A community nurse-led care model that sees management functions shared between staff and ensures at least 60% of time spent is with patients is being tested in the UK, following success in the Netherlands, Nursing Times has learnt.
The Buurtzorg – or “neighbourhood care” – model uses teams that have a maximum of 12 district nurses to deliver care in people’s homes.
The typical caseload for a team is 40 to 60 patients in the local area, although most nurses in Holland work part-time under this model.
Nurses are self-managed and co-ordinate care with other healthcare professionals, such as GPs and allied health professionals.
They work within guidelines including the requirement to have an office that is in a prominent place in the neighbourhood, to use 3% of their turnover for training, have a diversity of nurse specialisms, and to share eight defined management and administrative responsibilities between them.
Nurses must also spend at least 60% of their working time with patients and no more than 40% on other activities such as meetings and travelling.
They have access to coaches for wider support and a central back office that processes their billing, but are responsible for their team’s own finances and use of time.
In Holland there are now 850 teams, with more than 10,000 nurses since the model was devised in 2006 by former nurse Jos de Blok.
Research and patient surveys have suggested the model has improved outcomes for people, with patient satisfaction in particular having increased, according to those behind it.
In the Netherlands the social enterprise model is estimated to run at around 30% less cost than conventional hierarchical health and social care systems in the country.
Meanwhile, nurse job satisfaction is high due to the autonomy of the role according to Brendan Martin, managing director of consultancy organisation Public World, which is the official partner for delivering the Buurtzorg model in the UK.
“In terms of job satisfaction, it speaks for itself. There’s a lot more nurses wanting to join Buurtzorg than Buurtzorg is able to provide jobs for,” he said.
“There is a huge pent-up desire of nurses to work in this way because they want to be treated as professionals, with responsibility and freedom at the frontline,” he added.
However, he acknowledged there were some challenges to address in adaptation for the UK, due to the model’s requirement for frontline nurses to have additional management responsibilities.
“One of the issues Buurtozorg is grappling with is, because nurses are providing care in this way, it can be difficult to manage their work/life balance,” he said.
“We don’t want to swap one type of burnout for another. We are trying to solve that problem of stress at the frontline, rather than producing another kind of stress,” he said.
Around a dozen organisations in the UK – including one that provides home care – are currently looking at how the Buurtzorg approach could be adapted for this country.
Two are due to pilot versions of the model later this year – Guy’s and St Thomas’ NHS Foundation Trust in London and a consortium of health and social care providers and commissioners in West Suffolk.
The Netherland health service is funded by insurance – compared to the UK’s free and means-tested health and social care services – which has allowed the model to grow at a slow pace by taking on gradually increasing numbers of patients.
But Mr Martin said he believed it was possible to transfer it to UK organisations quickly based on the success of similar, large organisations adapting the approach in Holland.
He referred to one private health and social care provider – Zorgaccent – which has more than 2,000 staff, but switched to the Buurtzorg model within 18 months.
Mr Martin also said, although the care model had been designed for community nursing, he believed some aspects could be applied to acute settings in the future.
“There is absolutely no reason why the fundamental ethos of Buurtzorg – in terms of enabling frontline care givers to exercise their vocation and to be supported to be nurses rather than be controlled from above – can’t be applied very successfully to other settings, including acute,” he said.