The UK’s District Nurse workforce is under severe threat due to long-term underinvestment in training, education and skills, posing a direct threat to patient safety, warn the authors of a new, independent report, commissioned by the Queen’s Nursing Institute (QNI) and published today.

District Nursing today: the view of District Nurse Team Leaders in the UK, is the first general review of the district nursing profession to be released since the publication of ‘2020 Vision Five Years On’ in 2014.

The findings reveal an evolving healthcare workforce crisis, set against a backdrop of rising demand for district nursing services across all UK regions. This study shows that for District Nurses (DNs), working conditions, pay, education and training have not improved since the previous QNI report was published (2014). If anything, conditions, lack of support and career development for DNs has deteriorated further, leading to:

  • Working large amounts of unpaid overtime: One in five (22%) of respondents work a day or more of unpaid overtime each week. One-third of respondents work over 4-7 hours per week that is not reflected in their salary; unpaid overtime is undertaken by 90% of all respondents and there is significant variation between regions;
  • An ageing workforce heading for retirement; the workforce is drawn from an ageing population, with the majority of respondents to this survey aged over 45 years and with 46% planning to either retire or leave in the next six years (25% to retire, 21% to leave);
  • Lack of IT support to do the job efficiently: 36% of respondents reported that Information Technology, or lack access to efficient IT systems, connectivity and support infrastructure is one of the main factors making their role more difficult to sustain;
  • The lack of training and development available to District Nurses is a key factor reported to be influencing those looking to leave the profession. Other factors cited include a lack of appraisals and access to regular clinical supervision;
  • Unmanageable caseloads per individual is cited as another challenging factor with almost 30% of teams having a caseload of over 400 patients/people;
  • Insufficient time to devote proper care to patients. 63% respondents say they defer visits or delay the delivery of patient care on a daily basis;
  • Stagnation and lack of progression in the workforce: 75% of respondents state they have vacancies or ‘frozen posts’ in their teams;
  • No administrative support: 28% of respondents have no access to administrative support staff;
  • Variation in pay of District Nurses acting as team leaders and significant regional variation in the pay band of District Nurses holding the Specialist Practitioner Qualification.

Responding to the findings, the QNI argues that a fundamental misunderstanding of the crucial role played by the District Nurse in providing a critical, nurse-led service in every local community that has led to a lack of investment and undervaluing of their role and the valuable work they do. The QNI is now calling on the future Government to intervene, in order to prevent a deepening crisis.

Dr Crystal Oldman CBE, Chief Executive of the QNI said:

“District nurses are the backbone of community healthcare in this country. They provide a solution to the current crisis in acute hospital care by reducing delayed transfers of care and ensuring that patients are kept safe at home, preventing thousands of unplanned admissions and attendances in the Emergency Department every day.

Most people probably do not realise exactly what the daily work of a District Nurse entails. They are the key co-ordinators of multiple services and manage the treatment for complex conditions, preventing patients from needing hospital admission. They provide end of life care for the dying, and they administer a range of complex, clinical treatments at home to patients of all ages and abilities, supporting their families and carers too.

End of life care is also the bread and butter work of a district nurse and a steep decline in their numbers will inevitably lead to a rise in the number of hospital admissions, placing more pressure on an already overburdened NHS.

To stem this crisis, what is needed now is a significant programme of investment by government into the training, education and development of a new generation of highly skilled District Nurses, who will become the leaders of community services.  We need to return the numbers in the workforce to what they were in 2011, or better. More research is also needed to ascertain the future capacity and capability of a District Nursing workforce that can respond to increasing national demand for the service.”

Professor Alison Leary MBE, a QNI Fellow who is also Chair of Healthcare Workforce Modelling at London South Bank University (LSBU) said:

“Right now, with district nursing we are seeing a perfect storm with a set of circumstances that – if left untended, without intervention from government, directly threaten patient safety.

We need to seriously address what that crisis will look like for local communities in the future and what such a shortage of qualified district nurses will mean for people in our community with complex care needs who desperately need caring for at home.”

Concerns highlighted in this review echo previous warnings from the Royal College of Nursing of a steep decline in district nurse numbers – an estimated 48% drop in numbers over eight years since 2010, with 46% of the remaining workforce intending to either retire or leave the profession within the next six years.


For more information please contact: Matthew Bradby, Head of Communications, The Queen’s Nursing Institute matthew.bradby@qni.org.uk


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