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Four in 10 district nurses lost in last 10 years, report warns

The number of district nurses has fallen by almost 43% over the last decade in England, according to a new report from the Royal College of Nursing (RCN) and Queen’s Nursing Institute (QNI).

The report, which examines outstanding models of district nursing and is the first joint publication from the two nursing bodies, urgently calls for a commitment to investment and training for district nursing.

The document warns that there only 4,031 district nurses providing care for a population of around 55.8 million in England, a drop from 7,055 a decade ago. This decrease in the number of district nurses combined with a rise in patient demand has led to many district nurses working at unsafe levels.

As a result, the QNI and RCN are calling for safe staffing and safe caseloads in the community to meet RCN, QNI and NHS Improvement recommendations.

They're also calling for a standardised data set within England, with 'meaningful data that recognises "value for money"', to promote a strong economic case for investment into district nursing. 

In addition, they recommend a strategy to expand commissioners', health providers' and the public's understanding of the role. With this, they hope to further underline the value district nursing brings to quality of care and economically to the NHS.

The report, entitled Outstanding Models of District Nursing, is the first result of a joint QNI/RCN project examining high quality examples of district nursing services across England.

It presents a blueprint for what constitutes a district nursing service that meets the needs of patients and carers, and features a series of recommendations that arose from their findings.

It highlighted that district nurses must continue to gain a post-qualifying District Nurse Specialist Practice Qualification (DNSPQ) in order to create a workforce fit for purpose.

The QNI and RCN have also suggested exploring the idea of co-locating district nurse teams within the newly-formed primary care networks to improve continuity of care and improve working relationships within primary care.

The recommendations come after the NHS Long Term Plan identified district nursing as a key part of the strategy to deliver more care at home and in the community in order to reduce patients’ length of stay in hospital and avoid unplanned admissions.  

Dr Crystal Oldman CBE, the QNI’s chief executive, said the report illustrates that the district nurse is ‘the key professional in delivering outstanding healthcare to people in the home and the community’.

She continued: ‘Working with GPs and other members of the multidisciplinary team, district nurses have the knowledge and skills to support people living with complex long term conditions to manage their own health and avoid unplanned hospital admissions.

‘Conversely, lack of investment in the district nursing service leads to greater strain on other parts of the health service, including GP practices and hospitals. With a rising and ageing population, many of whom are living with multiple long term conditions, we need a deliberate and intentional investment to support district nurses to continue to deliver complex care to the patients, families and communities that they serve.

‘The success of the NHS Long Term Plan depends on the capacity and capability of district nursing teams and renewed investment in their education, recruitment and retention is urgently needed.’

Yinglen Butt, associate director of nursing at the RCN, said: ‘Given the fundamental role district nurses play in delivering personalised care close to home, and in reducing the burden on hospital providers, the chronic underfunding of this service is an outrageous false economy.

‘District nurses provide a lifeline for patients, many of them frail and elderly, who often can’t leave their own homes to get care elsewhere. It’s time ministers undertook a proper assessment of staffing needs based on the fundamental principle of patient safety, and enshrined explicit accountability for delivering this into law.’