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District nurse downgrading sparks fears for standards


Nursing leaders have made clear their concern about the widespread downgrading of district nursing posts.

They warned that band 7 posts were increasingly being replaced with band 6 or even band 5 posts, despite the shift towards more complex care and procedures being provided in the community rather than acute settings.

Royal College of Nursing primary care and independent sector adviser for the Eastern region Kellie Norris said primary care trusts were “stripping out the band 7s in all sorts of ways”.

She said: “Downgrading staff gives the wrong message. You need highly trained, highly developed staff if you want to move services into the community. As people’s needs get more acute in the community, the specialisation needs to be higher.”

Nursing Times has found some district nursing teams are now mostly staffed by band 5 staff.

Half of NHS Peterborough’s 92-strong district nursing team are on band 5, 28 are healthcare assistants and six are band 6 community nursing sisters.

A Peterborough Community Services spokesman said two band 7 nurses had run the service before a reorganisation in 2005. It now has no band 7 district nurses. Staff were divided into 12 teams, each led by a band 6 nurse.

In February this year, community services in the South West had 45 more district nurses than they did last April. All but two of these new posts were on band 5.

Queen’s Nursing Institute director Rosemary Cook told Nursing Times: “This is part of the larger picture of what is happening to specialist nursing. Primary care trusts are going to have to look again at all this and make sure that their workforces are up to it.

“The provider can’t simply recruit a big workforce of healthcare assistants and a few nurses on a higher grade and say ‘they will manage it’ because they won’t have the skills.”


Readers' comments (32)

  • i work with in an office with 6 teams 6 band 7 's and quite frankly wonder what the all do all day .

    they take very few visits and spend most of thier time at meetings ,

    not supporting teams members !

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  • I am a Community Matron and work with a fabulous team of community staff. They have an ever increasing workload as wards push to discaharge quicker, with no increase in staffing. They are split into teams of b5's, b3's and b2's, each led by a b6. The band 6's have to lead the team and manage a caseload. They should be rewarded more but because they don't 'officially' hold the budget, they don't qualify for band 7. Sneaky but AfC saw to that.............and trusts are ever grateful.

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  • They did it to Health Visitors and look at the huge vacancies there.

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  • I totally agree wih Rosemary Cook, community nursing require skills and training in that field. Making 'do' with cheaper labour will have its consequence .

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  • District nurses are managing larger teams, bigger caseloads with many patients presenting with complex health needs. Our district nurses are ONLY band 6. Many organisations no longer value the work undertaken by district nurses - band 6 staff nurses are being employed in the role (with out any form of training) the term district nurse is being phased out in favour of case manager etc: this leads to confusion within society (especially the patient population which we deliver care - the elderly) and other health care professionals and many trusts are no longer seconding their staff onto the specialist course! so where is our future workforce?
    District nurses work hard and with a shift to community based care, and its time they recieved the recognition and respect they deserve, to drive forward quality health care in the community!!
    District nurses need a louder voice within policy and healthcare, we need to raise our profile making do is no longer acceptable!

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  • what more can we say, who gives a shit about district nurses, I had a junior doctor shadow me and he thought my sole purpose was to give injections and wound care, needless to say he got his eyes opened when he saw me administering morphine sub cut and setting up the infusion pump on my own. I was left in the office all day yesterday doing appraisals and completing a draft 6 for continiuing health care. Maybe a comment above wondering what band 7s actually may point her in the right directions. I never have time to write my mileage form out but I do see the rest of my staffs on a daily basis on their desk, I frequently take paper work home, but I never see a band 5 taking any home, it maybe that we will be down graded with 4 years pay protected, but honestly do you think we will be in that post in 4 years times, district nursing will be a thing of the past and how does that fit in with transforming community services. They want us to take on board more clinical procedures such as IV antibiotics, IV hydration, and at what cost ???

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  • It is interesting to note that policy focuses on transforming community services;moving care closer to home, giving patients more choice.....yet district nurses are ignored. District nurses have a pivatol role within the community yet we are often invisible and forgotten when it comes to politics. Posts are frozen; teams are understaffed, no extra funding or resources yet the district nurse is supposed to deliver care ans as stated above much bigger teams, more responsibility for a band 6!

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  • As a District Nurse who no longer practices in that role, (now a specialist nurse) I am afraid that many of us saw this coming. District Nurses were not vocal enough about what they did and how valuable their holistic skills were. A trained District Nurse can fully assess a patient and plan holistic care which includes not just the referred problem but all aspects of that patients care. What we have now is trained nurses (band 5 or band 6 )trying to deliver a service for which they do not have the skill set . We are returning to task orientated nursing were only the referred problem is addressed and were nurses are unwilling to change care plans because they are worried that they do not have enough knowledge to make informed decisions.

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  • After reorganisations in 2005 and 2007 I found thatI could only remain a Band 7 as a manager. My specialist practice degree that I had worked so hard for and to become a District Nurse was now deemed a Band 6 role, without any formal training and the title changed to Case Manager. I have seen many collaegues with excellent and valuable experience leave community nursing as they were not valued by the managers of service, ever driven by meeting targets with less money. It scare me to see how fragile these community services are for the patients we serve and the stress that some nurse face on a daily basis. Agenda for change is only part of the problem, a tool for managers to use to save money when reconfiguring services. The modernising drivers of the furture nursing proferssion is graduates and quality. We will not be able to attract senior nurses into Band 6 roles. I have left my community nursing career bahind me and I feel saddened that it has turned out this way. I have every respect for my ex colleagues that are out there every day, struggling to provide high quality nursing care in the community.

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  • After reading all the above comments, I feel disheartened to say the least. The main point is what can be done and how can we go forward from here? I was a district nurse on G grade before AFC.After a career break, I am now returning to community nursing and of course when I did my return to practice nursing updating myself on community care but was told my district nurse Diploma qualification is not recognised and hence the band 5. I am happy on band 5 because my main reason of returning to nursing is that I have a passion for caring for nursing like a 'virus' that I cannot get rid of.However, I feel that unless we nurses stick together and work a solution to ensure that district nursing service will still be around when we reach those lovely twilight years when we may or may not need the service.Please fellow nurses what ever your Bands are, you are all amazing people to get to where you are thus far,we have to work together on this.Distict nursing service have been around for 150years please keep up the good work.

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