Overstretched district nursing services pile workload on GPs
Exclusive Cuts and restructuring in district nursing teams are forcing extra work on GPs, delaying urgent referrals and, in some cases, damaging care for terminally ill patients, LMCs have warned.
LMCs in London, the Midlands and Yorkshire have flagged up reports of a catalogue of issues with ‘declining' district nursing services including increasing workload for practice nurses, delayed referrals for terminally ill patients and severe problems contacting district nursing teams, with some only accepting faxes from GPs.
LMC leaders in Birmingham said the recent introduction of a ‘single point of access' call centre, where non-clinicians process community health requests from GPs, had led to delays in urgent referrals getting through, with the LMC receiving reports of a case where a terminally ill patient was delayed nursing care.
Dr Robert Morley, chair of Birmingham LMC and a GP in the city, said: ‘The idea that a district nurse is not going to treat a terminally ill patient is nonsense. A nurse themselves wouldn't do that, but when you get this system which is more anonymised, more remote, you end up with something like this.'
Birmingham Community Healthcare NHS trust, who run the service, said: ‘We are aware that there have been initial problems with citywide single point of access call answering times and we have seen an improvement since we went live.'
In September Doncaster LMC, warned of district nursing services being ‘practically nonexistent' in some areas, with board minutes showing a report of a terminally ill patient having ‘nine different nurses during a 10 day period.'
The LMC's newsletter stated: ‘Concerns have been raised that the district nursing service is declining and in some areas is becoming practically nonexistent, with district nurses not visiting surgeries or accepting telephone calls, only faxes.'
Meanwhile, LMCs in Redbridge and Waltham Forest in North London claim that over-stretched and under-staffed district nursing services are offloading post operative care duties onto practice nurses, with financial implications for GP practices.
Dr Terry John, chair of Waltham Forest LMC and a GP in London, said: ‘The big issue at the moment is the removal of stitches – which has always been done by district nurses – is now being bounced back to practices with the suggestion that practice nurses should be doing this. That is not part of our GMS contract.'
‘As district nurses leave due to the extra workload, they are not being replaced due to financial reasons. So there are less people carrying a bigger workload so some of it is now being offloaded to GPs inappropriately.'