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Does district nurse training have a future?

Clarity on the long term funding plans for district nurse training programmes is a matter of urgency to  ensure a creditable workforce plan, writes Crystal Oldman.

Clarity on the long term funding plans for district nurse training programmes is a matter of urgency to  ensure a creditable workforce plan, writes Crystal Oldman.

The King’s Fund report, Reimagining community services: making the most of our assets, adds to the ever-growing body of evidence stressing the importance of community health service and reinforces Queen’s Nursing Institute (QNI) concerns that ‘the longstanding ambition to strengthen community services has not been realised’.


Photo: John Houlihan

As our older population increases, ill-health becomes increasingly complex and more people are living with long-term conditions, healthcare services face unprecedented challenges. Community nurses are central to alleviating pressures on services and addressing many of these challenges. This has been reflected in numerous policy documents. The Five Year Forward View, for example, says care in the community ‘needs to become a much larger part of what the NHS does’.

The importance of joined-up care

The dissonance between this aspiration and the reality illustrates that much work still needs to be done. Between April 2010 and September 2017, the number of nurses working in NHS community health services fell by 15% – including a 46% cut in district nurses.

The King’s Fund report highlights the importance of joined-up care and better integrated services and community nurses are central to this. District nurses act as coordinators in joining up health, social and third sector services to ensure seamless care for patients. QNI research indicates that one in four over 75s and one-in-two over 85s will receive care from a district nurse. The fall in district nurse numbers by almost half in seven years therefore presents challenges for the future.

The shortfall in the nursing workforce has dominated headlines and political conversation in recent months. The QNI welcomed the plans from the health and social care secretary last year, to increase training places for nurses by 25%. It is critical to the delivery of the Five Year Forward View that students spend a good proportion of their training in community settings.

'At the 2017 QNI annual conference, 50% of delegates predicted that their local university district nurse programme would close'

A QNI survey of more than 3,400 General Practice Nurses (GPNs) demonstrated that students often have limited exposure to primary care, with 27% of employers in general practice providing placements for pre-registration nurses, compared to 61.5% offering places to medical students. QNI research indicates that 33.4% of GPNs will be eligible to retire by 2020.

The QNI has also raised concerns that the current number of district nurses qualifying is insufficient to replace those expected to retire and to meet increasing demand. At the 2017 QNI annual conference, 50% of delegates predicted that their local university district nurse programme would close. Cutting the pipeline of qualified district nurses in this way is detrimental to patient safety and will result in an increase in delayed transfers of care from the hospital to the community, and increases in unplanned admissions and in emergency department attendances.

Calls for a credible workforce plan

Two universities in England are to close their district nurse programmes in September 2018 as there is no secure funding for district nurse students, even though the demand for training continues from service provider organisations.

The QNI is calling on Health Education England to provide clarity on its plans for the long term funding of district nurse programmes as a matter of urgency, and for a credible workforce plan that meets the needs of patients, families, carers and communities to support the ambitions of the Five Year Forward View.

Further information


About the author

Crystal Oldman is chief executive, Queen's Nursing Institute, London


 

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