Community matrons do make a difference

Respondents on bmj.com are right to wonder whether the tail wagged the dog when policy on case management emerged three years before the publication of the research from Gravelle et al.^{1 2} However, the emphasis on research is misleading. Local implementation at the level of the primary care trust was never intended to be a research project. Instead, it was a bold local decision to invest to save, at a time when the Bristol health community was in financial crisis.

Policy making is an illogical world. Meanwhile, back in the real world, despite the research that tells us that it shouldn't work, the approach does what we want it to: patients are alive and well and still living at home and avoiding hospital; and the trust's board is pleased with the local evidence showing that our community matrons more than cover their costs in emergency admissions saved (unpublished data triaged by a nurse and medical consultant).