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The waiting game

GP leaders to call for removal of home visits from contract

English GP leaders are calling for a removal of home visits from the core contract work because GPs no longer have the capacity to carry them out.

LMC leaders will vote on a motion at the England LMCs conference on 22 November, calling for the GP Committee England to negotiate a change.

Kent LMC, which has proposed the motion, will debate on whether to instruct the GPC to negotiate a separate acute service for urgent home visits.

The LMC says that GPs can no longer carry out home visits as part of their current core work.

The current GP contract outlines other healthcare professionals such as physician associates and advanced paramedic practitioners to undertake home visits once they are recruited.

GPs in the area have sympathised with the motion, including Kent dispensing GP Dr Mark Ironmonger.

Kent locum GP Dr Andy Parkin, who put forward the motion said the reason was to 'remove the expectation' that home visits are part of general practice.

He said: ‘Even though I don’t tend to do home visits as they’re not part of my terms and conditions, I will do them if needed and they’re paid for.

‘The main thing is the workload and demand on time in general practice. It’s not to remove the ability to do home visits if GPs want to. If there are truly house-bound patients or palliative care patients, I think GPs should still be able to do that.

‘The key thing is to remove the expectation that home visits are a part of general practice. They are the most time-consuming part of the job; they are one of the most litigious parts of the job. Even trying to triage visits causes a lot of aggravation from patients who ring up and want a visit and don’t need a home visit.’

He added that not only is the difficulty from rising GP workload but also from widening GP footprint.

He said: 'With the GP footprint getting wider from PCNs and mergers, visits can be a long way away. They can take an hour to go and get back. There isn’t that free time in general practice anymore.’

He continued: ‘In Kent, there is a home visiting service run by paramedics and nurses. Urgent visits requests are passed over to them but they have a limited capacity. Where there are seven visit requests, only two are passed over which still leaves five for us.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: 'Home visits can be very time consuming and take the GP away from the surgery when they could be seeing other patients, and where there are far better facilities to properly assess patients.

'But for some of our more complex and vulnerable patients, home visits are an invaluable, and often the only, means of seeing their GP.

'We are very supportive of proposals to train other members of the GP team such as physician associates and advanced paramedics to carry out home visits as appropriate, but they are not a substitute for GPs and it is vital that patients who need the skills of a GP are able to access them.'

Welsh GPs recently called for afternoon home visits to be passed onto ambulance services at the Wales LMCs conference over the weekend.

But delegates at the conference voted against motion, which argued that the Welsh GPC should negotiate an amendment to the GP contract so that urgent home visits after 2pm would be passed on the urgent care services.

Motion in full:

KENT: That conference believes that GPs no longer have the capacity to offer home visits and instructs the GPC England to:

i. remove the anachronism of home visits from core contract work

ii. negotiate a separate acute service for urgent visits

iii. demand any change in service is widely advertised to patients.

Readers' comments (50)

  • This could be dynamite leading up to the general election on 12th Dec. (hopefully we won’t be ‘hoisted with our own petard’).

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  • well you dont have to visit....if we left shift human resources aka consultants into the community do you reckon that would stop home visits quicker...

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  • why not refuse to provide home visits till we actually get paid properly for them. as long as we offer appointments in surgery for them to attend we are not breaking the terms of our contract and we are not obliged to attend if we don;t have staff available to go in the first place. if its an emergency then that's a 111 or 999 call anyway. time for talk has gone. as long as we keep attending no matter what, the government has no incentive to change anything. even with public pressure it will only be a half hearted measure that does nothing - see pensions as an example - time for action or shut up and put up.

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  • Now you people are talking .
    if this is done it will reduce GPs stress by 50% trust me.Canada and Australia have their home visits paid for by the patient which does not come cheap so patients think twice before calling for a home visit and this has resulted in little no home visit for the average GP working full time for a whole year.

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  • Finally something that will be a game changer. It will reduce stress dramatically and increase capacity in general practice

    I would re join the BMA if they take this on - a real tangible benefit

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  • I suspect an attempt to stop home visits will be met with the usual emotional blackmail:
    'patients will suffer if you don't'
    Home visits should be for bedbound, dying and nursing home patients only and yes we should get remunerated for the time and effort it takes to do a home visit.

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  • Great idea. Home visits put both the patient and particularly doctor at risk. They are time consuming and of no benefit unless the patient is dead (to confirm death) or dying (by agreement of the doctor for terminal care). For the genuinely housebound they can be of in a very small proportion of the calls actually requested. For acute care they are a liability. The patient should pay for them directly.

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  • Home visits for those that truly need them; the terminally ill, frail house bound and nursing homes are a cornerstone of general practice. To farm them out to none GPs will be a giant step forward in producing a tiered system of care, resulting in more patients being sent to A&E. GPs should jettison all the additional none GP work being piled upon them first rather than condemning those in greatest need to a second class service . we will all be old or terminally Ill one day, is this really a system we would wish to be cared for by ???

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  • Shame. I well understand the time pressures but if you take this out of the GP role I would fear GP role is ever more becoming just a job rather than a treasured vocation. Nice as it sounds superficially to ditch home visits, how more monotonous will daily working become?
    Capacity is the issue, why else discuss this move.
    We need to Bolster the GP speciality not cut it down. certainly set more stringent tests of need for a visit. certainly renegotiate the contract terms, especially the afternoon "urgent" call but don't cut visiting out. Your life will be more dull for doing so.

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  • David Banner

    Health Minister - “Hmmmm, GPs want to give up home visits. How much does this currently cost us?”
    Lackey- “nothing, Minister”
    HM - “And how much would it cost to provide a visiting service?”
    Lackey - “Many many millions, Minister”
    HM - “Right, issue the the usual BS about how we “really value GPs”, reheat the 5000 more GPs, make that 6000, it doesn’t really matter, there’s none any way....., and butter them up with all that “jewel in the NHS crown” crap, that usually fobs the moaners of for a year or so. Oh, and don’t forget the “out for consultation” tripe too”
    Lackey- “Yes Minister”

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