District nurse numbers plummet leaving services under-resourced and unsafe

Only 4,031 “full-time” district nurses are now working in the NHS in England.

Matt Bodell
21 May 2019
community nurse

Under-resourced and sometimes unsafe services are impacting on patient care.

A new report from the Royal College of Nursing (RCN) and Queen’s Nursing Institute (QNI) has called for urgent investment in District Nursing, as new figures show the number of District Nurses working in the NHS has dropped by almost 43 per cent in England alone in the last ten years.


As a result, there are only Only 4,031 “full-time equivalent” district nurses are now working in the NHS in England, compared with 7,643 in 2009. A ratio of only one District Nurse for every 14,000 people – this compares with one GP for every 1,600 people.

The report warns that District Nursing services are significantly under-resourced, sometimes with unsafe staffing levels, and have serious retention and recruitment challenges – directly impacting on patient care.

It calls for a commitment to investment and training to meet the challenges caused by simultaneous rising patient demand and falling numbers of these highly-qualified staff.

Helping to avoid hospital admissions.

Dr Crystal Oldman CBE, the QNI’s chief executive said: “This new joint report illustrates the central position of the District Nurse as the key professional in delivering outstanding healthcare to people in the home and the community. Working with GPs and other members of the multidisciplinary team, District Nurses have the knowledge and skills to support people living with complex long term conditions to manage their own health and avoid unplanned hospital admissions.


“Conversely, lack of investment in the District Nursing service leads to greater strain on other parts of the health service, including GP practices and hospitals. With a rising and ageing population, many of whom are living with multiple long term conditions, we need a deliberate and intentional investment to support District Nurses to continue to deliver complex care to the patients, families and communities that they serve.

“The success of the NHS Long Term Plan depends on the capacity and capability of District Nursing teams and renewed investment in their education, recruitment and retention is urgently needed.’

District Nurses are a lifeline for patients.

Yinglen Butt, Associate Director of Nursing at the Royal College of Nursing, said: “Given the fundamental role District Nurses play in delivering personalised care close to home, and in reducing the burden on hospital providers, the chronic underfunding of this service is an outrageous false economy.

“District Nurses provide a lifeline for patients, many of them frail and elderly, who often can’t leave their own homes to get care elsewhere.


“It’s time Ministers undertook a proper assessment of staffing needs based on the fundamental principle of patient safety, and enshrined explicit accountability for delivering this into law.”

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