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GPs go forth

GP pilot set to test if earlier home visits reduces admissions

GP practices are testing a new system of early-morning home visits, aimed at reducing pressure in surgeries and unnecessary overnight hospital admissions.

The scheme, rolled out across Bath and North East Somerset, sees patients able to call in the early morning to request a home visit, either by a GP, a nurse practitioner or a specialist paramedic.

NHS Bath and Nort East Somerset CCG said this meant patients who need to go to hospital for further checks following the home visit will have time to do so and return home again on the same day.

The CCG said this differed from the historical practice of home visits being carried out during late morning, which meant patients sometimes had to stay overnight in hospital when they did not need to.

The pilot is a collaboration between NHS Bath and North East Somerset CCG, its member GP practices, B&NES Enhanced Medical Services (BEMS) and the South Western Ambulance Service NHS Foundation Trust.

CCG clinical chair Dr Ian Orpen said: 'It takes time to make a proper assessment of a patient’s condition, both by primary care professionals and by the day-patient team at the hospital.

'If we start this process at the very beginning of the day, there is a much higher chance that if a patient does need to go to hospital, they will be seen and be able to go straight home again, where they will recover faster and feel more comfortable.'

Readers' comments (14)

  • The problem with this scheme is obvious; a lot of visits are requested near lunch time of afternoon when the carers/relatives come in. Quite often they completely refuse to accept any responsibility and expect the medical team to be blamed if the visit was not done on the same day.

    As such, this scheme'll either be reviewing reasonably well that can wait till the next day (i.e. doesn't need admission anyway) or dangling their legs waiting for visits to come in. Seems a waste to me.

    What they need is a late pm visiting service with support wrapped around it (such as carers and intermediate care beds) which can respond with in couple of hours. It may sound like a pipe dream but far cheaper to provide then hospital admission

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  • Cobblers

    This baffles me. It does not reduce pressure in GP surgeries. It might make it easier to plan the day but in truth we are looking at spreading the workload for the hospital making it easier for them.

    My take on this is that home visits are medicolegally higher risk and anachronistic in the modern world. If someone needs a house call then they need to be seen in one of two places BOTH of which should be safe, well lit and well staffed. That would be the Surgery or the Hospital.

    Then the question would be how to get the patient to telephone at an earlier time. But that would not be our problem.

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  • Whole idea is wrong. Should never give patients the impression they may ring for a home visit. They contact the GP for assessment / triage and are the offered an appointment at the most appropriate location, which is rarely a home setting. Home visits are a historic anomaly that we have almost eradicated.

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  • AlanAlmond

    I guess this might make sense if the local hospital has an efficient day assessment service that can reliably see, assess and treat patients within a single day. I suspect BANES might be quite good at that. It'd be pointless if your hospital happens to be somewhere in the middle of our wonderful country and totally lacking in the' interface with primary care' department. Alas the vast bulk of home visit requests do indeed arise out of sheer patient laziness, they just couldn't be arsed to come to the surgery, some are however necessary and can make a big difference. I dread to think what would have happened to my poor bed bound father in law today had he not received a visit from his experienced and sensible GP and had instead to rely on an ambulance and assessment in the local 'stack 'em high' a&e. Maybe they don't do visits in Canada or the France...that's their loss. Some visits are still necessary even if most of them take the p.

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  • Rather than trying to remove or weed out the culture of a demanding or requesting HV this is just trying to do the opposite

    God save the NHS

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  • Dear All,
    Asylum, lunatics, running. Hey why not intervene even earlier, say at 3am when most MIs occur? Why wait til the sun has risen, get out there during teh night. Or even the day before the problem might begin, but hey there's a problem, we'd have to visit every patient every day to be sure to pick up the ones who were going to develop their illness the day after, and you know what, there aren't enough of us to do that, otherwise rated as an idea, well simply brilliant......again.
    Paul C

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  • Did someone get this idea from watching Minority Report! Send the precog GPs to assess the future possibilities. Be sure to take your crytal balls with you.

    What a ridicuolous waste of time and resources. Leave us alone to manage uncertaintly, its what we do well but not when expectation is beyond the realms of reality and underfunding.

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  • 'If we start this process at the very beginning of the day, there is a much higher chance that if a patient does need to go to hospital, they will be seen and be able to go straight home again

    If they can go home "straight away" why would we as experienced and skilled clinicians bother sending them to hospital in the first place, they obviously didn't need to be there. We don't refer them in for fun and we DON'T ADMIT ANYONE!!!

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  • It sounds remarkably similar to the admission avoidance scheme, which is being axed. I can understand the principle in that patients may require investigations straightaway and if the patient comes to hospital late in the day there is often not enough time to carry out the investigation and so the patient is admitted overnight. So, basically GPs or others are being asked to start the day very much earlier. However we are also being asked to remain open longer at night as well, and all with no extra resources. What about spending more money on investigative services to keep the services open to midnight for routine investigation. Why is it always general practice that is picked on to do more and not hospital services? The answer is probably because we are not paid by volumes of activity, unlike hospital services. There lies the answer to our problem, to be paid according to volumes of activity.

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  • we did this 2 winters ago. really annoys me this is presented as a new idea. we got our local practices paid to do this as part of a winter pressures scheme. there was evidence it helped - the biggest problem was although the GPs did earlier visits - the ambulance service were still taking 4-6 hours to get the pt into hospital ruining the whole point of them being seen earlier in the day!

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