The Buurtzorg Nederland (home care provider) model
Royal College of Nursing
An introduction to Buurtzorg
What is it?
Founded in the Netherlands in 2006, Buurtzorg is a unique district nursing system which has garnered international acclaim for being entirely nurse-led and cost effective. The latter point has sparked particular interest in the UK where a key challenge is meeting the needs of an ageing population increasingly susceptible to co-morbidity and complex long-term conditions.
Buurtzorg was set-up by Jos de Blok (himself a former nurse) who envisaged a reformed district nursing system in the Netherlands. Prior to Buurtzorg, home care services in the Netherlands were fragmented with patients being cared for by multiple practitioners and providers.
Ongoing financial pressures within the health sector led to home care providers cutting costs by employing a low-paid and poorly skilled workforce who were unable to properly care for patients with co-morbidities, leading to a decline in patient health and satisfaction.
Buurtzorg’s answer to this problem was to give its district nurses far greater control over patient care – a factor which it attributes as key for its rapid growth. In 2011, Buurtzorg employed nearly 4,000 district nurses and nurse assistants across 380 teams. By 2013, this had
risen to 6,500 nurses (an increase of 62.5 per cent) across 580 teams.
How does it work?
Nurses lead the assessment, planning and coordination of patient care with one another. The model consists of small self-managing teams of a maximum of 12 professionals (comprising both nurses and other allied health professionals). These teams provide co-ordinated care for a specific catchment area, typically consisting of between 40 to 60 patients.
The composition of these teams in terms of specialty and level of practice varies according to the needs of each catchment area.
In the Netherlands, integrated care has been cited as easier to deliver because district nurses tend to be well known in the small neighbourhood/community they work in. This has helped them to build good working relationships and strong dialogue with GPs, home doctors, police, paramedics and social care providers.
What services does Buurtzorg provide?
The Buurtzorg model comprises six key services. These are:
1. Holistic assessment of the client’s needs which includes medical, long-term conditions and personal/social care needs. Care plans are drafted from this assessment
2. Map networks of informal care and assess ways to involve these carers in the client’s treatment plan
3. Identify any other formal carers and help to co-ordinate care between providers
4. Care delivery
5. Support the client in his/her social environment
6. Promote self-care and independence.
The aim of this approach is to engage three key national health priorities:
Management of conditions, and
Buurtzorg cares for patients who are terminally ill, suffer from long-term conditions, dementia or require home care following major surgery. Most of the nurses who join Buurtzorg are trained at a ‘generalist’ level – similar but not directly equivalent to a UK Registered Nurse in Adult Care. This allows them to deliver treatments from wound care and diabetes monitoring to IV infusion therapy and end-of-life care. Importantly, unlike in the UK, there is no formal district nursing qualification in the Netherlands.