As a profession, district nursing has experienced significant depletion in recent years. However, district nurses are centre stage in terms of the delivery of government policy to move care closer to the patient’s home. This article reviews some of the challenges faced by district nurses, such as the changing patient demographic and delivering specialist care in people’s homes, the effect of current policy and the development of a new course in one university designed to equip practitioners with the skills required to address the demands of the 21st century.