The COVID-19 pandemic is a challenging and complex time for individuals, families and communities, both personally and professionally. District nursing (DN) services have continued to provide complex person-centred care for people at home. However, their caseloads have expanded rapidly and care delivery has become more complex due to the requirements for enhanced personal protective equipment and other factors to ensure patient safety due to COVID-19, at a time when other services have been reduced (Green, 2020). The leadership role of the district nurse is pivotal to DN teams being able to manage and deliver person-centred care in this increasingly complex landscape and across populations. Completion of the district nurse specialist practitioner qualification (DN SPQ) increases the confidence of district nurses as individuals, managers and clinicians while enhancing their understanding of patient expectations, team management and leadership (Hill, 2020). At the same time, the Queen's Nursing Institute's (QNI) DN education report for 2018–19 identified a small increase of 4% in the number of newly qualified district nurses, with many respondents concerned regarding the future funding of the DN SPQ programme (QNI, 2020).
It is in this increasingly complex backdrop of care delivery and education that the Nursing and Midwifery Council (NMC) is reviewing its post-registration standards. Although the use of technology to support virtual engagement is to be commended, the reality of care delivery during the pandemic and time pressures mean that not everyone is aware of the review or has been able to attend the webinars. The review includes standards for specialist community public health nurses, alongside a review of the specialist practice qualifications (SPQs). Several key DN organisations, including the Association of District and Community Nurse Educators, the DN Apprenticeship trail blazer group (England), the Royal College of Nursing and its district and community nursing forum, the QNI and Queen's Nursing Institute Scotland, are engaged in the review.
The NMC review was proposing a single generic SPQ, which would subsume the current five recordable qualifications: district nurse, community children's nursing, community learning disability nursing, general practice nursing and community mental health nursing. More recently, in response to widespread concerns raised by those involved in the review and following a letter from the Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, the NMC has now confirmed that the current five SPQs will remain, alongside the introduction of a sixth generic specialist community qualification (Mitchell, 2020). The generic SPQ has potential for inclusion of many other areas, such as care home nursing and inclusion health nursing. This will require further development but is a welcomed proposition.
Although the commitment to retain the DN SPQ can be viewed as a victory, it represents one step on a journey where ongoing engagement from all those with an interest in DN remains crucial. The community SPQs being retained is within the context of future regulation of advanced practice, and it is essential that there is future recognition for the community SPQs alongside an acknowledgement of their advanced level of practice. District nurses must engage in this debate and respond to the NMC consultation, due to open in February 2021.