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The future of district nursing

District Education QNI
Kathy Oxtoby explains the QNI’s assessment of the state of district nursing education and what it means

The increase in district nurse student numbers has ‘slowed down’, a report on district nurse education by the Queen’s Nursing Institute (QNI) has found. The QNI’s District Nurse Education Report 2015-2016 1 has revealed that 554 new students were enrolled in the specialist practice qualification (SPQ) – District Nurse programme in 2016/17 compared to 565 new entrants in 2015/16.

The charity has raised concerns about the new figures, warning that given the numbers who retire from the service annually, ‘this will represent a major challenge to current and future recruitment efforts to district nursing teams’.

The report

The QNI’s fourth annual report found 517 district nurse specialist practitioners had qualified in 2016, compared to 479 who qualified in 2015, and 382 in 2014.

There are 44 universities in the UK approved by the Nursing and Midwifery Council (NMC) to offer the District Nurse Specialist Practice Qualification (DNSPQ). There were 40 universities that responded to the survey, two of which did not run the programme, and another was offering the programme for the final time with a small cohort of just two students.

Just 66% of universities ran programmes with more than 11 full or part-time students in each cohort in 2015/16, compared to 54% in 2014/15. There were 554 new full (441) and part-time (113) student intakes for the academic year 2016/17, and 82% of university respondents had mapped their programmes to the QNI/QNIS Voluntary Standards for District Nurse Education and Practice. 2

Almost all respondents had ‘major concerns about future funding and viability of district nurse programmes’, the report states.

The QNI says it will ‘continue to lobby and influence decision making bodies to invest in the district nurse leadership role and training, to ensure that specialist practitioner programmes continue to be offered, ensuring people receive high quality nursing care at home’.

The QNI’s annual report on district nursing was established to identify trends in district nurse education programmes leading to a SPQ. Julie Bliss, senior lecturer in the faculty of nursing and midwifery, and palliative care, King’s College, London, and chair of the Association of District Nurse Educators, says the QNI’s decision to have an annual report was prompted by concern about the ‘apparent reduction in district nurse education programmes leading to an SPQ’. For David Pugh, chair and facilitator of the National District Nursing Network, the report reveals some positives for the profession, such as how the number of district nurses who qualified in 2016 being higher than in 2014. However, he points out that ‘as the QNI has recognised, there are concerns this [situation] could be about to change’.

The findings

This year’s QNI report indicates that there will be a ‘crisis’ regarding the numbers of district nurses working in the profession, suggests Liz Alderton, a district nurse and specialist community practice teacher, Harold Hill Health Centre, in Romford, Essex.

‘District nursing has an ageing population – many are approaching retirement. There is also anxiety and confusion surrounding whether district nurse courses are being commissioned after this academic year. So while there is a drive to move care into the community, there are going to be fewer district nurses,’ Ms Alderton says.

Ms Bliss emphasises the ‘mismatch between the ambition of having care closer to home and allocation of funding which tends still to go more into hospital settings’. This mismatch was highlighted this year in a report published by the King’s Fund – Understanding NHS financial pressures: how are they affecting patient care? 3

The report reviewed the impact of financial pressures on four services: genitourinary medicine (GUM), district nursing (DN), total hip replacements and neonatal care. It found that district nursing was one of the areas where financial pressures were having the greatest impact.

Commenting on other QNI report findings, Ms Bliss says it is ‘interesting that just under 25% of district nursing programmes include independent prescribing, which is quite low’.

‘It appears not all commissioners want independent prescribing. But it has the potential to streamline care, such as potentially avoiding hospital admissions,’ she says.

Ms Bliss also noted the report highlighted how candidates failed to receive offers for places on district nursing programmes because they had an ‘insufficient understanding of the role’.

What does this mean for district nursing?

The QNI’s findings, particularly regarding ‘significant concerns that the number of district nurses qualifying will not be sufficient to meet the increased demand for district nursing services and to replace those due to retire’, highlighting potential difficulties for patient care in the community in the future, Ms Alderton believes.

‘The implications of these findings are that there will be a reduction of nurses with an SPQ, which will affect the way in which excellent care is delivered in the community.

‘It is short sighted to put complex care into the community unless there are highly trained leaders [with an SPQ] to manage it,’ she says.

Having fewer district nurses with a specialist qualification ‘could lead to challenges in some provider organisations’, Mr Pugh believes.

‘Provider organisations will need to look at different models of care delivery, such as more integrated working within multidisciplinary teams, rather than district nursing teams,’ he says.

He explains that some provider organisations are developing in-house training packages that are replicating some district nursing skills, rather than supporting external district nurse courses. He suggests this approach to training ‘could probably result in having fewer qualified district nurses’.

Workforce planning ‘is really important’ to address the potential gap in district nursing services and there should be support for ‘district nursing SPQ programmes as well as education for community staff nurses and support workers’, Ms Bliss says.

The nursing profession needs to ‘learn from best practice across the four countries’, she believes. And it should show-case nursing teams so that pre-registration students understand that community nursing can be a ‘first destination’ post, and encourage them to consider district nursing as a career option. Ms Alderton would like to see all community case loads run by a district nurse with an SPQ ‘so that every GP or CCG knows who their named district nurse is’. ‘I don’t think this happens everywhere because there aren’t district nurses in every area,’ she says.

For Mr Pugh, in an ‘ideal world’, he would like to see the continuation of funding for district nurses to help them achieve a specialist qualification. But to help achieve this funding, district nurses will ‘need to continue to provide evidence of the fantastic work we do’.

‘We don’t sell ourselves that well. So we need to ensure we collect the right data, present the right cases studies, and champion the value of our role’.


1. Queen’s Nursing Institute. Report on District Nurse Education in the United Kingdom 2015-16. 2017. (accessed 8 November 2017)

2. Queen’s Nursing Institute. The QNI/QNIS Voluntary Standards for District Nurse Education and Practice. 2015. (accessed 8 November 2017)

3. Robertson R, Wenzel L, Thompson J, Charles A. Understanding NHS financial pressures: How are they affecting patient care? 2017 (accessed 11 October 2017)