Safe caseloads must be determined for district nursing, urges QNI

A new paper from nursing charity, the Queen's Nursing Institute, is being used to start discussions among policy makers, commissioners and service planners about what safe caseloads look like in district nursing services.
District Nursing

Significant work must be done to establish what safe caseloads look like for district nursing services, according to a new report.

The Queen’s Nursing Institute (QNI) has published a discussion document summarising the challenge in managing safe caseloads in district nursing.

District nurses
Managing a safe case load in district nursing. Photo: iStock

The issue has become prominent in recent years, as district nurse capacity has reduced, skill mix has become more diluted, and more care is moved into the community setting.

Growing concerns

QNI chief executive Crystal Oldman said the organisation receives more questions on the subject than any other and has called for a new framework to inform workforce planning.

Dr Oldman said: ‘The issue of safe caseloads is one that is a growing concern to district nurses in recent years.

‘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 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 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.’

Understanding Safe Caseloads in the District Nursing Service describes key issues to determine a safe caseload, including:

  • 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.
  • Geographic factors, such as housing.

Research published last Thursday by The King’s Fund warned district nursing services are at breaking point and the quality of patient care was being compromised.

King’s Fund policy researcher Anna Charles said: ‘For years, health service leaders have talked about the importance of providing more care in the community.

‘But this objective cannot be achieved when district nursing is at breaking point and a poverty of national data means the quality of services is not properly monitored.’

The QNI has now invited feedback on the issues covered in the paper and has expressed hopes of a wider discussion.