Non-elective demand management: the renaissance of district nursing?

Despite the fact that the majority of district nurses are grasping opportunities to provide care to increasingly complex patients at home there have been concerns expressed recently that district nursing as a discipline is in decline. This is partly attributed to a lack of leadership and focus (Lowe, 2006). This alleged decline is set against a backdrop of rising rates of emergency admissions with associated cost pressures for many primary care organizations. This paper presents an overview of a programme which targets district nursing services at the avoidance of non-elective (emergency) admissions. The programme used a model to match staff capacity with demand to free up capacity within teams to tackle admissions from a range of client groups. Using care pathways staff were able to provide structured care for individuals at home. Teams were set targets for the number of admissions they needed to try and avoid. Within the first five months staff reduced non-elective admissions by 17% and achieved savings of 668,000 UK pounds. At a time when community services are being opened up to competition as a result of the changes proposed by "Commissioning a patient-led NHS," district nursing is capable of playing a key role in demonstrating the value of the services to commissioners.