Analysis

The challenges facing community nursing

Networking and sharing ideas will be high on the agenda for community nurse practitioners at the Queen’s Nursing Institute (QNI) conference in September. But it’s also an opportunity to hear from specialist speakers.

Networking and sharing ideas will be high on the agenda for community nurse practitioners at the Queen’s Nursing Institute (QNI) conference in September. But it’s also an opportunity to hear from specialist speakers

At this year’s Queen’s Nursing Institute (QNI) conference (25-26 September), designed specifically for all nurses working in the community, delegates will hear from a range of expert speakers.

Topics will include the latest developments and innovations in workforce, education, service delivery, technology and transformations of care.

The conference is also an opportunity for practitioners to network and learn from others in their own and related specialties.

Equally, the event will act as a platform for nurses to discuss challenges facing front-line community nursing, and this discussion will help inform future QNI policy and campaigns.

33.4%

of general practice nurses are expected to retire by 2020

Current situation

Healthcare services are facing unprecedented challenges as the ageing population increases; more people are diagnosed with long-term conditions and ill-health becomes increasingly complex. With their role providing support and prevention, community nurses assist those with minor and long-term conditions, and are at the core of primary care discussions.


  Community nurses are at the core of primary care discussions
as the ageing population increases.  Picture: Alamy

One of the most significant aspects of managing demand is having an adequate supply of nurses. The QNI has long advocated the need to have the right nurse, with the right skills at the right place and time. However, the institute is increasingly concerned about declining numbers in the workforce.

43.1%

of general practice nurses do not feel their nursing team has the right number of appropriately qualified and trained staff to meet the needs of patients

The number of hospital-based nurses has decreased, but the figures for community nursing are even starker. Between 2009 and 2016, community and mental health nurses employed in the NHS fell by 13%, but there was a 42% decrease in the number of district nurses (The Health Foundation 2017). QNI research found that 33.4% of general practice nurses (GPNs) are expected to retire by 2020, and 43.1% were concerned that their team did not have an appropriate number of trained and qualified nurses (QNI 2015).

This dwindling workforce not only places primary care services under further pressure, but also adversely affects staff well-being and in turn patient care. It is imperative that more is done in not just recruiting, but also retaining community staff. This includes abolishing the 1% pay cap and making community care a more attractive career path. NHS England's recent ten-point plan for GPNs is an attempt to address these issues (NHS England 2017).

Shifting from reactive to preventive

The provision of care needs to shift away from reactive to being more preventive. This means educating people to self-care and take ill-health prevention measures, which will reduce health service demand. This requires a holistic and whole-team approach to healthcare provision, encompassing other government departments, not just health.  

Patients need to play an active part in looking after their own minor self-limiting illnesses and long-term conditions. Care needs to become more person-centred, with healthcare being something patients participate in rather than just receive.

27%

of employers offered placements for pre-registration nursing students, compared with 61.5% offering placements to medical students

Evidence from the growing consumer market shows that patients are actively engaged in their health such as using online web tools to diagnose. However, the health service has not technologically advanced at the same pace as the increase in patient numbers has, and this presents challenges (QNI 2012). For example, measures which permit care to be undertaken remotely, such as telehealth (RCN 2012), have not been exploited fully.

Staff training

Training staff is the responsibility of Health Education England and employers. QNI research into GPNs found that approximately 27% of employers offered placements to pre-registration nursing students, while 61.5% offered placements to medical students (QNI 2015).

The Apprentice Levy introduced in 2017 has raised concerns about apprenticeships replacing specialist community nurse education.

More opportunities such as placements and financial support for pre- and post-registration nurses to explore community nursing are needed. These placements must be provided on a universal scale to pre-registered nurses, to encourage them to enter primary care after graduating.

How can we commission self-care environments?

QNI chief executive Crystal Oldman

  • Care must become person-focused, with patients taking an active role in the decisions made regarding their health. They must be appropriately supported to choose treatment options they feel most suitable.
  • More emphasis must be placed on campaigns and social marketing which raises awareness on how to manage ill-health and prevent conditions. These should take place in community settings, such as GP surgeries and clinics.
  • Healthcare must use a range of services to address every aspect of health and well-being in a more ‘joined-up’ manner. With many isolated communities and rural areas facing transport cuts and an increasingly ageing population, there is need for outreach services to be held in community settings not traditionally associated with healthcare. In providing joined-up care, signposting is imperative to ensure all patients’ needs are addressed by those best placed to help. 
  • For those commissioning care, services must be designed around users and providers, with patients lived experiences taking precedence when provision planning.
  • Partnership working must be appropriately funded and cover a range of services from across the healthcare, social care and voluntary sector to address all aspects of need.

 

Sustainability and Transformation Plans

Across many Sustainability and Transformation Plans, the workforce aspect demonstrates a lack of understanding of the role of community nurses. The potential further decline of community nurse numbers (RCN 2017) across a backdrop of public service cuts and austerity bears no relationship to the increased demand for their services.

Recent updates on the progress of the NHS Five Year Forward View show that primary and community care have been overlooked with increasing financial support provided to sustain secondary care, particularly to compensate for hospital deficits. Overlooking primary and community care serves as a barrier to a whole-system NHS.


About the author

Louise Clanfield is a research officer at the Queen’s Nursing Institute. Her role involves undertaking health research and policy work, assisting with publications and analysing data

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