title: Innovation and change: shaping district nursing services to meet the needs of primary health care.
abstract: BACKGROUND
  National Health Service reforms and government directives have placed primary care in the forefront of health care provision. Robust information is needed to inform and direct the district nursing response to these initiatives.
  
  
  OBJECTIVE
  To gain a detailed understanding of the district nursing service in the West Hertfordshire area, determine capacity for development and formulate plans for the 21st century.
  
  
  METHODS
  Action research was the supporting methodology. A project group of working professionals led the study, identifying several areas for development, of which two are discussed: workload measurement and caseload profiling.
  
  
  RESULTS
  An understaffed service with unpredictable workload which mitigates against proactive working. The inappropriate use of staff skills prevents efficient, cost-effective care.
  
  
  CONCLUSIONS
  Robust caseload management with strict referral and discharge criteria and prioritization of visits offers the possibility of more effective time management. Skill mix review could enable more appropriate use of specialist skills.
authors.affiliation: St.Albans and Harpenden PCT, St.Albans, Herts, UK. linda.thomas@stalbansharp-pct.nhs.uk
authors.forename: Linda M
authors.initials: LM
authors.lastname: Thomas
authors.forename: Trudy
authors.initials: T
authors.lastname: Reynolds
authors.forename: Loretta
authors.initials: L
authors.lastname: O'Brien
mesh_terms: D000203:Activities of Daily Living; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D004739:England; D018166:Health Care Reform / Q000458:organization & administration*; D006285:Health Planning / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D015401:Nursing Administration Research; D009936:Organizational Innovation; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011637:Public Health Nursing / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration; D017748:Time Management / Q000458:organization & administration; D016526:Workload