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At the heart of general practice since 1960

Home visits are a bad thing – unless you are a community matron looking to fill the hours

A man of consequence

You will be familiar with the Law Of Unintended Consequences. You only have to look at the legislative record of New Labour to see many classic examples. From the legislation on dangerous dogs, through the law making hand guns illegal, via just about anything to do with education, you can see that our Government has managed to produce more or less the opposite effect to that intended.

Health policy is no exception. They have an idea that looks good on paper so they do it. Then reality bites them on the arse.

Community matrons and the 24/7 team sound like good ideas in the abstract. All these highly qualified nurses rushing around in the community are bound to improve patient care and reduce hospital admissions; how could it be otherwise? Well, this is how.

A patient of mine, a fit 49-year-old, went to the walk-in centre last week because her asthma was getting worse and the inhalers didn't seem to be working. The nurse on duty gave her a course of steroids. So far, so fair enough.

However, the nurse also checked her blood pressure (why?) and found it to be 'only' 120/62. As a result of this, and possibly for further monitoring of her asthma (the letter doesn't say) she was referred to the 'urgent care team'.

The urgent care team may be the same people as the 24/7 team, I'm not sure. Whoever they are, they referred her to the community matron, who went to visit her the next day. Her asthma was better, her blood pressure was the same.

I would regard a blood pressure of 120/62 as something of a result, but the community matron was worried enough to visit her on the next three consecutive days. As it didn't get any higher, she made an appointment for my patient to see me for 'further assessment'.

It was an interesting encounter. 'Let me get this straight,' I said. 'You went to the walk-in centre with asthma, which is now better, and since then you've had four home visits and been asked to come and see me because of your blood pressure – which is normal?'

She was nervous. 'That's what the nurse told me. Is there anything the matter with me, doctor?'

I could understand her concern. She is a healthy lady with her own car, and yet a health professional had been visiting her on a daily basis as if she were an invalid. What sort of mixed message is being sent out? I would expect her to attend the surgery if she had had both legs off at the hip, but this nurse is blowing my patient education out of the water.

Some practices use community matrons as a free home visiting service. However, in our practice we feel that if a patient needs a home visit we should do it ourselves. We never refer patients to community matrons. We didn't ask for them and we don't need them.

This means there are highly qualified nurses out there, fidgeting and wondering how to justify their salaries. They fill the hours by visiting people who don't need it. All this attention just generates anxiety and worry and ultimately more unnecessary interaction with the health service.

The Law Of Unintended Consequences rears its ugly head. It has been statistically proven, in our area, that community matrons have made no difference to the hospital admissions rate.

Is it so reactionary to suggest these nurses would be far better employed in hospitals where their skills are so evidently needed, rather than in the community where the evidence shows they aren't?

pulse@cmpmedica.com

Dr Phil Peverley is a GP in Sunderland and PPA and MJA Columnist of the Year

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