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District nursing: what the future holds

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The Queen’s Nursing Institute report on the future of district nursing highlights issues with the workforce, mobile working and partnerships

Citation: Oldman C (2014) District nursing:  what the future holds. Nursing Times; 110: 26, 23.

Author: Crystal Oldman is chief executive of the Queen’s Nursing Institute.


The Queen’s Nursing Institute recently published a landmark report, which provides a clear picture of the current issues facing the district nurse workforce (QNI, 2014). The report is based on the views of 1,035 nurses who deliver care to people in their own homes; three major issues are highlighted:

  • Workforce;
  • Mobile working;
  • Partnerships in practice.

All of these are inextricably linked.


Workforce issues were not unexpected. The QNI’s Right Nurse Right Skills campaign, which has been running for the last three years, has highlighted the significant decline in the number of district nurses. These community specialists are needed to lead the teams in the comm-unity and are prepared for this role by studying for the specialist practitioner qualification. The value of this qualification is clearly articulated in the survey responses and the extensive narrative data illustrates the positive impact it has on patient outcomes.

The workforce issues should be viewed within the changing context of care. District nursing teams are under increasing pressure: the numbers of older people in our communities who have multiple comorbidities is rising; there is increased complexity in the care they require; and a greater number of people wish to receive end-of-life care in their own homes.

Many respondents reported that they lacked the capacity to accept all referrals, even if they had voluntarily extended their working days to accommodate a growing caseload - a situation which, it is reported, is contributing to low morale.

Mobile working

Mobile working should be linked to a workforce that is more efficient and more effective, securing better outcomes for patients and with caseloads that are scheduled appropriately using bespoke IT systems. However, this ideal was not the reality for the majority of the respondents and surprising numbers of teams are still using paper-based systems. The situation is changing rapidly, however, and the QNI’s recent report on district nurse workforce planning, which was commissioned by NHS England (QNI and NHS England, 2014), highlighted several areas of best practice about how to use IT to support the scheduling of caseloads and activity reporting.

Partnership working

Partnership working is also an essential element in the effective delivery of the district nursing service.

The service is highly dependent on the development of good, productive working relationships with other services, but it is a challenge to establish such relationships where there is a lack of capacity in teams.

General practitioners were identified by the majority of respondents as having excellent working relationships, supporting high-quality patient care by the district nursing service. Some respondents identified this as being dependent on being physically close to the GP practice - if not based in the same place - and many GPs would support this position.

Discharge planning

There is some disappointment that the issue of poor discharge planning was raised by most respondents. In an era where there is ease of communication with mobile phones and emails, which are accessible to all professionals, it is of great concern that there were still large numbers of district nurses in the survey who reported major problems with hospital discharges.

There were also examples given by respondents in which discharge planning had noticeably deteriorated after the removal of the discharge-planning post from the hospital nursing team. The QNI has previously suggested that discharge planning could be enhanced with an appreciative approach to learning about the pressures of each others’ roles. As an example, a hospital-based nurse might consider spending a day of continuing professional development work-shadowing a district nurse to learn about the positive impact of planning robust community support before the patient is discharged.

District nurse title

On a more positive note, the job title of district nurse is clearly meaningful to patients and carers. As such, there is no valid reason to revisit this argument and waste valuable time debating terminology. The title, which was created more than 150 years ago, endures as a trusted designation and is synonymous with high-quality nursing care that is provided for patients in their own homes.

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