Exploring place-based care and the role of the community matron in delivering proactive frailty care

Place-based care (PBC) is an approach to providing healthcare services and resources within a community or geographical location based on the needs of the local population. A fundamental aspect of PBC is partnership working between local public, voluntary and community organisations. PBC models are being established in primary care across England and Wales, often in the form of multidisciplinary teams (MDTs). To function effectively, such teams require leaders with strong relationship-building and collaboration skills who can engage with local populations. Community matrons use case-management and possess leadership skills that align with a PBC approach, putting them in a key position to lead and deliver place-based MDT approaches to care. In this article the author provides an overview of PBC and discusses how the use of segmentation and risk stratification can help to identify local population health needs. The author also describes how the community matron role supports a PBC MDT approach to identifying local population health needs and assessing, planning and coordinating support for patients, using frailty as an example.