National District Nurses Network Annual Report 2013-14

National District Nurses Network
Sue Hill, Group Facilitator
Telephone: 01245 544600
Fax: 01245 544610
Email: [email protected]
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
As the round of meetings commenced for 2013-14 the clear message was to focus on the aims and
objectives the network had reviewed and revised. (The terms of reference for the network can be
found in appendix 1)
It was felt important to build robust relationships with key national figures influencing community
nursing in order to be able to influence, comment and be aware of what was happening in community
A continued presence on the National Community Advisory Group, chaired by Wendy Nicholson at
the Department of Health, has meant an up-to-date knowledge of national ideas and changes.
Regular attendance at network meetings by Crystal Oldham has enabled us to forge close links with
the Queens Nursing Institute.
Membership has grown and the profile of the network has developed and is now recognised in the
national arena. Additionally, opportunities for promotion of the network have been seized by article
publication and conference attendance.
The sharing of issues and members news has helped people to see that the challenges they face are
common across the country. Discussion of these is useful for thinking of ways of dealing with them
and realising no one is alone.
The overarching message from this round of meetings has been that we all face huge challenges
ahead especially with the complexity of the work expected, the volume of patients receiving care in
the community and the difficult IT systems cause.
Going forward the network will continue to promote and support the issues faced and have a voice in
the national arena.
Sue Hill
NPAG Best Value Group Facilitator
Firstly, I want to say what another great year it has been for the National District Nurse Network
It is my belief, as a group we continue to grow from strength to strength evidencing that it is possible
to make a positive difference to the wider agenda of community nursing and in turn to patient care.
Over the course of the 4 meetings we have had some fantastic speakers who have been inspiring,
whilst at the same time have provided the group with positive challenge in a way that has made us
think about what we want the NDNN to achieve.
I want to particularly thank Crystal Oldman (CEO, QNI) and Wendy Nicholson (Professional Officer,
DoH) whom I feel have been pivotal in supporting the group this year, not only by attending some of
our meetings but also through showing their support in various other ways. Examples of this support
have been shown through our attendance at the DoH Community Nursing Advisory Group meetings
and the QNI allowing us to exhibit at the annual QNI conference.
Likewise, a huge thank you to Sue Hill our facilitator who has continued to work tirelessly to ensure
that each meeting is planned with packed agendas.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Lastly but in no ways least, I want to say a big thank you to all group members who continue to show
their commitment to the NDNN by travelling sometimes long distances to meetings actively
contributing to discussion, sharing best practice and ultimately possessing a drive to want to improve
community nursing services and patient care.
I continue to look forward to again chairing the next round of meetings commencing in July 2014 and
leading the work of the NDNN.
David Pugh
NDNN Chair
Meeting 1 - June 12th in Birmingham
As a group, work was done on creating a National District Nurse Specification. Various specifications
from across the country were considered and after discussion a comprehensive document was
completed. This has been given to the Community Nurse Advisory Group lead at the Department of
Health. It has also been requested by NHS England and someone working with a CCG cluster. It can
be found in Appendix 2
Kay Durrant, Head of Service for District Nursing for Stockport and RCN Forum Chair attended the
meeting to discuss the recent document “District Nursing - harnessing the potential” that was
published by the RCN.
District nursing - harnessing the potential. The RCN s UK position on district nursing
The Community Nursing Advisory Group continues to be attended on a bi monthly basis by our chair,
David Pugh. They had asked if consideration could be given to the topic Professionalism in District
Nursing – what it means for staff, the patients and public and commissioners. This was completed
during the meeting as a group exercise and the results fed back to CNAG.
Members issues and news were also discussed.
Meeting 2 - August 29th in London
Crystal Oldman Chief Executive of the Queens Nursing Institute was welcomed to this meeting.
Crystal talked about a number of actions currently being undertaken by QNI including:Developing a resource for transition to community practice - will be launched 25th September. It is for
use by staff new into the community and supports learning, context of care, policy and guides
practitioners to find a mentor and develop an online portfolio.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Carers project - to see what support nurses need to be able to support carers better. Has been done
in collaboration with Carers Trust. So far have had a literature review which has demonstrated the
hole in evidence base for nurses caring for carers. By the end of the year the QNI will have a web
based interactive resource to support nurses. Similar piece of work will be done for practice nurses.
Workforce planning - QNI has been funded to start looking and scoping examples of good practice of
workforce planning, demonstrating what is working and what should be in a workforce planning toolkit
and feed outcomes to CCGs.
QNI report on DN education is now out. The QNI want to answer the question “so what?” What
difference does having trained DNs make in the community? Would like case studies around clinical
leadership, holistic viewpoint, management of staff/caseload. One suggestion is having pre and post
and one year on interviews with staff that are doing the course.
Wendy Nicholson - Professional Office- Department of Health
Wendy reported that it is a great time for District Nursing as they are currently seen as a priority area.
The next steps from transforming community care are getting public mindset to see that hospital is
only one step in a care pathway. We need to change the image of the district nurse being a dynamic
and complex care giver.
The DN vision is being implemented and led by Jane Cummings. There is a 3 year strategy around
implementation being set up with various work-streams to support it.
Workforce issues, training and education
Public health - every contact counts, link with public health agenda
Innovation - promoting and identifying innovation
Technology - good use of technology fund
Commissioning - how commissioners commission intelligently and how district nurses can have more
The work-streams are very joined up and use the Community Nurses Advisory Group (CNAG) as
expertise and grounding.
The group spent time comparing the roles of bands 2, 3 and 4s across the country. This showed huge
variation in different trusts and a big difference in expectations for each band. Appendix 3 shows the
Sue Boran - Course Director for District Nursing - London South Bank University - presentation
enclosed with meeting minutes.
Sue explained that there is no standardisation across the country for district nurse training! The
course she runs is based on key strategies such as dementia, compassion in practice, Francis report
and care in the community.
Louise Bicknell - DominiC System - born out of the QNI innovation fund, Stockport developed a
capacity tool to help with choice of time, continuity of care, improved communication, time to care and
medical device management. An explanation of the tool was given.
Members’ issues and news were also discussed.
Meeting 3 - December 11th in Leeds
Crystal Oldman - Queens Nursing Institute
Two of our members had received their Queens Nurse award - Ian Bailey and David Pugh. Crystal
talked about terminology used. She is endeavoring to get a change in the way we talk about acute
and community care and start referring to it as hospital based and community based care.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
DN practice resource - now available on line but also in hard copy. A resource to use with staff new to
the community. Follow the link:
Survey just closed revisiting 2020 Vision document. Have had over a 1000 responses. Data is
brilliant! Captures the current challenges of community nursing. Results should be out about March. It
evidences what is happening in district nursing.
DN education report - catalyst for looking at what educational needs are. Hope to repeat in 2014 to
see what difference there is. Aware of 3 or 4 more universities offering the specialist practitioner
course this year. Standards for Specialist Practitioner Qualification - QNI would like to formulate
standards - not replacing or impinging on NMC ones but as up to date standards that raise the profile
of District Nurses being properly qualified in the community.
At this meeting there were a variety of presentations by members demonstrating mobile working
methods and capacity management tools.
An exchange of issues and news was also held between members.
Some comments on the network day were as follows:“Wonderful day, very enlightened. Good to network with people. Learnt a lot. Thank you”
“Totally inspiring day listening to all the great work going on nationally and how DN services are
embracing changes nationally to improve patient care. Thank you”
“Excellent day and wonderful venue. All talks inspiring and will be extremely beneficial.”
Meeting 4 - March 12th in London
There were 3 key speakers at this meeting and discussions re tariffs and a response to the NMC
revalidation exercise completed.
Crystal Oldman: Chief Executive of QNI gave an update.
DN caseload analysis literature review has been completed and a copy given to each member.
Carers project - a resource for DNs supporting carers is now available on the QNI website. There is
also a literature review supporting this.
The link is: -
2020 vision - 5 years on. Nearly 1100 surveys were completed. Currently being written up and the
results will be out in April with further detail later in the year. Early thoughts show a very mixed
DN education - the survey of universities and numbers being trained is to be repeated this year. GPs
are some of the greatest allies in supporting the work of DNs.
Monument Trust has funded the QNI to continue their work with the homeless project. Would like to
extend the project for asylum seekers, gypsies, travelers and sex workers.
QNI website has a wealth of information so please do visit.
Michelle Mello - Head of Commissioning (Nursing) NHS England
Primarily Michelle works with nurses in commissioning roles and is helping to shape the community
nursing strategy.
National programme is starting to work on the various work streams:Innovation and technology
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Workforce issues
Population and public health
Feels we need to sell ourselves as District nurses better. We need quality outcome measures.
Joining up of the pathway from hospital to community.
Think about our strap line....”Keeping the patient safe and out of hospital”
Clear message form our network was a shared purpose
Case studies that show a day in the life of a DN would be really helpful.
Tim Curry - Deputy Head of Nursing - RCN
What is the RCN doing to raise the profile of district nursing?
There are a series of documents produced by the RCN to help raise the DN profile.
There is a ratching up of the pressure in the community. Few extra nurses going into the community.
Student experience is patchy
Financial investment is going down in real terms
Innovation is not really happening
Policy rhetoric is wanting to increase the community care but not being felt by the workforce.
IT and workforce planning - no national agreement.
DN survey has been done - where is the unique selling point?
Meets regularly with CNO and raises DN issues.
Everyone is asking for more money!!
For the future we need:
- to work differently
- think differently
- join with acute/voluntary and independent sector to look at ways of changing
- self care
- better professional/community/patient links
- we cannot have more of the same!
Comments about the meeting from members included:‘Really enjoyed it, great learning and sharing forum.’
‘Hugely helpful hearing discussions from other areas especially CQC’
‘Very empowering and a great opportunity to share opportunities. I found Michelle very motivational’
‘Great networking experience and knowledge of the networking team is fantastic’
All presentation slides, notes and tabled documents are made freely available to Group members.
The NPAG maintains a library and register of all documents/papers for distribution upon request.
These are also made available to members of other NPAG Best Value Groups, with the agreement of
the originator.
All presentation slides, notes and tabled documents are loaded onto the member’s web page within
the NPAG website with password security.
Please visit
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
An article about the network was published in the British Journal of Community Nursing Vol. 18, No. 7
P. 351.
Attendance with literature about the network at the QNI Conference generated further national
Several members were present at the Westminster Briefing - The Evolving District Nurse and
Michelle Mello plugged the network and there were opportunities to talk to potential new members.
An article in the Journal of Community Nursing is due for publication in spring 2014.
The future of the National District Nurse Network looks bright as there is a huge appetite to join and
share the challenges being faced with this nursing sector.
Meetings will continue on a quarterly basis, attracting national speakers who can inform of the
changes occurring.
Subjects for the coming year include -:
Technology and innovation
CQC and what it means to the community
The network will continue to have regular input from QNI and hopefully Department of Health and
NHS England.
Meetings dates have been set as:9th July - Birmingham
17th September - London
December and March to be advised
For further information about the National District Nurses Network please contact NPAG on 01245
544600 or e-mail:
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The NPAG is a part of the East of England Ambulance Service NHS Trust
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The NPAG is a part of the East of England Ambulance Service NHS Trust
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The response to questions raised has been excellent. The NPAG Network provides a managed
forum for colleagues to share information - saving time and money in not re-inventing the wheel!
Questions raised in the past month have included the following topics:Decontamination of portable medical equipment
Ward hairdressers
Laundering heat labile items
Fleet vehicle insurance
Use of latex gloves
Use of chute system for waste disposal
Equipment service intervals
Anaesthetic circuit change frequency
Car-share schemes
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Summer / Autumn 2014 - Clinical Professional Development for Occupational Health Nurses
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Please contact Victoria Combes for details.
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Ambassadors for district nurses nationally
Engage with, and thereby influence, the service.
Access communication and direction from leaders of national initiatives.
To share experiences.
• Provide a proactive networking forum for all district nurse services organisations to share the
benefits of current developments and best working practice.
• Provide critical and creative thinking about community services developments, nationally and
• Provide concerted responses to national initiatives.
• Give constructive feedback to presentations/ideas from a service perspective.
• Provide a reference group to policy makers.
• Encourage developments in district nursing services consistent with developments at a
national level.
• Systematically spread best practice and innovation.
• Share learning.
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The NPAG is a part of the East of England Ambulance Service NHS Trust
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To include:
• Department of Health
• Strategic Health Authorities
• NHS Foundation Trusts
• NHS Trusts
• Primary Care Trusts – particularly those that host District Nurse Services
• Healthcare Commission
“To provide management consultancy services and advice to managers in the NHS across the UK to
help them achieve improvements in the performance, quality and cost effectiveness of their service”.
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The NPAG is a part of the East of England Ambulance Service NHS Trust
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The District Nursing Service delivers holistic and proactive, quality nursing care to ensure that
patients and their carers are able to maximize independence and to remain at home whenever
The District Nursing Service is the main provider of domiciliary community nursing care to adults to
prevent hospital admissions, to support early discharge from hospital, to allow patients to die at home
when this is their preferred place to die and to receive nursing care in their own home or a clinic
setting when this is required and commissioned.
The District Nursing Service provides a wide range of nursing care that offers health promotion and
education, curative, restorative, supporting and or palliative function. It is personalised to meet the
health needs of each individual and their carers and family. It also promotes patient self care
wherever possible.
The District Nursing Service places the patient at the centre of the care planning and decision making
process and co-ordinates care with others.
The District Nursing Service works in close partnership with GP practices, CCGs, secondary care,
community services, voluntary services, the Local Authority and others to meet the nursing needs of
adults and to prevent hospital admissions and facilitate timely discharges from hospital.
The District Nursing Service provides educational placements for other health care professionals,
including both pre and post registration nurses and others as required.
The service will identify people with long term conditions and will provide access to a range of
services which are personalised to meet their needs. They will be supported by services which
promote self management, health and well being, independence, reduce the frequency of
exacerbation of their long term condition, and prevent unnecessary use of hospital or specialist
services. They will support timely effective transfer from hospitals to community services.
General Overview
District Nurses are registered nurses who have undergone a specialist qualification, other nurses who
work in their teams are community nurses.
District Nursing roles are central to the capacity of individuals remain in their own homes and as
specialist practitioners ensure that District Nurses have a pivotal role as patient assessors, care coordinators and team leaders.
At the end of life, patients and their families have the re-assurance that the district nursing service is
committed to supporting them throughout this time and to achieving a peaceful and dignified death.
The service should support, influence and work in partnership with the Clinical Commissioning
Groups and organisations strategic direction to provide care closer to home this will require an
integrated approach to deliver healthcare alongside social care; maintaining strong and effective links
with GPs as the key to seamless care.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
The focus of care is to meet the needs of individual patients in partnership with the individual and
their family/carer and in collaboration with other professional and agencies. The principle functions of
the service are:•
Provision of nursing care in patients homes.
Support and training for carers/families
Provision of specialist advice and treatment in liaison with other specialist nursing services.
Health promotion and screening.
Provision of audit and take part in research as appropriate.
Multi-agency approach to collaborative provision of care.
Provide teaching and assessment of nurse students; familiarisation of the role to medical staff
and other nursing staff and health professionals.
Promoting self care
District Nurses are specifically trained to provide holistic nursing care and offer advice in the following
Holistic health and social care assessments, treatment plans, with counselling and support
where appropriate.
Curative care with early interventions reducing deterioration and hospital admission.
Rehabilitation to promote independence and create opportunities for self care and carer
Supportive care to patients, families and carers.
Palliative and bereavement care for terminally ill patients and their carers including pain and
symptom control with access to specialist services.
Service objectives:•
To provide evidence based, high quality care and education to patients and their families.
To prevent unnecessary hospital admissions and promote independence.
To deliver services in line with standards and best practice guidelines and local and national
Expected outcomes
Integration between health and social care partners will ensure patients receive the right care
at the right time from the right person improving efficiency and enhancing the patient
Reduction in the number of inappropriate and unnecessary hospital admissions.
Evidence Base
Care in local communities, a new vision and model for District Nursing –DH (2013)
High Quality Care for All – NHS next stage review final report DH (2008)
Improving and Supportive and Palliative Care for Adults with Cancer NICE (2004)
National Service Framework for Long Term Conditions DH (2005)
Our Health, Our Care, Our Say – A new direction for community services, White paper DH
Our NHS, Our Future DH (2007)
Nice Guidance for the management of COPD, Diabetes, CHD and other long-term conditions
NICE (2002-2008)
Department of Health (DH 2004) Standards for Better Health, HMSO, London
Nursing and Midwifery Council (NMC 2009) Record Keeping: Guidance for nurses and
midwives, NMC, London
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The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Nursing and Midwifery Council (NMC 2008) The Code Standards of conduct, performance
and ethics for nurses and midwives, NMC, London
2020 Vision - the future of district nursing (QNI 2009)
The Mid Staffordshire NHS Foundation Trust Public Enquiry Report : London (2013)
Service Description
The service provider will ensure that the service is delivered in such a way that it provides; (adapt for
local agreement)
A service for all housebound adults aged 18 or over (including those in care homes or intermediate
care) who have a community nursing healthcare need.
Care packages as agreed with the commissioner to fulfill the services objectives and outcomes.
All opportunities are taken to promote a healthier lifestyle among patients and the wider communities.
The service will be flexible and responsive, adapting to individual needs in terms of their requirements
e.g. level of risk, culture, ethnicity, language and disability.
All those involved in providing the service should acknowledge and respect patients’ gender, sexual
orientation, age, race, religion, culture, disability, lifestyle and values.
Local agreement may mean specific exclusions are necessary.
SERVICE DELIVERY (adapt for local agreement)
Service Model
District Nursing teams will provide an equitable community nursing services for all permanently or
(temporarily due to illness) housebound adults including those in care homes and residential care.
The service promotes healthier lifestyles, physical, social and psychological well being, and supports
and encourages people with disability and long term conditions to live independent lives.
The District Nursing Service provides advice, support and care to an individual and their carers and
family to ensure the palliative care needs are met and they live well until the end of life.
District Nursing practitioners will demonstrate comprehensive assessment skills for patients who have
complex needs, planning, delivering and evaluating appropriate care.
The provider has a duty to safeguard and promote the welfare of children and vulnerable adults.
Staff should comply and adhere with Local Safeguarding policies and procedures.
All staff should know who to contact if they are concerned that a child or adult is at risk or has
experienced harm.
All staff should access safeguarding support, advice and supervision in line with organisational policy.
Intervene appropriately, in line with current policy requirements, when issues of domestic violence are
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Seek child/adult protection supervision with the safeguarding team in line with current policy
3.2.1 Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards
The provider has a statutory duty to comply with the principles of the Mental Capacity Act (2005) and
the Deprivation of Liberty Safeguards.
All staff should comply with the principles of the Mental Capacity Act (2005) and “have regard” to the
Code of Practice to the Mental Capacity Act.
Staff should adhere to policies regarding the Mental Capacity Act (2005)and the Deprivation of Liberty
All staff must be aware that they have a statutory duty to refer to the Independent Mental Capacity
Advocacy Service in certain situations.
All staff must know how to report an actual or suspected deprivation of liberty.
Intervene appropriately when it is identified that a person may lack capacity to make specific care and
treatment decisions. Staff must ensure that capacity assessments are undertaken and that the
statutory Best Interest decision making principles are followed.
Staff must be aware of the powers of registered health and welfare Lasting Power’s of Attorney,
Advance Decisions to Refuse Treatment, Court Appointed Deputies and the role of the Court of
3.2.2 Patient Records
Excellent record keeping in line with Nursing and Midwifery guidelines will be adhered to at all times.
It is essential to share information regarding individual patient’s assessment and care plan to other
healthcare professionals in order to facilitate the effective co-ordination of care.
District Nurses should discuss the possible need to share information with other healthcare or social
care providers with the patient and seek their explicit consent for information to be shared. This valid
consent will be recorded within the patient record at least annually.
For the contracted period, the service provider must be able to produce accurate and comprehensive
records for each patient referred into the service, all assessments, personalised care plans and all
Best Interest (Mental Capacity Act) and safeguarding decision making processes and evaluation.
Where other specialist services are undertaking care for a patient on the District Nurse caseload, they
should be provided with access to the patient’s records to ensure coordinated care with the patients’
3.2.3 Information Requirements
The provider will collate and compile information in a format that will support the organisation to
measure and evaluate the delivery of the planned outcomes and benefits from the service.
Assessment and Care Packages
The service provider must offer a District Nurse Service centred upon initial and ongoing specialist
District Nursing assessment.
The specific care package and frequency of District Nurse visits will be determined during the initial
visit when a holistic assessment of the nursing needs of the patient is undertaken and a personalised
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
care plan is developed in partnership with the patient and/or their carers. Re-evaluation of nursing
needs will be undertaken as required and deemed necessary by the nursing team.
Referrals to other agencies such as social services may be made as part of the assessment and care
planning process
3.3.1 Assessment Process
Every patient referred to the District Nursing Service undergoes an assessment commensurate with
the presenting needs; this assessment will explore in detail the individuals physical, psychological,
(including whether they have mental capacity to consent to the care and/or treatment proposed),
social and spiritual functioning. Lasting Powers of Attorney and an Advance Decision to Refuse
Treatment will be clearly recorded.
The assessment will identify any active intervention for behaviour change and ill health prevention.
Reassessments will be done as patients’ condition demands.
Carers’ assessments may also be necessary using the assessment tools which form part of the care
management process.
Governance Framework and Quality Assurance
The service provider will be required to demonstrate compliance with national guidance and clinical
best practice, including: reference to national requirements, local best practice, Trust formulary etc.
The service provider must comply with National Department of Health clinical governance
requirements and, as a minimum meet the clinical governance standards laid down by the Care
Quality Commission.
The service provider will be required to have a quality assurance system and mechanisms to monitor
and quality assure the service.
Audit and Effectiveness
An annual programme of audit as an integral part of a quality improvement programme that seeks to
improve patient care and outcomes will be established.
The audit programme should be developed according to the needs of the service, the specialist
interests of staff and requirements for any participation in national audit. The programme will include
both new audit activity and the continuation of existing audits to ensure the full audit cycle is
Staffing requirements
Registered and appropriately trained staff must be in place to ensure that the District Nursing Service
is provided in accordance with the service specification and NHS employment regulations. In
particular there will be a requirement to ensure that the service is fully operational to ensure service
levels are maintained during staff holidays, or absences due to sickness, training or any other
The District nursing service will be required to meet all the core skills and competencies which
Risk assessment and appropriate management of risk.
Clinical assessment skills and physical assessments.
Knowledge of wound care, diabetes, continence care, palliative care etc.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Ability to use information in undertaking community nursing assessments and clinical decision
making including Mental Capacity Act assessments and applied knowledge of the statutory
requirement involved in Best Interests decision making.
Knowledge and understanding of therapeutic interventions, including relevant pharmacology
and medicines management.
Independent prescribing/nurse prescribing.
Long Term Condition assessment and management.
Health promotion and ill health prevention.
Advanced communication and interpersonal skills.
Palliative and end of life care for cancer and non cancer patients.
Knowledge of/ability to apply relevant legislation and full understanding of the ethical issues
involved in caring for people within the community.
Application of holistic person-centred approaches to care.
The provider will have adequate communication systems in place for providing regular contact and
clinical and professional updates with their constituent GP practices
The District Nurses will attend regular Practice multi-disciplinary care meetings and as required
between times to discuss new, ongoing or changes to a patient’s care needs and management;
Practices will be aware who their named District Nurse is; face to face contact and good
communication will need to be ensured.
Geographic coverage boundaries (adapt for local agreement)
The District Nursing Service will be provided to patients who reside within a defined area or those
patients registered with specific GP Practices.
Location(s) of Service delivery (adapt for local agreement)
Days/Hours of Operation (adapt for local agreement)
Referral criteria and sources (adapt for local agreement)
4.4.1 Eligibility for Home Visits (adapt for local agreement)
All patients must be registered with a GP.
To receive a domiciliary visit, a patient must be considered housebound i.e. unable to leave
the house except with specialised transport for example ambulance.
Patients requesting home visits may be experiencing difficulties attending clinic appointments
due to a variety of reasons e.g. relative/carer work commitments. Clinicians determining
whether home visits will be provided or not should liaise with the patient and relative/carer in
order to try and identify appropriate solutions.
Short term or one-off visits may be provided for patients in some circumstances e.g. following
hip replacement; acute illness; etc. and where it may be deemed more appropriate to provide
care in the patient’s home.
This list is not exhaustive. Consideration must be given to other factors that may determine suitability
or appropriateness of home visits as opposed to clinic appointments:
Terminal illness which results in patients being housebound.
Patient attendance in clinic environment would lead to risk of harm or injury to patient or
clinician e.g.
Severe dementia, agoraphobia, patient at certain risk of falling.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Patient attendance in clinic would negate the benefit of treatment or exacerbate condition.
Referral route (adapt for local agreement)
Exclusion criteria (adapt for local agreement)
Patients are discharged following assessment, by a registered nurse, on completion of an
episode of care. Patients are left a contact number and re-refer themselves to the nurses if required
or contact them for advice.
Criteria for discharge
Completion of treatment
Self management plans
Admission to hospital or other setting
Patients refusing treatment
Rarely, patients who are abusive to staff
Admission to a nursing home
Move out of area
QUALITY AND PERFORMANCE STANDARDS (adapt for local agreement)
A capacity review will commence when the commissioner is alerted to a swing in capacity
either side of the 10% threshold set out in the District Nursing service contract.
CONTINUAL SERVICE IMPROVEMENT PLAN (adapt for local agreement)
The District Nursing service will be monitored against the annual key performance indicators
identified within the community contract.
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Role of unregistered staff by area
Band 2
Band 3
Band 4
N. Somerset
Generic support
workers - nursing and
therapy skills. Have a
competency book to
work to.
Have band 4s in each
team. Great attitude
& positivity.
Injections, flu clinics,
catheters, catheter
clinic, wound care
and clinics.
Mid Yorks
Depends on team from only ordering to
skilled working bladder washouts/eye
Intermediate tier beds
facility. Similar role to
band 3s
Phlebotomy &
basic wound
service medication
prompts &
Leg ulcer - 3 & 4
layer bandage
Stable diabetics
Wound care
One band 4 per team
- same as band 3
n/support work
MUST assessment
Follow up supporting
of care staff in
residential homes
Programme of
development of 3 and
Wound management
Continence care
Diabetes - insulin
Meds management
Equipment and follow
Competence based
Additional roles working on training
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Band 2
Stoke on Trent
Band 3
Band 4
Medication support
Pressure area care
Support staff in
palliative care
Monitoring inhalers
Equipment monitoring
Some insulins and
Administration roles
Many have gone on
to do nurse training.
Debate around role
Wound care
Simple reviews
Admin role
Simple dressings
Eye drops
Injections - B12 and
stable diabetics - not
in rest homes
Long term heparin on
an individual patient
Moving an handling
CSH Surrey
Eye drops
Support for end of life
Simple assessments
Pre drawn up
Removal of sutures
Five Boroughs
Night sitters
Wound care
Urgent bloods
end of life care
Catheter care
MUST & risk
Leg ulcer clinics
Female catheters
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Band 2
Band 3
Band 4
Double up
with trained
Wound care
Pressure area care
Support carers
Basic observations
Falls assessment
Wash legs/leg ulcer
OOH service
double up
Wound care
Catheter care
Leg ulcers
Remove bandages &
layer 1 &2 of long
standing wounds
Eye drops
Pressure area care
phlebotomy all band
Rapid response generic support
workers therapy and
Palliative care home
support and personal
Personal care
End of life
Night sitting
support on
Low level wound care
Catheter care
Eye drops
Flu injections
No band 4s in DN
service - 5 people
going to do
foundation degree in
Equipment service
has band 4s to do
equipment reviews
Double up on
night service
Domicillary anti
coagulant screening
Eye drops
ear syringing
Clerical strand to the
Very few left
LTC monitoring
COPD house bound
Flu injections
© NPAG 2014
Few band 4s - not
replacing those who
leave - little
difference from band
The NPAG is a part of the East of England Ambulance Service NHS Trust
National District Nurses Network
Band 2
Band 3
Band 4
Short stretch
Support for end of life
Blurred lines between
3 and 4s
NE London
Basic observations
Bandaging but not
Removal sutures and
Packing and more
complex dressings
Basic observations
Equipment reviews
Short stretch
Removal sutures and
ECG and sats levels
© NPAG 2014
The NPAG is a part of the East of England Ambulance Service NHS Trust