High workloads and increasing demand on district nurses have led to missed appointments and workers undertaking large amounts of unpaid overtime, a new survey has suggested.
The Queen’s Nursing Institute (QNI) recently published the results of a national survey of district nurse team leaders, and is calling on health leaders to better fund the workforce to prevent care being missed and workers being overworked.
“The next government must work to boost the district nursing services that deliver essential individual and population health in communities everywhere”
Crystal Oldman
The QNI said “many though not all” of the concerns raised by district nurses in the survey could be addressed by better funding from the UK Government.
The survey, which took place last year and was led by Professor Alison Leary, director of the QNI International Community Nursing Observatory, received responses from more than 1,500 district nurse team leaders.
A key finding was that caseloads had increased in 2023 compared to 2019.
District nursing teams with caseloads of between 101 and 200 fell from 24.8% in 2019 to 20% in 2023, while those with 600 or more increased from 11.5% to 16.2%.
The impact of this, the survey showed, was a rise in teams having to turn patients away.
The findings showed that number of teams which had never needed to refuse any referrals because of capacity or workload problems fell from 61.7% in 2019 to 56.6% in 2023.
Nursing teams also reported that some aspects of care were not done, or done to an unsatisfactory level, due to capacity or workforce. The most common of these were psychological care or support (43.3%), assessment (38.6%) and continence management (30.8%).
The survey showed that almost a third (31.9%) of respondents had to delay or defer visits to patients every day. This figure was even higher for nurses who had to do this on “most” days (32.6%), while only 1.7% said they “never” had to.
Just less than half (43%) of respondent nurses, as a result of additional workload, were taking on four-seven hours of unpaid overtime each week, with 33% performing 1-3 hours extra, 15% taking on seven-10 hours and 8.7% working more than 10 hours per week unpaid.
Nurses told the survey that measures which some workplaces had adopted to tackle the issue of rising pressure on services had not necessarily helped.
For example, 46.2% said virtual wards and remote monitoring made “no difference” to workload, and 28% said it had instead increased it; 4.5% of respondents said these measures had decreased workload.
Dr Crystal Oldman, chief executive of QNI, called on whichever political party forms a government after July’s general election to take immediate action on the issues facing district nursing.
“We have a growing and ageing population and this is having a profound impact on how health and social care must be planned and delivered: district nurses are increasingly responsible for people living with very complex healthcare needs,” said Dr Oldman.
“The next government must work to boost the district nursing services that deliver essential individual and population health in communities everywhere.
“It is a testament to the district nursing profession that many nurses are taking their education to the next level to address increasingly complex needs in the people they serve, but frustrating to see the barriers to accessing this.”
The QNI said a “sustainable financial investment” in the district nursing workforce would be necessary to address these issues.
It also recommended the “removal of barriers” to recruitment and retention, investments in IT systems and other digital infrastructure district nurses use, and measures to end unpaid overtime.
As well as this, the QNI said it would like to see greater recognition for the “essential value” of district nursing in the NHS – and for the creation of a national strategy to campaign to raise the profile of district nursing.
The QNI’s survey also showed a higher level of qualifications and specialisation among district nurse team leaders.
More than a quarter (27.9%) of respondents in 2023 said they had a prescribing qualification, compared to 18.5% in 2019.
Similarly, 43.4% in 2023 said they had completed an advanced clinical assessment course, up from 38.2% in 2019.
District nurse team leaders are, on average, being paid better as a result; the survey found that the number who were on Agenda for Change band 7 had increased since 2019, while the number on bands 5 or 6 fell.
Nursing associates have also become more common in district nursing, according to the survey.
Just over half (52.4%) of respondents said their team had no nursing associates, compared to 73.9% in 2019.
Dr Oldman added that, as well as more money, access to training such as the district nurse specialist practitioner qualification would be necessary for giving the workforce the skills it needed to combat the changing – and increasing – caseloads.