Aim To describe actual patient caseload sizes among case managers for
long term conditions and explore issues of caseload manageability.
Background Department of Health guidance advises that community matron case managers for long term conditions should manage caseloads of 50–80 patients. However, there is currently no evidence to justify these caseload targets.
Method In-depth interviews were conducted with 46 case managers for
long term conditions, ﬁve clinical leads and six programme leads across six Primary Care Trusts.
Findings Case managers had caseloads of 10–55 patients each, although numbers ﬂuctuated from week to week. The current caseload target was regarded as difﬁcult to manage. Heavy caseloads were perceived to result in a shift from proactive care towards reactive care, decreased quality of care and increased hospital admissions.
Conclusion Case managers for long term conditions are struggling to achieve and maintain caseload targets. Further research is necessary to identify the most appropriate caseload size and provide an evidence base for policy.
Implications for nursing management Programme leads and managers need to carefully assess the local situation, the characteristics of the target population and the practicalities of delivering the model of care before identifying appropriate caseload targets.
Case management, nursing, community matrons, chronic conditions