District nursing numbers have been cut by up to a third in some parts of England since 2011, according to research by the RCN.
In Cambridgeshire, 79 per cent of the district nursing service is provided by registered nurses, with 21 per cent provided by healthcare assistants (HCAs), but in South West Essex the service is run with only 57 per cent registered nurses and 43 per cent healthcare assistants.
The DH's district nursing vision states clearly that a district nurse should be 'a qualified nurse with graduate level education and a specialist practitioner qualification'.
In a separate report entitled District nursing - harnessing the potential, which sets out the RCN's UK position on district nursing, 69 per cent of district nurses surveyed reported staffing levels were dropping; 91 per cent cited an increase in stress in the past year and 83 per cent said their caseloads had increased.
Ben Bowers, professional lead for community nursing (honorary) at Hertfordshire Community NHS Trust, said: 'A number of practitioners have retired while provider services and commissioners have not invested in specialist training places for district nurses. There remains a lack of understanding of the role of district nurses or the complex caseload management skills community leaders need.
'This can lead to misunderstandings and provider organisations employing HCAs to undertake task-based interventions when qualified practitioners are needed to oversee care.
'To meet the needs of local populations there needs to be a rapid investment by commissioners and provider organisations in district nurse specialist practitioner course places which equip practitioners with the right skills to lead and deliver complex community care.'