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NHS commissioning bodies have been tasked with addressing the organisational structures of their provided services. These services, typically involving substantial numbers of community nursing staff and professionals allied to medicine, have generally received little managerial review or audit. This programme has developed an audit tool for district nursing staff, health visiting staff and similar clinical groups identifying work programmes, appropriate managerial structures and an audit of service delivery. This work normally is completed within three months of initiation and provides the commissioning body with a strategy for ensuring the creation of an efficient and effective provider service capable of independent management and service delivery.

The audit is not about cost improvement but improved equity and service delivery. Nonetheless in our experience the District Nurse Audit has always identified major resource flexibility for reinvestment in higher priority objectives.