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Draft guidance out on safe district nursing caseloads

Draft guidance on safe caseloads in district nursing published by NHS Improvement.
district nurse with patient

Draft guidance on safe caseloads in district nursing has been published by NHS Improvement (NHSI).

The guidance is for a range of workforce decision-makers from district nursing service team leaders to the board of directors.

While it does not specify a nurse-patient ratio, it does recommend a number of workforce planning measurements, including 'care hours per patient day' created following the Carter Review of hospital efficiency.

Key variables

Managers and team leaders are advised to consider factors including:

  • Needs of patients, their families and carers
  • Patient safety
  • Geography the implications for travel and use of mobile technology of urban or rural environments
  • Housing and the home as an environment for care
  • Staff safety lone working or care that needs

Draft guidance on safe caseloads in district nursing has been published by NHS Improvement (NHSI).


The caseload guidance comes at a time when district nurses are 'overstretched'  Photo: Alamy

The guidance is for a range of workforce decision-makers – from district nursing service team leaders to the board of directors. 

While it does not specify a nurse-patient ratio, it does recommend a number of workforce planning measurements, including 'care hours per patient day' created following the Carter Review of hospital efficiency.

Key variables

Managers and team leaders are advised to consider factors including:

  • Needs of patients, their families and carers
  • Patient safety
  • Geography – the implications for travel and use of mobile technology of urban or rural environments
  • Housing and the home as an environment for care
  • Staff safety – lone working or care that needs to be given by more than one member of staff
  • Care pathways and interventions – collaboration with other services providing care in the home

Association of District Nurse Educators chair and Queen’s Nurse Julie Bliss was part of the NHSI working group that wrote the guidance.

Timely information

She said: ‘This is incredibly timely, given how the district nursing service has become so overstretched.

‘The demands for the service is increasing, the workforce is forced to become task-focused, and there is then an inevitable impact on quality of care.

‘The ultimate aim of this consultation is to make sure we have the right staff, in the right place, at the right time.

‘There is also a need to balance time spent being reactive and time spent being proactive. It is vital therefore that we know what as many nurses as possible in the service are doing around the country and what their needs are.

'This guidance aims to work towards a time when all nurses put useful information into a workforce planning system and get useful information out. Look at the draft, ask yourself if it will work, and let us know.’

The consultation runs until 28 April. Read the draft guidance here


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