The NHS continues to face great reform (NHS Confederation, 2017), and the balance of care is shifting from acute to primary care (Department of Health and Social Care, 2019). A vital role in community services is that of the district nurse. District nursing has been around long before the birth of the NHS, yet a day in the life of a district nurse is steeped in mystery and myths. The values and beliefs that inspired district nursing from the beginning still drive practice today: the importance of keeping people at home where they want to be; the relationship between nurse and patient as the prime therapeutic tool; the need to work with the whole family and carers as a unit; the importance of expert assessment and care, both clinical and social; and the need to promote coping and independence, both practical and psychological, while delivering person-centred care. District nursing is often described as the ‘glue’ of the entire community care system.
District nurses provide high-quality complex care in communities and practice in an autonomous manner. Advances in healthcare technology, the ability to deliver more care in the community and the impact of the COVID-19 pandemic mean that today's district nurse must possess a broad range of skills and a very high level of expertise (Queen's Nursing Institute (QNI), 2015). Nursing bodies have called for a commitment to investment and training for district nursing services that provide a lifeline to patients and families as, although demand for primary care services has increased, healthcare workforce data suggest a decline in the numbers of nurses working in the community (Buchan et al, 2019). Additionally, the number of nurses in senior district nurse posts has fallen dramatically (Maybin et al, 2016) as the complicated multifaceted nature of the role has changed dramatically.
An additional threat to district nursing is that the nursing regulator-the Nursing and Midwifery Council (NMC)-is undertaking a major review of post-registration education and practice standards. Registrants have the option of undertaking one of nine specialist practitioner qualifications (SPQs), one of which is in district nursing, and these are noted as an annotation to their PIN, once achieved. It is feared that a possible decision may be to replace the existing SPQs with one generic SPQ. This proposal is seen by many as a misunderstanding of the level of skill required by district nurses, and many have commented on this during constructive engagement events held by the NMC.
The DN SPQ, to date, is viewed as essential preparation for the challenging role of leading a team to deliver the district nursing service in the community and to contribute to future policy decisions within the context of interprofessional working (QNI, 2015). As a nurse who completed the SPQ, and recently completed an MSc, the SPQ developed my leadership and management skills, ensured I was competent in the area of clinical assessment and prescribing and was invaluable in helping me to become a safe and autonomous decision-maker. I now have the privilege of assisting with the learning and teaching of district nursing students at Teesside University, while still practicing clinically, and I am looking forward to seeing how the newly approved DN apprenticeship standard enhances work-based and theoretical learning for our students.
The district nurse is the lifeline of our communities, and their value must be recognised. Thank you district nurses.