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District nurses are 'facing extinction', warns RCN

District nurses are “critically endangered” and face extinction by the end of 2025 if urgent investment is not made, the Royal College of Nursing has warned.

The past decade has seen a 47% fall in qualified district nursing staff numbers in England. But research commissioned by the RCN predicts the present shortage of district nurses will get worse, with 35% currently over 50 years old and approaching retirement.

The research was carried out for the RCN by the National Nursing Research Unit at King’s College London and was due to be revealed on Tuesday at the college’s annual congress in Liverpool.

A quarter of nurses told researchers they had seen more than 12 patients on their last shift and more than 80% reported working additional hours. Three quarters said they had left necessary activities undone due to a lack of time, and nurses said a fifth of each day was spent on paperwork and only 37% of time was spent delivering direct care.

One respondent said: “At times I can’t help but feel I have been unable to provide the care I feel I want to give. This frustrates and saddens me.”

The skillset of community teams is also being diluted, with 16% lacking a specifically qualified district nurse. District nurses make up an average of only one in five of the staff employed in community nursing teams.

The college called on the government to fulfil a pledge to increase the community workforce by 10,000 and said these extra posts should specifically be filled by district nurses.  It also called for all trainee nurses to undertake a mandatory placement in the community to meet the demands of the future.

Peter Carter, RCN chief executive and General Secretary, said: “The district nurse role is the foundation of a system which should be able to manage conditions and keep sick and frail people at home. Remove those foundations and the whole edifice could come crashing down.”

The report follows a similar survey by the Queen’s Nursing Institute, which was published at the start of June and also raised concerns about the morale and staffing of district nursing teams.

Readers' comments (17)

  • Let us ask ourselves why we're in this fix. While crucial we haven't modernised. If I look at my other community nursing colleagues I see so many lost opportunites for us. We don't use advanced practice clinical skills, we haven't all embraced independent prescribing, some of us would even kick up a fuss if we had to cannulate and administer intravenous drugs.

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  • seems to be the same for GPs and the impression i got when I left one recently. A very bright and highly qualified chap with so many skills which largely seem to be wasted. all he seems to do is fill in forms, look at his computer, write notes and transfer letters and attend meetings. in the consultation I sat side on to him so he didn't even look at me in conversation or make many general observations or even examine me when I explained my symptoms. he just handed me a form and told me to make an appointment for some analyses and then on the next visit for the results same routine and said he would send a transfer letter to a consultant. He was very pleasant and helpful but I just left thinking how boring just seeing most patients for a ten minute consultation all day long and catching up with the paperwork - how boring. He also expressed, but in as constructive and 'diplomatic' manner possible how fed up he is with the NHS - another, unless things radically change, which is highly unlikely in view of the shortage of GPs, for early retirement maybe although I would guess he was only in his mid-40s.

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  • The government sadly has known about the future shortage of district nurses for the last 10 years and yet they insist that patients are better cared for at home and not the hospital. When are they going to take heed that there are not enough qualified district nurses to ensure patients get the best treatment available and can stay at home? When are they going to invest more into community nursing and not all these different speciality teams? We are best placed to look after these patients as we know them.

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  • The health needs of the population are changing, many more health professions work in community and domicilliary settings yet district nursing has not really modernized or embraced skill sharing with these professions.

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  • District nurses do provide complex and skilled care in patients homes. Student nurses learn a lot from us, and as a DN I have even had to go into hospitals to teach nurses how to do some things. The reason we resist 'tasks' like IV's is because they are so time consuming and we are already over stretched. You have to remember we can't just say our beds are full and turn down work we just keep stretching. District Nurses have always adapted to changing needs of the population, there has been a systematic reduction in district nursing and that restricts development not the other way round.

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  • You want evidence that the Tories cannot be trusted with the NHS?

    How about Circle Health, which has recently landed £1.36 billion worth of health service work (including the contract to takeover the first privatised NHS hospital, Hinchingbroke)

    Circle Health is part of Circle Holdings PLC, which is owned by a series of hedge funds, all of whom were founded by major Tory party donors.

    Lansdowne Partners (29.2% stake) was founded by Sir Paul Ruddock, who donated £692,592 to the Tories.
    Odey Asset Management (14.8% stake) founder Robin Odey donated £220,000.
    Invesco Perpetual (28.7% stake) was set up by Sir Martyn Arbib, who donated £466,330.
    BlueCrest Capital (5% stake) was set up by Michael Platt, who has donated £125,000.

    All those secret dinners with Tory donors certainly paid off there, it would seem, as they clinked glasses and raised a toast to 'all in it together'

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  • Nurses in the community are constantly being stretched. We are learning more skills.so quite rightly patients can stay at home. Along with our daily work, we mentor students, do clinics, keep up with training, both mandatory and extra training. Paperwork is a nonsense. Even patients we visit comment on this. Sometimes staff are not replaced when someone leaves. We are having to work longer. If I work much longer I will need a stairlift to get upstairs to my office. Joking apart please we need more nurses. Our workload is horrendous at times. I came into nursing to do my best for all people. I very rarely achieve this.

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  • The government sadly has known about the future shortage of district nurses for the last 10 years and yet they insist that patients are better cared for at home and not the hospital. When are they going to take heed that there are not enough qualified district nurses to ensure patients get the best treatment available and can stay at home? When are they going to invest more into community nursing and not all these different speciality teams? We are best placed to look after these patients as we know them.

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  • Maybe there should be more encouragement of the senior band 5 staff nurses to move forward into a DN post. Access to DN courses should also be updated we ith as veiw to more flexibility perhaps .However, due to the increasing work loads professional development is not encouraged in my area only taking more and more visits on a daily basis.

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  • Maybe there should be more encouragement of the senior band 5 staff nurses to move forward into a DN post. Access to DN courses should also be updated we ith as veiw to more flexibility perhaps .However, due to the increasing work loads professional development is not encouraged in my area only taking more and more visits on a daily basis.

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  • Check out the care makers song, to remind us of the 6Cs. That will make all the bad business go away. Maybe we should all start the day holding hands singing it before seeing patients. We all have spare 30minutes in our day to do this surely?

    I often think what is the point of me doing my specialist community practice if the larger culture won't change.

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  • I left District Nursing 6 years ago due to low staffing, constant change and PAPER work! Where is the NHS digital strategy used in the community??? We are in the digital age now. Surely paper is a thing of the past??¿

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  • Why do you all post anonymously ? Do you not want people to know what you really think?
    I work in a GP practice as an NP and often visit people at home- it is so time consuming yet essential.
    There needs to be more awareness across the board that working in primary care is an interesting, challenging and essential job-not just an option to hospital care-is it essential and deserves more respect. And more training for those of us who are out there doing this essential job.

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  • Kirsty I have been asking why nurses feel the need to post anonymously for a while, I think they are scared to speak out, which is a really sad thing and nothing will change while it continues. Nurses must feel more supported to speak out on such serious matters.

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  • Why complain? What difference will it make posting anonymously or not? This isn't a formal discussion, as long as people are contributing to a discussion. Plus it's good just to let it all go, who understands nurse better than nurses themselves.

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  • it is not a name, or pseudonym or anonymous that is important here but the content of the comment! value those you find interesting or agree or disagree with and ignore those you dislike. you are free to choose. some threads lead to a flowing discussion others are just a collection of facts, random thoughts and opinions. comments are just what they say they are, but please do not obsess about what people choose to head them with that is their affair and their own personal choice.

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  • If the government continues as it is, patients will be left at home untreated, until they realise that more people are attending A&E for issues that ought to have been dealt with at home. Community nurses will eventually be unable to visit all the patients referred to them and patients will end up calling 999.

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