Missed care in community and primary care

Background: Studies have shown that understaffing may result in missed care, compromising patient outcomes. However, most of these studies have been conducted in secondary care, and there is a lack of similar evidence about the prevalence and type of missed care in community and primary care.

Aim: To explore the prevalence of missed care in community and primary care settings, and to better understand its association with staffing levels.

Method: A staffing survey was administered by the Royal College of Nursing to explore the working experiences of nurses from all settings across the UK. Respondents were asked questions about their latest shifts. For this study, the authors performed a secondary analysis of that data, focusing on the responses from primary and community care.

Results: There were 3,009 responses to the survey from primary care, community care and care home nurses pertaining to the prevalence of understaffing, staffing levels and missed care. Analysis showed that, in primary care and the community, missed care was significantly more likely to occur on understaffed shifts (39%) compared to fully staffed shifts (23%).

Conclusion: There is a high prevalence of understaffing in community nursing and instances of missed care are more likely to occur on understaffed shifts. Assessing appropriate staffing levels and skill mixes in community nursing is complex and current models tend to emphasise caseload numbers rather than workload. Local and national planning should focus on workload measures, incorporating a range of indicators that place safe and effective person-centred care at their core.