Some employers ‘replacing’ district nurses with lower band roles

Some employers are creating ‘new roles’ at lower pay bands in ‘replacement’ of district nurses, the chair of the Royal College of Nursing (RCN) District and Community Nursing Forum has suggested.

Gail Goddard, who is also a district nurse team manager, warned there was a ‘widespread lack of understanding’ about the level of expertise that district nurses bring to the community nursing workforce.

She said the issue was compounded by recruitment challenges, including ‘falling’ numbers of those undertaking a district nursing specialist qualification (SPQ) and the fact that ‘some trusts are creating new roles in replacement of district nurses at lower pay bands’.

‘Recruitment into community nursing is also hindered by outdated perceptions – such as the belief that hospital experience is a prerequisite, or that community roles offer limited opportunities for skill development. These myths must be challenged,’ she told Nursing in Practice.

Her comments come after a report by the Nuffield Trust revealed that registered nurse numbers were falling as a proportion of the district nursing workforce – accounting for fewer than three in four staff (72%) in 2024 compared to 82% in 2009.

The report, based on data from 113 NHS trusts, also found that 27% of professionals listed as ‘district nurses’ and employed under Agenda for Change (AfC), were working at Band 5 in England. This is despite the typical starting point for district nurses being a Band 6.

Related Article: Over a quarter of district nurses lower than Band 6, report finds  

Overall, the report found that the number of district nurses has plummeted by a staggering 43% since 2009.

Ms Goddard said the decline came alongside reports from members of ‘rapidly increasing caseloads’.

She told Nursing in Practice that this was ‘an imbalance that is simply not sustainable to provide high quality care without increasing the risk of burnout’.

Ms Goddard said forum members had ‘long voiced serious concerns’ about ‘the unsustainable workload facing community nursing teams’.

‘The number of individuals requiring increasingly complex care at home, along with rising patient acuity, continues to rise, yet the workforce has not expanded to meet this growing demand,’ she added.

The Nuffield report found that the between 2009 to 2024, the number of staff recorded in NHS district nurse roles fell from 7,643 to 4,322.

The researchers estimated that staffing levels relative to need had fallen by over half (55%) since 2009 – comparable to losing around 4,200 full-time equivalent district nurses.

In the year to September 2024, an estimated one in four district nurses (25%) working at Band 6 or above had left that staff group, the report found.

This was previously as high as one in three (33%) in the year to September 2022.

Related Article: Interview: ‘District nurse pay bands have been a fight for a long time’

In contrast, across all nurses and health visitors, one in 11 left in the year to September 2024, according to the report.

Researchers highlighted a lack of patient continuity of care, loss of skills and experiences, and additional burden for team mangers as key factors undermining district nurse retention.

‘Addressing high leaver rates will require purposeful, well-designed strategies as retention programmes for hospital nurses may not apply directly to district nursing, given the nature of the role, the demographics of those receiving care and the motivations of those providing it,’ the report noted.

Improving pay and working conditions

Professor Alison Leary, professor of workforce modelling, warned that dwindling district nurse numbers meant community care could not be done in a safe or effective way.

‘At a time when the focus is on moving care into the community, the crisis in district nursing means that this cannot be done safely or effectively without this key workforce.

‘There seems to be little will to retain or return experienced professionals, we need to think about returners more thoughtfully and also improve pay and in particular working conditions to retain staff,’ Professor Leary told Nursing in Practice.

Related Article: What’s next after CQC’s warning over nurse shortages?

In April, the QICN warned that some district nurses feel ‘obliged’ to accept lower paid job roles to achieve changes to their hours, working conditions or to further their education. 

Last December, health and social care secretary Wes Streeting said district nurses were an ‘absolutely vital part’ of the NHS that are often ‘undervalued and understaffed’.

Last summer, the QICN published a report showing that district nurses were having to defer end of life care due to rising workloads and increasingly complex patient needs.