Tighten up your home-visiting policy
What we did
Our visiting was out of control. With a list of around 10,000 we were averaging seven visits a day, but on some days we were doing 20.
We decided to triage the patients, with this done by the doctor who would visit, incentivising them to triage well. We came up with (and notified patients of) three categories we would visit: terminally ill, bedbound (not housebound) and those who would be harmed if moved. The triaging doctor can decide to visit others.
We now have only one visiting doctor in the morning, one duty doctor all day, and all other doctors do surgery. Instead of sharing all the visits, the doctors doing surgery have more appointments, but that is offset by the knowledge that they do not need to rush out at lunchtime.
Overall home visits (excluding the CCG’s care home initiative) are down by half. We now average one or two visits a day and often get days with no visit requests whatsoever. Figures show a 38% reduction in home visits in 2015 from 2014 figures, and a 47% reduction in 2016 compared with 2014.
To do this, you need enough doctors to free one up for visiting in the morning. Doctors must understand there is a trade-off from not visiting – they will see more patients.
From Dr Michael Wong, Derbyshire