Even before the COVID-19 pandemic there was a shortfall in the community nursing workforce and an increasingly ageing population. The motto during the pandemic was to ‘stay at home, save lives and protect the NHS’. Media images were of NHS staff at full capacity in the acute sector, with weekly clapping for NHS heroes outside emergency departments. The media portrayal of the NHS at this time arguably favoured acute services, which was well deserved, but, in doing so, perhaps created a disservice to frontline staff in the community.
In reality, ongoing and additional care continues to be delivered at community level, with capacity struggling to meet current demands. Community data identified that 1 201 200 community referrals relating to patient care were received in August 2021, with length of referral to treatment and assessment times under strain (NHS Digital, 2021).
As a consequence of the pandemic, we must ask ourselves whether it is time for nurse education to shift its priorities from a predominantly secondary care-focused programme to one centring on community and public health. In a world that moves so rapidly, has nursing as a profession become shortsighted? It has long been identified that investment in community nursing is essential (Queen's Nursing Institute (QNI), 2019). Judging the value of nursing by its ability to save lives in emergencies, as opposed to preventing those emergencies in the first place, would no doubt prove complex.
Policies developed over more recent years state that paediatric care, mental health, long-term conditions and newer models of integrated care are future priorities (Department of Health and Social Care, 2019). However, to sustain and deliver services to the next generation one could surmise that vision and policy require accurate translation. That is, translation to ‘future proof’ the workforce, develop current practice and, with it, sufficiently educate the next generation of nurses. Nursing applications have increased and many students from young and mature demographics are seeking to join caring professions, which are perceived as valued, challenging and secure.
Routes to higher practice roles
As in secondary care, there is an abundance of unfilled vacancies in community nursing. Specialist community practitioner (SCP) courses in district nursing (SCPDN), child nursing (SCPCN), and specialist community public health nursing (SCPHN), health visiting and school nursing, are additional recognised routes to a higher level of practice within the community.
They are held in high esteem by community nursing teams and employers alike, and places are limited compared with many other academic courses. SCP and SCPHN programmes are awarded with a recordable Nursing and Midwifery Council (NMC) qualification, providing a status not currently available for advanced clinical practice. Stringent recruitment criteria are implemented to ensure only elite candidates are enlisted from trusts annually.
However, therein lies the problem. There can be difficulties recruiting and releasing experienced members of the team to attend a 40- or 52-week course. Resources needed to support and provide education can cause pressures on care delivery from a local perspective. Nevertheless, a deficit of students partaking in these programmes could in fact perpetuate a further cycle of shortages, particularly in terms of leadership skills, and both assessor and supervisor numbers.
Such highly accomplished practitioners are needed to ensure quality of care delivery, to support the student experience, and achieve competencies required by the NMC for pre- and post-registration students (NMC, 2018). The proposed new NMC standards for these specialist roles are critically important and the discussions already generated are testament to their contemporary nature.
Despite technological advancements during the COVID-19 pandemic, a lack of accessibility to deliver care to vulnerable groups was an overarching theme. The subsequent drive for the implementation of community digital assessment platforms, self-management of conditions and the explosion of interest in social prescribing, mean that the impact on community services and roles will be far reaching.
Investment
It is about time that the value of the community nurse is recognised by everyone, and not just in the media. Community nurses are widely regarded as the hidden workforce, and this must change. Political issues aside, perhaps investment in community pathways at a pre-registration level, in partnership with higher education institutions, is the first step towards attracting a committed and autonomous workforce. Students can be educated to deliver safe and compassionate care to the local communities they serve, if they realise that this is an option.
The QNI has long championed the skills and value that community nurses possess, and actively encourages students through its ‘welcome to the community’ initiative, a mantra education and community providers should consider adopting.