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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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  • While you are all at it why not stick broom handles up your a**es and sweep the floor too :)

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  • My patient's house is infested with rats. I am concerned she will contract Weil's disease. Am I allowed to prescribe a cat?

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  • Do you really think that this type of nonsense is going to attract young doctors into GP and then people wonder why GPs are looked down upon by our hospital colleagues.We're fast turning into a laughing stock of the medical profession.

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  • No one can argue there's a role for checking on vulnerable people, but really I don't think GPs are the right people to do this. They have skills that are far better utlisied focusing on patient's health needs. This kind of home visit, touchy feely stuff is much more appropriate for someone with a social work/social care background and focus. The trouble is, they have cut back social services to the bone and there is too much political micro management.
    NICE really live in another world of ideal scenarios. Primary care funding is being cut drastically. They have taken £20 billion out of the NHS in the last 5 years. We are exhausted with QOF, QIPP (rationing by another name), CQC inspection (still not caught up from that one!), MPIG/PMS cuts, Unplanned Admissions care plans, locality meetings, federation meetings and 'Quality Engagement and Delivery' (that's the latest local micro management wheeze where we are based). Not to mention the relentless demand of patients with coughs and colds demanding urgent appointment for pointless antibiotics, complaex mental health patients waiting 15 months for a secondary care appointments, and the queue of patients wanting their secondary care referral expedited.

    It's time for some honest open debate about what can be delivered for the funding we get. I don't know how much longer we can carry on like this. And I am the most positive, optimistic person I know! Not good...

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  • What is really scary is the drive for increased data sharing around this and other issues. Soon the GP record will be a complete database of your medical, social and family history to be used and abused at will by governments and control structures.

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  • The reason they want GPs to do it is because they what it done for nothing.
    NICE get lost bunch of idiots !!!
    I say it again retire or emigrate.
    Too early for me to retire I chose the latter.

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  • THis is nonsense. Yes we should be aware ,as GPs. of elderly and younger poor patients who may be suffering from the cold. However what is this "should" meant to imply? That the CQC can ask how we are measuring it? If so-there are a million "shoulds" .There is good practice, and "god enough practice"v and soon there will be no one practising at all.

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  • Vinci Ho

    In our society , those with the best knowledge of what is happening are also those who are furthest from seeing the world as it is.
    1984 , George Orwell

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  • Good to see that your union and RCGP also think you GPs should be doing this. It's good that they look after you GPs' workload and professional standing like this.

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  • Yeah just wait a couple of weeks and the CQC will be demanding that GPs do this because NICE has said so, and practice CQC reports will be downgraded because the GPs are not doing this!

    How many times do you have to stab a GP in the back before the GP will defend themselves? How much blood does a GP have to lose before they will fight back?

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  • Peter Swinyard

    NO!!! STOP!!!
    This is a public health issue - and a real one.
    We are not public health doctors.
    Public health doctors now work for Local Authorities.
    To coin a phrase - "public health doctors are ideally placed to......."
    And really, Tim Ballard - you are a superb GP and a brilliant trainer. But whatever misguided thought made you and the RCGP think that this was a good idea???

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  • So this is why I spent 5 years at medical school, years working in the hospital and years working as a GP.

    These doctors floating around in their ivory towers have lost the plot. They need to get their head out of the clouds and plant their feet firmly back on the ground with the rest of us.

    General Practice has become a joke. The saddest thing is that jobbing GPs will do this utter b.......s. They are as guilty as those pulling the strings from their legal highs.

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  • Just finished choking! Seriously, are NICE fit for purpose, are they seriously stupid or just misguided.

    This is social! Use the Voluntary Sector, Social Services. Not a profession thats on its knees.

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  • In my experience many older people always turn on the heating if they know that you are going to visit them and are too embarrassed to admit their problems

    Many keep the heating off because they can not
    afford to heat their homes. How could we remedy that? Many are used to cooler homes and wear multiple layers of clothes

    Anyway, as others have said, we could check thousands of things, but we do to have the time.

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  • When NHs and GMCMPTS have drastically removed the numbers of practicing GPs,it is a pipe dream to accept any more from overworked services

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  • When it is stiflingly hot in summer and there is a danger of heat stroke then we should just "pop-in" and arrange a portable air conditioning unit . This is simple because I always carry a couple of spare units in my boot .

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  • Easy solution - pass the work onto Respiratory medicine (sorry guys). As boiler medicine is beyond my remit.

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  • NO WAY! NEXT....

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  • What the F--- !!
    Next thing they will suggest we take up the CORGI Certified Gas Boiler Installer course for our next PDP.

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  • Nice meeting to draw guidance are laded by people , who are unrealistic but so and so in the profession.
    Last time I represented on one meeting representingGPC few years back, we had a professor who encountered a patient 15 years back. That should say it all. Do Nice advisor spend a week in normal general practice.
    Dr Swinyard is correct Dr Tim for RCGP should stop
    being in Ivory tower. We had Health Visitor per practice
    who art from children helped to provide us back up.
    Govt. got rid of them.
    Next job for GP will be to check , Meals on wheels are of correct temperature and delivered at a right time.
    I thank the Lord for being able to retire.
    Who wants a job in general practice when so many half baked organisation wish to rule on you for their glory
    with stupid ideas.

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  • NICE --> N- Not
    I - In
    C - Control of
    N - cog-N-ition

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  • NICE = National Institute for Cutting Expenditure

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  • how 'bout

    N - number of
    I - idiots
    C - controlling
    E - everyone

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  • on a serious note - is it possible for the BMA or GPC to ballot GPs on a vote of confidence on NICE. If so can we reject NICE and walk away and get on with clinical care?

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  • "Anonymous | Salaried GP | 05 March 2015 1:18pm
    on a serious note - is it possible for the BMA or GPC to ballot GPs on a vote of confidence on NICE. If so can we reject NICE and walk away and get on with clinical care?"

    What, and upset the cosy atmosphere when all the old chums meet at their club? Heaven forfend.

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  • Nice should check weekly whether or not they are still in the real world!!

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  • Well - we're on our own folks!

    NICE are deluded and so far from the coalface it's a joke.

    Shame on the RCGP for being the government's mouthpiece on these sort of social issues and not backing grassroots GPs

    Even the GPC think we would be useful to signpost in these circumstances.

    Unless we unite and form a proper union, we are all f*cked.

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  • Are we being tested ??
    This is not now and never will be our job.
    National institute for comptemptible edicts.

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  • So how do we define 'cold'
    Do NICE publish an ideal temperature range for different age groups?
    Are we going to invite a plumber to our MDT and LTC meetings, so that heating systems can be assessed?

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  • Anonymous | GP Partner | 05 March 2015 5:23pm

    on page 6 of the 54 page document Cold Weather Plan for England 2014 Protecting health and reducing harm from cold weather it mentions '
    revision of the indoor temperature guidance in light of a recent literature review
    and stakeholder consultation to a broad minimum temperature threshold for
    homes in winter of at least 18°C (65F), with additional flexibility around the advice
    for vulnerable groups and healthy people'

    that document is actually referenced by the helpful short 58 page NICE document 'Excess winter deaths and morbidity and
    the health risks associated with cold
    homes
    NICE guideline
    Published: 5 March 2015' that those helpful folks at NICE spent the time and money (taxpayers) to write.

    Can't believe you guys have not read it yet !

    like a lot of the NICE documents it is brief with lots of helpful ideas. thank god we have NICE otherwise i would be totally lost.

    the question is does it go far enough ?

    take food poisoning for example - some of our patients due to ill health may not be able to properly clean themselves after doing a poo (arthritis, musculosketal problems etc) - if they then go and make a sandwich -> bingo food poisoning which we all know can kill. I'm waiting for NICE guidance on that.

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