The NHS Long Term Plan (NHS, 2019) points the way forward for the service, recognising concerns about the growing and ageing population, staffing and funding, while highlighting opportunities for improving healthcare provision and health outcomes. It sets out strategies for a new service model for the 21st century, specifically highlighting the need to ‘boost out-of-hospital care’ and ‘focus on population health’. This is set within the context of the changing role of the district nurse in response to increasingly complex care being delivered within the home, earlier discharge from hospital and increasing comorbidity (Green et al, 2017). The value of community and primary care in the development and delivery of care is well recognised, with district nurses (DNs) identified as core members of neighbourhood teams.This recognition of the contribution of DNs and district nursing teams comes at a time when the number of students entering specialist practitioner DN programmes is falling despite an increase in 2014/15 (Queen's Nursing Institute (QNI), 2018). This is compounded by reduced funding for continuing professional development (CPD) for registered nurse and midwives (House of Commons Health Committee, 2018).
The district nurse apprenticeship standard published on 8 March 2019 provides an opportunity to redress the reducing numbers of qualified DN nurse specialist practitioners and enhance the DN role as the cornerstone of care closer to home. A trailblazer group consisting of 45 organisations delivering district nursing services has demonstrated the commitment of service providers to the DN role.This group presented evidence to the Institute for Apprenticeships (IfA), making the case that the occupation of DN is unique and proving that DN specialist practitioner qualifications while having some similarities to advanced clinical practice, were significantly different from it. As a result, the IfA agreed to district nursing being recognised as a unique occupation and that it required a separate apprenticeship standard.
The district nursing apprenticeship standard is written at level 7 and linked to the postgraduate diploma for district nursing with integrated nurse prescribing. At a time of reduced funding for CPD, the apprenticeship provides an opportunity to access the apprenticeship tariff and complete the qualification over 2 years while employed within a community provider, with 20% learning off the job. The standard sets out 10 occupational duties and the knowledge, skills and behaviour of the DN, which further develop the Voluntary Standards for District Nurse Education and Practice (QNI and QNI Scotland, 2015). Work continues on the development of the standard, and details are provided on the IfA website for those who would like to be involved.