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GPs set for new enhanced service for urgent home visits under NHS plans

Exclusive Commissioners are considering local enhanced services for GPs to do more urgent home visits next year under new NHS England plans to reduce A&E pressures.

NHS England has asked CCGs to work with NHS 111 providers and councils to set up A&E Delivery Boards to consider this model alongside measures such as more GPs in A&E departments.

The boards will be responsible for drawing up plans to avert winter pressures, but NHS England has also sent out ‘best practice’ guidance for year-round measures to reduce pressure on A&E, due to be implemented by June next year.

As part of the plan, NHS England has advised the boards to ‘have processes in place to respond to and prioritise requests for urgent home visits, usually through early telephone assessment and a duty doctor rota'.

The guidance said: ‘Early and effective assessment of frail and vulnerable adults can enable general practice to plan alternatives to hospital admissions or arrange for early specialist hospital review.

‘Where specialist assessment is needed, early conveyance ensures that patients attend hospital early enough to avoid a default admission, which is typical where patients arrive after 2pm.’

Asked how this may be delivered on the ground, an NHS England spokesperson said LESs was one way but that it was ‘for local systems to determine the best solution for implementation’.

GPC deputy chair Dr Richard Vautrey said these initiatives are being pushed because of increased demand on the NHS all year round.

He said: ‘Many CCGs, and PCTs before them, have developed schemes focused on winter pressures. The reality now is that the health and social care system is under severe pressure 12 months of the year, and needs additional support throughout the year.

‘It's important that all such schemes are properly resourced and don't just have a narrow focus on A&E activity and hospital admission but also recognise the significant pressure that general practices are under as well.’

He added that incentivising GP home visits should ‘be negotiated with LMCs who would know what was workable for their particular area’.

But Dr Peter Swinyard, chair of the Family Doctor Association, said incentivising GPs to carry out urgent home visits is 'trying to put a sticking plaster' on increasing ambulance delays, and GPs no longer have 'the resources to go rushing off in the middle of surgery'.

He said: 'If you’re working in the surgery during the day, you are absolutely chock-a-block and you don’t have time to rush out and do an emergency home visit. If you do that you have four patients sitting in the waiting room who are not going to be seen.

'I think the Government is trying to put a sticking plaster on the fact that the ambulance services are not responding in a timely fashion and they are trying to dump the problem on to general practice.'

Pressures on urgent care services

The news of the new scheme for GPs to pick up more urgent care work in hours comes as Pulse revealed earlier this week that worsening delays to ambulance response times had left some GPs to drive patients to hospital themselves.

Very young and elderly patients are dying because of these worsening delays, said campaign group GP Survival, calling on the Government to step in to ensure emergency services are properly funded, and GPs not left to pick up the pieces.

But in Yorkshire, the ambulance service is instead trialling longer response times for when a GP or other healthcare professional dials 999.

Response times are being extended to as much as 40 minutes for certain serious health conditions when the patient is already with a GP or other healthcare professional, including heart attacks, strokes, sepsis, meningitis, and acute exacerbation of COPD or asthma.

Readers' comments (68)

  • New enhanced service. No thanks.

    Less work please.

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  • Depends on the money.

    If they are offering £300-400 a visit (going rate for a doctor visit in developed country), I'd be very happy to set up an alliance with other practices to provide this service.

    If they think it should be done at £30-40 (judging from out of area visiting), they can forget it.

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  • We've been down this route before years ago. Contacting patients within 20 minutes of a visit request . It made NO difference to any outcomes. Just another stupid management idea. It is becoming more and more clear that the problem is that the cull of managers a few years ago has resulted in them in-breeding and coming up with even more pointless ideas

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  • Why is it so important to protect A "n" E all the time . Is it because the politicians see this as a bench mark? It would be better to boost the whole of General Practice including OOH rather than a bit here like visiting or a bit there like extended hours . Fewer Gp's mean fewer things they can take on . Anyone who thinks this would be paid at more than £20 per visit is wildly optimistic .

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  • a cull leading to inbreeding. harsh but fair

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  • All about costing and a voluntary opt in - if it was paid properly you could fund more people in your practice and actually do some proper doctoring rather than counting QOF targets. Remember an NHS 24 (thats all i know) phone triage costs over £30. That and a Dr to go (and an ambulance probably £400) at £300 a callout is good value - in a free market!! As a GP in the 80s we did all that for nothing!

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  • Long ago in the 1970s, I knew an Islington GP who had a habit of visiting his at risk patients weekly and so he did not get called out by them at night. He said his younger partners did not copy his habit and were always being called out at night. There is some merit to this habit. But the reason why currently A&E are feeling flooded by emergencies is the severe underfunding of the NHS by this Government which has robbed A&E and all other parts of the NHS of staff. The Government wastes 15% of the NHS budget on the administration costs of the expensive, wasteful and disastrous commissioning system and this money would be better spent on recruiting and training more doctors and nurses, shortening waiting times and improving patient care. Tony Blair increased NHS funding to the EU average healthcare level of funding and got waiting times radically shortened but this Government has reduced NHS funding to the bottom rung of the EU league table, below that of other nearby EU countries. That is why there is so much stress in the NHS at present coupled with rocketing waiting times.

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  • Shropdoc is working hard to achieve this already
    https://vimeo.com/188133873

    Its working really well, patients love it, Dr's love it.....
    A new team in primary care that keeps people out of hospital, whats not to like.
    Contact me if you want to find out more

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  • It would have to be

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  • 'Anything' to reduce hospital activity, but it won't work.

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