Re: District nurses

I think the criteria is really silly. They should have more district nurses seeing patients with mobility issues or chronic conditions) to stop them wasting time at the GP surgeries. Unfortunately though they can't recruit enough nurses to manage that. It shouldn't just be patients who are 100% housebound because that's a very narrow bracket. I mean what type of patient really fits that criteria? The super-morbidly obese? It should be a service that's in place for those who struggle to get around.

Re: District nurses

I'm sure that if you are mobile enough you can just make an appointment at your GP surgery with the nurse every other day. If the GP surgery have arranged district nurses and the service is not fit for purpose then they need to manage it. Little things like cleaning out a stomach drain may seem trivial but are incredibly important if infection is to be avoided.

I hope you manage to get the treatment you need Val.

Re: District nurses

You might be surprised to find that many people do fit the criteria Annie. If a person has mobility (and if someone can go out to the shops) then I cannot see why they cannot go to the GP surgery for the treatments that a DN would perform. DN services are very expensive (they can see many more patients in a clinic than they can on a home visit, so it is a very effective way of using nursing time). In an ideal world, where money is no object and there are plenty of nursing staff I might agree that the DN service could be extended to those who are mobile but struggle. However, the NHS does not have infinite resources and has to make the money go round everybody who needs the provision of the NHS.

As an aside, the GP practices do not employ the district nurses. They contract with the Primary Care Trust for the service and the PCT pays their wages.

Re: District nurses

I don't agree about the cost. It's far more cost effective to increase district nursing services than to have more people turn up at A&E as Deylon does week after week. What is very expensive is a hospital admission and particularly a blue light to get there. The number of people needed to coordinate a hospital stay vs a district nurse visiting regularly just don't add up to any cost savings by expecting people who can't walk well to turn up at a gp surgery.

You have to remember the NHS isn't a charity that's free. It's funded handsomely by tax payers. There is no such thing as a free public service.

The NHS has money to fund district nurses and it would make great savings if they could expand them. The problem is that it is very difficult to recruit and retain them. PCTs are no more. The CCGs are meant to be run by GPs, that was the main change Andrew Lansley made in his reforms. So therefore GP groups do pay for district nurses and decide how to design that service.

I think that particularly in the older population, more access to services in the home should be made available. Studies have time again shown that's the best model rather than expensive hospital stays & bed blocking.

Re: District nurses

I don't disagree that hospital visits are expensive Annie and district nurses play an important role. I am sure you know that their services are largely used when a person has been discharged from hospital for such things as wound management, diabetic care, after surgery, etc. They are not an emergency service.

Titles die hard and I am aware the PCT's have now become Clinical Care Commissioning Groups, (as they were before I retired from it all). See attached link. However, it it is not the GP's alone who hold the monies and make the decisions on how funds are allocated. The GP's do contract for the DN service collectively through the CCCG - unlike the practice nurses who are employed directly by GP practices themselves. There are many different specialists (not just district nurses) working in community and amongst them are some very skilled and highly qualified nurse specialists. As I understand it these professionals have an essential role in providing treatments at home (or in clinics) - and thereby minimising hospital admission if it is not essential. These treatments and procedures, only a few years ago, had to be provided in hospital. However, these types of nurses are too thin on the ground.

There might seem like a lot of money available, but there is never enough to go round, either for Acute or Community care. More complex procedures and surgeries become available yearly and, as you say people are living longer and they can have complex needs. The only way to provide them is to pay more in taxes IMO and even then there will be problems. The NHS is such a huge complex machine and there are many demands for services which get more expensive by the week. If not extra taxes to raise the finance, then individual private provision can step in, but that is not affordable for everybody and does not provide equity. We are not set up for insurance provision and as I said many can't afford it anyway. I hold the NHS dear and would gladly pay more in tax if I could be sure it would be spent within the NHS.

https://www.nhscc.org/ccgs/

Re: District nurses

There will always be many people who will rely on District Nurses and without transport or someone to care for them it must be very worrying. I have had good service in recent days from them but have now decided that we can probably manage to do my stomach drain by ourselves but they will still call weekly to see how we’re managing and have given us 24 hour phone numbers for assistance if required.

Re: District nurses

No, but they play a vital role in preventing people from needing emergency services. I'm sure you know it only takes a minor incident with a wound dressing to turn into a serious incident if someone has a chronic condition (or worse).
I totally agree they are too thin on the ground but that is where resources should be directed don't you think? If only people with seemingly minor ailments could be treated really effectively at home then they may rarely need a hospital admission. As it is people either ignore the minor or they are ignored. Which is ok in the young and healthy....but.



I don't agree about taxes. NHS funding rose exponentially under labour and is still rising. It's like you say, it's all too complex. But it's the complexity that swallows the money. That and cancer drugs.

Re: District nurses

That's great Val. I really hope you feel better soon.