Community nursing has a key role to play in the future health and wellbeing of the UK's population (Chilton, 2025), predicted to grow by 4.9 million (7.3%) from mid–2022 to mid–2032 (Office for National Statistics, 2025). An example of the demographic changes is the number of people receiving the state pension—using the current state pension age of 67 years, the Office for National Statistics (ONS) estimates a 13.8% increase in people at state pension age (Office for National Statistics, 2025).
District nursing teams work across the lifespan and are not restricted to caring for older people. This means that demographic changes across the lifespan inevitably have an impact on district nursing teams. Policies that underpin health and social care across the UK also reflect these changes (Department of Health Northern Ireland, 2016; Scottish Government, 2016; Welsh Government, 2018; NHS England 2019). However, the reality is that in practice district nurse caseloads do not have a minimum or maximum threshold, therefore, putting greater pressure on them and their teams to cope with this increasing demand and to ensure that people receive optimum care. This context is worthy of further consideration.
To meet the emphasis on reducing hospital admissions—a clear benefit for local populations and individuals—it is essential to equip the district nursing workforce of the future. To maintain and increase a competent professional district nursing workforce, it is important to address recruitment, retention, training and wellbeing needs (While, 2024). District nurses’ involvement in pre-registration curricula development and the delivery of practice learning is key to ensuring that the registered nurses of the future consider district nursing as a career pathway, while understanding the patient journey (Bliss, 2024).
The Nursing and Midwifery Council (NMC) is currently undertaking a review of nursing and midwifery practice learning. The review focuses on the pre-registration practice learning of nurses, midwives and nursing associates. Building on previous work that examined practice learning internationally, which highlighted that its quality depends on several key elements (NMC, 2022), this review explores all aspects of practice learning to ensure the NMC can effectively support high-quality outcomes. The earlier findings identified key influences on practice learning quality, including the integration of theory and practice, high-quality simulation, effective clinical teaching, focused learning experiences and structured graduate programmes for newly qualified nurses.
Co-production underpins the review, with the perspectives of all stakeholders—students, service users, carers, approved educational institutions and practice learning and employer partners—at its core. Professor Alex McMahon, former chief nursing officer for Scotland, is the chair of the UK-wide independent steering group. Two advisory groups also feed into the independent steering group: a public advisory group chaired by a director of services within a charity, and a student advisory group chaired by a nursing student. This ensures that the unique and shared perspectives of all four UK nations are taken into consideration during discussions. As chair of the review, Alex McMahon (co-author) said,
‘It was hugely important that we heard from all stakeholders and from all four countries across the UK. In particular it was hugely beneficial to have two subgroups working alongside the steering group which represented the views of student nurses and midwives and also the voice of patients.’
The discovery phase of the practice learning review was presented to the NMC in January 2025 and consisted of independent research (Palmer et al, 2024), an evaluation of simulated practice learning for pre-registration nursing students (Hol, 2024) and the NMC's education quality assurance activity, including the review of the 2024 mandatory exceptional reports (NMC, 2024).
Practice learning is crucial for students to become safe, effective and kind practitioners with a consensus view that quality of practice learning experiences is key to students developing competence and confidence (Palmer et al, 2024). Supportive learning opportunities, feedback and rehearsal in safe learning environments enable students’ attainment of proficiency. For instance, the opportunity to experience complex and sensitive practice scenarios in simulated practice learning that students consider to be a safe, supportive and non-judgemental environment (Holt, 2024).
The review identified that the culture of the practice learning placement team, the location of placements and the level of student support all influence students’ learning. Additionally, challenges related to equality, diversity and inclusion—before, during and after placements—also have an impact on learning outcomes. Factors that may influence outcomes include race, ethnicity, disability and sociodemographic status. For example, reasonable adjustments for students with protected characteristics are not always adequately considered (Palmer et al, 2024).
The tendency to describe hospitals as acute providers influences how some nursing students perceive community nursing, and the range of knowledge, skills and behaviours required to deliver what can be complex and acute care. Despite this, the review's findings show that after a community practice learning experience, nursing (and midwifery) students reflected on positive experiences with community teams, including care homes, health centres and in people's homes. Students felt a sense of belonging as they were often working with the same team and reported more time for one-on-one supervision and debriefing, which many felt identified their personal learning needs (Palmer et al, 2024).
Community placements are essential in consolidating the knowledge and skills required to deliver holistic care; an opportunity to understand how living conditions and social circumstances impact health and wellbeing. While the focus on holistic care means that community placements have a key contribution to make throughout pre-registration nursing programmes, some nursing students felt that community placements were more suited to final year placements to consolidate practice learning when they had more autonomy (Palmer et al, 2024). This is further compounded by the availability of student nurse placements in community settings.
Consensus from stakeholders, including members of the public and people who use services, concludes that the quality of practice learning is more important than the quantity of practice learning hours, with many indicating that maintaining the status quo is no longer an option (Palmer et al, 2024). The independent steering group agreed that maintaining the status quo by relying on counting the number of programme hours and the number of specific care activities as a proxy for the quality of the student learning experience is not an option. There was no agreement on what the optimum numbers might be. Instead, the steering group identified the need to consider innovative ways to ensure quality of practice learning.
The findings of the discovery phase of the practice learning review have informed the next phase of this work. In January 2025, the NMC (2025) approved five key lines of enquiry (KLOEs) (Box 1). These KLOEs will explore the benefits of refining the wording of focused education and training standards. In addition, work exploring a new quality matrix for practice learning can further strengthen the NMC education quality assurance model. Several of the factors identified as impacting on practice learning, for example funding, are not part of the regulatory remit for the NMC. These workstreams will also clarify where responsibility lies with others. Once completed, the findings of the KLOEs will inform recommendations to the NMC's Council in the winter of 2025.
Review of practice learning key lines of enquiry
The independent steering group and the public and student advisory groups will continue during this next phase of the practice learning. Alongside these groups, the authors will continue to work with subject matter experts and key stakeholders across the four nations of the UK. They will use the review's community of interest, which is for everyone, including students, registrants and members of the public, interested in the review of practice learning to share opportunities for people to get involved and keep them up to date with the practice learning review. The authors encourage nursing students to sign up to the community of interest to ensure that student practice learning in the community is showcased within the KLOEs.