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Gold, incentives and meh

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)

  • The shropdoc model looks great - I would be concerned that the daytime visiting job would be much more attractive to paramedics than their current horrible shifts, and they would all want to leave to do this!

    But I for one would welcome them with open arms.

    Visits are very difficult to squeeze in when we start surgery at 8.30 (or 7am if doing extended hours), finish morning surgery at about 2pm and start afternoon surgery at 2.30pm, without any time to do any other work in between (or eat, pee, drink etc). We are already doing the paperwork till 10 at night.

    Not enough hours in the day! Bring in some noctors to do the home visits please!

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  • The tone of this thread revealing, if not just to confirm that anyone who is or has not been a GP partner really doesn't understand what is involved or the pressures, responsibilities, risks and threats. (though I am sure are being sincere)

    Simplistic assumptions and conclusions abound and 'moaning' is a crass and naive dismissal of serious concerns.

    Comments relating to finance and income are not just motivated by personal interest.

    Most of us try and maintain our staff income and give a rise each year and be generous in that respect absorbing the cost personally each year - yes we have been taking annual paycuts for years?

    We cannot attract replacement partners to take on the role when the accounts have a clear downward trajectory and locum works pays far more for less commitment - that's just simple economics.

    This dumping of emergency work onto GPs is purely politically motivated. Hospitals are to be banned from issuing Black alerts and a new scheme to grade pressures is coming. So patients can't easily spot the frightening levels of underfunding.

    Don't conveniently blame GP representatives in the face of a sledge hammer government wearing earplugs.

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  • 1222
    You are lucky to escape. I have a few years left perforce. On top of urgent Home visits, we have shortly to do ALL the 'ologoies' as well.
    Messieurs Hunt/Stevens et al. are like June, we should more and more. Oh never mind payment for work, we are a vocation and should do it all for free.

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  • Whatever!

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  • One of our local CCGs has informed us, as far as I can understand, that essentially due to increased secondary care activity this year they will be over budget. In order to balance the books enhanced services will need to be cut starting from April 2017 and if they do not do this a team from NHSE will come in and mandate it. Against this background I am not sure where the funding for this new enhanced service is budgeted from?

    At a time of problems in GP recruitment the idea of labelling yet another service "GP" seems disingenuous. In principle I would work to support the concept but would prefer replacement of GP with Clinician or Clinical Team and suggest robust resourcing to give the win-win a chance!

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  • Some people appear worried about the impact the end of the NHS will have on their lives.
    Instead of trying to help the people who are doing their best to support the NHS ie gps, some seem to be attacking them completely vociferously and very unfairly.
    No gp reading their comments will have any more love for patients as a result of these outbursts. Indeed somewhat surprisingly the opposite sentiment may occur!
    Eventually with the collapse of the NHS everyone will have to get used to a new world of paying vast sums of money to get treated. In the US, appendicectomies can cost many tens of thousands of dollars.
    The more people with these kinds of attitudes will reduce the last dregs of goodwill left and will just encourage gps to leave or go private.
    So patients rather than biting the hand that treats them for next to nothing, better start getting their checkbooks out and at the ready. If this is what makes them angry well that is their hard luck.

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  • Hey everybody when o when will the penny
    drop
    THE NHS IS UNAFFORDABLE
    will everyone grow up and tell the truth

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  • we have had an Acute Visiting Service in my area for several years, and it has been very popular. If the model is being replicated nationally, then GPs have nothing to fear. As visit requests come in to your surgery through the day, you decide which ones fit the criteria for the AVS and refer them on. The only effect on the GP is fewer home visits. Unfortunately the CCG found the service too expensive, so it has been reduced, but an Enhanced Service would help reinstate it.
    The whole point of this is to REDUCE the visiting burden on GPs , who otherwise would have to make the patient wait many hours. With an AVS the patient is seen quickly, and it's one less visit for me to do.

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  • I don't see why gps or any one has to do home visits at all. If people are ill they should go to A&E or their doctor's surgery.
    They should go to the doctor so they can be examined in the best environment and have the correct faculities to be tested too. This should help gp's indemnity as if they missed something through examining a patient in suboptimal conditions then this may be a problem.

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  • June,
    No one wants to go pre 1948 but it is clear that the current system , which no one wants to replicate, is unsustainable. Why not follow the French or German model? The NHS was very different in 1948 and unlimited treatment being given to an ever growing(and ageing) population is unsustainable.The first thing we need is an honest debate.

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