The Queen’s Nursing Institute has published a discussion document on safe caseloads in the District Nursing service.

The document summarises the challenges in managing safe caseloads in the District Nursing service, and points to specific actions the QNI believes are necessary to improve and safeguard the future quality of services. It is considered that significant work is required to establish recognised principles of safe caseloads, prediction of patient demand, and the desired clinical outcomes.

The issue of safe caseloads is one that has become increasingly prominent in recent years, as District Nurse teams have seen staff capacity reduced and skill mix become more diluted, at the same time as more care is moved into the community setting. Despite this, there is a lack of robust data about how to measure and predict what a ‘safe caseload’ actually is, which has led to uncertainty among commissioners, service providers and team leaders.

This is something that was clearly articulated in the report, ‘Understanding quality in district nursing services’ published by the King’s Fund. The King’s Fund report references previous research by the QNI in this area and the report’s findings are strongly endorsed by the QNI.

The new QNI document provides a thematic overview of the issues that should be taken into account when determining a safe caseload. These include: patient need; complexity of care required; rate of hospital discharge; skill mix within the team; capacity of other health and social care services; use of technology; and local geographic factors such as housing.

The issue of safe caseloads is one that has been of growing concern to District Nurses in recent years and we receive more questions on this subject than almost any other. This is against a background of overstretched services that are struggling to cope with the number of patients being referred to them for the expert care that they provide.

Frequently these are patients with complex long term conditions, who need specialist healthcare in the community for them to be able to live with dignity in their own homes.

There is now general recognition among policy makers, commissioners and service planners that we need a stronger framework of principles and measures in order to meet individual and population need. The QNI is committed to excellent care for all patients, families and carers in their homes and communities and understanding all the elements on which a well-resourced District Nursing service can be built and managed is critical to this.

It is intended that this paper will be the catalyst for a wider discussion on safe caseloads in the District Nursing service and the QNI welcomes feedback on the issues covered in the paper.

Dr Crystal Oldman, chief executive

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