District nursing today

Changing demographics, improved therapeutics and modifications in healthcare practice, such as early discharge, have changed the volume, nature and complexity of district nursing practice. The latest report from the Queen's Nursing Institute (QNI) (2019) sets out data collected from 2858 online survey respondents across the UK over 6 weeks in June–July 2019 and describes the state of district nursing.

The report outlines workforce challenges that include an ageing workforce, with 46% stating their intention to retire (25%) or leave (21%) the workforce during the next 6 years. And a huge variety of job titles were reported, which cannot help the unique selling proposition (USP) of district nursing as a profession. Similarly, the report reveals wide variation in caseload size across teams as well as roles, responsibilities and pay for those holding the Specialist Practice Qualification for District Nursing (DNSPQ), with significant regional differences.

Nearly 30% of teams were reported as having caseloads of over 400 clients. Therefore, it was not surprising that 48% of respondents reported deferring visits or delaying the delivery of care, that is, leaving work undone, on a daily basis. However, 63% of respondents reported that their team never refused referrals even if they were under-resourced, with 90% of respondents reporting that they worked unpaid overtime with a significant variation in unpaid overtime across pay bands. The extent of reported overtime also varied considerably across the regions, as did the number of vacancies and frozen posts reported, with London and the south-east seemingly having to manage with less cover in their teams.