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District nurse crisis flags up problems for GPs

Crystal Oldman, Chief Executive of the Queen’s Nursing Institute

GPs face major challenges with the ‘accountable clinician’ model for the frail elderly, said Dr Michael Dixon, chairman, NHS Alliance. Speaking at the NHS Alliance Annual Conference in London he warned that one of the challenges is how to expand the General practice workforce – particularly working with more district nurses.

Posted: 29 November 2013

Over the last decade the General practice share of the NHS budget has fallen 20% and there has been a 40% fall in the number of district nurses, Dr Dixon said.

Crystal Oldman (pictured), Chief Executive of the Queen’s Nursing Institute, said district nursing is in crisis and there is a ‘huge variation’ in the training of practice nurses. ‘You wouldn’t take a consultant doctor out of a hospital and put them to work in General practice without training so why would you do that with a nurse’ she questioned. District nurses need special training she said but the number of university courses are dwindling and so too the numbers of district nurses who are qualifying to begin their careers in primary care. Only 5 district nurse candidates were qualified in London this year and across the UK the numbers are just as startling with only 265 new district nurses newly qualified this year, she said.

More must be done to raise the profile of district nursing so that nurses see it as equal to working in the acute sector, rather than something they do as a second choice, she said. District nurses are specifically trained to care for and manage elderly people. ‘The potential is there for district nurses to be delegated as the named physician,’ she said. But pressures on existing district nurses mean that all too often those who are approaching the age of 55 are quitting, she said. Fifty percent of district nurses are due to retire in the next decade and 25% will do so in the next 5 years. Of existing district nurses, 25% say they are unable to take on new referrals due to their existing workload of patients, Oldman told health professionals attending the conference.

GPs need to present more opportunities for student nurses to work in their practices and in the community so that they can get insights into what it is like to work in the community rather than acute setting, she said. Universities must also fund more courses for district nurses to achieve the Specialist Practitioner Qualification, she said.

District nurses have the potential to be delegated as the ‘accountable clinician’ or named physician for elderly patients, given their specialist training in elder care but more must be done to train new nurses to take on the role, she said. Currently the numbers being trained are nowhere near the ‘replacement level’ required to maintain the District Nursing workforce that GPs and clinical commissioners will need. A report on district nurse training published by the Institute earlier this year found widespread concerns about the number of new district nurses currently being educated, particularly in England. The report found 21% of district nursing courses in England did not run a cohort in 2012-13 and 67% of district nursing courses in England in 2012/13 had 10 students or less on the programme and 13% had only 5 students or less.