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Wolverhampton Information Network

Community Matrons

Case management for adults with long term conditions or who are at high risk of hospital admission.   Short term interventions to support patient self-management and prevent unplanned hospital attendance/admission.

Pro-actively manage patients to reduce hospital admissions and lengths of stay

Provide a direct link between the acute trust and community services via an on-call community matron

Support the acute trust with complex discharge planning

Provide patients with the knowledge and understanding of their long term health conditions to enable them to self-manage

Provide 100% of all patients with multiple long term conditions an electronic personalised management plan which is accessible via hospital records.

The Community Matrons within the team are independent non-medical prescribers with advanced physical assessment skills



Who to contact

Contact Name
Community Matrons
01902 442609

Where to go

West Park Hospital
Park Road West
West Midlands

City Wide

South East Locality– Bilston Health Centre

South West Locality– West Park Hospital

North East Locality– Primrose Lane Health Centre

Time / Date Details

When is it on
Service operates Monday – Friday 8.30am – 5.00pm
Time of day

Other Details


Referral required
Referral Details

Yes, via health or social care professional 

Referral Criteria

a) Be taking 4 or more regular medications (poly-pharmacy) and

  • Frequent primary care consultations / GP call outs in the last 6 months
  • Recent exacerbation or decompensation of chronic illness
  • Medically unstable, cognitively impaired.


b) Have ONE long term condition and

  • Take many different medications (poly-pharmacy).
  • Recent exacerbation or decompensation of chronic illness
  • Cognitively impaired, living alone, medically unstable, and high intensity social service package.

Record Last Updated on: 07/07/2017

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