Improving primary and community care

Realising the neighbourhood NHS: delivering a new deal for primary care in England | The Institute of Public Policy Research

This paper provides new evidence and ideas to improve the provision of primary and community care.  It argues there should be a ‘new deal’ for general practice which should consist of:

  • creating neighbourhood care providers to deliver the ‘neighbourhood NHS’
  • offering all GPs the right to NHS employment
  • reforming new GP roles to create career progression, time to care and realistic workload
  • a radical transformation of the primary care infrastructure.

District Nursing Today

The UK’s District Nurse workforce is under severe threat due to long-term underinvestment in training, education and skills, posing a direct threat to patient safety, according to independent report, commissioned by the Queen’s Nursing Institute (QNI)

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Findings of a new report reveal an evolving healthcare workforce crisis, set against a backdrop of rising demand for district nursing services across all UK regions.

This study shows that for District Nurses (DNs), working conditions, pay, education and training have not improved since the previous QNI report was published (2014). If anything, conditions, lack of support and career development for DNs has deteriorated further, leading to:


  • Working large amounts of unpaid overtime: One in five (22%) of respondents work a day or more of unpaid overtime each week.
  • An ageing workforce heading for retirement: 46% of respondents planning to either retire or leave in the next six years
  • Lack of IT support to do the job efficiently: 36% of respondents reported that Information Technology, or lack access to efficient IT systems, connectivity and support infrastructure is one of the main factors making their role more difficult to sustain
  • The lack of training and development available to District Nurses is a key factor reported to be influencing those looking to leave the profession.
  • Unmanageable caseloads per individual is cited as another challenging factor with almost 30% of teams having a caseload of over 400 patients/people
  • Insufficient time to devote proper care to patients. 63% respondents say they defer visits or delay the delivery of patient care on a daily basis
  • Stagnation and lack of progression in the workforce: 75% of respondents state they have vacancies or ‘frozen posts’ in their teams
  • No administrative support: 28% of respondents have no access to administrative support staff
  • Variation in pay of District Nurses acting as team leaders and significant regional variation in the pay band of District Nurses holding the Specialist Practitioner Qualification.

Full report: District Nursing today: the view of District Nurse Team Leaders in the UK

See also: Sharp Decline in District Nursing Workforce Poses Direct Threat to Patient Safety | QNI

Impact of the Community Network

Delivering for community services | NHS Providers and the NHS Confederation 

This report sets out the achievements of the Community Network since it launched in May 2018 and its plans for the future.  The network brings together and represents NHS and not-for-profit organisations providing NHS community health services.

Full document: Delivering for community services

See also: NHS Providers blog:  Delivering for community services | The community network story so far

Community Mental Health Framework

NHS England and NHS Improvement have published The community mental health framework for adults and older adults. This framework describes how the Long Term Plan’s vision for a place-based community mental health model can be realised, and how community services should modernise to offer whole-person, whole-population health approaches, aligned with the new Primary Care Networks.

Full document: The Community Mental Health Framework for Adults and Older Adults

See also: NHS Providers briefing

Community Services: Our time

The latest report of this Provider voices series explores the future of the community services sector in the context of the NHS long term plan. Through ten interviews with representatives from social care, primary care, integrated care systems and community services providers, the authors draw out the common themes, opportunities and challenges | NHS Providers

The NHS long term plan, published in January of this year, puts the community services sector at the forefront of the health service’s drive to deliver truly integrated care. For the first time, community services, along with primary care, will receive a greater than average funding increase. This comes with the expectation they will lead a reimagining of community-based urgent care, working alongside GPs, with whom they will be forging new working relationships via primary care networks (PCNs).

All of the leaders interviewed for this publication expressed a sense of optimism about the community sector in light of the NHS long term plan’s recommendations.

Further detail at NHS Providers

Social Care Institute for Excellence: Webinar recording: Integrating Better

Social Care Institute for Excellence | March 2019 | Webinar recording: Integrating Better

The purpose of this webinar, recorded on 29 March 2019, has been to introduce a new guide which captures common features of good practice of integration between health, social care and the voluntary and community sector. The guide and associated materials are called Integrating Better: new resources on health and social care integration.

The guide – and the accompanying webinar – covers key topics such as: Leadership for integration; Promoting self-care; Supporting care closer to home; and care and support in a crisis

Webinar recording: Integrating Better

Guide available (requires SCIE registration)

Help at Home – Use of assistive technology for older people

This review presents a selection of recent research on assistive technology for older people funded by the National Institute for Health Research (NIHR) and other government funders. The review focusses on research around the use of technology in the home, remote monitoring systems and designing better environments for older people | NIHR

More people are living longer with complex conditions and needs. Technology can help people to stay living well and safely at home as they get older. But technology is changing rapidly and it can be challenging to get the right technology for the right person with the right support. There has been considerable investment recently in developing and evaluating assistive technologies for older people. But this is a relatively new field and there are important gaps in what we know.

Full report: Help at Home – Use of assistive technology for older people

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