THE FUTURE OF COMMUNITY NURSING IN THE UNITED-KINGDOM - DISTRICT NURSING, HEALTH VISITING AND SCHOOL NURSING

This paper examines the future of community nursing, within the wider framework of a rapidly changing National Health Service. The research was commissioned by the Community Performance Review Network, as part of a series of comparative studies between community healthcare NHS tr usts. Three questionnaires were sent to 24 trusts, covering three of t he community nursing services: district nursing, health visiting and s chool nursing, Of the 24 trusts involved in the network, 22 responded to some or all of the questionnaires, A wide range of management struc tures and working practices were found between trusts, but several com mon themes and issues of concern emerged. For district nurses, these i ncluded the shift from secondary to primary care and the changing dema nds of the client population served, with increasing numbers of elderl y and chronically disabled patients, This led to anxiety over the comm unication between different providers of care, such as community, acut e and social services, and the skills mix and training requirements fo r nurses, Health visitors and school nurses were concerned about being marginalized in the move towards integrated primary health care teams , As the emphasis changes from treating illness to health promotion, c oncern was expressed about how performance could be measured on the le ss quantifiable outcomes of preventative care, and hence how jobs coul d be justified to purchasers of health care. A central theme was the p otential role of the nurse practitioner in provision of primary care, and this formed a focus for other anxieties concerning both the curren t situation and future of community nursing services.