District nursing teams seeing ‘diluted’ skill mix  

District nursing teams in Scotland have seen a decline in registered nurses and an increase in nursing support workers in what has been described as a ‘dilution’ of skill mix.

A recent report from the Royal College of Nursing Scotland analysed NHS workforce data from 2010 to 2025 and suggested an ‘unexplained variation’ in the skill mix within NHS Scotland district nursing teams.

While there has been growth in the overall district nursing workforce since 2010, an increasing proportion of the workforce is made up of nursing support workers.

In 2010, registered nurses accounted for 93% of staff in district nursing teams but in 2025 they accounted for only 78%.

Meanwhile, the number of nursing support workers has grown from 6.7% to over a fifth of the workforce (22.2%). The analysis showed that percentages ranged from 6.25% in one NHS board, to nearly half of the workforce (47.5%) in another.

RCN Scotland has called for action to ‘stabilise and future‑proof’ Scotland’s community nursing workforce, warning that the data ‘shows a failure to invest in the skill mix of Scotland’s community nursing teams’.

It added that the numbers of community nurses being supported to undertake specialist qualifications in district nursing, health visiting and school nursing has been ‘dropping sharply in recent years’.

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The union sent a  Freedom of Information (FOI) request to NHS Trust Boards asking how many nurses had been supported in gaining a Specialist Practitioner Qualification (SPQ) – a post-registration credential for registered nurses that aims to equips them with the advanced clinical, leadership, and prescribing skills needed to lead and deliver complex care in community and primary care settings.

Of the 12 boards that replied, data shows there has been a decline in the number of registered nurses being supported to complete the SPQ in district nursing since 2020, according to RCN Scotland.

Three boards had not supported any staff over the last five years in taking the SPQ, while out of the other boards, the high point was 2021 when almost 80 nurses were supported to complete it.

This had reduced by two-thirds by 2024 (under 30 nurses) with a small increase to above 30 in 2025.

It also showed that only 24% of registered nurses within district nursing teams hold the SPQ qualification.

In terms of health visitors, the data revealed that, between 2010 and 2020, the number of registered nurses in the health visiting workforce ‘grew significantly’.

However, the level has not been sustained and since 2020 the registered nursing workforce in health visiting teams has fallen by 7% and is now at its lowest point since September 2017.

Between 2010 and 2022 there was also a growth in the number of nursing staff within school nursing teams.

However, similarly to health visiting, this growth has not been sustained, and has fallen again in the last few years.

RCN Scotland asked NHS Trust Boards how many nurses within health visiting and school nurse roles had been supported in gaining Specialist Community Public Health Nursing (SCPHN) qualification, which aims to prevent ill health, protect health, and promote the well-being of specific communities.

For health visitors, 115 nurses were supported in 2022, compared to 55 in 2025. For school nurses, 82 nurses accessed the qualification in 2022 which fell to 16 in 2024 and 13 in 2025.

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RCN Scotland wants to see community nurses recognised by the government through investment and support to gain these additional qualifications.

RCN Scotland’s associate director of nursing, policy and professional practice Eileen Mckenna said: ‘The Scottish Government has been talking about shifting the balance of care into the community for years. It’s vital that real progress is delivered in the next parliamentary session.

‘Politicians from all parties must recognise that community nursing is central to achieving this ambitious agenda.

‘From prevention to end-of-life care, community nurses have a vital role as the Scottish Government shifts care from hospitals to community.

‘Community services already do an excellent job every day, however, we know that community nursing teams are under immense pressure and lack capacity to lead this shift without significant investment in the workforce.

‘That’s why it’s so concerning to see things going in the wrong direction, with falling numbers of community nurses being supported to undertake specialist qualifications.’

The Scottish Government was urged to set out ‘fully funded plans’ to grow the registered nurse workforce in community settings and ‘secure a pipeline of qualified nurses to work in district nursing, health visiting and school nursing’.

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‘Investing in the learning and development of the existing community nursing workforce is also vital to improving retention as well as enabling the workforce to grow, lead and innovate to meet challenges,’ she said.

‘Strengthening Scotland’s community nursing workforce is one of the best investments the government could make.

‘They are key to delivering expert interventions to help people live healthier lives in their communities and prevent costly hospital admissions.’

The Scottish Government has been approached for comment.