Royal College of Nursing concern over fall in district nurses in Wales
The number of district nurses in Wales has fallen to its lowest level in six years, prompting concern patients who are cared for at home could be at risk.
In 2015, there were 412 district nurses in Wales, down 42% from 712 in 2009, figures have shown.
The Royal College of Nursing said it was placing pressure on GP surgeries and emergency departments.
The Welsh Government said overall, the total number of nurses providing community services had increased.
District nurses are senior, experienced nurses sometimes compared to being the GPs of nursing and clinically supervise less experienced staff or those with fewer qualifications, such as health care workers.
The Welsh Government figures showed that in six of the seven health boards in Wales, the number of district nurses has fallen between 2009 and 2015.
Only staffing at Aneurin Bevan University Health Board remained at the same level it was six years ago.
The RCN said it wanted more information gathered about outcomes for people being nursed at home instead of in hospital.
It said it was concerned the move to look after more people at home could have affected the care people receive.
In hospitals, outcomes are measured - such as with waiting lists - but there are less ways to judge nursing care received at home, it added.
Tina Donnelly, director of the RCN in Wales, said it has "undoubtedly" contributed to to GP waiting times and possibly re-admissions to hospitals, as more care is given in the community.
She also claimed district nurses have seen a big increase in their caseloads over the past few years, from around 30 patients to 150.
"That beggars belief in terms of the absolute contact time that nurse will be able to spend with that patient," she said.
A Welsh Government spokesman said while the number of district nurses had fallen, the overall number of nurses providing community services had increased by 17% over the past six years, from 3,338 full time equivalent community nursing staff in 2009 to 3,915 in 2015.
"This is largely because health boards are keen to develop a more effective skills mix at local level, using highly experienced district nurses to direct, lead and advise community nursing teams," he said.
"With regards to outcomes for patients, the recently launched NHS Outcomes and Delivery Framework 2016-17 - which was developed through engagement with patients, clinicians and stakeholders - identifies key outcomes and priority areas the NHS must be measured against.
"The framework has been balanced to ensure that all aspects of care are represented, including care provided in the community."