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More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England.

Drennan, VM (2019) More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England. J Health Serv Res Policy, 24 (1). pp. 11-18. ISSN 1758-1060
SGUL Authors: Drennan, Vari MacDougal

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Objectives Many countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development. FINDINGS: All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development. Conclusion There is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.

Item Type: Article
Additional Information: © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
Keywords: district nursing, home healthcare, qualitative methods, workforce, Health Policy & Services, 1117 Public Health And Health Services, 1402 Applied Economics
Journal or Publication Title: J Health Serv Res Policy
ISSN: 1758-1060
Language: eng
1 January 2019Published
12 May 2018Published Online
9 March 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Project IDFunderFunder ID
UNSPECIFIEDSouth London Health & Social Care SystemUNSPECIFIED
PubMed ID: 29754532
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