{"id":48695,"date":"2020-09-29T16:04:41","date_gmt":"2020-09-29T15:04:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48695"},"modified":"2020-10-01T17:31:21","modified_gmt":"2020-10-01T16:31:21","slug":"expanding-the-nhs-community-workforce-what-might-this-mean-for-the-future-of-district-nursing","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/29\/expanding-the-nhs-community-workforce-what-might-this-mean-for-the-future-of-district-nursing\/","title":{"rendered":"Expanding the NHS community workforce: what will this mean for the future of district nursing?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">During the covid-19 pandemic, coverage has been largely silent on the issue of those working behind the closed doors of a patient\u2019s home. For example, district nurses operating in a non-clinical environment have been working at heightened risk to themselves, navigating environments that do not have standard infection control management. Part of this risk has been a result of unclear guidance, as well as practical issues including a lack of PPE and the impossible task of social distancing in a patient\u2019s home (<\/span><a href=\"https:\/\/www.rcn.org.uk\/news-and-events\/blogs\/covid-19-a-lasting-impact-on-district-and-community-nursing-teams\"><span style=\"font-weight: 400\">Green, 2020).<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">District nurses are typically responsible for health education; general nursing care, and on occasion responsive clinical care in the community (<\/span><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/quality-district-nursing\"><span style=\"font-weight: 400\">Maybin et al., 2016<\/span><\/a><span style=\"font-weight: 400\">). Their ability to provide chronic care management contributes to palliative care provision and where possible, hospital avoidance. The uniqueness of their role comes from their ability to also navigate being a professional guest in a patient\u2019s home, as well as boundary spanners integrating wider services and teams (<\/span><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/supporting-integration-new-roles-boundaries\"><span style=\"font-weight: 400\">Gilbert, 2016<\/span><\/a><span style=\"font-weight: 400\">). District nurses\u2019 perceptions of both their role and the way in which they uphold care delivery may differ from other professions in primary or community settings. Consequently, the invisibility of their work frequently creates confusion amongst other professions and the public (<\/span><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/quality-district-nursing\"><span style=\"font-weight: 400\">Maybin et al., 2016<\/span><\/a><span style=\"font-weight: 400\">; <\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/\"><span style=\"font-weight: 400\">NHS Long Term Plan, 2019<\/span><\/a><span style=\"font-weight: 400\">).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Government strategy has called for more nursing care to be delivered in the community and in people\u2019s homes (<\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/\"><span style=\"font-weight: 400\">NHS Long Term Plan, 2019<\/span><\/a><span style=\"font-weight: 400\">). This drive is intended to reduce both hospital stays and unplanned admissions. To meet this aim, district nursing teams are being positioned as crucial to the delivery of the Long Term Plan objectives, and as such they are a specific focus for workforce expansion plans. However, future efforts to expand the district nursing workforce are likely to be compounded by the covid-19 pandemic.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">At present, a considerable number of vacancies for nurses within the community are filled by bank and agency workers (<\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/publication\/interim-nhs-people-plan\/\"><span style=\"font-weight: 400\">Interim NHS People Plan, 2019<\/span><\/a><span style=\"font-weight: 400\">). According to a <\/span><a href=\"https:\/\/www.qni.org.uk\/resources\/outstanding-models-of-district-nursing-report\/\"><span style=\"font-weight: 400\">report<\/span><\/a><span style=\"font-weight: 400\"> from the Royal College of Nursing (RCN) and Queen\u2019s Nursing Institute (QNI), figures indicate that the number of district nurses working in the NHS in England has slowly declined over the last ten years by almost 43%. The decline in workforce numbers has continued despite the government\u2019s 2018 <\/span><a href=\"https:\/\/www.nursinginpractice.com\/postgraduates-choosing-district-nursing-receive-%C2%A310000-golden-hellos\"><span style=\"font-weight: 400\">golden hello of \u00a310,000<\/span><\/a><span style=\"font-weight: 400\"> to newly qualified district nurses which coincided with the scrapping of nursing bursaries for prospective students.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">More recently and as part of efforts to raise the profile of district nursing, <\/span><a href=\"https:\/\/www.hee.nhs.uk\/our-work\/community-district-nursing\"><span style=\"font-weight: 400\">HEE has pledged<\/span><\/a><span style=\"font-weight: 400\"> to grow pre-registration clinical placement capacity, emphasise high-quality learning experiences within community settings and have set aside \u00a318.5 million to support community nurses wishing to take the new specialist practitioner qualification. While the NHS interim people plan and the NHS long term plan both focus on addressing the nursing shortage, recruitment and retention strategies alone may not help to increase or create a sustainable future for district nurse services.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The future of district nursing may involve role transformation including greater emphasis on care coordination rather than delivery. Leading community teams and managing the integration of community and primary care may become a priority as their boundaries become blurred. Despite this there appears to exist an implementation gap from policy to practice, one which may not consider front-line capacity, experience or desire. Making these implementation pathways clearer, particularly in the post pandemic recovery phase, in terms of raising the profile and working conditions of district nursing may require addressing a number of difficult questions about the profession\u2019s future. For example, who is best employing district nurses if they are to work across networks; how will differing perceptions of care be reconciled across services; what does the blurring of primary and community services mean for the accountability and responsibility district nurses are required to uphold?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The future of district nursing looks set to become embedded among teams of GPs, pharmacists, community paramedics and other allied health professionals (<\/span><a href=\"https:\/\/www.longtermplan.nhs.uk\/\"><span style=\"font-weight: 400\">NHS Long Term Plan, 2019<\/span><\/a><span style=\"font-weight: 400\">). Sustainable workforce expansion may require exploration into multi-stakeholder perspectives including both frontline workers and those at a leadership and human resource management level. It may also require a necessary questioning of whether the expectations being place upon a profession dwindling in numbers, is setting them up for failure or success.\u00a0\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Ruth Abrams<\/strong> is an organisational psychologist researching workforce experiences of organisation, workflow and service delivery within the healthcare sector within the Faculty of Health and Medical Sciences, University of Surrey.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Kamal R. Mahtani<\/strong> is a practising NHS GP, Associate Professor and Co-Director of the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Veronika Williams<\/strong> is Director and Associate Professor, School of Nursing, Faculty of Education and Professional Studies,\u00a0Nipissing University, Canada; Honorary Researcher, Nuffield\u00a0Department of Primary Care Health Sciences and Associate Senior Tutor, Department of Continuing Education, University of Oxford.\u00a0\u00a0<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.\u00a0<\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Disclaimer<\/strong>: The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.<\/span><\/em><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">BMJ Group declaration of interests statement<\/span><\/p>\n<p><span style=\"font-weight: 400\">We have read and understood the BMJ Group policy on declaration of interests and declare the following interests:\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">Competing interests: None declared<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>During the covid-19 pandemic, coverage has been largely silent on the issue of those working behind the closed doors of a patient\u2019s home. For example, district nurses operating in a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/29\/expanding-the-nhs-community-workforce-what-might-this-mean-for-the-future-of-district-nursing\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48204,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-48695","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Expanding the NHS community workforce: what will this mean for the future of district nursing? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/29\/expanding-the-nhs-community-workforce-what-might-this-mean-for-the-future-of-district-nursing\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Expanding the NHS community workforce: what will this mean for the future of district nursing? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"During the covid-19 pandemic, coverage has been largely silent on the issue of those working behind the closed doors of a patient\u2019s home. 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