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Buurtzorg: the district nurses who want to be superfluous

BMJ 2017; 358 doi: (Published 06 July 2017) Cite this as: BMJ 2017;358:j3140
  1. Tony Sheldon, journalist, Netherlands
  1. tonysheldon5{at}

A Dutch model of coordinating care at home for elderly and vulnerable people could revolutionise healthcare, commentators effuse. Tony Sheldon asks whether Buurtzorg lives up to the hype

By 2006, Jos de Blok had spent nearly two decades working as a district nurse and homecare manager in the Netherlands. He had watched the care being offered getting gradually, and seriously, worse.

Reorganisations and mergers of social care and district nursing, starting in 1994, had imposed new layers of management. He had witnessed district nurses’ work being concentrated on the more complex cases, fragmenting the delivery of care as a whole. Links with local neighbourhoods, with their networks of volunteers, and health promotion had disappeared.

“I knew how it could be,” De Blok told The BMJ. So in 2006 he cofounded a not-for-profit homecare provider called Buurtzorg, which means “neighbourhood care” in Dutch.

Buurtzorg started with a team of just four district nurses, in Almelo, a small city in the east of the country, but today it has 900 teams with 10 000 staff who care for 90 000 clients a year. De Blok is being heralded as leading a revolution in the way that elderly and vulnerable people are cared for. His model is receiving international interest, including from the UK, US, China, Sweden, and Germany.1

Buurtzorg’s principles

Buurtzorg aims for its professionals “to make their patient stronger and independent.” Good district nurses, De Blok argues, should aim to make themselves superfluous.

Professional nurses are trusted to be professional, working in small self governing teams, providing the whole range of care from medical to support services such as help with washing and feeding—tasks normally done by cheaper, less qualified, staff. Hours are clocked but nurses are not answerable to managers. There are no team leaders; decisions are made collectively. Instead teams can …

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