Providing tailored support for nurses interested in working in the community is one way to halt the worrying decline in district nurse numbers, according to the chief executive of Health Education England.
Professor Ian Cumming said ensuring nursing students had the chance to work in community services on placement and providing specific programmes for those keen to explore the role were ways to encourage more nurses into district nursing and expand the workforce.
He made the comments while giving evidence to the Commons’ health and social care committee in the second of two sessions to explore the long-term plan for the NHS in England.
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The NHS Long Term Plan, published earlier this month, has promised more investment in community and primary care, in an effort to provide more services outside of hospitals.
The ultimate goal is to create multi-disciplinary teams – including district nurses – aligned to groups of GP practices to provide “fully integrated community-based health care”.
However, nursing organisations have questioned whether there will be enough staff to make this vision a reality especially given plummeting district nurse numbers. The number of whole-time equivalent district nurses has fallen by nearly 50% since 2010.
Meanwhile, a report on district nurse education published by the Queen’s Nursing Institute in November last year found a more than 10% drop in the numbers gaining specialist district nursing qualifications in 2017.
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Professor Cumming told the committee that Health Education England had been “particularly disappointed” by the reduction in district nurses.
However, he said one key to boosting numbers was the “correlation between training and where people end up working”.
The fact that new standards for nursing education and training placed more emphasis on training in a range of settings was key, he told the MPs.
“We have been working with colleagues from the Nursing and Midwifery Council who recently launched their Future Nurse standards that make specific reference to nurses being based in the community as part of their undergraduate training to make it more likely that they choose jobs in the community in future,” he said.
“The community health workforce has suffered in part because of the relative squeeze on community spending”
He also flagged up a joint project between HEE, NHS England and the Queen’s Nursing Institute to support and encourage nurses to go into district nursing.
“That specifically looks at taking nurses who are expressing an interest in working in the community and giving them a proper structured programme around an induction to district nursing – rather than perhaps what we may done in the past, which is leave it up to individuals around how their career choices develop and how they make decisions around ongoing education and training,” he said.
Providing a bespoke programme was a way to “boost interest, boost applications and therefore expand the workforce”, he said.
Simon Stevens, chief executive of NHS England, told the committee that guaranteed extra funding for community services would go into boosting the workforce.
The long-term plan promises that real teams funding for primary and community care will grow faster than the overall NHS budget, which means spending on these services will be at least £4.5bn higher in five years’ time.
“The community health workforce has suffered in part because of the relative squeeze on community spending relative to GPs and acute hospitals and the extra investment we’ve had in mental health, which is why the new guarantee around primary, medical and community health services growing faster than the overall budget will provide the purchasing power and the funding streams for that workforce,” he said.
The fact that funding for community health services, including community nursing, had flip-flopped between local authorities and the NHS over the lifetime of the health service and there were separate funding streams for general practice and community health had also had an impact.
“We have ended up with different organisations with responsibility for different parts of the community and primary care workforce with different funding steams and that’s what we’re overcoming with the blended arrangement set out in the long-term plan,” he said.
He claimed a push to expand the non-medical primary care workforce, including practice nurses, pharmacists and physician associates had proved successful.
“We had aimed to have 5,000 more people by 2020. We have actually already got those 5,000 more people – more than 5,000 – so we are doing well on expanding the primary care workforce,” he said.
However, the latest official figures show there has only been a relatively modest increase in the number of practice nurses, with a 1.5% increase in the number of full-time equivalents – 238 more nurses – between September 2017 and September 2018.
Mr Stevens indicated that funding to boost the workforce under a new “primary care network contract” would focus on “professional groups where we know there is supply”