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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)

  • 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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