For more than 30 years, one of the most significant and long-running letdowns of policy and implementation in the NHS and social care has been the failure to grow and invest in primary and community health and care services (The King's Fund, 2024). Several reasons are given for the lack of focus on health and care in the community, including the fact that such services are hard to quantify and easy to overlook, and that there are hierarchies of care, with urgent problems taking priority over longer-term issues.
A tacit hierarchy can also be identified in schools of nursing, where students continue to attribute a different value to the learning opportunities available in the community (Dalsmo et al, 2023). There is also a perception that the community environment will not meet a student's educational requirements to qualify as a registered nurse (Bedin et al, 2013) and that there is little or no potential to develop specific nursing skills (Garbrah et al, 2017; Cooke et al, 2021; Skills for Care, 2021).
Community nurses form an important part of the NHS and Private, Voluntary and Independent workforces in the UK. There are a wide variety of community nursing roles, each requiring specific educational preparation to provide care to people, their families and communities across a range of health and social care settings. Community nurses work within care homes, GP surgeries, prisons, schools and clinics, and also offer outreach services to people living without a secure home. A stated aim of the NHS Long Term Workforce Plan (NHS England, 2023) is to recruit and retain more nurses in primary and community health settings, to enable more preventive and proactive care across the NHS. Investment in the social care workforce is also vital for the NHS to function. In 2017–2018 and 2019–2020 ‘awaiting a residential or nursing home placement’ accounted for around one in four delayed discharges from hospital (NHS Confederation, 2023). Social care provision also has a significant impact on urgent care demand, identifying and intervening in health emergencies, and reducing accident and emergency attendance.
Demand for nursing care in the community is increasing as the population continues to age and grow. The world's older population is projected to triple by 2050 (United Nations, 2019) and the number of people aged 85 years and over is set to double over the next 20 years; between 2015 and 2035, the number of older people with four or more diseases will double and a third of these will have mental ill-health (Kingston et al, 2018).
Yet, the number of nurses choosing to work in community and older person nursing is alarmingly low, with many perceiving it to be low-status and strenuous with impoverished care environments. Supportive and developmental student placements in community settings can positively impact choice of first staff nurse post (Wareing et al, 2017; Naughton et al, 2019). The undergraduate curriculum often focuses on hospital-based care, with insufficient consideration of the needs of older people (Garbrah et al, 2017).
Community and older person nursing network
Reflecting current national priorities for health and social care, the community and older person nursing network (COPNN) is a collaborative initiative, which was established to raise the profile of community and older person nursing. Based within the School of Nursing and Midwifery at Oxford Brookes University, the network has a representative membership group (currently around 40 people) including nursing academics and researchers and practice colleagues from primary, community, secondary, third sector and service users.
The network intends to support high quality nursing in a variety of community settings and older person settings and raise its profile among nursing students by using evidence-based recommendations to influence its three key themes: curriculum development, placement development and research and publication, and their associated objectives:
Curriculum development
Placement development
Research development
The network is supported by a small steering group consisting of academic staff and external colleagues who have research or practice experience of relevance. Three working groups have also been established to reflect the three key themes and include COPNN members with an interest in each.
These groups are chaired by a member of the COPNN steering group and meet regularly in between the main COPNN meetings to work on agreed priorities from a dynamic action plan of ideas and suggestions gathered from the wider COPNN members.
Members of COPNN meet three times a year; the meetings are very well attended and provide an opportunity to offer updates on latest developments, gather feedback, and share ideas and suggestions to inform future priorities. Career progression and future employability are key aspects of this initiative, and promoting strong links between staff on the pre-registration nursing programme and their post-registration colleagues within the school is pivotal. To this end, colleagues who lead the post-graduate specialist practice programme in district nursing and the specialist community public health nursing programmes in health visiting and school nursing are members of COPNN. Raising awareness of the inherent job satisfaction as well as future learning opportunities available in both community and older person nursing is designed to dispel many of the myths associated with these nursing disciplines.
Updates from the COPNN are also a rolling item on the agenda for the regular adult nursing team meetings, which provides an opportunity to inform the wider staff base of network activities and gather any ideas they may wish to contribute. In this way, COPNN forms an integral part of the school's wider infrastructure.
Curriculum development
There is an acknowledged focus on hospital-based curriculum, rather than community care and research, and there is a paucity of content specifically related to nursing older people (Dahlke et al, 2020) in pre-registration nursing programmes. These findings are particularly concerning considering the changing demographics and growing need for nursing care. The COPNN is focused on influencing and developing content related to community and older person nursing in pre-registration curriculum.
Current initiatives include purposefully incorporating more community-based scenarios and workshops into simulation sessions and creating resource films on community and older person nursing with practice colleagues. Videos on learning opportunities on community placements and in nursing homes are available online for students to view and are used in placement preparation sessions.
Inviting community and care home nurses to deliver teaching sessions and describe their roles in detail addresses the growing need to promote ‘first destination’ roles/careers in the community. To this end, NHS England is supporting the development of pre-registration blended-learning nursing degrees with a community/primary care focus (Ford, 2023). Cooke et al (2021) highlighted the urgent need for adult nursing faculties to review their curriculum and increase the visibility of caring for older people, thus reducing students' perceived misconceptions about older adult nursing.
With this aim in mind, the COPNN began the process of mapping out the learning outcomes in the curriculum to identify areas in the modules where increasing content for community and older adult nursing could be considered.
Three modules were identified and subsequently learning outcomes, along with teaching and learning resources, were developed to focus on older adult nursing and were integrated into the modules.
Evaluative feedback was gathered online following these sessions in order to build on this development and identify further learning outcomes.
Placement development
A student nurse placement in the community offers a wide variety of learning opportunities, including nurse-led management of complex conditions, as well as experience in public health, health promotion and safeguarding roles which are vital to reduce the burdens of disease, injury, social isolation and the health consequences of deprivation (Chilton, 2025). A positive learning experience can have a profound impact on the decision of the learner to remain in their profession and, on qualification, to identify their preferred career pathway and place of work (Garbrah et al, 2017).
The ‘placement development’ working group focuses on increasing placement capacity across care homes, health centres and GP practices, schools and prisons. Sustainability of the placement area and quality of the student learning experience are key. Building effective and productive professional working relationships and learning lessons from placement evaluations are essential elements in achieving these aims. The specific use of local intelligence, alongside national quality assurance reporting such as Care Quality Commission inspections, ensures high-quality care delivery settings.
A key element of the placement development theme is the community pathway, which nursing students are introduced to at the beginning of their course and then at regular points throughout the curriculum. Interested students apply for the pathway in their second year, guaranteeing placements in a variety of community settings for the final year of their programme, if successful. Career progression and future employability are key elements of the pathway. A community pathway booklet provides updated information on the learning opportunities available to students, and community-centred study days and action learning sets are also offered on this pathway.
One innovation is the creation of a weekly ‘care home academy’ where students on placement in different care homes meet online with an assigned lecturer at the school of nursing to reflect on practice, offer feedback and discuss clinical scenarios. Feedback related to the academy is overwhelmingly positive, and can be used to further develop the placement (Lloyd-Penza et al, 2019).
Research and publication
There is a recognised lack of research addressing challenges or issues that are relevant to community nursing settings (Henshall et al, 2022). Meanwhile, older people have often been excluded from clinical trials because of age, multimorbidity and disabilities (Pitkala and Strandberg, 2022). Research is essential in providing evidence-based care for patients: a lack of research has implications for the recruitment and retention of staff and the quality and safety of patient care (Henshall et al, 2022).
Members of the COPNN network have committed to research and publication in this area, producing a core textbook on community nursing, recently published in its third edition (Chilton and Bain, 2025), peer-reviewed research articles on nursing curriculum and the older person (Garbrah et al, 2021; 2017), and experiences and perceptions of student nurses on placements in care homes (Cooke et al, 2021). A presentation of the COPNN took place at the Royal College of Nursing education forum conference in April 2024.
Additionally, research suggests that nursing students at the beginning of their studies have a skewed perspective towards community and older person nursing (van Iersal et al, 2018), fuelled by stereotypical attitudes in the media. Aiming to change the narrative, members of the network have written on the reality of nursing roles in the community (Cowan, 2022; 2023). Student nurses are also encouraged to identify an area of research relevant to community or older adult nursing for their final year dissertation project.
As a result of a James Lind Alliance priority setting partnership, the top ten community nursing research priorities have been identified, reflecting the complexity of care delivered to patients and the workforce pressures community nurses face (Henshall et al, 2022). Members of the COPNN are working with nurse academics to address these questions, which reflect the needs, views and priorities of community nurses, patients and carers of different ages across England and different geographical regions. These should take account of any differences in perspectives according to gender and ethnicity so that the findings are wide-reaching in their impact.
Conclusions
The community environment is a fascinating yet complicated matrix. There are myriad individuals, groups, agencies and organisations involved in the delivery of health and social care. Appreciation of the true complexity of meeting the health and social care needs of the population, particularly older adults, living in the community only really becomes evident with experience. Visualising community care as a ‘process’ rather than a ‘context’ can help community nursing be valued as advanced specialist practice rather than as institutional or hospital-based nursing in another setting. This emphasises the need for nursing academics, with their varying experiences, to ensure that the learning opportunities for student nurses are representative of primary, secondary and tertiary care settings, providing the range of knowledge, skills and values required for working in each sector. The COPNN is focused specifically on developing the curriculum, placements and research and publishing activities to raise the profile of community and older people nursing and increase the number of student nurses choosing community nursing as a first career post. This initiative will be of interest to other nursing schools, and communication and collaboration are welcomed to address the rapidly changing nursing needs of an ever-growing older population.