Setting: This feasibility study is planned to take place within two neighbouring Clinical Commissioning Groups (CCG) that serve a population of 335,000 people (Office for National Statistics 2011). The intervention locality has nine community nursing teams linked to GP practices and grouped as three clusters. The patients in the usual care arm of the trial will be recruited from a neighbouring CCG which has a similar configuration of community nursing teams, including community matrons and specialist nurses. All the nursing working with patients in the intervention cluster will be trained in UBC.