District nurses play an important and crucial role within the primary and community health care team, visiting and providing care to patients in their own homes, which can include residential care homes. As well as providing direct patient care, district nurses also have a teaching role and work with patients and their relatives to help them manage their condition and treatment, avoiding unnecessary admission or readmission to hospital.
Some positive steps have been taken to promote a better understanding of district nursing services but the boundaries of the role are not always understood and opportunities to streamline and better integrate care are not being realised. The limited understanding of demand makes it difficult to assess whether there is sufficient capacity, and leads to significant variation in resourcing and uneven workload between teams. The Health Board has developed flow charts to improve referrals to district nurses but issues remain with the quality and appropriateness of referrals. The absence of an information system means that the Health Board is unable to effectively assess demand and determine its district nursing workforce requirements to inform staff deployment.