This article presents and reviews the evidence from a pilot project in the North of England in which a social worker was based in a surgery and worked proactively with a district nurse to introduce an integrated case management approach for patients in the practice. Decision-making was noticeably simplified and speeded up, with most assessments completed in a single day. The authors recommend that PCTs should consider the benefits of social care input to case management, especially when planning new services and new roles such as that of community matron.

BackgroundFamily caregivers of patients with cancer and other advanced progressive illnesses, especially during the final year of life, can incur increasing burden, affecting their health, ability to care and likelihood of hospital admission for the patient. It is essential carers' needs are assessed to alert health and social care professionals to their increasing level of burden and trigger additional support. This multi-phase study developed and piloted a Carers' Alert Thermometer (CAT), for use by the generalist healthcare workforce, to alert staff to increasing carer burden and provide guidance on appropriate interventions.Aim of the studyTo gain consensus on the most important burdens raised by carers for inclusion in the CAT (Phase 1) subsequently rated and ranked by professionals and carers (Phases 2 and 3).MethodsPhase 2: A two-round Delphi survey was conducted with carers, health and social care professionals and organisations supporting carers. Round 1 involved 44 burdens in eight main themes. Round 2 contained 29 burdens which had been rated as‘extremely important’or where a high level of disagreement between carers and professionals existed.Phase 3: A virtual panel, comprised of carers together with professionals from national and regional organisations with strategic roles in end-of-life care and carer support, commented on the Delphi findings ranking their top 10 burdens for inclusion in the CAT.ResultsThere was a high level of agreement between the professionals and carers on the main burdens for inclusion in the CAT. Understanding the current caring situation and supporting carer's health and well-being were the main priorities. Interestingly, end-of-life planning was ranked lowest by both groups.ConclusionsDespite the complex needs of carers clear consensus on the main burdens exists which can be utilised in an alert tool to identify increasing burden and guide appropriate targeting of support and resources.