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November 2025 - Health

One in four district nurses in England are leaving the NHS, according to new research: A recent study on the state of district nursing in England found that 1 in 4 district nurses had left the profession in the year leading up to September 2024. It suggests that high staff turnover is adversely affecting the continuity and quality of patient care, resulting in postponed visits, a decline in preventative care and increasing pressure on remaining staff due to heavier workloads.  

The research conducted by the Nuffield Trust between February and May 2025 utilised a mixed-methods review of district nursing services in England (from 2009 to 2024) as the basis for its study. This included key papers from previous studies, analysis of published data (such as NHS workforce data), reviews of job advertisements, and consultations with experts. It shows that between 2009 and 2024, the number of district nurses in England decreased by over two-fifths (43%), from 7,643 to 4,322, despite a surge in demand for these services. 

The report highlights that low pay and insufficient career advancement opportunities for district nurses are negatively affecting staff retention. The findings indicate that most nurses remain at band 6 or lower, with only 2.8% advancing to band 8 or higher. Additionally, heavy workloads and the requirement to work unpaid overtime (a reality for one in four district nurses) undoubtedly make the role seem less attractive.

The report also finds that total NHS spending on district nursing services has not kept up with demand, citing underinvestment as another key factor for the decline in numbers. In 2009, the NHS spent £1.5 billion on district nursing, which had increased to £1.8 billion by 2024. However, the proportion of district nursing within community health services significantly decreased during this period. Evidence of this decline is shown by the reduction in contacts with NHS district nursing services in England, which fell from 32 million in 2009 to 29.2 million by 2023/24. This represents a 9% decrease, despite a 24% increase in patient demand for these services. 

Thea Stein, Nuffield Trust Chief Executive, commented: “If the government doesn’t begin to address the glaring issues with district nursing and build a workforce plan that better supports this pillar of community care, it will be a core weakness of efforts to shift more care from hospital to home. Urgent action is needed to ensure the training pipeline for district nursing is fit for purpose”.

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