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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)

  • 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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