Will District Nurses Go The Way Of The Dinosaur?

Education and Societies

Fewer and Fewer

The RCN ihas issued an unprecedented warning that district nurses are currently “critically endangered” and face extinction by the end of 2025 if urgent investment is not made.

The past decade has seen a 47% reduction in the number of qualified district nursing staff in England, threatening the ability of the whole health and social care system to cope with soaring numbers of frail older people in the coming decade.

The NHS and successive governments have expressed their commitment to making the workforce available to deliver care closer to home.  However, new research from the National Nursing Research Unit, commissioned by the RCN, reveals that the current shortage of district nurses is expected to get worse, with over a third (35%) being over 50 years old and coming up to retirement age.

The RCN is calling on the Government to fulfil its commitment to increase the community workforce by 10,000 in order to plug this growing gap. This is the only way to meet the growing demands of an ageing population, many of whom need care at home and help to manage long term conditions.

The RCN recommends that these extra posts should be district nurses – specifically qualified staff who are trained to deliver the best possible care for multiple conditions in a patients’ own home.  A quarter of nurses said that they had seen more than twelve patients on their last shift, forcing them to reduce the time spent and jeopardising the quality of visits to vulnerable patients.

Many community staff reported being pushed to breaking point, with more than eight out of ten working additional hours on their last shift. Three quarters said they had left necessary activities undone due to a lack of time, and four in ten said that they would leave the job if they could.

A fifth of each day is spent on paperwork reducing patient contact time still further, with only 37 per cent of time being spent delivering direct care.

A nurse told the RCN:


“It is a privilege to work in the community and in people's homes. If I was given more time to do my job I would love it but at times I can't help but feel I have been unable to provide the care I feel I want to give. This frustrates and saddens me. The need to keep patients out of hospital is being highlighted at the moment but no extra help is being given to front line staff.”

The level of skill in community nursing teams may also be under threat, with 16 per cent of teams being without a specifically qualified district nurse. District nurses, who have advanced training in managing patients in the community, make up an average of only one in five of the staff employed in community nursing teams.

The RCN is also calling for all trainee nurses to undertake a mandatory placement in the community in order to meet the demands of the future.

Dr Peter Carter, Chief Executive & General Secretary of the RCN said:

“People are living longer, but not necessarily healthier lives. This trend will grow over the coming decades and presents a very specific nursing challenge.

“The district nurse role is the foundation of a system which should be able to manage conditions and keep sick and frail people at home. Remove those foundations and the whole edifice could come crashing down.

 “The NHS, and the people who run it, have long paid lip service to the ideal of moving care closer to home. But many people up and down the country are still in need of expert care from district nurses.

“By 2025, there will be many thousands of families with frail older relatives, who may well have survived a number of illnesses – and when they look for help to manage at home, it simply won’t be there.

“It looks as though the NHS is trying to run these services on goodwill alone and staff should not be spending their working lives at breaking point. Patients simply cannot wait forever for these services to be properly resourced.

 “When expert care at home is not available for vulnerable or dying people, the end result is unnecessary hospital admissions which are both expensive and distressing.  It is a false economy to leave patients in limbo, rather than training and employing enough district nurses to meet demand.”

The RCN is also publishing a new range of reports outlining the nursing experience of integrated care in the UK and lessons from the model of integration in the United States. The report follows a survey by the Queen’s Nursing Institute which also raised concerns about the morale and staffing of district nursing teams.