The Queen’s Nursing Institute has announced the publication of its latest review of District Nurse education. The report by the QNI is an accurate and independent analysis of Specialist Practitioner District Nursing education across the United Kingdom. 

The report summarises the results of an audit of District Nurse education for the academic year 2021/22. This is the tenth annual District Nurse (DN) Specialist Practitioner Qualification (SPQ) education audit, a process that was established by the QNI in 2013. 

Programme Directors for Nursing and Midwifery Council (NMC) approved SPQ programmes in District Nursing at Higher Education Institutions (HEIs) from across the four countries of the UK were invited to complete an online survey. The audit report based on their responses includes quantitative data and quoted comments from educators that complement the numerical findings.  

Headline findings 

  • 668 District Nurses qualified with a SPQ in the 2021/22 academic year; this is a decrease of 6% from the previous year.  
  • 647 new students enrolled on the DNSPQ for 2022/23, 54 of these are on the apprenticeship route (England only). This represents a decrease of 9% on the number of enrolments in the previous year, representing a further decline in the number of students.  
  • There are 32 universities currently registered to deliver the DNSPQ programme with the NMC; five universities are delivering programmes and awaiting revalidation using the new NMC post registration standards (2022).  
  • 33 universities responded to the QNI audit survey.  
  • Respondents shared widespread, ongoing concerns over central government funding of the DNSPQ.  

Difficulty of access affecting course demand 

The NHS Long Term Workforce Plan (2023) emphasises the need for a significantly more qualified and well-prepared District Nurses to meet the increasing healthcare needs of our communities. The adoption of the ‘virtual wards’ model by the NHS is just one of the policies that will place greater demands – and value – on district nursing services, as more complex care is delivered in the home, supported by new technologies. 

Community service providers and HEIs show increasingly strong support for the DNSPQ programme, but in England at least, they are navigating an unclear future where the DN Apprenticeship and centrally funded places will need to be carefully balanced.  

Various factors affect the gap between commissioned numbers of DNSPQ programme, and the numbers enrolled each year, with a 9% reduction seen from 2021/22 to 2022/23. One of the factors is uncertainty and late notification of confirmed central funding for universities and employers, which results in employers not having sufficient time to plan the release of nurses to undertake the programme. 

The QNI believes that the direction of travel for more care to be delivered in the community is being hampered by insufficient numbers of District Nurses, contributing to delayed discharge and more hospital admissions (Age UK 2023). The NHS Long Term Workforce Plan (2023) aims to double the number of District Nurses by 2028, which under the current system will mean increasing the number of university places year on year. Recruitment and retention of district nurse students will be key to this objective. Without taking these steps, the forecasted shortfall in District Nurses will have detrimental impacts on the healthcare of the UK’s growing and ageing population. 

The National Health Service is now three years into its Long Term Plan, published in January 2019 and now supported by the NHS Long Term Workforce Plan (2023). Longer term visions for the growth of the NHS workforce are to be encouraged and the number of qualified District Nurses are a key component of the workforce. The QNI is concerned that the salary Agenda for Change banding of many qualified District Nurses does not reflect the complexity of care they deliver, which is at an advanced level of practice. The DNSPQ is an educational programme designed for the community setting and it should be integral to the government’s plans to increase the number of skilled, registered practitioners in the community.

Dr Crystal Oldman CBE, QNI Chief Executive

The QNI have built upon the NMC post-registration standards (2022) to create DN Field Specific Standards which when adopted by universities will ensure that the quality of district nurse education can be standardised and endorsed by the QNI. HEIs can now apply for access to the QNI’s DN field-specific standards.   


Notes to Editors 

 The NHS Long Term Plan (NHS, 2019) https://www.longtermplan.nhs.uk/  

 The NHS Long Term Workforce Plan (NHS, 2023) https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/  

 The QNI Field Specific Standards for Community Nursing (2023) https://qni.org.uk/nursing-in-the-community/standards/consultation-on-qni-field-specific-standards/    

 The State of Health and Care for Older People in England (Age Concern, 2023) https://www.ageuk.org.uk/latest-press/articles/2023/age-uk-issues-clarion-call-for-a-big-shift-towards-joined-up-home-and-community-based-health-and-social-care-services-for-older-people/  



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