‘District nurses fundamental to government’s plans to shift more care to the community’
31 October 2025
The Nuffield Trust has unveiled its latest report which evidences the decline in District Nursing and makes recommendations for the future. The research aimed to explore whether, and how, district nursing could contribute to improving public and patient outcomes and deliver the government’s vision for the NHS.
The Queen’s Institute of Community Nursing (QICN) played a key role in supporting and facilitating this project, which used rapid research design to maximise the opportunity to influence key policy strategies currently in development.
Key findings include:
- An estimated 24% increase in the need for district nursing since 2009/10 and a prediction that demand will increase 34% by 2040.
- A 43% fall in the number of recorded FTE NHS District Nurses between 2009 and 2024
- 8 million fewer recorded district nursing contacts in 2023/24 than in 2009/10.
- Up to a fifth of district nurses’ time is spent on administrative tasks.
- The estimated mean average cost of a face-to-face district nurse contact is £57, half that on an A&E attendance and a 40th of the cost of an average emergency short-term hospital admission.
The report concludes that ‘District nurses are fundamental to the government’s plans to shift more care from hospital to the community, as well as contributing to more preventative care and supporting under-pressure GP and social care services’. However, it also notes clear challenges to manage the demand of district nursing services and to support the efficiency and productivity of these services. It highlights the changes the government urgently needs to consider to deliver universal, high-quality district nursing services.
The report’s recommendations include:
- Looking at the training pipeline for district nurses
- Ensuring pre-registration education for district nurses supports the move to more care in the community
- Job guarantees for newly qualified district nurses
- Improving data on activity within, and outcomes from, district nursing
- Developing a strategy to value, promote and protect the district nursing profession
- Detailed consideration of appropriate pay banding
QICN Chief Executive Steph Lawrence said:
Thank you to the Nuffield Trust for undertaking this critical research, which shows the extent of the demise of District Nursing in recent years. There are many things that have contributed to this, but the District Nursing workforce has been overlooked by policy makers for too long. If the 10-year plan and shift of care from hospital to community is to be realised, urgent action is required, as it will not happen without a robust District Nursing workforce.
This is growing evidence as to why we are seeing care left undone – this represents the corridor care of community, with increasing numbers of coroners’ reports citing lack of District Nursing resource as a factor in patients’ deaths.
The QICN has been calling on Government and NHS England to ensure we train adequate numbers of District Nurses for a number of years. We now say this has to be seen by Government as a critically urgent issue. More funding to train District Nurses is required, alongside ensuring we have continuation of level 7 Apprenticeships and finally ensuring we remunerate at the correct Agenda for Change band for the specialism – a minimum of band 7 to reflect the advanced and autonomous practice of District Nurses today.
About Nuffield Trust
The Nuffield Trust is an independent health think tank which aims to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
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