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Why the district nurse title is under threat – and what you need to do about it

The suggested removal of the district nurse specialist practice qualification poses an existential threat to district nurses

The suggested removal of the district nurse specialist practice qualification poses an existential threat to district nurses

The district nurse (DN) title was documented as early as 1859, almost 100 years before the NHS was established. Since then the role has adapted and responded to many changes: an ageing population which has increased demand and expectation; rising patient acuity accompanied by multimorbidity and complex conditions; requirements for advanced consultation, diagnostic and prescribing skills becoming routine; and resourcing issues that affect caseload management.

District nurse specialist practice qualification is transformational

Newer challenges include integration into primary care networks as a member of the wider multidisciplinary team and the delivery of exceptional, person-centred care through the second wave of the COVID-19 pandemic.

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    The suggested removal of the district nurse specialist practice qualification poses an existential threat to district nurses

    Picture: Alamy

    The district nurse (DN) title was documented as early as 1859, almost 100 years before the NHS was established. Since then the role has adapted and responded to many changes: an ageing population which has increased demand and expectation; rising patient acuity accompanied by multimorbidity and complex conditions; requirements for advanced consultation, diagnostic and prescribing skills becoming routine; and resourcing issues that affect caseload management.

    District nurse specialist practice qualification is transformational

    Newer challenges include integration into primary care networks as a member of the wider multidisciplinary team and the delivery of exceptional, person-centred care through the second wave of the COVID-19 pandemic.

    More than 90% of clinical care is now delivered in the community, in or near the patient’s home. Sadly, this is often unseen as care is delivered behind closed doors; it goes unquantified and, some feel, unvalued. Despite delivering the lion’s share of care, the allocation of resources to community services never reflects this.

    A DN is a registrant who holds the district nurse specialist practice qualification (DN SPQ). This transformational qualification – recorded with the nurse’s registration by the Nursing and Midwifery Council (NMC) – is career changing. It develops advanced clinicians, leaders of teams and specialists who deliver care provided in the most challenging of circumstances, to populations with ever-increasing complex needs.

    Review of post-registration standards poses threat to the district nurse role

    District and community nurses face many challenges including the urgent need to establish:

    • Fair grading that truly reflects the advanced skills required to be a DN
    • Detailed workforce planning with appropriate investment to ensure safe caseloads and effective staffing
    • A progressive career structure alongside effective support for staff health and well-being
    • A single system for electronic patient records for seamless care delivery, accessible for all providers
    • An expansion of community preregistration placements that can attract newly qualified nurses to the specialty and strengthen our future workforce to meet growing demand.

    The most significant challenge to the role of the DN is the NMC review of post-registration standards. This review has involved extensive meetings, vociferous debate and an NMC draft plan, ahead of a profession-wide consultation early in 2021. But is the voice of DNs being heard? The review and the subsequent plan put the future of the DN role at risk; a threat that many DNs may not be aware of.

    ‘It is the very title “district nurse”, the DN-specific, pedagogically innovative SPQ route and the annotation of the qualification that assures the safety of our patients and the advanced standing of the role’

    The NMC review is suggesting the removal of the DN-specific SPQ route and for this to be merged with four other community SPQs to form a single, generic community nurse specialist qualification. There is a risk that the annotation of the SPQ qualification will be discontinued.

    District nurses must unite to protect their title and their role

    It is the very title ‘district nurse’, the DN-specific, pedagogically innovative SPQ route and the annotation of the qualification that assures the safety of our patients and the advanced standing of the role. It is key to motivating commissioners to support nurses to undertake the programme.

    DNs need to be vocal. We need to define the DN role, demand fair remuneration and, ultimately, protect the specialist training and our title for future generations of DNs.

    We need to intensify the national voice for the care delivered outside of hospitals and to exploit the powerful, influential and authoritative leadership skills of DNs to realise and implement healthcare policy across our four nations. The loss of the DN-specific route, the title and the recordable nature of the qualification will be irretrievable, and will affect the future of care delivered in the community for many years to come.


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