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Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study
  1. Vari M Drennan1,
  2. Melania Calestani1,
  3. Fiona Ross1,
  4. Mary Saunders2,
  5. Peter West3
  1. 1 Centre for Health and Social Care Research, Kingston University Faculty of Health Social Care and Education, London, UK
  2. 2 QUEST Community Health Care Consultancy, London, UK
  3. 3 Independent health economist, London, UK
  1. Correspondence to Professor Vari M Drennan; v.drennan{at}


Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives.

Objectives What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service?

Design Mixed methods case study.

Setting Primary care.

Participants Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses.

Results The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service.

Conclusions The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses’ working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.

  • organisation of health services
  • human resource management
  • quality in health care
  • primary care

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  • Twitter Follow: Vari Drennan: varidrennan, Fiona Ross: ProfFionaross and Melania Calestani: melaniacale.

  • Contributors VMD was the principal investigator and with FR, MS and PW conceived, designed the study and was awarded the funding. VMD, MC, MS and FR contributed to the collection of data, and all authors undertook analysis or interpretation of data for the work. VMD developed the first draft of the paper, and all authors contributed to different sections and revised the paper critically for intellectual content. All authors gave final approval of the version to be published.

  • Funding This independent evaluative study was funded by Health Education England (South London), a non-departmental public body under the provisions of the Care Act 2014, in collaboration with Guy’s and St. Thomas’ NHS Foundation Trust.

  • Disclaimer The views expressed are those of the authors and not necessarily the views of Health Education England, Guy’s & St. Thomas’ NHS Foundation Trust, the NHS or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study met all NHS governance requirements, including participant consenting procedures, and permissions and was approved, including participant consenting procedures, by Kingston University Research Ethics Sub Committee for the Faculty of Health, Social Care & Education (reference FHSCE REC 12-16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement None available.

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