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GPs should check annually whether vulnerable patients are living in cold homes, says NICE

GP practices should check at least once a year whether their elderly or vulnerable patients are at risk from living in a cold home, and where needed refer them for help, say new NICE recommendations unveiled today.

In wide-ranging new public health guidance aimed at cutting the estimated 24,000 excess winter deaths a year, NICE is calling on GPs to identify their patients who live in cold or hard-to-heat homes, particularly the elderly and those with chronic conditions who are vulnerable to cold weather.

Once identified, GPs should include any concerns a patient is living in a cold home on their records, and share the data with relevant local organisations so they can get help with getting adequate heating and insulation, says NICE.

It also recommends that health and wellbeing boards should set up a ‘single point-of-contact health and housing referral service’ in their area which GPs and other health professionals, as well as other public and charitable services, can refer people to for support.

The recommendation comes after health secretary Jeremy Hunt suggested GPs could prescribe lunch clubs and damp treatment to their patients as part of a more ‘holistic’ approach to commissioning.

GP leaders said the suggestion GPs could review patients annually was ‘ludicrous’.

The new advice for GPs comes as part of a raft of recommendations for local health bodies, councils and community organisations as well as the NHS to tackle ill health resulting from cold homes - defined as those where the temperature falls below 21 degrees Celsius.

It says GPs should ‘at least once a year, assess the heating needs of people who use their services, whether during a home visit or elsewhere, taking into account the needs of groups who are vulnerable to the cold’, using their time with people ‘to assess whether they (or another member of the household) are experiencing (or are likely to experience) difficulties keeping their home warm enough.

GPs would also be required to ‘in collaboration with relevant local authority departments, use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes’.

It adds they should ‘include this information in the person’s records and use it (with their consent) to assess their risk and take action, if necessary’.

Dr David Sloan, public health expert and former GP who co-chaired the guidelines, said GP practices would be ‘seeing these patients anyway’, for example offering them flu vaccinations.

He said: ‘It’s trying to get awareness of cold as an issue in its own right embedded in the system. Many practices are doing old-people checks anyway – but “think cold” within that, or something else you’re doing.’

Dr Sloan added that while care would be needed to make sure patients had given consent to sharing information about their risk from housing issues, concerns around data sharing should not get in the way of helping patients in need.

He said: ‘Data sharing at a local level is tricky, it has to be done with consent and people need to be clear about what they can and can’t pass on – but not passing on information is leaving people at risk.’

NICE experts said cold homes are a cause of the 24,000 excess winter deaths every year – with the elderly, people with chronic health problems, such as cardiovascular or respiratory conditions, and babies and young children particularly at risk.

They said the guidelines offer a ‘huge untapped opportunity to spot and help vulnerable people’ and that ‘every contact that a vulnerable person has with health and care staff and heating engineers is a chance to improve health and save lives’.

NICE said that although it has not done any economic analysis to back up the initiative, a recent Age UK report estimated cold homes were costing the NHS around £1.36bn a year in avoidable GP visits, prescriptions and admissions.

Dr Richard Vautrey, deputy chair of the GPC, said GPs would be willing to ‘signpost’ people for support heating their homes but questioned whether services would be adequately funded.

Dr Vautrey said: ‘The reality is that local authorities are having their funding slashed and the availability of services is often non-existent. There’s no point GPs rushing round with thermometers and checking heating if there’s no real support to be put in place afterwards.’

Dr John Grenville, chair of Derbyshire LMC, agreed with the principle of GPs signposting people to support on housing, but said they would need extra resources.

Dr Grenville said: ‘The only way to make it compulsory would be to make it a contractual obligation with money attached to it – it all takes time and that’s what GPs don’t have.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee warned GPs could not be major players in the scheme - and that the recommendation they review patients yearly was ‘ludicrous’.

He said: ‘GPs do come across people in cold homes, and when we do this should be addressed as we would any other risk factor for disease, but this involvement is bound to be sporadic and hence we cannot be regarded as major players in this work, which must remain the responsibility of others.

‘As often happens, the actual guidance appears to have got carried away with itself, and suggestions that we should assess “the heating needs of people who use our services at least once a year” is simply ludicrous and distracts attention from otherwise valuable advice. As ever, NICE should be asked “what activity would you like me to stop to enable me to do this?”, a question frequently put, but never answered.’

Dr Tim Ballard, vice-chair of the RCGP, welcomed the new guidance, saying that healthcare ‘had an important part to play’. He added: ‘We look forward to [the guidance] being a catalyst resulting in some of the most vulnerable in our society having the opportunity for a better quality of life in dryer warmer homes.’

Source - NICE guidelines: Excess winter deaths and morbidity and the health risks associated with cold homes


Readers' comments (67)

  • Anything else they expect?

    Perhaps we should check if they've brushed their teeth and washed behind their ears?

    How about if they've eaten all their greens and tidied their bedrooms

    I suppose we'll have to help them with their homework as well.

    Did any of you reading this study hard so you'd have to perform this bulls***??

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  • NICE has become an incompetent organisation run by zealots and buffoons. It needs to be disbanded and some senior management needs bringing before the law lords for some of the downright criminal way they have allowed a simple yet honourable profession become bastardised with meaningless gobbledegook and quack statistically methodology. QALY my arse. If works... use it. if it doesn't then don't. "What price life?", as Shakespeare may have wrote.
    And to address this latest bit of stupidity head on. Have these nincompoops never heard of social services?
    The head shakes, the eyes roll, but alas my friends life in general practice goes on!!!

    Disillusioned GP Partner (2yrs)

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  • Vinci Ho

    Yes: politically correct
    But: this is always for opportunistic NOT carpet screening ( in fact , many of us will have checked this question when we are visiting our patients with chronic diseases e.g. COPD , Asthma).
    Have this information on the record for every single 'vulnerable' patient will further exhaust our time and resources(by the way, this is the workload we talked about outside number of appointments in case you have read the article about the Nuffield report).
    Finally:this is perhaps paving the road for the council to take over the ultimately combined health and social care budget but for GPs to become 'extra' social workers ?? Then I would rather have social workers appointed to work for each practice to deal with these issues.

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  • And also GPs should check who their gas supplier is and whether they are on the right payment tariff.

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  • Don't give them ideas !

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  • And that's why 7/10 GPs ignore nice guidelines... , why can't social workers do an annual social check on vulnerable patients and as part of this annual assessment make sure the house is warm enough

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  • A speech depriving "GPs should". Perhaps NICE could list all their recommendations to us and then put them into some sort of hierarchy. Does this come above or below CPR training for example as we prioritise our day to day work.

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  • Just Your Average Joe

    The stupid time wasting NICE appointed political buffoons, are living in a parallel universe where GPs still sit around scratching their behinds drinking tea all day.

    Sorry that's their job.

    Why not make it the energy companies job to ensure their customers are safe and not being ripped off, and check when they go round to read the meters!

    They are already going round at least twice a year, and this would be a far more efficient service and not waste valuable GP time and resources.

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  • A lot of patients have fully functioning central heating systems and choose not youse them for financial, or other, reasons.
    Will there be a heating police who force them or will we it's have to report them to the authorities?

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  • Can you imagine if they instructed any of our secondary care colleagues to perform such ridiculous and demeaning tasks?

    No doubt it will form part of a DES that over 50% of our esteemed colleagues will sign up to.

    Our profession is being turned into a laughing stock and we have to carry some of the blame- where are our leaders to rebut this nonsense?

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  • Took Early Retirement

    "We welcome this advice from NICE"- Oh Dear! Tim, what has become of you?

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  • Saw the NICE doctor inspecting heating systems on BBC this morning and really...made my day. Does a 200k salary bracket always result in hallucinations and delusions in NHS? NICE - the UGLY side.

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  • It's horrifying that the BMA and RCGP think this is a fundamentally good idea. Why is any GP still a member of those idiotic organisations. What is wrong with you?

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  • Your house is very cold Mrs Squid. Box ticked. Bye.

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  • I left the BMA after 9 years naïve me! We still have a lot of confidence in these impotent organisations that take contributions and offer only lip service and when they do intervene - nobody bothers to take notice because they are more like the hidden arms of the government and literally have no inclination to stand up and fight for GP rights.

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  • I like the idea of creating a list of all the jobs GPs should do - according to other bodies - then publishing the list - adjusting it each year.

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  • 2 pound per check for adequate heating , more then 70 percent gp will agree for it.

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  • If you haven't already resigned from the BMA or RCGP
    surely this helps your decision

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  • 1)Why do you want to become a GP?

    GP trainee: I want to provide holistic care.

    2)Give an example of holistic care?

    GP trainee: Doing a home visit to check if the plumbing is all OK.

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  • Checking the garden for any holes.

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