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‘The GP in the home’: the vital role of district nurses

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Crystal Oldman, Chief Executive, The Queen’s Nursing Institute

The media is currently full of stories about winter pressures in the NHS; stories of ambulances waiting for hours outside A&E and of record numbers of patients being seen in GP surgeries. Many of the people waiting to be seen in these contexts are older people.

The increase in average life expectancy in the UK is a cause for celebration and the needs of older people should be appropriately accommodated. But without planned and sustained growth in the capacity and capability of health and social care services, these stories will surely only get worse year on year.

One of the ways to address this would be to recognise the significant contribution that the District Nursing services make in supporting people to be cared for at home. District Nurses have a unique skill set that is frequently overlooked by those who have never witnessed their practice and refer to District Nursing as simply ‘nursing in another context of care’.

This could not be further from the truth; District Nursing is a specialist area of practice, requiring study for a qualification that is recorded and regulated by the Nursing and Midwifery Council. The full extent of the expert knowledge, skills and competence required, as an autonomous clinician and team leader, is described in the QNI/QNIS Voluntary Standards for District Nurse education and practice.

At a time when there are increasing numbers of people living with multiple, complex long-term conditions, it is the District Nurse that can coordinate and manage care, prescribe medications and ensure patients are cared for in their own homes, avoiding A&E and the GP surgery.

At a time when we want to give more people the choice to receive end of life care in their own homes, it is again the District Nurse who can orchestrate the provision of equipment and services to ensure that the person and their family are properly supported at that time.

A GP recently described the District Nurse to me as ‘the GP in the home’. It is extraordinary then that in England, 50% of all universities are now considering the closure of their District Nursing programmes in 2018 as the funding for training students is to be withdrawn.

In Wales, the number of District Nurse training places has been doubled for 2018, with the recognition that these highly skilled nurses have a significant role in supporting the whole system by leading the provision of a service which prevents hospital admissions, facilitates timely discharges and enables more people to be safely cared for at home.


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Comments

I have been a District nurse for 10 years and i feel we do a remarkable underestimated job of caring for patients with a various often time consuming package of care to enable them to spend as much time ast they can throughout their illness or even last days of life. We try as a service to find a way of promoting/ highlighting the good we do but i feel through statistics we are letting ourselves down. The complexity of us GENERAL NURSES so nicely put in even the 21st century is still the same review of Bps and cups of tea.This is so far from the truth and as a specialist practitioner i feel so frustrated. Our expertise is so vital in working along with all health professionals and patients.
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I gained the msc dn spq. Its a very unfair system when you have nurses with the qualification banded the same as those who do not have the spq or even a degree level registration. Much of my time I worked as band 5 even band 3 some days. Disillusioned I left district nursing.
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District nurses are instrumentAl in holding the community teams together and providing expert care to people in the community. All staff in the community have unique skills. It is our daily role as community staff, to coordinate services, provide expert care and prescribe medications and dressings as required.
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I am currently undertaking the specialist practitioner qualification for District nursing and feel it is an integral part of broadening my already acquired skills set. It seems a logical solution to employ and offer more training to our district nurses, especially as the ageing population needing care are presenting with more comorbidities. The NHS is struggling, care in the community is a key factor for preserving it in the future. Aswell as working alongside other sectors such as private, social and voluntary in order to provide seamless wrap around care. I am proud to be working towards becoming a fully qualified District nurse and hope by doing so my future shall be a bright one and the NHS will prosper.
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