Wolfiefan
I take it we don't need to go back to 1859 when it began?
Thinking about my time in the community since 2002...
We used to have more time to spend with our patients and less we needed to do with them. We used to pick up and accept referrals for all sorts of things, there was no particular criteria. As time has gone by we (community nursing) have had to become strict about only delivering the services the commissioners have bought from us. And this is hard, especially as the gaps in what we provide may not be met by anybody else.
For the same reason we have had to become more strict about only visiting housebound patients. That means those who only get out for medical appointments and require hospital transport to do so. They are those who are seen at home by their GP. (End of life are an exception, if they manage to go out somehow we say that's great, we'll see them another day 
). This is really hard, as there is obviously a world of difference between being able to be taken in a car by family to the hairdresser once a month and getting to the local surgery three times a week for a dressing. With no buses, no money, frailty, and family members in precarious employment without the freedom to nip out of work for an hour to take them.
I think we have upped our game clinically. I remember a scenario in my interview when I first came into the community, it was about a poorly patient. I said I'd do a set of observations and they laughed at me ' not out here you wouldn't '! Now I would not dream of contacting a GP without a set of obs!
I could go on forever and ever but for now I apparently have to help one dd tidy her room and watch Oliver with the other.