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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)

  • Katharine Morrison HV to confirm death - any competent adult is able to do that, certainly does not require a Dr.

    English law:
    -does not require a doctor to confirm death has occurred or that “life is extinct”
    -does not require a doctor to view the body of a deceased person
    -does not require a doctor to report the fact that death has occurred
    -does require the doctor who attended the deceased during the last illness to issue a certificate detailing the cause of death

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  • Consulting without notes or being able to check for interactions etc using the computer and not having a chaperone is risky to both patients and doctors alike.
    False accusations, dog bites, being mugged on the way, car stolen or scratched etc.
    Nobody has died abroad without home visits and if they are that bad they should be in hospital.
    It is time we stop doing visits.

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  • Funny to note that both in Wales and here, those voting against stopping home visits are either locums (so can declined) are were retired.

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  • Freeing us from visits will actually allow more of us to register patients from further away with no risk of visits and perhaps do some favorite online consultations of Mr Hancock without the risk of a visit.

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  • i think visits are an important part of healthcare and GP but people need to stop caving in a visiting those who are not bed bound. if they can get to the front door they can get in a taxi. Better to get rid of all the qof ccg pcn beaurocrasy

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  • I moved from the toxic NHS a while ago and work in Canada. I have never heard of request for home visit, I see many 90+ year olds. If they are very I'll they go to emergency. If not, we have a few wheelchairs at the practice - relatives take one to the parking lot, get the patients in and wheel to the office. After the consultation the patient is wheeled back and relatives return the wheelchair. This has made it possible for me to plan my day and expect no disruption from home visit request. If a patient or relative feel an urgent appointment had become necessary on the day, just bring the patient, tell the reception what is the problem. A doctor is notified and will see if necessary.

    Whilst working in England, I can't count the number of requests for home visit when the reasons have been anything but medical - no cars/funds for transport (and you find cars parked in the yard or booze all over the house), relative cannot bring patient as expecting a delivery, snow outside. There have even been request not to come at certain times as hairdresser will be there.

    As said before by some colleagues, Australia, Canada, USA, New Zealand amongst others are by no means less developed than UK - if home visits were absolutely necessary and evidence-based they will implement it.

    As for the UK, it is no skin off the government's nose as general practice is an all-you-can-eat-buffet, the average Joe Blogg thinks this is the most evident way he can justify his 'taxes' (if he ever pays one).

    Unfortunately for GPs, for any meaningful change in our lot to happen, we would have to get rid of the dinosaurs and gong-seekers in BMA who constantly throw frontline doctors under the bus to fulfill their self-interests. I wonder if the profession would ever wake up to this reality.

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  • It was always rediculous that my most expensive piece of medical investigation equipment was my motorcar. As the patients would say, " in this day and age we can do better".

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  • An end to Home Visits is long overdue . I feel they should still be done for Terminally Ill and genuinely bed bound patients though . Even Care Home Patients can be brought to the Surgery if not bed bound . There should be an item of service payment for the small number of visits we would still do .

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  • Please can we have this motion carried at conference. The idea of a home visit is a very british thing which is not sustainable in the current model. Trying to squeeze them into our day in our lunch hours is not safe nor sustainable. This has to change.

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  • Or at very least a national definition of what needs visiting and when to decline as once again when implementing the change we will come in for lots of abuse .

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