An examination of caseload management is currently being undertaken by 2 community palliative care nurses who cover a large area, encompassing the environs of city to remote moor land. The remote areas have no mobile telephone access and poor infrastructure.

The caseload was analysed and divided into 7 geographical areas (zones). Visits were to be arranged to these zones on specific days to optimise efficiency, taking into account mdt commitments.

The aims were:

• To increase efficacy of visits, reduction of interruptions

• Reduce travelling time and mileage

• Improve response time from referral to first visit,

• Improve reliability and therefore develop stronger integrated working.

• Improve wellbeing and support of the CNS.

• Move from reactive “fire fighting” to proactive care where crises were predicted where possible.

The approach used was:

• A time table of areas and days was created.

• Two nurses covered the caseload of approx 60 patients.

• The timetable took into account mentorship needs of the new CNS. It promoted men- tee and mentor working in neighbouring zones. Meeting places in the field (literally!) were highlighted should support be required.

• 1 nurse per day was allocated to triage calls and trouble shoot.

• The administrative team were involved in planning and were aware of who to call.

Outcomes – to be measured / reviewed September 2013

• Supportive mentorship of new CNS in rural environment

• Reduced Mileage

• Reduced interruption from mobile phone calls.

• Reduced sickness

• Improved record keeping. The two nurses were reliant on each others records to provide continuity of care.

• A more efficient use of laptops reducing the need to return to base.

• Development of professional relationship between nurses encouraging peer review.

• Improved relationships with GPs and community nursing teams