The prevalence of long-term health conditions is increasing as the population ages. Resources are limited and costs are increasing. Patients are often elderly with multiple co-morbidities. This article focuses on heart failure and the complexities and challenges of managing it in a community setting. It describes the authors’ roles of heart failure specialist nurse and advanced community practitioner for long-term conditions, and how they have worked together to improve patients’ experiences and provide timely, holistic care. Their aim is to reduce unnecessary hospital admissions, improve patients’ quality of life and end of life care, and support their family and carers.