patients grouped together. Also, like a hospital ward, patients are admitted and discharged from those beds. The ward is termed virtual as these beds are not real, and care takes place in the most appropriate setting for the patient, usually at home. Initially, the patients at highest risk of admission to hospital are considered for admission to the ward and for intensive case management. When one of these "beds" becomes vacant as the patient stabilises then the predictive algorithm is looked to for a replacement. The virtual ward team use enhanced tracking to ensure that they can reduce the likelihood of admission, and should the patient be admitted into secondary care follow their process through hospital and attempt to facilitate an earlier discharge back into the community. Admission Admission to a virtual ward is determined both by predictive modelling and by clinical decision making by the virtual ward team and the patient's doctor. This ensures that the patients admitted to a virtual ward are truly those who will benefit the most, i.e. those most at risk of unplanned hospital admission. The NHS in England owns two predictive risk models which were commissioned from a consortium led by The King's Fund. These predictive tools are known as PARR (Patients At Risk of Readmission), which was built by New York University and the Combined Model, built by Health Dialog. At the time of admission to the virtual ward, the virtual ward lead, which may be an assertive case manager as in Dudley PCT's collaborative model, or a community matron visits the patient at home and conducts an initial assessment. This record, and all further entries by ward staff, are entered into a community care record, and additionally recorded at the patient's GP practice. A summary from the GP computer system is pasted into these ward notes before the initial assessment, so as to provide background information and avoid unnecessary duplication of work. The GP practice is informed of all significant changes to the patient's management. Staff The day-to-day clinical work of the ward is led by a senior nurse which may be an assertive case manager or a community matron. Other staff include a social worker, health visitor, pharmacist, community nurses and other allied health professionals. A key member of staff is the ward administrator ("ward clerk"). With a dedicated telephone number and email address, the ward administrator is able to collect